以行為流行病學架構探討高齡者久坐行為之研究

Abstract

久坐行為是影響高齡者健康的重要因素之一，國內久坐行為與疾病關係及關聯因素鮮少被探討。本研究根據久坐行為流行病學架構：建立行為與健康之關係、發展測量工具、找出久坐行為高危險族群以及環境決定因素等，四個研究階段分別進行探討。本研究採用橫斷性調查法及客觀測量進行資料蒐集。調查法以簡單隨機抽樣選取1,068位居住於臺北市及嘉義縣年滿65歲以上之高齡者，採以集中式電腦輔助電話訪問，蒐集社會人口背景資料、身體質量指數、慢性疾病狀況、久坐行為時間、休閒身體活動量及知覺社區環境，以二元邏輯斯迴歸計算出勝算比，以了解久坐行為與慢性疾病之風險、高危險族群及知覺社區環境關聯因素。客觀測量方面，以年滿65歲之社區高齡者為對象，實施高齡者久坐時間問卷並配戴三軸加速規測量久坐時間，以組內相關及斯皮爾曼等級相關，了解再測信度及同時效度。所得結果如下：一、整體久坐時間與六種久坐行為，僅發現長時間看電視(≥ 2 時/天) 會增加1.58倍的機率有第二型糖尿病之風險。二、中文化高齡者久坐時間問卷、休閒嗜好時間及靜態通勤時間題項有良好再測信度；看電視時間、使用電腦時間、閱讀時間和其他久坐時間為可接受再測信度；社交久坐時間再測信度為普通。久坐時間問卷與加速規之同時效度未達顯著水準。三、年齡、性別、婚姻狀態、工作狀態、教育程度、居住地區、居住狀態、身體質量指數及休閒身體活動量等不同社會人口背景因素，與整體久坐時間、看電視時間、使用電腦時間及靜態通勤時間有顯著之關係。四、高齡者居住在高密度地區及知覺社區環境交通不安全，會有較高風險比率有過量看電視時間。未來高齡者過量看電視時間會增加第二型糖尿病之風險；中文化高齡者久坐時間問卷有良好再測信度，校標關聯效度有待更多研究進一步驗證；未來減少高齡者久坐行為宜針對不同社會人口特性之高危險族群及知覺社區環境特性進行介入。Sedentary behavior is a factor that exhibits a critical association with health in older adults; however, only limited research has been conducted to determine what factors correlate with sedentary behavior and how sedentary behavior may be associated with chronic disease risks in Taiwan. Based on a behavioral epidemiology framework, the current study conducted an investigation of sedentary behavior that consisted of the following four phases: (i) examining the relationships between sedentary behavior and various health outcomes, (ii) measuring sedentary behavior, (iii) characterizing the prevalence of sedentary behavior in at-risk populations and (iv) identifying the determinants of sedentary behavior. A computer-assisted telephone-based interview survey was used. Self-reported data (socio-demographic, body mass index [BMI], sedentary behaviors, chronic disease, leisure-time physical activity [LTPA] and perceived neighborhood environment) were collected from 1,068 adults aged ≥65 years in Taipei City and Chiayi County. A binary logistic regression analysis was performed to calculate the adjusted odds ratios for sedentary behavior of chronic disease risk and correlated factors. In an objective intervention, community dwelling older adults (aged ≥65 years) completed the questionnaire during a 7-day period and wore an accelerometer. Test–retest reliability and validity were assessed during this 7-day intervention period using Spearman (ρ) correlations and intraclass correlation coefficient. The results were as follows: a. Excessive television (TV) viewing (≥2 hours/day) was associated with type 2 diabetes. b. For the Chinese version of the measuring older adults’ sedentary time (MOST) questionnaire, the test–retest reliability was excellent for hobbies and transport time; acceptable for TV viewing time, computer use, reading and other sedentary time; and poor for socializing. Total sedentary time had excellent test–retest reliability but weak validity. c. Socio-demographic factors (age, gender, marital status, job status, education level, residential area, living status, BMI and LTPA) were associated with total and domain-specific sedentary behavior. d. Older adults whose responses indicated higher residential density in their neighborhoods and perceived their neighborhoods to have unsafe traffic were more likely to report excessive TV viewing time. These findings suggest that excessive TV viewing might increase the risk of type 2 diabetes among older adults. In addition, it was found that while the Chinese MOST questionnaire has good repeatability, its validity for self-reported total sedentary time against accelerometer-derived sedentary time was not strong. Interventions for reducing specific sedentary behaviors in older adults should focus on distinct socio-demographic and perceived neighborhood environment factors.