高齡化社會已成為台灣人口結構趨勢，老人的健康議題備受關切。居住在社區中的老人，其健康與社會支持間有著不容忽視的關連性。而社區老人在退出原有的社會角色後，對社會活動參與有所期待，需以健康及社會支持觀點檢視影響社會參與程度的因素。
研究目的方面，第一部份研究主要在瞭解社區老人之健康狀況與社會支持在第一時間點的分布及兩個時間點間的變化，並探討人口學變項、健康狀況及社會支持三大因素對兩階段間健康狀況與社會支持改變之影響。第二部份研究則在瞭解社區老人於第二時間點之社會參與狀況，並探討兩個時間點間健康狀況改變與社會支持改變對社會參與之影響。
本研究資料來自行政院衛生署國民健康局進行之「台灣地區中老年身心社會生活狀況長期追蹤調查」，本研究採用1999年及2003年所進行之第四及第五波調查資料，研究樣本為1999年時居住於社區且年滿65歲之2828位老人及2003年同一世代之追蹤樣本共2131位。統計分析是以SPSS 14.0 for Windows版套裝軟體進行資料處理，統計方法除包括各面向之描述性統計外，並以卡方檢定、T檢定、單因子變異數分析、邏輯斯迴歸分析及複迴歸分析模式進行各因素間關係的驗證。
研究結果為1.社區老人健康情形在四年間的改變，身體與心理健康變差者都佔三成五以上，唯認知功能變差者較少佔一成六；而醫療服務使用方面，門診、機構照護、急診、居家照護使用變多的分別佔32.7%、18.5%、15.5%及1.5%。2.社區老人社會支持在四年間的改變，改變為獨居者佔4.5%，非同住網絡變小的佔六成一，工具性及情感性支持變差者則分別佔了三成一及三成五。3.社區老人的六項社會參與，在第二階段平均參與2.03項，以休閒類參與佔97.2%最高，其次是宗教類及社團類參與，以學習類參與比率最低。4.社區老人的性別、年齡、籍貫、教育程度、居住地區、宗教信仰、工作狀況、月收入、自覺健康狀況、身體功能、慢性病數、認知功能、憂鬱狀態、門診使用、機構照護服務使用、急診使用、非同住網絡、情感性支持等因素，與其健康情形的改變有顯著關係。5.社區老人的性別、年齡、教育程度、居住地區、認知功能、急診使用、工具性與情感性支持等因素，與其社會支持的改變有顯著關係。6.社區老人的性別、年齡、籍貫、教育程度、居住地區、宗教信仰、婚姻狀況、月收入、身體功能改變、認知功能改變、機構照護使用改變、非同住網絡大小改變、工具性與情感性支持的改變等因素，均與其社會參與情形有顯著關係。
針對研究結果，建議衛生體系工作者著重於老人社區支持性網絡的建構，加強老人對社區或團體活動的參與度，並配合老人特質增加豐富多元的社會活動，並增進老人預防性的保健措施。此外，建議我國長期照護十年計畫，亦可加強規劃社區活動，增加社會支持人力的培訓，並將老人社會參與活動納入補助體系，提供老人更完整的照顧。

關鍵字：社區老人、健康狀況、社會支持、社會參與

Aging society has become a population phenomenon in Taiwan; elderly healthcare has become a widely concerned issue. The connection between health of elders who live in a community and support from the society is critical.Community-dwelling Elderly have expectations to participate in social activities after they discontinue performing their part in the society; thus, social participation factors need to be examined from the viewpoint of health and social support.
The purposes of this study were: 1) to understand the distribution of the first time frame and changes between the two time frames for community elderly health condition and social support, and to investigate the effect of three factors, including demographic characteristics, physical condition and social support on the changes of physical condition and social support between two stages; 2) to understand the elderly social participation at the second time frame, and to investigate the effect of changes of physical condition and social support between the two time frames on social participation.
The study sourced data from the “Long-term survey of middle-age and Senior People’s Physical and Psychological Health Social Life Condition in Taiwan” conducted by the National Health Bureau, Department of Health, Executive Yuan in Taiwan. The data collected were the fourth and the fifth survey results in 1999 and 2003, respectively. Research samples were 2828 community-dwelling elders over the age of 65 in 1999, and 2131 cohort samples in 2003. The data were analyzed by using SPSS 14.0 for Windows, and the analysis methods, including descriptive statistics, Chi square test, t-test, one-way ANOVA, logic regression analysis and multiple regression analysis, were adopted for validation.
Research results indicated that: 1) the health condition of elders change over the course of four years, and over 35% of the elders experienced both physical and psychological deterioration, while only 16% indicated deterioration in cognitive function; in medical service use, the use of out-patient service, medical facility, emergency care, and assisted services increased by 32.7%, 18.5%, 15.5%, and 1.5%, respectively; 2) in terms of social support, 4.5% of the elders changed the life style to living alone, 61% had smaller non-resident network, 31% and 35% indicated deterioration in instrumental and emotional support, respectively; 3) among the six types of social participation, the elders participated in an average of 2.03 types during the second stage, of which, the highest was recreation (97.2%), followed by religion and association, whereas the participation in learning was the lowest; 4) factors, including gender, age, hometown, educational background, location of residence, religious belief, current employment status, monthly income, perceived physical condition, body function, number of chronic diseases, cognitive function, depression status, outpatient use, medical facility service use, emergency care use, non-resident network, and emotional support, had significant effects on the elders’ changes of health conditions; 5) factors, including gender, age, educational background, location of residence, cognitive function, emergency care use, instrumental and emotional support, had significant effects on the elders’ changes in social support; 6) factors, including gender, age, hometown, educational background, location of residence, religious belief, marital status, monthly income, body function and physical changes, changes of cognitive function, changes of medical facility use, changes of non-resident network, instrumental and emotional support, had significant effects on the elders’ social participations.
Based on the study results, the study suggested that physical health system workers should focus on the elderly community supportive networks, strengthen the elders’ participation in community and group activities, provide various and diversed social activities that meet the elderly's needs, and improve the protective health care measures for elders. In addition, the ten-year long-term health care plan should first improve the community activities, increase manpower training for social support, and include the elderly social participation activity into the funding system in order to provide complete elderly care.

Key words: community-dwelling elderly, health status, social support, social participation

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