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題名：台灣中老年人社會關係軌跡對復原力與死亡風險之影響
作者：曾慧嘉
作者(外文)：TZENG, HUEI-JIA
校院名稱：國立中正大學
系所名稱：社會福利研究所
指導教授：李妙純
學位類別：博士
出版日期：2023
主題關鍵詞：中老年人；生命歷程；逆境；復原力；社會關係；社會支持；Middle-aged and older adults；Life course；Adversity；Resilience；Social relationship；Social support
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研究背景：中老年期是一個充滿挑戰、動盪以及適應社會關係和健康變化的時期，隨著人類壽命的延長，重大生命逆境可能無法避免，如何藉由增加中老年人可用資源，並透過衛生福利政策介入提高復原力越來越重要。良好的社會關係不僅可降低死亡風險，也是中老年人經歷逆境後的重要復原力資源。
研究目的：本研究主要目的在於探討社會關係軌跡對中老年人復原力和死亡風險之影響。
研究方法：本研究採用「台灣地區中老年身心社會生活狀況長期追蹤調查(TLSA)」1996、1999、2003年共三波資料。逆境是指在1996年調查中受訪者指出過去曾經歷喪偶、喪子(女)和經濟惡化。本研究先以群組軌跡模型檢視1996至2003年之復原力和社會關係軌跡，再以多項式邏輯斯迴歸分析社會人口學變項和社會關係軌跡之關係，並以邏輯斯迴歸分析逆境、社會人口學變項與復原力之關係、以及社會關係軌跡和復原力之關係，最後以Cox 比例風險迴歸分析逆境、復原力、社會關係軌跡和死亡風險之關係。復原力指標包括自評健康、憂鬱、生活滿意度；社會關係軌跡包括工具性社會支持軌跡、情緒性社會支持軌跡、社會接觸軌跡、社會參與軌跡；控制變項包括年齡、教育年數、性別、族群。
研究結果：本研究分析1996年至2003年時仍存活之樣本共4,234人。曾經歷之逆境：經濟惡化(55.10%)、曾經喪偶(37.08%)、曾經喪子(女)(22.15%)。具復原力比例：自評健康復原力(47.1%)、憂鬱復原力(73.0%)、生活滿意度復原力(67.4%)。社會關係軌跡：不管工具性和情緒性社會支持軌跡皆以持續高度支持軌跡比例最高，分別為82.3%及76.6%；社會接觸軌跡以中度連結最多(70.2%)；社會參與軌跡以參與一個(含)以下社會團體最多(75.9%)。多項式邏輯斯迴歸分析顯示：教育年數越多，獲得較佳的社會關係軌跡機率相對較高。邏輯斯迴歸分析顯示：男性的自評健康和憂鬱復原力較女性佳(OR=1.21-1.54)，教育年數較多之中老年人自評健康、憂鬱和生活滿意度復原力皆較佳(OR=1.02-1.11)；持續高度工具性和情緒性社會支持之自評健康、憂鬱和生活滿意度復原力均較佳，強連結和持續參與四個以上團體之自評健康、憂鬱和生活滿意度復原力亦較佳。Cox 比例風險迴歸分析顯示：經歷過逆境之中老年人死亡風險較高(HR=1.18-1.50)；具復原力比不具復原力之中老年人死亡風險較低(HR=0.47-0.63)。此外，工具性及情緒性社會支持可調節逆境對死亡風險的影響，特別是對喪偶及經濟惡化對死亡風險的減弱效果較明顯。
結論：本研究結果證實不同社會關係軌跡對復原力有顯著相關，且工具性和情緒性社會支持軌跡對死亡風險亦有顯著影響。對於曾經歷重大生命逆境的中老年人，若能提供適度且持續性的社會支持，避免社會支持的減少，應有助於提升中老年人的復原力及降低中高齡時期之死亡風險，並增進其健康與福祉。
Background: Middle and older age can be a time of particular challenges, upheaval, and adaption with respect to both social relationships and health. As human lifespan increases, major life-time adversities may not be avoided. The improvement of resilience by increasing available resources for middle-aged and older adults and implementation of health and welfare policies are becoming more and more crucial in the contemporary society. Good social relationships can not only reduce mortality risk, but also serve as an important resource of resilience for middle-aged and older adults after experiencing adversity.
Aim: The main purpose of this study was to explore the influence of social relationship trajectories on resilience and mortality risk among middle-aged and older adults.
Method: This study used the data of three waves in 1996, 1999, and 2003 from the Taiwan Longitudinal Study on Aging (TLSA). Life-time adversities prior to 1996’s survey include widowhood, loss of a child and experiencing the deterioration of family economic situation . We used the group-based trajectory modeling (GBTM) to identify trajectories of resilience and social relationship from 1996 to 2003. Multinomial logistic regressions were used to examine the relationship between sociodemographic variables and social relationship trajectories, and logistic regressions were used to analyze the relationship among adversity, sociodemographic variables, social relationship trajectories and resilience. Finally, cox proportional hazards regressions were used to analyze the relationship among adversity, resilience, social relationship trajectories and mortality risk. Three dimensions of resilience include self-rated health, depression, and life satisfaction. Social relationship trajectories include instrumental social support trajectories, emotional social support trajectories, social contact trajectories, and social participation trajectories. Control variables include age, years of education, gender, and the ethnic group.
Results: The study sample consists of 4,234 middle-aged and older adults who were alive throughout 1996, 1999, and 2003. By 1996, 55.10% of the respondents had experienced the deterioration of family economic situation; while 37.08% of them were widows or widowers and 22.15% of them had experienced the loss of a child loss. The proportions of the respondents who had demonstrated resilience were 47.1% for self-rated health, 73.0% for depression, and 67.4% for life satisfaction resilience. Results of social relationship trajectories from GBTM demonstrate that most of the respondents had shown continuous high support trajectories, 82.3% and 76.6% for instrumental and emotional social support trajectories, respectively. Results also show that 70.2% of the respondents had demonstrated continuously moderate social contact trajectory and 75.9% of them had participated one social group. The multinomial logistic regression analyses showed that years of education were positively associations with favorable social relationship trajectories. Logistic regression analyses showed that men had higher probability of self-rated health and depression resilience than women's (OR=1.21-1.54). The respondents with more years of education had higher probability to be resilient (OR=1.02-1.11). Moreover, the respondents with continuous high instrumental and emotional social support, strong social connection, and higher social participation had higher probability of resilience of self-rated health, depression and life satisfaction. Cox proportional hazards regression analyses showed that the respondents who had experienced any kind of adversity had higher risk of mortality (HR=1.18-1.50). The respondents with resilience had lower risks of mortality than those who without resilience (HR=0.47-0.63). In addition, instrumental and emotional social support can moderate the effect of adversity on mortality risks, especially the moderating effects for the associations between widowhood and the deterioration of family economic situation and mortality risks were greater.
Conclusion: The results of this study demonstrate that different social relationship trajectories are significantly related to resilience. Controlling for sociodemographic variables, social connection and social participation trajectories, instrumental and emotional social support trajectories had significant effects on mortality risks. Results from this study highlight the importance of providing sufficient and continuous social support for middle-aged and older adults in order to maintain health and wellbeing in later life, particularly for those who had experienced major life-time adversities.
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