中国老年人社会参与和健康的关系及影响因子研究

发布时间：2018-05-10 15:45

  本文选题：老年人健康 + 老龄化　； 参考：《华东师范大学》2015年博士论文

【摘要】：银发浪潮汹涌而至,21世纪是老龄化的世纪。中国乃至全球人口结构的老化在相当长的时期内都是不可逆转的,人口老龄化将成为人类社会的新常态。健康长寿是人类文明的标志,健康可以使人长寿,但长寿不一定健康。我们需要延长的是“健康寿命”,但是目前中国老年人“长寿不健康”的状况堪忧。社会参与和健康是反映老年人生活状态与生活质量的重要方面,对于两者的研究及其关系均存在争议,有必要进一步深入研究两者之间的关系及影响因子,这对实现积极老龄化、成功老龄化和健康老龄化具有现实意义,也对提高老年人的生命质量有重要的意义。社会参与和健康的相关关系已经有不少的研究。研究发现,健康是影响社会参与的重要因素,同时也有研究发现社会参与影响健康状况,即两者可能存在互为因果的关系。但由于以往的研究大多基于横截面调查数据,主要揭示了两者的相关关系,难以确定是否存在因果联系,尚没有对两者之间可能存在的互为因果关系及影响因子进行深入分析。本文在对国内外有关老年人社会参与和健康的文献进行综述的基础上,应用北京大学开展的全国大型调查“中国老年人健康长寿影响因素调查”(CLHLS)2002-2011年的纵向数据,结合本人的定性访谈资料,采用定量和定性分析相结合的研究方法,对中国老年人的社会参与状况与健康的关系及影响因子、社会参与和健康相互影响的内在机制进行了深入研究。本文研究分为理论框架、实证分析和理论总结三个部分。理论框架主要回顾与评述以往研究成果,提出本文研究的理论基础和分析框架；实证分析采用定量与定性相结合的方法研究中国老年人社会参与的状况、影响因素,以及与健康的关系,解释老年人社会参与和健康互相影响的机制等；理论总结主要概括全文的研究结论,并对研究成果展开关联性讨论,最后提出政策启示。本文的研究结论主要包括：1.中国老年人的社会参与和健康存在互为因果关系。本文采用多水平模型和事件史分析等研究方法,在一个研究框架中分别将社会参与和健康作为因变量,相应地,健康和社会参与分别作为自变量来分析老年人社会参与和健康之间的关系。研究发现,在控制社会人口、社会经济、社会支持变量的情况下,社会参与的两个维度文化组织活动和家事个人活动与健康的关系呈一致性。健康状况较好,则文化组织活动和家事个人活动参与水平较高；文化组织活动和家事个人活动参与水平较高,则健康状况较好,死亡风险较低；即中国老年人的社会参与和健康之间存在互为因果的关系。2.文化组织活动和家事个人活动随时间动态变化的趋势呈一致性,但下降的速率不同。研究结果显示,无条件模型时,两种社会参与活动均呈动态下降趋势,整体参与水平接近,但在控制社会人口、健康、社会经济、社会支持诸多变量后,健康较差的老年人,文化组织活动和家事个人活动均呈现略微上升的趋势,文化组织活动比家事个人活动参与水平更低,文化组织活动比家事个人活动下降的速率更大。3.老年人社会参与和健康的动态趋势及两者关系受多维度综合指标的影响,存在个体差异。研究发现,客观上的健康指标、主观上的自评健康指标对社会参与、日常生活自理能力(ADL)和死亡风险有不同程度的影响。社会参与和健康状况整体上呈下降趋势,均存在显著的个体差异,影响两者关系的主导因素社会人口、社会经济、社会支持因素也不尽相同。在控制社会人口、社会经济、社会支持变量的情况下,健康较差的老年人,由于基期参与水平较低,9年观测期内文化组织活动和家事个人活动的T值呈现略微上升的趋势；同时,社会参与较低的老年人,由于基期的ADL状况较差,观测期内ADL的T值呈现略微下降的趋势(ADL状况略微变好的趋势)；心理健康对社会参与和身体健康的重要性凸显。4.老年人社会参与和健康在两者的因果关系中具有不同效应。健康对社会参与的影响表现为选择性效应,即健康状况较好的老年人更多地选择社会参与,随着时间的推移,患慢病等健康较差的老年人参与家事个人活动的下降速率慢于文化组织活动,活动类型存在较为明显的选择倾向性。社会参与对健康的影响表现为促进效应,即社会参与促进老年人的身心健康改善与生活质量的提高；影响社会参与的因素也会不同程度地影响健康。5.社会参与和健康表现为手段和目的的关系。本文采用定性访谈法对社会参与影响健康的机制,以及健康影响社会参与的机制进行了深入的研究,研究结果显示,健康是老年人社会参与的最重要目的,社会参与是促进健康的重要手段。社会参与主要是通过活动直接影响身体,通过影响经济、社会关系、心理与精神状态等进而间接影响健康。这也进一步阐释了患有慢病的老年人文化组织活动参与水平较高的定量分析结果。本研究的创新之处在于：1.基于全国大型纵向调查的截面数据和纵向数据,结合定性调查资料,通过深入研究社会参与的两个维度和健康各个维度之间的关系,在进一步论证社会参与和健康存在相关关系的基础上,深入地论证了中国老年人社会参与和健康之间的互为因果关系。2.对老年人社会参与和健康互为因果关系的影响机制进行了深入研究。通过定量研究方法,发现了老年人社会参与和健康在两者的因果关系中具有不同效应；通过定性研究方法,发现了老年人社会参与和健康互相影响的不同机制,健康和社会参与是目的与手段的关系。3.对老年人社会参与和健康关系的研究方法进行了新的探索。本文将多水平模型、Cox等比例风险模型、定性访谈法与观察法有机结合,多维度多视角深入探讨了社会参与和健康的关系；先确保变量之间时间上的“前因后果”,这样同时考察变化与事件发生,排除了“反向因果关系”(即内生性问题),从而证明了老年人健康与社会参与是先因后果,以及社会参与和健康同样也是先因后果的互为因果关系。本文的不足之处在于：未深入探讨影响老年人社会参与和健康的不可观测的异质性,未对横向的省级区域的差异进行分层分析。
[Abstract]:The wave of silver hair surged. Twenty-first Century is the century of aging. The aging of the population structure in China and even the world is irreversible for a long time. The aging of the population will become the new normal of the human society. The health and longevity is the symbol of human civilization, health can make people long life, but the longevity is not necessarily healthy. We need to extend our life. It is "healthy life", but the status of "long life is not healthy" for the elderly in China is worrying. Social participation and health is an important aspect of the life and quality of life of the elderly. There is a dispute about the research and relationship between the two. It is necessary to further study the relationship between the two and the influencing factors, which is the product of the product. Aging, successful aging and healthy aging have practical significance, but also have important significance to improve the quality of life of the elderly. There have been many studies on the relationship between social participation and health. Research has found that health is an important factor affecting social participation, and there are also research findings that social participation affects health, that is, two But since most of the previous studies are based on cross-sectional survey data, the relationship between the two is mainly revealed, it is difficult to determine whether there is a causal link, and there is no further analysis of the possible causation and influence factors between the two. On the basis of the literature review of the participation and health, the 2002-2011 year longitudinal data of the nationwide survey on the factors affecting the health and longevity of the elderly in China (CLHLS) carried out by the Peking University, combined with my qualitative interview data, and the method of combining quantitative and qualitative analysis to the social participation of the elderly in China. The study is divided into three parts: the theoretical framework, the empirical analysis and the theoretical summary. The theoretical framework mainly reviews and reviews the previous research results, and puts forward the theoretical basis and analytical framework of this study; the empirical analysis is an empirical analysis. The combination of quantitative and qualitative methods is used to study the status of the social participation of the elderly in China, the influencing factors, the relationship with health, the explanation of the mechanism of the social participation of the elderly and the mutual influence of the health of the elderly, and so on. The theoretical summary mainly summarizes the conclusions of the full text, and the related discussion of the research results, and finally puts forward the policy enlightenment. The main conclusions of this paper are as follows: 1. the social participation and health existence of the elderly in China are mutually causality. In this paper, a multi level model and a history of event analysis are used to analyze the social participation and health as the dependent variable and the health and social participation are respectively used as independent variables to analyze the elderly respectively. The relationship between social participation and health has been found. In the case of controlling social population, social economy and social support variables, the relationship between the two dimensions of social participation and the relationship between personal activities and personal activities of family affairs is consistent. The higher level of Cultural Organization and personal activities, better health and lower risk of death, that is, the relationship between social participation and health of the elderly in China has a causal relationship between.2. cultural organization activities and the trend of personal activities of family affairs consistent with time, but the rate of decline is different. In the unconditional model, the two kinds of social participation activities showed a dynamic decline trend and the overall participation level was close. However, after controlling the social population, health, social economy and social support, the elderly with poor health, cultural organization activities and personal activities were slightly upward trend, and cultural organization activities were more than family activities. The participation level of human activities is lower and the rate of cultural organization is lower than that of personal activities. The dynamic trend of social participation and health of.3. elderly people and the relationship of the two are influenced by the multi dimension comprehensive index, and there are individual differences. Living self-care ability (ADL) and death risk have different degrees of impact. Social participation and health status as a whole has a downward trend, and there are significant individual differences. The dominant factors affecting the relationship are social population, social economy, and social support factors. Under the low level of participation in the base period, the T values of Cultural Organization and personal activities in the 9 year period showed a slight rising trend. At the same time, the social participation of the lower aged people, because of the poor ADL status in the base period, showed a slight decline in the T value of ADL during the observation period (the trend of ADL condition slightly better. The importance of mental health to social participation and health highlights the different effects of social participation and health in the causal relationship between.4. elderly people and health. The effect of health on social participation is a selective effect, that is, the elderly with better health are more selected for social participation, and with the passage of time, slow disease and other health care. The decline rate of poor elderly people involved in personal activities of family affairs is slower than cultural organization activity, and the type of activity has a more obvious choice tendency. The effect of social participation on health is promoted, that is, social participation promotes the improvement of the physical and mental health of the elderly and the quality of life, and the factors that affect the social participation will also be possible. The relationship between social participation and health performance of healthy.5. is influenced by various degrees. The qualitative interview method is used to study the mechanism of social participation and the mechanism of health impact on social participation. The results show that health is the most important purpose of the social participation of the elderly, and the social participation is the promotion of the social participation. The important means to enter health. Social participation is mainly through activities directly affecting the body, by affecting the economy, social relations, psychological and mental state and so on indirectly affecting health. This further explains the result of the high level analysis of the participation level of the elderly people with chronic disease. The innovation of this study lies in: 1. Based on the cross-sectional data and the longitudinal data of the national large longitudinal survey, the relationship between the two dimensions of social participation and the various dimensions of health is deeply studied. On the basis of further demonstration of the relationship between social participation and health, the social participation and health of the elderly in China are demonstrated. The reciprocal causal relationship.2. has studied the influence mechanism of social participation and health mutual cause and effect relationship among the elderly. Through quantitative research, it is found that the social participation and health of the elderly have different effects in the causality of the two. Through qualitative research, we find the social participation and health of the elderly people to interact with each other. Different mechanisms, health and social participation, the relationship between health and social participation is the relationship between the purpose and means..3. has made a new exploration on the research methods of the social participation and health relationship of the elderly. This paper combines the multi level model, the Cox scale risk model, the qualitative interview method and the observation method, and probes into the relationship between social participation and health. In order to prove that the health and social participation of the elderly are the first cause, and the social participation and health are also the result of mutual cause and effect, the deficiency of this article is insufficient. There is no in-depth study of the unobservable heterogeneity that affects the social participation and health of the elderly, and there is no stratified analysis of the differences in the horizontal provincial level.

【学位授予单位】：华东师范大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：D669.6
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本文编号：1869907