安適老化：台灣中老年人喪偶、喪子經驗、復原力與死亡風險之關係

Comfortable and Peaceful Ageing: Associations between Spousal and Child Bereavement, Resilience, and Risk of Mortality Among Middle-aged and Older Adults in Taiwan

10.29461/TGGa.202311_18(4).0003

曾慧嘉(Huei-Jia Tzeng)；張家銘(Chia-Ming Chang)；李妙純(Miaw-Chwen Lee)

逆境 ； 復原力 ； 死亡風險 ； 群組軌跡 ； 中老年期 ； adversity ； resilience ； mortality ； group-based trajectory ； middle-aged and older adults

台灣老年醫學暨老年學會雜誌

18卷4期（2023 / 11 / 01）

279 - 292

繁體中文;英文

目的：中老年期無法避免面臨重大生命逆境，例如喪偶或喪子，並影響其生活品質及死亡率。因此，提升中老年人面對逆境復原力之積極策略是高齡社會發展之重要議題。本研究藉由分析台灣中老年經歷喪子、喪偶與復原力及死亡風險之關係，作為提出高齡預防醫學及老人福祉相關政策參考。方法：本研究為次級資料分析，以1996、1999、2003年「台灣地區中老年身心社會生活狀況長期追蹤調查（TLSA）」為資料來源。以群組軌跡模型估計1996至2003年之自評健康、憂鬱、生活滿意度之復原力，以Cox比例風險模型分析喪偶、喪子（女）之逆境、復原力和死亡風險之關係。分析樣本共4,166位50歲以上中老年人。結果：逆境經驗中，1996年喪偶者占21.2%、1996年前曾喪子占18.2%。具復原力軌跡者自評健康占48.6%、憂鬱占73.3%、生活滿意度占67.6%。喪偶及曾喪子者自評健康、憂鬱、生活滿意度復原力勝算亦皆相較未喪偶或未喪子者低。在控制其他自變數後，具自評健康（HR=0.59）、憂鬱（HR=0.78）和生活滿意復原力（HR=0.87）之中老年人比不具復原力者死亡風險低。但是喪偶（HR=1.12,）、喪子（HR=1.14）對死亡風險的影響卻未達統計顯著性。結論：多數台灣人之中老年期呈現復原力軌跡；但喪偶、喪子（女）會減少復原力機率，而且間接增加死亡風險。建議應增加主觀（例如自評健康）、社會、心理及精神指標之周全性老年醫學評估，特別是經歷喪親的中高齡者，以規劃未來中高齡社會需求之參考。

Background: Compared to younger individuals, middle-aged and older people are more likely to experience adversities in life, such as loss of a spouse or child, which may affect their quality of life or even mortality. Developing and implementing effective proactive strategies to enhance the resilience of middle-aged and older adults in the face of adversity is therefore a crucial issue in any aging or aged society. The study accordingly aimed at analyzing the relationship between spousal and parental bereavement, resilience, and risk of mortality among middle-aged and older adults in Taiwan, with the hope of offering insights for proposing welfare policies related to preventive geriatrics and gerontology in Taiwan. Methods: Based on secondary data analysis, the study used the data obtained from the 1996, 1999 and 2003 TLSAs (Taiwan Longitudinal Study on Aging). Group-based trajectory modeling (GBTM) was employed to identify trajectories of resilience from 1996 to 2003, and Cox proportional hazards regression used to analyze the relationship among adversity (spousal or child bereavement), resilience, and the risk of mortality. A total of 4,166 middle-aged and older adults over 50 years old were included in the analysis. Results: In terms of adversity experiences, 21.2% of the study subjects were widows or widowers in 1996 and 18.2% of them lost a child or children before 1996. Around 48.6% of the subjects had demonstrated a resilience trajectory for self-reported health, 73.3% for depression, and 67.6% for life satisfaction. Logistic regression analyses showed that those experiencing spousal or child bereavement had a lower probability of being resilient than those without the loss experience. With all demographic and social characteristics adjusted, the subjects marked with resilience trajectories had lower risks of mortality than those without resilience for self-reported health (HR=0.59), for depression (HR=0.78), and for life satisfaction (HR=0.87). However, the effects of spousal (HR= 1.12) or child bereavement (HR= 1.14) on the risk of mortality were statistically non-significant. Conclusions: The study found that the majority of older adults showed a multidimensional resilience outcome. The loss of a spouse or child reduces the probability of resilience and indirectly increases the risk of mortality. Results of this study suggest that long-term care policies should mandate comprehensive geriatric assessment (CGA) particularly for middle-aged and older adults who have experienced bereavement and adversities, examining their subject health (e.g. self-rated heath), social, and psychological indicators so as to help develop more supportive and effective care plans responding to the needs of this population in our aged society.