從社會生態學觀點探討高齡者疫情焦慮之模型比較─ 以身體衰弱、心理衰弱、社會衰弱為調節變項

Abstract

在2020年初全球進入新冠大流行危機，為了遏止疫情擴散，政府下令禁止社區關懷據點的各項群聚性社交照護活動，許多高齡者減少外出機會、社交聚會、走路運動，導致快速老化與健康問題。本研究探究臺北市高齡者身體、心理及社會衰弱程度之現況，以社會生態系統為研究視角，分析高齡者疫情焦慮受到社會環境因素、物理環境因素之影響情形，進而探討在高齡者身體衰弱、心理衰弱、社會衰弱三種衰弱模型對其調節影響之比較，以2019年至2021年歷經新冠疫情且居住於臺北市12行政區之65歲以上高齡者為研究對象，透過分層抽樣來抽取樣本，因正逢疫情高峰期，限於政府防疫政策，故以線上及實體紙本問卷發放，收回460筆資料，以剔餘之392筆資料進行描述性統計、相關係數分析及結構方程式分析。根據結果所示，在疫情期間，當臺北市高齡者的身體衰弱、心理衰弱、社會衰弱程度越高，其疫情焦慮感則會越深。在社會環境因素之「社會參與度」中，當臺北市高齡者越消極參與社會團體活動，其越傾向展現越強烈的疫情焦慮感；在物理環境因素之「鄰里生活品質」中，當臺北市高齡者感知到鄰里生活品質越優質，其越傾向展現越溫和的疫情焦慮感。本研究除了探討探索高齡者疫情焦慮受到社會環境因素、物理環境因素之影響情形，也進一步探討其受到身體衰弱、心理衰弱和社會衰弱之調節效果，並且發現到當高齡者的身體衰弱程度愈高，他越願意參與社會團體活動的情況下，容易展現出較高的疫情焦慮。當高齡者的身體、心理及社會衰弱程度愈高，他所處的鄰里生活品質越優質的情況下，容易展現出較高的疫情焦慮。透過社會生態學觀點能提供健康行為更廣泛的瞭解與探索，並且能適切地反映出改變物理環境與社會環境影響個人健康行為的效果，以期提早發現心理或社會面向較不健康之高齡衰弱者，並及早進行介入，未來如再發生類似的疫情事件能給予社區高齡者更合適的照顧與關懷。

In early 2020, the global COVID-19 pandemic was declared. Most activities in community centers declined as a countermeasure against the spread of COVID-19. Many older community dwellers reduced the extent of their social activities and daily exercise, causing rapid aging and health problems. We investigated the physical, psychological, and social frailty of older community dwellers in Taipei City during the pandemic. Using the social-ecological model, we explored the impact of social and physical environmental factors on coronavirus-related anxiety in our participants. We also compared models to better explore this issue, using physical, psychological, and social frailty as moderators. Using stratified sampling, we recruited 392 participants aged over 65 years who were living within 12 administrative districts of Taipei City during the pandemic (2019–2021). We distributed questionnaires both online and in hardcopy because the collection period included the peak of the pandemic and was subject to the government’s epidemic prevention policy. Data were analyzed using descriptive statistics, correlation coefficients, and structural equation modeling. We found that during the pandemic, the greater the participants’ physical, psychological, and social frailty, the deeper their coronavirus-related anxiety was. The less they participated in social activities, the greater their anxiety; conversely, the better their perceived quality of life in their neighborhood, the lower their anxiety. We also found that the greater their frailty and the less willing they were to participate in social activities, the greater was their anxiety. When they perceived the quality of life in their neighborhood to be poorer, their anxiety was greater. Social-ecology–based perspectives can provide a broader understanding of health behaviors and explain the effects of changing one’s physical and social environment on one’s health behaviors. This enables earlier detection of and intervention to help psychologically or socially unhealthy older community dwellers. If similar epidemics occurin the future, this approach would facilitate more appropriate care for older community dwellers.