学位論文 都市郊外在宅高齢者の健康3要因、社会経済的要因、就労と3年後の新規要介護度との関連構造

渡部, 月子  ,  繁田, 雅弘  ,  藤井, 暢弥  ,  櫻井, 尚子  ,  星, 旦二

pp.1 - 36 , 2017-03-25
内容記述
【目的】本研究の目的は、都市郊外に居住する介護認定を受けていない高齢者を対象として、健康3要因、社会経済的要因及び就労が3年後の新規要介護度に影響する因果構造を明らかにすることである。【方法】研究方法は、2001年9月都市郊外に居住する在宅高齢者16,462人全員を対象として得られた13,195人(回収率80.2%)を追跡対象とした郵送法による自記式質問紙調査である。2001年9月時点で要介護2以上の認定を受けている高齢者149人を除く8,136人を分析対象とし、3年後の要介護度の変化を分析した。分析にはSPSS19.OJ・Amos19.OJ for Windowsを用いた。【結果】探索的因子分析の結果、5因子が抽出された。第1因子は「近所つきあい」、「地域活動」、「趣味活動」、「外出」が抽出され“社会的健康”(“”は潜在変数を示す)と命名した。第2因子「主観的健康感」、「昨年比較健康」、「治療中疾病数」、「生活満足感」を“精神的健康”、第3因子「IADL」、「BADL」を“身体的健康”、第4因子「等価収入額」、「学歴」を“社会経済的要因”、第5因子「仕事日数」、「仕事の生きがい」を“就労”と命名した。5つの因子寄与率は54.9%であった。3年後の新規要介護度を規定する直接効果が最も大きく影響した要因は、健康3要因から要介護度で、男性-0.445、女性-0.585であった。就労から要介護度への直接効果は、男性0.013、女性0.015と影響は小さく、健康3要因から要介護度への総合効果は、男性-0.445、女性-0.584であった。3年後の新規要介護度の決定係数は20~34%であり、このモデルの適合・度指数はNFI=0.930、CFI=0.934、RMSEA=0.039と高い適合度が得られた。【結論】介護認定を受けていない65歳以上の都市部郊外に居住する高齢者の就労は、3年後の新規要介護度には直接影響せず、社会経済的要因に支えられた健康3要因の維持が要介護度を抑制する因果構造が明らかになった。
The purpose of this research is to clarify the cause and effect that three health factors, and economic factors (including job/work) influence the need for long-term nursing care. This was a before-after study. At the time of the initial survey, the elderly suburban dwellers did not have long-term nursing care needs, and the group was followed up three years later. A self-reported questionnaire was sent to 16,462 suburban dwellers aged 65 or more in a city in September 2001. A total of 13,195 questionnaires were returned, (a response rate of 80.2%). A follow-up survey of 8,136 participants who did not require long-term care (care levels 2-5) at the baseline survey, was conducted in September 2004 and analyzed as to the change in nursing care needs. Amos19.0J for SPSS19.0J and Windows was used for the analysis. The result of the exploratory factor analysis indicated that the Number 1 Factor grouped Neighborhood Relationships, Community Activities, Hobby Activities, and Going out of the House and was named “Social Health” (“” indicate a latent variable). The Number 2 Factor grouped Subjective Feelings of Health, Comparative Health During the Past Year, Number of Illnesses Which Are Being Treated, and Satisfaction with Life and was named “Mental Health”. The Number 3 Factor grouped Instrumental Activities of Daily Living (IADL) and Basic Activities of Daily Living (BADL) and was named “Physical Health”. The Number 4 Factor grouped Equivalent Income Amount and Academic Background and was named “Socioeconomic Factor”. The Number 5 Factor grouped Number of Working Days and Work Purpose and was named “Employment”. The five factors contribution ratio was 54.9%. Three years later, when evaluating the new nursing care level, the factor which showed the most direct effect and largest influence on the nursing care level were the 3 Health Factors with a measurement for men -0.445, and for women -0.585. The direct path from the Employment Factor to Nursing Level was Men 0.013, and Women 0.015, showing a small effect. So the overall effect result of 3 Health Factors to Nursing Level was Men -0.445, and Women -0.584. Coefficients of determination of the new nursing care level after three years was 20-34%, and the goodness-of-fit indices of this model that were obtained were NFI=0.930, CFI=0.934, RMSEA=0.039, indicating a high goodness-of-fit of our model to the data. In summary, the employment factor for suburban residents aged 65 years and older (who were not receiving long term nursing care at the time of the initial survey) had little influence on their level of long-term nursing care needed, three years later. The cause and effect structure became clear between the level of long term nursing care needed, and the maintenance of the 3 Health Factors supported by the Social Economic Factor.
首都大学東京, 2017-03-25, 博士(学術), 乙第147号
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