Beyond health care: Volunteer work, social participation, and late-life general cognitive status in Taiwan
Beyond health care: Volunteer work, social participation, and late-life general cognitive status in Taiwan
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DOI：
10.1016/j.socscimed.2018.06.001
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发表时间：
2019-05-01
影响因子：
5.4
通讯作者：
Chiao, Chi
中科院分区：
文献类型：
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作者：
Chiao, Chi
意义：除了与医疗保险和老年人对医疗保险的利用相关的复杂性外，我假设社会参与促进了更好的晚年一般认知状态，而不是像台湾的国民健康保险(NHI)系统所提供的那样。因此，本研究探讨社会参与，特别是社会参与和义工工作，是否独立于透过健保系统调整健康服务利用后台湾老年人的晚年一般认知状况。方法：采用以人口为基础的自然实验研究设计，分析台湾老龄纵向研究(TLSA，1993-2007)的资料。结果：多因素分析结果显示，较好的一般认知状况与积极参与志愿工作(Beta=014，p<；0.01)和社会参与(beta=0.14，p<；0.01)显著相关。此外，NHI还与较高水平的一般认知状态显著相关(beta=0.10，p<；0.01)。讨论：本研究表明，即使考虑到NHI系统及其相关的利用效果，社会参与对晚年一般认知状态也有显著影响。研究结果显示，在台湾老年人中，志愿者工作和社会参与的重要性，因为这种社会参与对他们的一般认知状况产生了积极的影响，而不仅仅是医疗保健本身。此外，还强调了生产性活动对增进晚年认知健康的贡献。
Significance: In addition to the complexity associated with health care coverage and its utilization by older people, I hypothesize that social engagement promotes a better later-life general cognitive status beyond health care availability as is provided by Taiwan's National Health Insurance (NHI) system. The present study thus explores whether social engagement, specifically social participation and volunteer work, is independently associated with later-life general cognitive status after adjusting for health service utilization among older Taiwanese via the NHI system.Methods: Using a population-based natural experiment study design, data from the Taiwan Longitudinal Study on Aging (TLSA, 1993-2007) was analyzed. Mixed-effects models were conducted to estimate the relative effects of volunteer work, social participation, and NHI on general cognitive status over time, while taking health status, medical care utilization, community development, and social support into consideration.Results: The multivariate findings showed that a better general cognitive status is significantly associated with being actively involved in volunteer work (beta = 014, p < 0.01) and social participation (beta = 0.14, p < 0.01). In addition, NHI is also significantly associated with a higher level of general cognitive status (beta = 0.10, p < 0.01).Discussion: This investigation suggests that social engagement has significant impacts on late-life general cognitive status, even taking into account the NHI system and its related utilization effects. The results highlight the importance of volunteer work and social participation among older Taiwanese because such social involvement produces a positive effect on their general cognitive status beyond health care itself. Furthermore, the contribution of productive activities to enhance late-life cognitive health is underscored.