| Abstract: | 研究目的：估計台灣地區中老年人的職涯晚期失業與自評健康程度變化軌跡，以及分析與老年時衰弱情形之間的關係。
研究方法：在這個長期追蹤的前瞻性研究中，數據資料是從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 )所取出。這項研究是從1999年至2007年，追蹤8年期間。首先用群組化軌跡模式估計出最適當的失業狀況曲線，最後軌跡分組共三組：持續就業組、持續失業組，及就業-失業組。再以持續就業組別當作參考組，使用邏輯式回歸來評估不同組別失業狀況軌跡及是否增加未來的老年衰弱的風險。同時，針對受試者也利用群組化軌跡模式估計出最適當的自評健康程度變化曲線，最後軌跡分組共四組：持續自評健康程度較差組、持續自評健康程度普通組、持續自評健康程度較好組，及自評健康程度下降組。再以持續自評健康程度普通組別當作參考組，使用邏輯式回歸來評估不同組別自評健康程度變化軌跡及是否增加未來的老年衰弱的風險。
研究結果：1999年參與者共1956人，其中持續就業組366人；就業-失業組481人；持續失業組1109人。而以自評健康程度軌跡分組時，其中持續自評健康程度較差組232人；持續自評健康程度普通組1123人；持續自評健康程度較好組335人；自評健康程度下降組226人。干擾因子部分，調整了性別比例、年齡分布、教育程度、收入滿意度、社會參與情形、抽菸狀況、喝酒狀況與慢性疾病罹病數量，進行多變項邏輯式回歸，結果顯示以持續就業組為參考值，結果發現就業-失業組【OR 3.228, 95% CI (1.278-8.513)】及持續失業組【OR 4.582, 95% CI (1.898-11.062)】衰弱的風險性都會增加。而在自評健康程度方面，以持續自評健康程度普通組為參考值，結果發現持續自評健康程度較差組衰弱的風險性增加【OR 3.091, 95% CI (2.036-4.692)】；而持續自評健康程度下降組【OR 0.192, 95% CI (0.059-0.625)】和持續自評健康程度較好組衰弱的風險性都會降低【OR 0.044, 95% CI (0.006-0.323)】。最後，我們將1999年失業狀態與自評健康程度做交叉分析，發現以有工作且自評健康狀態程度普通或好組為參考值，結果發現無工作且自評健康程度較差組衰弱風險性增加【OR 4.261, 95% CI (2.254-8.057)】，無工作且自評健康程度普通或好組衰弱風險性增加【OR 1.946, 95% CI (1.1-3.443)】。
結論：台灣中高齡族群失業情形和自評健康程度趨向持續不變，多數人落在持續失業與自評健康程度普通組別，以此做參考組比較，持續失業組及持續自評健康較差組老年衰弱風險增高。職涯晚期失業和自評健康程度較差均會提高老年人未來的衰弱比例，政策制定者應訂定相關政策以避免個人職涯晚期工作有劇烈變動，同時雇主應視中高齡工作者為資產，定期追蹤中高齡族群的自評健康狀態，應用策略提升自評健康程度。如此不僅可以降低老年人的衰弱，同時也可避免他們在失能的狀況下度過晚年，減少社會照顧成本。
Objectives: To evaluate late-career unemployment and self-rated health (SRH) trajectory and the relationship with frailty among elderly in Taiwan.
Methods: In this long-term prospective cohort study, Data were retrieved from the Taiwan Longitudinal Study on Aging. This study was conducted from 1999 to 2007. Analysis was restricted to respondents who were not frail or disabled in 1999 (n=1956). Frailty was defined using Fried criteria. Group-based model of trajectory was used to estimate late-career unemployment and self-rated health trajectories among elderly. Logistic regression analysis was used to examine the association between late-career unemployment status change and self-rated health change and frailty.
Results: Three late-career unemployment trajectory classes were identified across 8-year follow up. There were 366 participants (20.3%) in the constant employment group, 481 participants (44.7%) in the employment-unemployment group, and 1109 participants (28.4%) were in the constant unemployment group. For self-rated health trajectories, there were 232 participants (20.3%) in the constant low SRH group, 1123 participants (44.7%) in the constant normal SRH group, 335 participants (28.4%) were in the constant good SRH group, and 266 participants (28.4%) were in the good to normal SRH group. After adjustment of gender, age, level of education, income, social participation, self-rated health, health behaviors and major comorbidities, employment- unemployment group 【OR 3.228, 95% CI (1.278-8.513)】and constant unemployment group 【OR 4.582, 95% CI (1.898-11.062)】 were associated with increased frailty compared to constant employment group. For SRH trajectories, constant low SRH group 【OR 3.091, 95% CI (2.036-4.692)】 was associated with increased frailty, while constant good SRH group 【OR 0.044, 95% CI (0.006-0.323)】 and good to normal SRH group 【OR 0.192, 95% CI (0.059-0.625)】were associated with decreased frailty, compared to constant normal SRH group.
Conclusions: Our results showed either constant unemployment group or constant low SRH group had more opportunity to develop frailty in elder stage. Older adults should be encouraged to have normal employment during their late career. Employers should routinely examine the fitness for work and self-rated health for older employees for preventing possible future frailty |
