身體活動和居住環境宜走性在高齡者自我老化態度與憂鬱症狀間所扮演的角色

Abstract

研究背景與目的：過去研究顯示正向自我老化態度會降低憂鬱症狀，然而潛在影響機制尚未清楚。截至目前為止高齡者憂鬱相關因子研究多著重於個人層次因子，極少數研究是探討脈絡層次因子。本研究旨在探討自我老化態度、身體活動、憂鬱症狀與居住環境宜走性之間的關係。 研究方法：此橫斷性研究利用電腦輔助電話訪問系統以隨機撥號的方式訪問1,055位居住在社區之65歲以上高齡者的自我老化態度、身體活動量、居住地及憂鬱症狀，並利用Walk Score@計算其居住環境宜走性。透過拔靴法 (bootstrap)檢驗身體活動是否會中介自我老化態度對於憂鬱症狀的影響，並進一步透過調節型中介分析檢驗居住環境宜走性是否會調節自我老化態度透過身體活動對於憂鬱症狀的間接效果。 研究結果：在控制性別、年齡、教育程度、婚姻狀況後，研究結果顯示自我老化態度分別與身體活動呈現正相關及與憂鬱症狀呈現負相關；身體活動部分中介自我老化態度對於憂鬱症狀之影響。進一步將居住環境宜走性分成高、中、低三組，身體活動在高齡者的自我老化態度對於憂鬱症狀的影響扮演部分中介因子角色，此間接效果僅出現在中等程度宜走性之居住環境。 結論：研究結果顯示自我老化態度會經由身體活動影響高齡者憂鬱症狀，提高身體活動可作為降低高齡者憂鬱症狀之可行介入標的，特別在具中等程度宜走性的居住環境。本研究結果支持個人層次因子對於高齡者心理健康之影響會隨著脈絡層次因子而有所不同，然其關聯仍有待後續縱貫性研究進一步檢驗。研究結果建議未來在制定降低高齡者憂鬱症狀之相關介入策略時，可以鼓勵高齡者提高其身體活動量，並建構合宜的宜走性環境，進而提升其心理健康。本研究結果可提供高齡者心理健康促進介入計畫及政策制定的實徵研究基礎。

Introduction: Previous studies have shown that positive self-perceptions of aging (SPA) could reduce depressive symptoms; however, little is known about the underlying mechanisms. To date, research has highly focused on the individual factors rather than environmental factors associated with depressive symptoms. This study aimed to investigate the relationship between SPA, physical activity, depressive symptoms, and neighborhood walkability. Method: A sample of 1,055 Taiwan community-dwelling older adults aged 65 or above was obtained through a random-digit-dialing computer-assisted telephone interviewing. SPA, physical activity, depressive symptoms, and individual demographics were collected from the interview. Walk Score@ was used to assess the neighborhood walkability. Bootstrapping mediation and moderated mediation analyses were used to test whether physical activity mediated the relationship between SPA and depressive symptoms and whether this indirect effect was further moderated by neighborhood walkability. Results: More positive SPA were associated with higher level of physical activity and less depressive symptoms after controlling for age, gender, education, and marital status. Physical activity was partially mediated the relationship between SPA and depressive symptoms. Moreover, a conditional indirect effect was found. The significant mediated effect of physical activity in the relationship between SPA and depressive symptoms was only found in the medium but not in the low or high level of neighborhood walkability. Conclusion: The results showed that SPA could influence older adults’ depressive symptoms through physical activity. Improving physical activity could be a plausible intervention target to reduce older adults’ depressive symptoms, especially in the medium level of neighborhood walkability. This study extended past research providing the empirical evidence that the impact of individual-level factors on the mental health among older adults was differed by contextual-level factors. The results of this study highlight the main areas on intervention programs and policy formulation for mental health promotion in older adults.