由性別分析探討社區之健康內涵與永續推動機制－子計畫五：由性別分析探討人口老化社區之健康內涵與永續推動機制(II)

[[abstract]]本計畫為兩年期整合型計畫中之子計畫第二年，本子計畫之總目標為：以性別主流化理念檢視人口老化社區所呈現之性別於健康問題，並以行動研究方法了解社區需求，提升社區行動能力，實際營造具性別觀點之活躍老化社區，以研擬支持活躍老化社區婦女建立永續健康社區之推動機制。計畫分年目標如下： 第一年(上年度) 1. 以性別主流化理念檢視過去曾在人口老化社區執行過之相關方案，或以活躍老化為主題之健康分案，其中所呈現之性別與健康問題。 2. 研究國外推動過具性別觀點的活躍老化社區或計畫之典範，分析其內涵、運作特性與推動機制。 3. 訪談台灣中部地區重要健康社區推動成員，了解其運作模式與推動機制。 4. 選定及連繫第二年進行行動方案之社區。 第二年(本年度)： 1. 製作提升社區行動能力、活躍老化與性別概念之教材，並依社區團體之幹部與成員設計不同內容。 2. 對選定之社區團體幹部與成員進行演講，提升其行動能力，引入活躍老化概念與性別主流化概念。 3. 與社區團體所有成員進行座談，了解當地民眾對健康的定義與健康問題，以及對社區健康議題的優先順序，並指出社區具有之資源與阻礙。 4. 分析造成活躍老化社區的阻礙，尤其在性別差異部份，包括性別角色、族群差異、世代差異、家庭模式、生活型態、環境因素(社會文化經濟政策環境、醫療與長期照護環境、全球化變遷)等影響，進行社區診斷。 5. 提出具性別意識且適合該社區之健康議題，撰寫社區行動研究計畫書，回饋當地社區。 Abstract This sub-project is the second year of the integrated project. The overall purpose is to examine the gender and health problems in an aging community by gender mainstreaming perspective and gender analysis tools, and to construct an active aging community with gender perspective by action research method, to develop a sustainable mechanism of healthy communities by elderly women. The purposes of the project in each year are: First year (Last year): 1. To examine the problems of gender and health problems of the related action strategies fro active aging communities or related programs. 2. To analyze the contents, operations, and mechanisms of active aging community strategy/program paradigms with gender perspective. 3. To interview important community members at middle Taiwan to realize their mdoel and mechanism in empowerment and action. 4. To choose the action research community for the next year. Second year (This year): 1. To prepare the teaching material for improving action ability. 2. To improve the action ability for the community members by giving speech, thus to introduce the concept of active aging and gender mainstreaming. 3. To realize the health definition and health problems for the local people in the community, the priority of health issues, and indicate the resources and barriers in the community. 4. To do community diagnosis by analysis of barriers of active aging communities especially in the gender disparities, including gender role, ethnic group differences, cohort differences, family dynamics, life styles, environmental factors (social, cultural, economic, politic, medical, long-term care, global changes). 5. To decide the appropriate health issue with gender concept for the community, and write an action research proposal for the community for feedback and further action

成功老化之生命週期分析

[[abstract]]研究背景：成功老化為近年來全球老年健康的重要議題，過去研究以測量老年人成功老化的現況及其危險因子與保護因子，然而對於身體、心理、社會健康層面已經失能或不成功者，其危險因子的累積弱勢或負面影響早以難做改變，而應該採取生命週期觀點及早進行預防和健康促進。 研究目的：本計畫目的為探討生命週期對成功老化的影響，研究問題包括：1.生命週期與世代比較：將分析比較台灣中年人與老年人不同世代的成功老化情形，探討生命週期風險對成功老化的可能影響。2.成功老化軌跡：成功老化各指標之健康軌跡，以及相關因素對不同軌跡的成功老化變化之影響大小。3.身體失能與慢性病老人之成功老化分析與保護因子：對於身體面向失能者或患慢性病老人與完全成功老化老人在其他面向成功老化的情形之差異，以及探討保護其心理與社會面向健康和主觀幸福感的因素為何。4.年齡整合與成功老化：探討年齡整合是否有助於成功老化。 研究方法：本計畫定義成功老化指標包括身體面向(日常生活活動功能與工 具性日常生活活動功能正常)、心理面向(認知功能正常與無憂鬱症狀)、社會面向(良好社會支持與投入生產力活動)、以及主觀幸福感。資料來源為國民健康局「老人保健與生活調查」1989-1999 年資料(若2003 年資料已開放亦將申請)，該資料為具全台灣老人代表性之面訪調查之長期追蹤資料，1989 年樣本為60 歲以上老年世代樣本，於1996年並加入50-66 歲中年人世代樣本。分析方法預定將以SPSS/PC 或SAS/PC 等進行分析，統計方法採用長期追蹤資料與多變項分析，包括多類別邏輯式迴歸分析、重覆測量混合效果模式、概化估計方程等。 預期研究成果：預測未來老年世代(即目前的中年世代)的成功老化情形；了解生命週期中成功老化之危險因子作用時間與影響大小；了解成功老化者之保護因子，以及身體失能者之其他面向成功老化保護因子，以提供未來研究外在資源介入效果以及健康促進政策參考。 Successful aging has been the emergent issue of elder health in the world. Past research has found the successful aging status and related risk factors or protective factors. However, for those elderly who have failed in physical, psychological, or social dimension in successful aging, the cumulative disadvantage of risk factors is too late to intervene or modify. A life course perspective to analyze the successful aging in order to disease prevention and health promotion is necessary. The purpose of this project is to analyze the successful aging across life course. The research questions include: 1. Life course and cohort comparison:We will analyze the difference of successful aging between the middle-age cohorts and older cohorts, and the effect of risks across life course to successful aging. 2. Successful aging trajectories:We will analyze the trajectory of each successful aging indicator, and analyze the effect of related factors to different trajectory people. 3. Protective factors for disabled and sick elderly: For those elderly who were disabled in physical dimension successful aging or having chronic diseases, we will compare their difference with successful aging elderly in other indicators, and to explore the protective factors to psychological health, social health or subjective wellbeing. 4. Age integration and successful aging:We will explore if age integration helps in successful aging. This research project defines successful aging measures include physical dimension (normal function in activities of daily living (ADL) and instrumental activities of daily living (IADL)), psychological dimension (normal cognitive function and absence of depressive symptoms), social dimension (good social support and engagement with productive activities), and subjective wellbeing as well. Data come from “Survey of Health and Living Status of the Elderly in Taiwan”, 1989-1999, a national representative samples executed by Population and Health Survey Center, Bureau of Health Promotion, Department of Health, R.O.C. (We will apply the wave in 2003 if it is open). In 1989 the samples were the older cohorts who were aged 60 or more, and in 1996 the middle-age cohorts (aged 50-66) samples were added in the panel too. The analysis will be conducted by SPSS/PC or SAS/PC. The statistics methods include descriptive statistics, longitudinal data analysis and multivariable analysis, like multi-nominal logistics regression, repeated measure mixed effect model, generalized estimated equation, etc. This project is expected to predict the successful aging of the future elderly (current middle-age cohorts), to realize the effect of risk factors to successful aging across life course, to explore the protective factors of successful aging in other dimensions for physically disabled elderly, therefore to offer the suggestions and implications for future studies and intervention in health promotion.

失能者之成功老化：內在適應與外在資源

[[abstract]]研究目的：本計畫探討失能老人之成功老化意涵為何，了解失能者之內在調適與外在資源如何協助其適應，並希望由此可提出未來介入研究與政策建議，以促進失能者的成功老化。研究方法：以文獻探討為基礎，進行調查研究法設計問卷收集資料。本年度計畫資料預定採用面對面訪問方式。研究樣本預定包含社區樣本與機構樣本各200人，其中社區樣本預定於社區中選取使用社區式長期照護服務(例如日間照護、居家照護等)之老年失能者，而機構樣本預定於長期照護機構或醫院復健部門選取老年失能者進行訪問。變項包括失能者之主觀成功老化意涵與適應過程、客觀成功老化指標、內在適應與自我效能、外在資源(老年科技、輔具、老年教育與社會參與)、其他健康情形與人口社經變項等。問卷先經過預試以便修正問卷。所有訪員均需先經過訪員訓練以進行標準化訪問。在分析方法上，開放式問題將予以譯碼、分類，並與結構式問題結果進行三角測定。結構式問題分析預定以SPSS/PC，Lisrel 或Mplus 等統計軟體進行分析，統計分析包括敘述統計、多類別邏輯式迴歸分析、結構方程分析等統計方法。 預期貢獻：預期本計畫成果包括(1)了解失能者對成功老化的看法為何，以及萃取重要元素，以定義失能者的成功老化；並與過去研究成果比較失能者與一般老人之成功老化意涵之異同。(2)探討失能者在適應過程中之內在過程，外在資源或協助，以及遭遇的困難為何，以發展未來協助的重點。(3)對於失能者內在適應用與外在資源使用障礙之困難提供研究與政策建議。 Purpose: This project is to explore the meaning and content of successful aging for the disabled elderly, and how their internal adaptation and external resources help their coping process to being disability.We hope this research will contribute to effective intervention for successful aging in the research and policies to promote successful aging for the disabled elderly. Methods: We will conduct survey research based on the literature review to design the questionnaire. The survey is proposed to be a face-to-face interview. The samples include community-based and institutionalized samples: 200 persons for each. Community-based samples will be selected from the disabled elderly using community-based long-term care (e.g., day care or home health care), and institutionalized samples will be selected from long-term care institutions or rehabilitation departments of hospitals. The variables include a subjective definition of successful aging and adaptation to disability, objective successful aging indicators, internal adaptation, coping and self efficacy, external resources (gerotechnology, assistive devices, elder education, and social participation), health-related variables and demographic socio-economic variables. The questionnaire will be pre-tested and modified before the formal interview, and all the interviewees need to participate in training to conduct a standardized interview. The analysis of the open questions will be conducted coding, categorized and triangulated with structural questions. The analysis of structural questions includes descriptive statistics, logistic regression, and the structural equation model by SPSS/PC, Lisrel or Mplus. Expected contribution: This project is expected to contribute to the field of successful aging in the following: (1) to understand and extract the important components of successful aging for the disabled elderly, and compare with that of physically normal elderly; (2) to explore the inner adaptation and assistance from outer resources to the disability process, and what the difficulties and barriers are; (3) to provide research and policy suggestions for the disabled elderly to promote their successful aging through internal adaptation and external resources

Implicit exchanges in family caregiving for frail elders in Taiwan

[[abstract]]"In this study, the authors use in-depth interviews with inductive analysis to develop a conceptual framework for exploring social exchanges and their implicit calculations for caregivers in Taiwan. They interviewed 12 caregivers, based on theory-based sampling and maximum variation. They found some components of implicit exchanges of the caregivers, and drew a framework to describe it. At the beginning of care, motivations were mostly from obligation accompanied by reciprocity or repaying motives. In the process of caregiving, some unique, implicit cultural implicit exchanges were found, such as karma, a demonstrative behavior to investment, equitable share of responsibility, and the pressure or rewards from public opinion. These implicit exchanges might be intermediary factors in helping caregivers cope with their burden or even in influencing their continuation of care. The findings are implicated to help family caregivers continue their care and not damage their quality of care.

Gender differences in health-related quality of life among the elderly in Taiwan

[[abstract]]"Purpose: This study examines the gender disparity in the elderly’s health-related quality of life in Taiwan. Method: Data came from the National Health Interview Survey, a series of nation-representative face-to-face interviews held in Taiwan in 2001. The samples were chosen from those aged 65 or over, including populations drawn from the Taiwan area (with a number n=1845), remote mountain areas (n=169), and offshore islands (n=179). Health-related quality of life (HQOL) was measured by SF-36, including the dimensions of physical functioning, role limitation due to physical problems, bodily pain, general health, vitality, social functioning, role limitation due to emotional problems, and mental health. Two-stage linear regression models were used for analysis. Results: Elderly women showed lower HQOL in almost every dimension in the Taiwan area and offshore islands. After controlling for age, education, marital status, activities of daily living, and numbers of chronic diseases, women elderly showed a lower score in HQOL than men, and the difference was the most prominent in bodily pain which had a 23.6% lower score. The elderly in offshore islands and mountain areas had a lower HQOL than that in the Taiwan area. Other effects were greater than gender for the elderly in remote mountain areas. Discussion: Gender difference appeared across different dimensions of health-related quality of life. More effort to improve equal gender opportunities for health-related quality of life is necessary.

Too late to quit? Effect of smoking and smoking cessation on morbidity and mortality among the elderly in a longitudinal study

[[abstract]]This prospective study of the elderly population estimated the risks of smoking for morbidity and mortality and identified whether cessation of smoking reduced the risk of disease. Data came from face-to-face interviews that used a population-based probability sample of those aged 60 years or over in Taiwan, provided by the Population and Health Research Center, Bureau of Health Promotion. In total, 4,049 subjects were included at the baseline year of 1989 and followed up in 1993 and 1996. Smoking-related variables included current smoking status, smoking history, daily consumption, and years since the cessation of smoking. Cox regression models were used to analyze the relative risks for morbidity and mortality, controlling for demographics, physical function, and comorbidities. The sample was made up of 50.2% nonsmokers, 15.2% ex-smokers, and 34.6% current smokers in the baseline year. Current smokers were more likely to have lower respiratory tract diseases throughout the study. Current smokers had a higher risk of stroke from 1989 to 1993. No dose-response relationship for smoking exposure or impact of years since smoking cessation was found. Whether cessation of smoking is protective should be investigated for middle-aged adults followed to old age. An effective strategy for smoking cessation in the elderly is suggested, and people should be encouraged to quit smoking at any time

Risk factors of falling among the elderly in Taiwan: a longitudinal study

[[abstract]]This study aimed to analyze the prevalence of falls and repeated falls of national elderly samples and to explore the risk factors of falls. Methods: Data were obtained from the "Survey of Health and Living Status of the Elderly in Taiwan" conducted in 1996 (n=2,669) and 1999 (n=2,310). The related risk factors of falls included demographic variables, chronic diseases, disability and changes in physical function, depressive symptoms, exercise behavior, and use of assistive devices (walker/sticks or glasses). Logistic regression was used for analysis. Results: The prevalence of falls was 19.5%, with 12.3% single fall and 7.2% repeated falls. The risk factors of falls included being female, having disability, reduced ADL function, with depressive symptoms, using stick/walker but walking well, and not wearing glasses but not seeing clearly. Among the fallers, 73.8% reported fear of falls, and 45.1% attributed their falls to environmental causes. Conclusion: Physical and psychological factors as well as environmental factors may cause falls and injuries for elderly. Physicians in the fields of geriatrics or family medicine should pay more and closer attention to the possible risks of their senior patients; home safety and appropriateness of assistive devices for the elderly should be regularly evaluated and carefully maintained

Physical function trajectories, depressive symptoms, and life satisafction among the elderly in Taiwan

[[abstract]]"Objective: The purpose of this study was to examine the effect of physical function trajectories on emotional health and subjective well-being among the elderly in Taiwan. Methods: Data was from a 6-year nation-representative panel for analysis. Physical function trajectories were categorized as independent, declined, disabled, improved, fluctuating, died well and died disabled. The effects of physical function trajectories on depressive symptoms and life satisfaction were examined by controlling for demographics, chronic disease, cognitive function and social support. Mixed linear modeling was used for analysis. Results: Among the physical trajectory groups, differences were shown between depressive symptoms and life satisfaction. An increase in the difficulty of physical function also increases depressive symptoms and reduces life satisfaction. The died-well group showed a difference from the independent group in depressive symptoms and life satisfaction, but these who died without disability did have better emotional health and subjective well-being than the disabled survivors. Conclusion: Coping strategies and supporting resources to help the disabled elderly to improve their successful aging is suggested in future research and health policies.[ABSTRACT FROM AUTHOR] Copyright of Aging & Mental Health is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.Copyright applies to all Abstracts.

Does social participation by the elderly reduce mortality and cognitive impairment?

[[abstract]]Purpose: This longitudinal study examines the effect of social participation on mortality and cognitive impairment for the elderly in Taiwan. Methods: Data were from an elderly population panel in Taiwan 'The Survey of Health and Living Status of the Elderly' 1993-1999. Social participation was defined as paid/unpaid job and participating in volunteer and social groups. Logistic regression analysis was used for predicting the influence of social participation to 6-year mortality and cognitive function impairment, by controlling of socioeconomic status and health-related variables. Results: The elderly with continuous paid work were more likely to participate in social groups. Having paid or unpaid work at the baseline year could lower the risk of mortality six years later, especially for men. Having unpaid work was associated with a higher risk of impaired cognitive function compared to that of non-workers. Participating in a religious group reduced the risk of mortality for women and participating in political groups reduced the risk of impaired cognitive function for men. Discussion: Participating in some types of social activities may reduce mortality or cognitive function impairment in the elderly. However, different activities, gender roles and uneven opportunities for work and social group participation may affect the risk of these endpoints

Multiple trajectories of successful aging of older and younger cohorts

[[abstract]]Purpose: The purpose of this study was to apply group-based trajectory analysis to identify multiple successful aging trajectories by multiple indicators and to examine the factors related to successful aging among the elderly population in Taiwan. Design and Methods: Nation-representative longitudinal data collected from 1993 to 2007 and consisting of 2 cohorts were used, and the trajectories of the following 6 successful aging indicators were analyzed: chronic diseases, physical function difficulties, depressive symptoms, social support, social participation, and economic satisfaction. Results: Members of the cohorts fell into 4 groups: successful aging, usual aging (the older cohort)/insecure aging (the younger cohort), health declining, and care demanding. Successful aging trajectories reflected differences in self-rated health and life satisfaction. Implications: This study provides empirical findings of the heterogeneity of successful aging trajectories in multidimensional indicators