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題名:台灣老人健康狀況與健康變化的性別經驗探討
作者:王香蘋
作者(外文):Hsiang-Ping Wang
校院名稱:國立中正大學
系所名稱:社會福利系
指導教授:李美玲
學位類別:博士
出版日期:2001
主題關鍵詞:性別老人健康狀況活動功能罹病種類自評健康比例風險分析
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(6) 博士論文(3) 專書(0) 專書論文(0)
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  • 點閱點閱:80
摘 要
女性的年齡別死亡率多低於男性對應的年齡別死亡率,因此到老年的階段經常是女性多於男性。老年女性相對於老年男性依然有較低的死亡率,但健康狀況的性別差異卻和死亡率相反。本論文嘗試由老人的罹病特性、疾病發生、死因、功能狀態與健康自評的探討,釐清老年健康狀況的性別差異,探討影響健康變化的因素。分析上主要使用衛生署家庭計畫研究所1989年、1993年與1996年的「老人保健調查」。同時因該資料無法提供歷次調查之死亡樣本之死亡原因,代而使用1993-1997年「台灣地區死亡統計」資料,了解老人的死亡原因。也輔以1996年的「老人生活狀況調查」,分析老人重要疾病的發生率。
研究發現關節炎、高血壓、腸胃潰瘍、呼吸道疾病、白內障、以及心臟病,是兩性老人罹患率最高的疾病。而疾病與失能之間的關係除了疾病類型之外,年齡是另一個重要的因素。就相同的活動功能,男性老人自評健康為「好」的比率高於女性,而男性自評健康為「不好」的比率則低於女性。其次,自評「不好」的比率隨著年齡增加而增加,自評為「好」的比率則隨著年齡的增加而減少。另外,活動功能愈佳者,自評健康狀況愈好。而男女性的健康狀況差異隨著存活者年齡增加而減少,女性有較早的變化起點,但變化的速度較緩,且傾向於有較不合理或悲觀的自我健康評價。
Cramer’s V檢定系統疾病當中性別與活動功能的關係,發現Cramer’s V值同時達顯著水準,強度一定是男性大於女性。活動功能以及自評健康狀況與死亡的關係,男性在各種功能行動狀態與自評健康狀況者的死亡水準都高於女性,但是兩性的差距也隨存活者年齡的增加而縮減。另一方面,男性的死因分佈較為平均,沒有特別突出的死亡原因,女性則大幅集中在糖尿病、未提及精神病的老衰、及腦血管疾病等前三種死因。
比較性別的功能轉變,發現女性在各項活動功能狀態下死亡者低於男性。至於存活社區者,男性少於女性。影響老人死亡風險的分析,女性老人受較具致命性疾病因素影響而增加死亡風險的情況,較之男性老人少,反而女性老人罹患非致命性疾病而弱化其行動力,意外地獲得保守生命的效果的情形較男性老人普遍。
女性早年容易為照顧家庭而喪失經濟自主,晚年又長壽但慢性病的拖磨及活動功能上都無法自主的境況,更加深了女性老人在安老及養老的路途上的艱辛,其生活品質更加值得關切。
Gender Difference on Health Status and Health Change in Taiwan Elderly
Abstract
Given the age specific mortality for women is lower than that of men, feminization of later life is common in all societies. Although elderly women keep the lower mortality, the health status for women is not necessarily better than that for men. This assumption is well accepted, however, very few empirical study, nor thorough investigation has ever been done due to lack of appropriate data. In this study, first of all, I review the mortality change, elderly population, and the trend of feminization of later life in Taiwan. Secondly, different measures of health status, disease morbidity, and quality of life are used to analyze the gender differences of health status among Taiwan elderly, and to estimate the effects of factors which influence health change.
Using the data from Survey of Health and Living Status of the Elderly in Taiwan published by Taiwan Provincial Institute of Family Planning, I investigate the patterns of diseases, functional status, self-rated health, and the casual relationships among them. In addition, Death Statistics of Taiwan area and the Surveys on the Elder’s Status published by Department of Health are used to analyze the incidences of the diseases.
The results from my analyses of these data suggest that both elder man and women have the same pattern of disease: arthritis, hypertension, G-I peptic ulcer, respiratory diseases, cataract, and heart diseases. Other findings indicate that the association among disease pattern and functional status for men are much stronger than that for women. We also notice that diabetes mellitus, senility without mention of psychosis, and cerebrovascular disease are the main causes of death for women. Additionally, I employ hazard rate model to compare the dynamics of health and functional status for men and women. The results show that the probability of being institutionalized and/or death for women is lower than that for men, for all functional status. On the other hand, however, health status for women is not significantly better than men.
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