Yu Hsiao-Wei, Chen Duan-Rung, Chiang Tung-Liang, Tu Yu-Kang, Chen Ya-Mei
Institute of Health Policy and Management, National Taiwan University, 6F, No. 17, Xu-Zhou Road, Taipei 100, Taiwan, ROC.
Institute of Epidemiology and Preventive Medicine, National Taiwan University, 5F, No. 17, Xu-Zhou Road, Taipei 100, Taiwan, ROC.
Arch Gerontol Geriatr. 2015 Mar-Apr;60(2):272-80. doi: 10.1016/j.archger.2014.12.005. Epub 2014 Dec 22.
We aimed to identify disability trajectories and examine whether the predisposing, intra-individual, and extra-individual factors in the disablement process predicted different disability trajectories among older adults in Taiwan.
Data were from the Taiwan Longitudinal Study on Aging (TLSA) Survey in 1996-2007 (n=3186). Disability trajectories for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were identified by using latent class growth curves modeling. Factors including demographics, health conditions, health behaviors, social relations, and use of assistive devices were significantly predicted different disability trajectories of older adults over the following 11 years by applying hierarchical logistic regression.
Three disability trajectories--maintained function, progressive disability, and consistent disability--were identified. Predisposing factors such as younger age, more educational attainment, and better health conditions had protective effects of leading to a later healthier maintained function trajectory. Intra-individual factors such as engaging in leisure time activities (LTAs) were positively related to the maintained function trajectory but negatively related to the consistent disability trajectory; decreasing social networks was common to those on consistent disability trajectory; dissatisfaction with social support was noted in maintained function trajectory group. An extra-individual factor, using assistive devices, was significantly related to maintaining older adults' disability levels, even for those who started disabled.
The findings suggested that predisposing, intra-individual, and extra-individual factors play different roles in the development of later disability trajectories. More educational attainment, better health conditions, active in LTAs, and using assistive devices might benefit the maintenance of functioning in Taiwanese older adults.
我们旨在确定残疾轨迹，并研究致残过程中的 predisposing、个体内和个体外因素是否能预测台湾老年人不同的残疾轨迹。
数据来自1996 - 2007年台湾老年纵向研究（TLSA）调查（n = 3186）。通过使用潜在类别增长曲线模型确定日常生活活动（ADL）和工具性日常生活活动（IADL）的残疾轨迹。应用分层逻辑回归分析，包括人口统计学、健康状况、健康行为、社会关系和辅助设备使用等因素，显著预测了老年人在接下来11年中的不同残疾轨迹。
确定了三种残疾轨迹——功能维持、渐进性残疾和持续性残疾。年龄较小、受教育程度较高和健康状况较好等 predisposing 因素具有保护作用，可导致较晚出现更健康的功能维持轨迹。个体内因素，如参与休闲时间活动（LTA），与功能维持轨迹呈正相关，但与持续性残疾轨迹呈负相关；社交网络减少在持续性残疾轨迹的人群中较为常见；功能维持轨迹组存在对社会支持的不满。一个个体外因素，即使用辅助设备，与维持老年人的残疾水平显著相关，即使对于那些一开始就残疾的人也是如此。
研究结果表明，predisposing、个体内和个体外因素在后期残疾轨迹的发展中发挥着不同作用。受教育程度更高、健康状况更好、积极参与LTA以及使用辅助设备可能有利于台湾老年人维持功能。
