目的：在探討提供型或接受型的社會支持對於降低台灣老人死亡風險在不同教育程度的老年族群間是否會有差異。 方法：在這個長期追蹤的前瞻性研究中，數據資料取自臺灣地區中老年身心社會生活狀況長期追蹤調查 ( Taiwan Longitudinal Study in Aging )。這項研究是以1996年調查時老年受訪個案所陳述之其在提供型或接受型的社會支持的情形以及其當時的教育程度來追蹤探討老年個案在其後續12年(自1996年至2007年)期間之死亡狀況，研究其相關性。本研究參與者包括67歲以上男性1492人，女性為1177人。參與者所接受之社會支持包括財務型的、工具型的和情感型的，而他們所提供的社會支持則含社會參與的社會支持、工具型的，和情感型的社會支持。教育程度被分為低教育程度和高教育程度。低教育程度包括文盲和小學，而高教育程度包括初中到高中和大專以上的學歷。最後用使用 Cox Regression model 來評估提供及接受社會支持在不同教育程度的老年人中與長期死亡率是否有相關性。 結果: 1996年參與者的平均年齡為73.0（四分位距IQR為8.0）歲，參與者在研究期間之12年內平均存活年為10.3（IQR=6.7）年（1996-2007年）。大多數參與者教育程度較低，包括文盲佔 39.3％ 和小學程度佔 41.2％。參與者若具有較高的教育程度往往年紀較年輕且以男性為主。參與者教育程度較低者比教育程度較高者往往有明顯較差的水平收入、更多的憂鬱症、更多的認知功能障礙，且也有較多的工具性日常生活活動功能(Instrumental activities of daily living，IADL)及日常生活活動功能(Activities of daily living，ADL)失能。大多數參與者會接收到來自其他人工具型的社會支持(佔95.5％)和接受其他人情感型的社會支持(佔94.4％)。但大多數參與者提供給他人情感型的社會支持最多佔了97.7％。最後我們也得知，在老年低教育程度組經過調整了許多變項後，參與者提供工具型的社會支持仍有助降低死亡率的風險，且具統計學上的意義【風險比值 (Hazard ratio, HR)為0.83而95%信賴區間(95% confidence interval, 95% CI)為0.70-0.99；p =0.036】。 結論: 提供工具性社會支持會降低低教育程度老年人的死亡率。所以，這些老年人應鼓勵他們提供更多的工具性的社會支持給其他人。因為它不僅可以延長這些老人的壽命，也可能讓這些低教育程度的老年人有更好的身體或心理健康。 Objectives: To evaluate the differences of the effect of providing or receiving social support on mortality among the elderly with different educational levels in Taiwan. Method: In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was initiated from 1996 until 2007. The complete data from 1492 males and 1177 females aged ≥67 years were retrieved. Participants received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others and involved in social engagement. Education attainment was divided into two levels: high and low. The low education level included illiterate and elementary school. The high education level included junior high school to senior high school and above college. Cox regression analysis was used to examine the association between providing or receiving social support on mortality with different educational levels. Results: The average age of the participants in 1996 was 73.0 (IQR=8.0) years, and the median survival following years (1996-2007) of participants was 10.3 (IQR=6.7) years. Most participants were low educational level including illiterate (39.3%) and elementary school (41.2%). Participants with high educational level tend to be younger and more male significantly. On the contrary, participants with low educational level tend to have significant more poor income, more depression, more cognition impairment, more with IADL and ADL disability than high educational level. Most participants received instrumental support from others (95.5%) and also provided emotional support to others (97.7%). Providing instrumental support can reduce 17% of mortality risk among the elderly with a low level of education after adjusting several covariates [Hazard ratio (HR) = 0.83; 95% confidence interval (CI) = 0.70–0.99; p = 0.036]. Conclusion: Providing instrumental social support was associated with reduced mortality in the elderly with low educational levels. Those older adults should be encouraged to provide more instrumental social support to others. It may not only prolong their life expectancy but also may provide improved physical or psychological well-being among the elderly with lower educational levels.
