老人身體功能改變：福利國體制之間比較

Taipei Medical University Institutional Repository > 公共衛生暨營養學院 > 公共衛生學系暨研究所 > 碩博論文 > Item 987654321/50356

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題名:	老人身體功能改變：福利國體制之間比較 Change in ADL Disability among Elderly: Comparisons between Welfare States
作者:	林冠吟 Lin, Kuan-Yin
貢獻者:	莊坤洋
關鍵詞:	老人,身體功能,ADL,失能,福利國家體制 elderly;physical function,ADL,disability,welfare states
日期:	2013-06-18
上傳時間:	2018-09-27 14:15:06 (UTC+8)
摘要:	背景：福利國家體制是影響健康的重要因子，福利國家體制主要是透過不同福利國家衛生及社會服務等提供方式及種類進而影響到人民的健康，例如死亡率、罹病率等，而過去很少是針對老人來做探討的。在老人族群中，身體功能是用來作為健康的重要指標。另外了解老人身體功能失能或者下降情況可提供健康照護、社會服務等相關需求訊息，也是在已開發國家中重要的政策之一。本研究目的為探討歐洲11個國家中影響老人身體功能下降因子是否因福利國家體制不同而有所差異。研究方法：採用「歐洲健康、老化與退休調查」(Survey of Health, Ageing, and Retirement in Europe, SHARE)的跨國資料庫的第一波及第二波資料，研究對象為65歲以上社區老人，最後的樣本個案數為8,086位，並將11個國家分為三種福利國家體制(分別為俾斯麥、斯堪地那維亞、南歐)。本研究的結果變項是測量老人在ADL(limitations in activities of daily living)的下降情況，其他的預測因子為社經人口學、個人健康疾病等變項，如年齡、性別、教育程度、居住安排、家庭收入、有無憂鬱狀況、慢性病等變項，再依每個福利國體制分別獨立以邏輯斯迴歸分析檢測預測因子與結果之間的關係。結果：年齡在三個福利體制內皆是功能退化的顯著影響，但在斯堪地那維亞福利國體制中風險間的比值差距最大。家庭收入對功能退化的影響在各體系間並不一致，對俾斯麥福利體制的影響最明顯，但在南歐體制內，影響層面稍弱，只有在最高與最低收的比較時才有顯著關係，在斯堪地那維亞福利體制內則無顯著關係。社會資本變項對南歐有顯著影響，但在其它體制內並未發現有顯著關係。結論：家庭收入變項對福利體制有著不同的影響，俾斯麥福利國家體制中主要是受到公會所影響，而因公會主要是依照家庭工作者的職業來區分，所以俾斯麥福利國體制中無論處於何種收入階級皆有顯著風險關係。斯堪地那維亞福利國家體制由於福利提供的普遍性較高，使得較不受收入所影響，而在南歐中，由於退休機制有助於高薪者，使得在高家庭收入有顯著較低的風險。 Background：Past research has shown that welfare state was an important determinant of health, such as mortality and mortality. Welfare state asserts its influence on health through the provision of social and health services. However, few studies have focused on elderly. Among the elderly, physical function, rather than mortality, has been frequently used as the indicator of health. Improvement in the physical function of elderly has an significant impact on long-term care services utilization, and has become a policy priority among developed nations. The purpose of this research is to assess physical function of the elderly is influenced by welfare states. Methods：Data for this research come from the first and second wave of the Survey of Health, Aging, and Retirement in Europe, including 11 countries and 8, 086 elderly. Countries were categorized as Bismarckian, Scandinavian, and Southern European welfare states. The decrease in activities of daily living functions was used as the dependent variables. Socio-economic status, demographic characteristics, use of services, and number of chronic conditions were used as predictors. Logistic regression were used to assess the whether the significance of these variables differs among welfare states. Results：Age was a significant predictor in all three welfare states, with the highest odds ratio in the Scandinavian welfare state. The effect of family income differed among welfare states. It was not significant in Scandinavian welfare states, but showed some influence in Southern European welfare states, and a strong influence in Bismarckian welfare states. Social capital was important in Southern European welfare states, but was not significant in other welfare states. Conclusions：In the Bismarckian welfare states, benefits was in general highly associated with union or profession associations, which in terms was highly associated with income, and thus, a high association between family income and physical function. Because of needs-based service provision in the Scandinavian states, family income was not a significant predictor. Since retirement benefits favors those with higher income, it was observed that only high-income families, rather than middle-income families, showed a decreased odds of having a worse physical function.
描述:	碩士指導教授-莊坤洋委員-吳淑瓊委員-莊媖智
資料類型:	thesis
顯示於類別:	[公共衛生學系暨研究所] 碩博論文

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