| 摘要: | 研究背景：臺灣在2018年正式進入了高齡社會，根據國家發展委員會的預測，將在短短八年內邁入超高齡社會，人口老化的速度之快，使得我國高齡相關研究顯得更加重要。2021年的世界聽力報告指出聽力損失是嚴重的議題，其中，老年聽力退化更是常見的健康問題。過去研究指出聽力退化是增加認知障礙風險的重要因子之一。然而，目前的研究缺口如：（1）過去研究多探討高齡者聽力退化，較少研究探討中年50歲以上的中老年聽力退化相關之現象；（2）過去鮮少針對臺灣全國代表性樣本的聽力退化進行研究。
研究目的：本研究目的為探討中老年聽力退化與認知障礙之關係。
研究方法：本研究為次級資料庫分析，以我國衛生福利部104（2015）年「中老年身心社會生活狀況長期追蹤調查」，設籍於本島且年滿50歲之男女人口作為研究對象，將以IBM SPSS 26進行卡方檢定、T檢定、單因子變異數、多元線性逐步回歸及邏輯斯迴歸等進行統計分析。
研究結果：社會人口學變項（性別、年齡、教育程度、婚姻狀況、居住狀態、年收入、高血壓、糖尿病、抽菸、喝酒及憂鬱）的不同，皆與聽力障礙及認知障礙達到顯著差異，顯示其可成為聽力障礙與認知障礙的影響因子。透過統計分析得知，聽力狀態的不同與認知功能有顯著差異，其聽力清楚者認知功能平均分數顯著大於聽力障礙者（9.35；8.43）（p<0.001）進一步將年齡層分為50-64歲的中年族群及65歲以上的老年族群分析，結果顯示中年族群（50-64歲）中，聽力清楚在認知功能表現中較高（9.68；9.45）（p<0.001）；而老年族群（65歲以上）中同樣也是聽力清楚者認知分數較高（8.96；8.21）（p<0.001）。此外，在中年族群中有聽力障礙者與聽力清楚者相比，其認知障礙的比例顯著高於聽力清楚者（3.2％；0.4％）（p<0.001）；老年族群中有聽力障礙者與聽力清楚者相比，其認知障礙的比例顯著高於聽力清楚者（12.7％；5.5％）（p<0.001）。
除此之外，以多元線性逐步迴歸分析基本人口學資料對認知功能表現之預測，結果為聽力狀態、性別、年齡、國中教育程度、高中（職）教育程度、大學以上教育程度、婚姻狀況、居住狀態（僅與配偶居住）、年收入（中收入）、高血壓、糖尿病）、抽菸、喝酒（低度飲酒）及憂鬱都顯著有貢獻（p<0.001）。在考慮與認知功能達顯著影響的社會人口變項，將其納入控制後使用階層性迴歸分析，單獨探討聽力狀態對於認知功能表現的預測性為聽力狀態（β=-0.203, p=<0.001）。進一步將認知功能分成無認知障礙與有認知障礙兩組進行邏輯斯迴歸分析，結果顯示聽力障礙者發生認知障礙的勝算比為2.351倍、女性為2.049倍、65歲以上的老年人為4.477倍，與國小以下（含識字、不識字）的教育程度相比，擁有國中及高中（職）之學歷分別為0.114倍與0.09倍。與獨居者相比，僅與配偶同住者其勝算比為2.217倍，以及與低收入者相比，以中收入者其勝算比為0.992倍，相較於沒有飲酒習慣者，擁有低度飲酒習慣者其勝算比為0.027倍（p<0.001）。
研究結論：根據本研究結果可以得知，探討中老年聽力退化與認知障礙的相關性，可以得知有聽力障礙、女性、年齡愈大、教育程度國小以下、沒有伴侶、僅與配偶同住、低收入、患有高血壓、糖尿病，有抽菸習慣者、沒有飲酒習慣者以及有憂鬱傾向者，顯著增加認知障礙的風險。本研究結果建議未來可以進行縱貫性研究探討其因果關係，以及使用客觀性的聽力檢測作為研究方法使其結果更具可信度。除此之外，建議尤應針對中年人加強推廣健康檢查之重要性，使其能在中老年過程中維持良好的生活習慣。
Background: Taiwan has become an aged society since 2018. According to the prediction of the National Development Council, Taiwan will enter the next stage, the super-aged society, in eight years. Therefore, due to the increasing older population, age-related research has become more critical in Taiwan. Furthermore, the 2021 World Hearing Report pointed out that hearing loss was a common health issue, especially in middle-aged and older adults. As a result, the research gap in this study demonstrated as follows: (1)
Most of the previous studies discussed hearing impairment in old adults; however, a few studies investigated the phenomenon in the middle-aged, which was the age between 50 to 64; (2) In the past, there were few studies on nationally representative samples in Taiwan research on hearing loss.
Research purpose: This study aimed to explore the relationship between hearing loss and cognitive impairment.
Method: This study analyzed secondary data from the 2015 Taiwan Longitudinal Study on Aging (TLSA), which contained people who were 50 and above. All the data used the SPSS version 26 for descriptive statistics, Chi-square test, independent sample T-test, one-way ANOVA, multiple linear regression, and logistic regression analysis.
Results: The result presented significance in demographics (gender, age, education, marital status, residence status, annual income, hypertension, diabetes, smoking, drinking, and depression) and hearing loss and cognitive impairment, respectively. As can be seen from the statistics, the differences in hearing status and cognitive function were significant. Moreover, the average scores of cognitive functions of those with normal hearing status were significantly higher than those with hearing impairment (9.35; 8.43). Nevertheless, the age group was further divided into middle-aged groups (50-64) and the older population (over 65 years old). The result showed that in the middle-aged population who had normal hearing was higher in cognitive performance (9.68; 9.45) (p<0.001), while in the older adults (65+), the cognitive score was higher in the normal hearing group (8.96; 8.21) (p<0.001). In addition, the percentage of cognitive impairment was significantly higher among those with hearing impairment than those with normal hearing (12.7%; 5.5%) (p<0.001). Moreover, statistics illustrated that hearing status, gender, age, junior high school, high school, university education level, marital status, residence status (living with spouse only), annual income (middle income), hypertension, diabetes, smoking, alcohol consumption (low once), and depression all contributed to cognitive function significantly (p<0.001). After adjusted socio-demographic variables, the hearing status (β=-0.203, p=<0.001) can predict cognitive performance. The cognitive function was further divided into two groups: those without cognitive impairment and those with cognitive impairment. The results showed that the OR of cognitive impairment was 2.351 for those hearing impaired, 2.049 for females, and 4.477 for those aged over 65 years old. Compared with lower education levels, having junior high school and a high school education was 0.114 and 0.09, respectively. Compared with those who live alone, the OR of only living with a spouse was 2.217, and compared with low-income people, the OR of middle-income was 0.992. Compared with those without drinking habits, those with low drinking habits had OR of 0.027 (p<0.001).
Conclusion: People with hearing loss can contribute to cognitive function performance, which includes cognitive impairment. Therefore, females, older adults, people with lower educational levels, diabetes, and depressive symptoms, had a significantly higher risk of cognitive impairment. |
