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系統識別號 U0026-2807201613145600
論文名稱(中文) 休閒性園藝與中老年人健康之相關性
論文名稱(英文) Associations of daily home gardening with depression, mobility, and survival in aged adults
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 104
學期 2
出版年 105
研究生(中文) 凌千惠
研究生(英文) Chhian Hūi Lêng
學號 TA8961021
學位類別 博士
語文別 中文
論文頁數 59頁
口試委員 指導教授-王榮德
指導教授-謝淑蘭
口試委員-楊延光
召集委員-黃景祥
口試委員-張哲豪
口試委員-謝清麟
中文關鍵字 休閒性園藝  憂鬱  活動度  存活  老人 
英文關鍵字 gardening  depression  mobility  mortality  older adults  TLSA 
學科別分類
中文摘要 台灣地小人稠,西岸持續開發都市化,生活型態改變,約有一半成年人平常都久坐不動。本文擬探討休閒性園藝與台灣中老年人的身心健康之關係。利用「中老年身心社會生活狀況長期追蹤調查」在1996-2007四次的追蹤,了解休閒性園藝和活動度(mobility)及存活的長期相關性。台灣省衛生處家庭計畫研究所(今改制納入國民健康署)在1996年執行的第三次追蹤,共訪問5131位台灣五十歲以上的中老年人,不包括高山原住民。休閒性園藝屬於十二項休閒娛樂的其中一項。訪員先詢問: 平常沒在工作時,你都做些什麼消遣、娛樂活動?如果受訪者回答有做任一項,就會繼續追問: 「你是多久做一次這項休閒活動? 種花、整理花園、園藝、盆栽(專指無收入的園藝或盆栽)」:沒有、每月少於1次、每月2-3次、每週1-2次、幾乎每天都做。本論文分別以活動度限制及2007年12月底之前的衛生署死亡檔,做為結果變項。分析方法為重複測量的混合效果模型(mixed effects model for repeated measure),及時間相依共變項之存活分析(survival analyses with time-dependent analysis)。模型中皆調整最新的相關疾病、1996年之健康習慣及社經背景。最後以不同的補值法(imputation)做敏感度分析(sensitivity analysis)。
結果發現1996年每天參與休閒性園藝者,在後續的調查中有比較好的活動度。對於在1996年有活動度限制(mobility limited)但沒有憂鬱(depressive symptoms)這一組,每日做園藝會降低死亡風險(hazard ratio: 0.64, 95% confidence interval: 0.48–0.87);但在1996沒有活動限制也沒有憂鬱這組,休閒性園藝與存活沒有統計顯著相關。說自己有嚴重憂鬱症狀的人,對存活的影響遠大過休閒園藝,最好應接受醫療協助。規律的休閒性園藝可能可以減緩或改善活動度限制,並延長有行動度限制但無憂鬱者的壽命;雖然其作用機制的強度,可能不足以降低身心健康者的死亡風險。
每日從事休閒園藝可能的作用機制,一部分藉由降低久坐不動的風險、增加身體活動度、或協調相關的肌肉關節等;另外可能的社會心理機制,是與運動或散步不同,但無法在本研究探索的作用。如同所有觀察性研究的限制,即便在分析模式中調整可能的干擾因子(confounders),不能完全排除休閒性園藝者在1996年的身心社狀況原本就較好的影響。未來需更多更精確的跨領域研究來驗證。本研究英文發表文章請參考附錄2附錄3。
英文摘要 Healthy aging is to adequately maintain functional ability determined by physical and mental capacity, and environment in older age. Mobility limitation is possibly an early reversible indicator of aging, and mortality is the end point. The first study is to explore the potential risk/protective factors of mobility limitations, including mental capacity measured by positive affect, negative affect, and working memory. We further examine the effect of the significant factors on mortality. Approximately five thousand participants aged ≧50 years in 1996 enrolled the Taiwan Longitudinal Study on Aging (TLSA) for four waves of interview during the 12 years of follow-up. After adjustment of demographics and current comorbidities, the constructed mixed models with repeated measurements showed that ≧1 times/week gardening consistently predicted subsequent better mobility function. Neither included mental variables nor social relationships showed such an association. We further test if gardening is beneficial for survival. Gardening was defined as growing flowers, gardening, or cultivating potted plants for pleasure with five different frequencies. Daily gardening was associated with a high survival rate (hazard ratio: 0.64, 95% confidence interval: 0.48–0.87) for those with mobility limitations, but without depression at baseline. Chronic or relapsed depression weakened the protection of gardening. For those without mobility limitations and not depressed at baseline, gardening did not show a statistically significant protective effect. Daily gardening for pleasure was associated with reduced mortality for Taiwanese ≧50 years old with mobility limitations but without depression.
論文目次 中文摘要 i
Extended abstract ii
誌謝 v
目錄 vi
表目錄 viii
第1章 研究動機與資料庫介紹 1
1.1 背景與研究動機 1
1.2 思覺失調症患者的預期壽命與終生醫療費用研究 2
1.3 資料庫介紹:中老年身心社會生活狀況長期追蹤調查 2
第2章 文獻 4
第3章 研究方法、分析、與研究結果簡介 8
3.1 研究方法 8
3.2 變項 8
3.2.1 休閒性園藝及其他休閒活動 8
3.2.2 活動度限制與死亡 8
3.2.3 憂鬱症狀與疾病 8
3.2.4 健康行為與其他健康相關變項 9
3.2.5 社經背景與社交網絡 9
3.3 分析 9
3.4 結果 10
第4章 討論 16
4.1 台灣常見的休閒性園藝 16
4.2園藝和活動度 17
4.3園藝和預期壽命 17
4.4 憂鬱 18
4.5 結論 18
參考文獻 20
附錄 1: Chhian Hūi Lêng, Ming Hui Chou, Sheng-Hsiang Lin, Yen Kuang Yang, Jung-Der Wang. Estimation of life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for schizophrenia in Taiwan. (2016) Schizophrenia Research. 171(1-3):97-102. 26
附錄 2: Chhian Hūi Lêng and Jung-Der Wang. Long term determinants of functional decline of mobility: An 11-year follow-up of 5464 adults of late middle aged and elderly. (2013) Archives of Gerontology and Geriatry. 57(2):215-220. 32
附錄 3: Chhian Hūi Lêng and Jung-Der Wang. Daily home gardening improved survival for older people with mobility limitations: An 11-year follow-up study in Taiwan. (2016) Clinical Interventions in Aging. 11:947-959. 38
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