社区环境对老年人行为与健康的影响研究——不同年龄阶段老年人的群组比较
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摘要
居家养老是中国老年人最主要的养老模式,社区环境成为影响老年人健康的重要因素。基于复旦大学2014年"社区老年人健康邻里调查"数据,探讨了社区环境、步行行为与老年人健康的关系。研究发现:良好的社区休闲环境对所有老年人的健康均有显著正向影响,而从低龄到高龄,社区交往环境与步行对老年健康的影响路径呈现出从个体步行行为向社区人际交往转移的特征,社区交往环境对高龄老年人的健康具有极为重要的作用。步行的减少一定程度上降低了中龄老年人的健康水平,高龄老年人在较低的社区交往环境的压抑效应下进一步降低了健康水平。重视社区休闲环境与交往空间的优化建设,增加社区交往活动的组织等将对中国老年人健康起到极为重要的改善作用。
Home care is still the most important mode of old-age care for the elderly in China.The community environment has become an important factor affecting the health of the elderly.At the same time, the external factors and the internal factors that affect the health of the elderly do not exist separately, and also there are differences between the psychological needs of the elderly at different ages. The discussion of the health of the elderly requires comprehensive multidisciplinary and multi-dimensional research. Comprehensive studies on the multi-disciplinary and multi-dimensional aspects of internal and external factors of health among the elderly at different ages are still insufficient. Based on the 2014 "Community Elderly Healthy Neighborhood Survey" data of Fudan University, this paper used the structural equation model(SEM) analysis method to explore the relationship between community environment, walking behavior and the health level of the elderly, and revealed the difference of the elderly at different ages. The study found that from the overall characteristics of the elderly, the community physical environment, community communication environment and walking have a significant impact on the health of the elderly. The community physical environment affects the health of the elderly through the community communication environment and walking. The paths of "community environment-walking-the elderly health" for the elderly in different age stages are consistent and different: the consistency reflects that the physical environment of the community has a significant effect on the health of the elderly at different ages, and the difference is reflected in the impact of the community communication environment walking on the health of the elderly, which is that the characteristics of shifting from individual walking behavior to community interpersonal needs are presented as the degree of aging increases. As the level of aging increases, the level of health gradually deteriorates and the walking intensity decreases. Older people's evaluation of community communication environment is tremendously lower than that of younger and middle-aged people. For middleaged older people, lower walking intensity reduces health levels to a certain extent; while older seniors further reduce health levels under the repressive effect of lower community communication environment. Therefore, attaching importance to the optimization of the community's material environment and communication space, and increasing the organization of community interaction activities will play an extremely important role in improving the health of the elderly in China.
Home care is still the most important mode of old-age care for the elderly in China.The community environment has become an important factor affecting the health of the elderly.At the same time, the external factors and the internal factors that affect the health of the elderly do not exist separately, and also there are differences between the psychological needs of the elderly at different ages. The discussion of the health of the elderly requires comprehensive multidisciplinary and multi-dimensional research. Comprehensive studies on the multi-disciplinary and multi-dimensional aspects of internal and external factors of health among the elderly at different ages are still insufficient. Based on the 2014 "Community Elderly Healthy Neighborhood Survey" data of Fudan University, this paper used the structural equation model(SEM) analysis method to explore the relationship between community environment, walking behavior and the health level of the elderly, and revealed the difference of the elderly at different ages. The study found that from the overall characteristics of the elderly, the community physical environment, community communication environment and walking have a significant impact on the health of the elderly. The community physical environment affects the health of the elderly through the community communication environment and walking. The paths of "community environment-walking-the elderly health" for the elderly in different age stages are consistent and different: the consistency reflects that the physical environment of the community has a significant effect on the health of the elderly at different ages, and the difference is reflected in the impact of the community communication environment walking on the health of the elderly, which is that the characteristics of shifting from individual walking behavior to community interpersonal needs are presented as the degree of aging increases. As the level of aging increases, the level of health gradually deteriorates and the walking intensity decreases. Older people's evaluation of community communication environment is tremendously lower than that of younger and middle-aged people. For middleaged older people, lower walking intensity reduces health levels to a certain extent; while older seniors further reduce health levels under the repressive effect of lower community communication environment. Therefore, attaching importance to the optimization of the community's material environment and communication space, and increasing the organization of community interaction activities will play an extremely important role in improving the health of the elderly in China.
引文
[1]王俊,龚强,王威.“老龄健康”的经济学研究.经济研究,2012,(1):134-150.[Wang Jun,Gong Qiang,Wang Wei.A review of economics analysis on the elderly health.Economic Research Journal,2012,(1):134-150.]
[2]王琼.城市社区居家养老服务需求及其影响因素:基于全国性的城市老年人口调查数据.人口研究,2016,40(1):98-112.[Wang Qiong.Demands and determinants of community home-based care services for urban elderly:Based on the 2010 national elderly survey in China.Population Research,2016,40(1):98-112.]
[3]Lei X,Giles J,Hu Y,et al.Patterns and correlates of intergenerational non-time transfers:Evidence from CHARLS.Policy Research Working Paper,2012.
[4]曲嘉瑶,孙陆军.中国老年人的居住安排与变化:2000-2006.人口学刊,2011,(2):40-45.[Qu Jiayao,Sun Lujun.Living arrangements and changes of the elderly in China:From 2000 to 2006.Population Journal,2011,(2):40-45.]
[5]靳永爱,周峰,翟振武.居住方式对老年人心理健康的影响:社区环境的调节作用.人口学刊,2017,39(3):66-77.[Jin Yongai,Zhou Feng,Zhai Zhenwu.The influence of residential patterns on the elderly's depression:The moderating role of community environment.Population Journal,2017,39(3):66-77.]
[6]Simsek H,Doganay S,Budak R,et al.Relationship of socioeconomic status with health behaviors and self-perceived health in the elderly:A community-based study,turkey.Geriatrics&Gerontology International,2014,14(4):960-968.
[7]姜向群,魏蒙,张文娟.中国老年人口的健康状况及影响因素研究.人口学刊,2015,37(2):46-56.[Jiang Xiangqun,Wei Meng,Zhang Wenjuan.Study on the health status and influencing factors of China's aging population.Population Journal,2015,37(2):46-56.]
[8]Nishimori T,Imaoka M,Kuremoto T.Variance of divided step length in relation to walking speed in the elderly in a geriatric health services facility.Physiotherapy,2015,101(1):e1097-e1098.
[9]Bellelli G,Noale M,Guerini F,et al.A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery.An experiment in a rehabilitation unit in northern Italy.Osteoporosis International,2012,23(8):2189-2200.
[10]Zhao W,Shigekazu U,Takashi K,et al.Health benefits of daily walking on mortality among younger-elderly men with or without major critical diseases in the new integrated suburban seniority investigation project:A prospective cohort study.Journal of Epidemiology,2015,25(10):609-616.
[11]Hatta A,Nishihira Y,Higashiura T.Effects of a single bout of walking on psychophysiologic responses and executive function in elderly adults:A pilot study.Clinical Interventions in Aging,2013,(8):945-952.
[12]Abate M,Salini V,Schiavone C.Achilles tendinopathy in elderly subjects with type II diabetes:The role of sport activities.Aging Clinical&Experimental Research,2016,28(2):355-358.
[13]Yaffe K,Barnes D,Nevitt M,et al.A prospective study of physical activity and cognitive decline in elderly women.Archives of Internal Medicine,2001,161(14):1703-1708.
[14]Godes J F,Vi?ets J R,Balic M G,et al.Measurement of functional capacity and health related quality of life in an elderly group following a walking program:Pilot study.Revista Espanola De Geriatria Y Gerontologia,2011,46(3):147-150.
[15]Liu G,Dupre M E,Gu D,et al.Psychological well-being of the institutionalized and community-residing oldest old in China:The role of children.Social Science&Medicine,2012,75(10):1874-1882.
[16]薛新东,程明梅.农村老人社会资本、健康与幸福感的关系研究:基于湖北、河南农村老人的实证分析.经济管理,2012,34(12):166-175.[Xue Xindong,Cheng Mingmei.A study on relationship of social capital,health and happiness among rural elderly in China:Empirical analysis based on survey data in Hubei and Henan provinces.Business Management Journal,2012,34(12):166-175.]
[17]颜秉秋,高晓路.城市老年人居家养老满意度的影响因子与社区差异.地理研究,2013,32(7):1269-1279.[Yan Bingqiu,Gao Xiaolu.Home care satisfaction analysis of aging urban Chinese populations:Potential factors and community difference analysis.Geographical Research,2013,32(7):1269-1279.]
[18]Mulhern B,Shah K,Janssen M F,et al.Valuing health using time trade-off and discrete choice experiment methods:Does dimension order impact on health state values?.Value in Health,2016,19(2):201-217.
[19]Prins R G,Panter J,Heinen E,et al.Causal pathways linking environmental change with health behaviour change:Natural experimental study of new transport infrastructure and cycling to work.Preventive Medicine,2016,(87):175-182.
[20]Mcadams T A,Gregory A M,Eley T C.Genes of experience:Explaining the heritability of putative environmental variables through their association with behavioural and emotional traits.Behavior Genetics,2013,43(4):314-328.
[21]Wilson V,Jones P.DNA methylation decreases in aging but not in immortal cells.Science,1983,220(4601):1055-1057.
[22]张卫东.社区老年人的生活质量与心理健康:SEM研究.心理科学,2002,(3):307-309,382.[Zhang Weidong.The quality of life and psychological well-being of the community elder:A SEM study.Journal of Psychological Science,2002,(3):307-309,382.]
[23]姚远.从宏观角度认识我国政府对居家养老方式的选择.人口研究,2008,(2):16-24.[Yao Yuan.A macro perspective on China's choice in old-age support at home.Population Research,2008,(2):16-24.]
[24]Rizzello S,Turvani M.Subjective diversity and social learning:A cognitive perspective for understanding institutional behavior.Constitutional Political Economy,2002,13(2):197-210.
[25]扬?盖尔.交往与空间.何人可译.北京:中国建筑工业出版社,2002.[Gehl Y.Life between Buildings.Translated by He Renke.Beijing:China Construction Industry Press,2002.]
[26]Guo Z,Loo B P Y.Pedestrian environment and route choice:Evidence from New York city and Hong Kong.Journal of Transport Geography,2013,(28):124-136.
[27]马淑媛,王雪梅.老年年龄阶段的划分和护理要点.实用医技杂志,2008,15(30):4311-4312.[Ma Shuyuan,Wang Xuemei.Key points of care and age division in old age.Journal of Practical Medical Techniques,2008,15(30):4311-4312.]
[28]周刚,曹威,邓小海.老年旅游者主观年龄同实足年龄差异及其与旅游动机的关系研究.重庆师范大学学报:自然科学版,2016,33(4):180-186.[Zhou Gang,Cao Wei,Deng Xiaohai.Gap between the subjective age and the chronological age of senior tourists and its relation to tourist motivation.Journal of Chongqing Normal University:Natural Science,2016,33(4):180-186.]
[29]宋全成,张倩.中国老年流动人口健康状况及影响因素研究.中国人口科学,2018,(4):81-92,127-128.[Song Quancheng,Zhang Qian.Research on health status of the elderly migrant population in China and its determinants.Chinese Journal of Population Science,2018,(4):81-92,127-128.]
[30]Tsai A G,Boyle T F,Hill J O,et al.Changes in obesity awareness,obesity identification,and self-assessment of health:Results from a statewide public education campaign.American Journal of Health Education,2014,45(6):342-350.
[31]Pagotto V,Bachion M M,Silveira E A.Self-assessment of health by older Brazilians:Systematic review of the literature.Rev Panam Salud Publica,2013,33(4):302-310.
[32]Maddox L,Douglass E.Self-assessment of health:A longitudinal study of elderly subjects.Journal of Chronic Diseases,1973,17(5):449-460.
[33]Zhang M,Kang J.Subjective evaluation of urban environment:A case study in Beijing.International Journal of Environment and Pollution,2009,39(1):187-200.
[34]谭新建.科研院所建成环境主观评价方法研究:以中国林业科学研究院为例.北京林业大学学报:社会科学版,2015,14(4):73-77.[Tan Xinjian.A study on subjective evaluation methods of the built environment of research institutes:Taking Chinese academy of forestry as an example.Journal of Beijing Forestry University:Social Sciences,2015,14(4):73-77.]
[35]吴硕贤.建筑学的重要研究方向:使用后评价.南方建筑,2009,(1):4-7.[Wu Shuoxian.Post occupancy evaluation:An important research field in architecture.South Architecture,2009,(1):4-7.]
[36]方福前,吕文慧.中国城镇居民福利水平影响因素分析:基于阿马蒂亚·森的能力方法和结构方程模型.管理世界,2009,(4):17-26.[Fang Fuqian,Lv Wenhui.Analysis of impact factors of the welfare level of Chinese urban residents:Based on the ability method of Marty-Sen and SEM.Management World,2009,(4):17-26.]
[37]郑振华,陈鸿,彭希哲,等.中国“80后”群体的主观幸福感研究:相对优势群体与相对劣势群体的“幸福悖论”及其解释.人口与经济,2018,(4):63-76.[Zheng Zhenhua,Chen Hong,Peng Xizhe,et al.The subjective well-being of the China's post-80:The"happiness paradox"between powful groups and vulnerable groups and its explanation.Population&Economics,2018,(4):63-76.]
(1)世界卫生组织(The World Health Organization)中文官方网站:https://www.who.int/whr/previous/zh/
(2)为了尽可能使社区样本与老年人样本具有更好的代表意义,社区样本选取时尽可能覆盖新华街道中不同品质的社区,而对于社区品质的好坏需要从多方面考虑,其中地理区位、交通便捷程度以及建设年代往往具有较好的说明意义,因此本次调查主要以这几方面的多样性为抽样原则。
(3)总效应=直接效应+间接效应,总效应代表自变量对因变量的总体影响系数,间接效应代表自变量透过中介变量对因变量的影响系数,而直接效应代表不通过中介变量直接对因变量影响的部分,即模型路径图中显示的路径系数。
[2]王琼.城市社区居家养老服务需求及其影响因素:基于全国性的城市老年人口调查数据.人口研究,2016,40(1):98-112.[Wang Qiong.Demands and determinants of community home-based care services for urban elderly:Based on the 2010 national elderly survey in China.Population Research,2016,40(1):98-112.]
[3]Lei X,Giles J,Hu Y,et al.Patterns and correlates of intergenerational non-time transfers:Evidence from CHARLS.Policy Research Working Paper,2012.
[4]曲嘉瑶,孙陆军.中国老年人的居住安排与变化:2000-2006.人口学刊,2011,(2):40-45.[Qu Jiayao,Sun Lujun.Living arrangements and changes of the elderly in China:From 2000 to 2006.Population Journal,2011,(2):40-45.]
[5]靳永爱,周峰,翟振武.居住方式对老年人心理健康的影响:社区环境的调节作用.人口学刊,2017,39(3):66-77.[Jin Yongai,Zhou Feng,Zhai Zhenwu.The influence of residential patterns on the elderly's depression:The moderating role of community environment.Population Journal,2017,39(3):66-77.]
[6]Simsek H,Doganay S,Budak R,et al.Relationship of socioeconomic status with health behaviors and self-perceived health in the elderly:A community-based study,turkey.Geriatrics&Gerontology International,2014,14(4):960-968.
[7]姜向群,魏蒙,张文娟.中国老年人口的健康状况及影响因素研究.人口学刊,2015,37(2):46-56.[Jiang Xiangqun,Wei Meng,Zhang Wenjuan.Study on the health status and influencing factors of China's aging population.Population Journal,2015,37(2):46-56.]
[8]Nishimori T,Imaoka M,Kuremoto T.Variance of divided step length in relation to walking speed in the elderly in a geriatric health services facility.Physiotherapy,2015,101(1):e1097-e1098.
[9]Bellelli G,Noale M,Guerini F,et al.A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery.An experiment in a rehabilitation unit in northern Italy.Osteoporosis International,2012,23(8):2189-2200.
[10]Zhao W,Shigekazu U,Takashi K,et al.Health benefits of daily walking on mortality among younger-elderly men with or without major critical diseases in the new integrated suburban seniority investigation project:A prospective cohort study.Journal of Epidemiology,2015,25(10):609-616.
[11]Hatta A,Nishihira Y,Higashiura T.Effects of a single bout of walking on psychophysiologic responses and executive function in elderly adults:A pilot study.Clinical Interventions in Aging,2013,(8):945-952.
[12]Abate M,Salini V,Schiavone C.Achilles tendinopathy in elderly subjects with type II diabetes:The role of sport activities.Aging Clinical&Experimental Research,2016,28(2):355-358.
[13]Yaffe K,Barnes D,Nevitt M,et al.A prospective study of physical activity and cognitive decline in elderly women.Archives of Internal Medicine,2001,161(14):1703-1708.
[14]Godes J F,Vi?ets J R,Balic M G,et al.Measurement of functional capacity and health related quality of life in an elderly group following a walking program:Pilot study.Revista Espanola De Geriatria Y Gerontologia,2011,46(3):147-150.
[15]Liu G,Dupre M E,Gu D,et al.Psychological well-being of the institutionalized and community-residing oldest old in China:The role of children.Social Science&Medicine,2012,75(10):1874-1882.
[16]薛新东,程明梅.农村老人社会资本、健康与幸福感的关系研究:基于湖北、河南农村老人的实证分析.经济管理,2012,34(12):166-175.[Xue Xindong,Cheng Mingmei.A study on relationship of social capital,health and happiness among rural elderly in China:Empirical analysis based on survey data in Hubei and Henan provinces.Business Management Journal,2012,34(12):166-175.]
[17]颜秉秋,高晓路.城市老年人居家养老满意度的影响因子与社区差异.地理研究,2013,32(7):1269-1279.[Yan Bingqiu,Gao Xiaolu.Home care satisfaction analysis of aging urban Chinese populations:Potential factors and community difference analysis.Geographical Research,2013,32(7):1269-1279.]
[18]Mulhern B,Shah K,Janssen M F,et al.Valuing health using time trade-off and discrete choice experiment methods:Does dimension order impact on health state values?.Value in Health,2016,19(2):201-217.
[19]Prins R G,Panter J,Heinen E,et al.Causal pathways linking environmental change with health behaviour change:Natural experimental study of new transport infrastructure and cycling to work.Preventive Medicine,2016,(87):175-182.
[20]Mcadams T A,Gregory A M,Eley T C.Genes of experience:Explaining the heritability of putative environmental variables through their association with behavioural and emotional traits.Behavior Genetics,2013,43(4):314-328.
[21]Wilson V,Jones P.DNA methylation decreases in aging but not in immortal cells.Science,1983,220(4601):1055-1057.
[22]张卫东.社区老年人的生活质量与心理健康:SEM研究.心理科学,2002,(3):307-309,382.[Zhang Weidong.The quality of life and psychological well-being of the community elder:A SEM study.Journal of Psychological Science,2002,(3):307-309,382.]
[23]姚远.从宏观角度认识我国政府对居家养老方式的选择.人口研究,2008,(2):16-24.[Yao Yuan.A macro perspective on China's choice in old-age support at home.Population Research,2008,(2):16-24.]
[24]Rizzello S,Turvani M.Subjective diversity and social learning:A cognitive perspective for understanding institutional behavior.Constitutional Political Economy,2002,13(2):197-210.
[25]扬?盖尔.交往与空间.何人可译.北京:中国建筑工业出版社,2002.[Gehl Y.Life between Buildings.Translated by He Renke.Beijing:China Construction Industry Press,2002.]
[26]Guo Z,Loo B P Y.Pedestrian environment and route choice:Evidence from New York city and Hong Kong.Journal of Transport Geography,2013,(28):124-136.
[27]马淑媛,王雪梅.老年年龄阶段的划分和护理要点.实用医技杂志,2008,15(30):4311-4312.[Ma Shuyuan,Wang Xuemei.Key points of care and age division in old age.Journal of Practical Medical Techniques,2008,15(30):4311-4312.]
[28]周刚,曹威,邓小海.老年旅游者主观年龄同实足年龄差异及其与旅游动机的关系研究.重庆师范大学学报:自然科学版,2016,33(4):180-186.[Zhou Gang,Cao Wei,Deng Xiaohai.Gap between the subjective age and the chronological age of senior tourists and its relation to tourist motivation.Journal of Chongqing Normal University:Natural Science,2016,33(4):180-186.]
[29]宋全成,张倩.中国老年流动人口健康状况及影响因素研究.中国人口科学,2018,(4):81-92,127-128.[Song Quancheng,Zhang Qian.Research on health status of the elderly migrant population in China and its determinants.Chinese Journal of Population Science,2018,(4):81-92,127-128.]
[30]Tsai A G,Boyle T F,Hill J O,et al.Changes in obesity awareness,obesity identification,and self-assessment of health:Results from a statewide public education campaign.American Journal of Health Education,2014,45(6):342-350.
[31]Pagotto V,Bachion M M,Silveira E A.Self-assessment of health by older Brazilians:Systematic review of the literature.Rev Panam Salud Publica,2013,33(4):302-310.
[32]Maddox L,Douglass E.Self-assessment of health:A longitudinal study of elderly subjects.Journal of Chronic Diseases,1973,17(5):449-460.
[33]Zhang M,Kang J.Subjective evaluation of urban environment:A case study in Beijing.International Journal of Environment and Pollution,2009,39(1):187-200.
[34]谭新建.科研院所建成环境主观评价方法研究:以中国林业科学研究院为例.北京林业大学学报:社会科学版,2015,14(4):73-77.[Tan Xinjian.A study on subjective evaluation methods of the built environment of research institutes:Taking Chinese academy of forestry as an example.Journal of Beijing Forestry University:Social Sciences,2015,14(4):73-77.]
[35]吴硕贤.建筑学的重要研究方向:使用后评价.南方建筑,2009,(1):4-7.[Wu Shuoxian.Post occupancy evaluation:An important research field in architecture.South Architecture,2009,(1):4-7.]
[36]方福前,吕文慧.中国城镇居民福利水平影响因素分析:基于阿马蒂亚·森的能力方法和结构方程模型.管理世界,2009,(4):17-26.[Fang Fuqian,Lv Wenhui.Analysis of impact factors of the welfare level of Chinese urban residents:Based on the ability method of Marty-Sen and SEM.Management World,2009,(4):17-26.]
[37]郑振华,陈鸿,彭希哲,等.中国“80后”群体的主观幸福感研究:相对优势群体与相对劣势群体的“幸福悖论”及其解释.人口与经济,2018,(4):63-76.[Zheng Zhenhua,Chen Hong,Peng Xizhe,et al.The subjective well-being of the China's post-80:The"happiness paradox"between powful groups and vulnerable groups and its explanation.Population&Economics,2018,(4):63-76.]
(1)世界卫生组织(The World Health Organization)中文官方网站:https://www.who.int/whr/previous/zh/
(2)为了尽可能使社区样本与老年人样本具有更好的代表意义,社区样本选取时尽可能覆盖新华街道中不同品质的社区,而对于社区品质的好坏需要从多方面考虑,其中地理区位、交通便捷程度以及建设年代往往具有较好的说明意义,因此本次调查主要以这几方面的多样性为抽样原则。
(3)总效应=直接效应+间接效应,总效应代表自变量对因变量的总体影响系数,间接效应代表自变量透过中介变量对因变量的影响系数,而直接效应代表不通过中介变量直接对因变量影响的部分,即模型路径图中显示的路径系数。