台灣已於1993年邁入高齡化社會，因社會結構及傳統觀念的改變，高齡者逐漸重視自己退休後的個人生活，而選擇獨自或與配偶一起入住專為高齡者規劃設計之老人住宅的比例也逐年攀升；為有效促進高齡者從事對身心有益的休閒及社交活動，老人住宅應該配合提供安全、適當的日常活動公共空間及設施來支持。因此，老人住宅的公共空間規劃與設計就顯得相當重要。究竟老人住宅之公共空間是否可以真正滿足高齡者的使用需求？是否可促使高齡者積極使用？正是目前規劃、興建或改善老人住宅的重要課題之一，亦為本研究所欲探討之主要動機。 本研究運用資料調查、實地觀察、深入訪談及問卷調查等多元調查與評估方法，並選擇擁有多樣室內、室外之公共設施及共用空間的「長庚養生文化村」作為研究案例，分別針對「公共服務設施」、「室內休閒設施」、「戶外活動空間」及「共用服務空間」等4類公共空間進行使用及規劃等議題之探討，即藉由老人住宅用後評估，深入探討高齡者對於所居住的老人住宅現有公共空間規劃的滿意程度，探究高齡者對於老人住宅公共空間規劃設計之真實反應與感受；並依據評估分析成果，提出老人住宅公共空間之規劃原則建議，以供未來興建高齡者安居住宅之公共空間規劃參考。本研究結果及建議如下： 一、高齡者對公共空間需求滿意度以戶外森林步道及健康中心最高，以健康為主軸的休閒性設施仍為未來規劃重點。 二、老人住宅公共空間滿意度與「教育程度」、「身體狀況」、「子女探訪情形」等三項因素有關。 三、目前老人住宅公共空間議題，關心度低，容易被忽視及犧牲。 四、老人住宅公共空間規劃設計之主要議題包括： （一）餐廳為入住老人住宅之高齡者社交活動的重要空間，也是假日與探訪家人聚餐的重要場所，而餐廳的寬敞、舒適程度，及社交機會之提供，是高齡者關心的議題之一。 （二）設置報紙的交誼廳使用率較高，而設有書報的交誼廳，其照明及管理等議題必須加強考慮。 （三）中央式的走廊，因為通風及採光較不佳，降低了高齡者的社交機會。 （四）活動量大的活動休閒空間（如籃球場、桌球室等）僅能供探訪家人使用，效用不大，未符合高齡者需求。 五、規劃適合每一位高齡者的居住空間，建議朝向「通用設計原則」來進行規劃設計。 六、老人住宅基本生活之公共空間（如交誼室、洗衣室等），應配合生活單元作可及性高的簇群式配置，以增加高齡者使用機會；至於提供全部高齡者共同使用之休閒空間（如學習教室、娛樂室、會議室等），建議集中配置，以方便管理。 / Taiwanese society has become an aging society since 1993. Due to changes in societal structure and traditional concepts, phenomenon such as aging people started to emphasize more on their personal life after retirement and increasing ratio of aging population, either single or with domestic partner, move into specially designed retirement apartment have brought up to attention. In order to effectively encourage aging resident to exercise beneficial recreation and socialization activities, safe and proper common activity areas in retirement apartments are necessary and thus, the design and planning of the common recreation areas has become an essential issue. Questions regarding whether the retirement apartments will fully satisfy the needs of their aging resident and whether the aging residents actively utilizing those facilities are two of the most essential regards for planning, building, and improving retirement apartments; this is also the motivation for conducting this research. Our research focuses four main issues regarding as utilization and planning of public area such as “public service facility”, “in-door recreation facility”, “out-door activity space”, and “shared service space” in Chang Gung Health and Culture Village which possesses varieties of in-door and out-door public facilities and public areas; the research itself is conducted by data investigation, on-site observation, detailed interview, and paper-based survey to insightfully investigate the degree of satisfaction of aging residents toward existing planning of shared area and real feeling and reaction toward existing planning of public area. Suggestions for planning of shared areas, as results from analysis of conducted surveys, are provided for the reference of future planning of shared areas in aging resident village. The suggestions are as followed: 1.Out-door forest trails and healthcare centers are the two types of facilities that are listed among the highest degree of satisfaction by aging people. Health-oriented recreation facilities are still regarded as the most essential element in future planning of retirement apartment construction. 2.The degree of satisfaction in retirement apartment is directly associated to three factors which include “degree of education received”, “physical condition of the aging person”, and “the frequency of family visits.” 3.The current issues for public area in retirement apartments are low degree of attention and easily neglected or sacrificed. 4.Issues regarding the planning of public areas in retirement apartments includes: A.Cafeteria is one of the most important socializing space for aging residents in retirement apartment and an important space for family visits. Degree of comfortableness and spaciousness of cafeteria and whether the cafeteria offers socializing opportunities to aging residents are the two main concerns of aging residents. B.Utilization degrees in lobbies that provide newspaper are higher than lobbies that do not provide newspaper. The lighting and management of such lobbies are needed to be emphasized. C.Socialization opportunities decrease due to the facts that lighting and aeration in central hallway are not quite satisfactory. D.Recreation areas that involve physical activities such as basketball and table tennis are only for family members that visit the aging resident and are not satisfactory to the demand of aging residents. 5.Plan the resident area for each aging resident by utilizing principles of universal design is suggested. 6.The public space of retirement apartment for daily live, such as social room or laundering room, shall be disposed fitting Cluster of Living Style for accessibility to increase the using of the elderly; As for the common space of leisure for all elderly, Such as learning room, recreation room, conference room, it is suggested be allocated together for the convenience of management.

本文係針對台灣地區各縣市1999至2008年之老人安養機構設立之床位數進行分析，利用雙因子固定效果模型（two-factor fixed effects model）探討台灣地區各縣市老人安養機構設立之重要影響變數，以及這些變數對於老人安養機構設立床位數影響程度之強弱。本文首先將文獻之檢閱做整理介紹，先概述至今國內外討論老人安養機構設立及使用之相關文章重要觀點，了解這些文章作者的研究時間與空間範圍、所使用分析方法、論點及其變數設定，在最後與本研究之結論相互比較，觀察文獻與本研究之間是否具有一致性。 由於本論文重視各地區變數之影響，故本研究使用具地域性之各縣市數據資料作為變數，經由資料蒐集，將合適之變數納入研究考量，參閱文獻資料，加上能夠取得之數據資料為考量。本文將討論下列變數：台灣地區實質薪資、各縣市老年人口數、各縣市人口密度、各縣市教育程度為大專及以上人口之比率、各縣市失業率、各縣市女性勞動參與率、各縣市15歲以上人口婚姻狀況有偶人數比率、各縣市出生率、各縣市外籍與大陸配偶人數、各縣市社福外籍勞工人數以及各縣市每萬老人接受居家服務人次等十一個變數。對於老人安養機構設立數之關係，觀察其影響程度，了解各地區差異，期能對政府提供具體的政策建議，並對未來各縣市公私立老人安養機構之設立提供參考。 / This study analyses the number of the beds established of the long-term care (LTC) facilities of each city and county in Taiwan between 1999 and 2008, using “two-factor fixed effects model” to explore some of the important influential variables of the long-term care facilities of each city and county, and the strength of the relation of these variables of the hospital beds. This article firstly introduces and reviews some articles and studies that are basically related, and overview the important points of view of the establishment of the long-term care facilities, to understand the analytical methods and the arguments of these articles and authors. As the importance of this thesis, the effect of regional variables, the study uses cities and counties level variables. Through data collection, using the variables in the study that are considered appropriate. Refer to the literature, adding with data obtained for the considerations. This article will discuss the following variables: the real wage of Taiwan each year, the number of counties and cities in the elderly population, the population density, the population with tertiary education level, the unemployment rate, the female labor force participation rate, the population over the age 15 that have marital status, the proportion of birth rate, the number of foreign and mainland spouses, the number of the welfare of foreign workers per 10,000 of the elderly receiving home care people, totally 11 variables. To establish the relationship between the number of observed effect level of long-term care facilities of each city and county, to understand the regional differences, to provide the government on specific policy recommendations. In the future, we expect to provide the public and private sectors the reference establishment of nursing agencies of each city and county.

在逐漸高齡化的社會中，關注老人的生活議題並加以分析益顯重要。在研究老人問題時，由於研究對象均曾經歷不同的時空背景與人生閱歷，各個體間存在的差異極大；不同族群的老人對其所慣用語彙的理解與表達亦不盡相同。故若利用傳統的統計分析研究結果，強迫人們採用二元邏輯的方式思考與解釋，可能會導致偏差或錯誤的結論。且傳統的統計檢定方法，往往假定取樣的樣本滿足某個分配，因而導致過多的解釋，影響決策品質。 因此，為避免因誤解老人而造成虛耗社會成本，使有限的社會資源得以充分運用，本文於研究老人身心特質與個人期待時，嘗試以模糊理論的軟計算，提出反模糊化轉換。並應用中位數檢定及變異數檢定，建立當統計參數為模糊數或模糊區間時之小樣本無母數模糊統計檢定方法模型。由實證例子分析結果顯示，我們提出的檢定方法，能有效分析模糊樣本的問題，並進而期望能對老人議題的分析和決策有所貢獻，及將此方法運用於其它模糊性議題之研究。 / In a gradually aging society, it is important to pay attention to and then analyze elderly people’s life issues. When a study about elderly people is undertaken, the subjects are very inconsistent given their diverse life experience, and various subgroups of subjects have quite different understanding of and way of expressing a vocabulary. Therefore, analyzing study result with conventional statistical analysis method, which forces thinking in a binary logic way, may lead to biased or erroneous conclusion. Furthermore, a conventional statistical test, usually assuming a certain distribution for its samples, may lead to exaggerated explanation, which is detrimental to the quality of a decision. So, in order to avoid the waste of our social cost from misunderstanding of the elderly, and to make the most use of our limited social resource, when we investigated the elderly people’s personal characteristics and expectations, we tried to apply the soft calculation of the fuzzy theory, proposed the counter-fuzzy transformation, and, by using the median test and variance test, established a nonparametric fuzzy statistical model for small-sized samples and for parameters of the fuzzy number or fuzzy interval types. The analyses of real-world examples demonstrated that this method of statistical test can analyze the problems of fuzzy samples, and can hopefully contribute to improved analysis and decision making of the elderly people’s issues, and apply this method on the investigation of other fuzzy social issues. Key words: counter-fuzzy transformation, fuzzy statistical analysis, median test, variance test, aging society.

傳統上國人寄望養兒防老，但面臨少子化及壽命延長，家庭已無法獨力負擔照顧老年人的責任，必須仰賴個人（老年人自己）、國家及政府分擔人口老化造成的需求，這也是政府在過去二十年來積極投入更多資源，制訂與老年人有關的社會保險、福利及政策的原因。像是1995年開辦的全民健康保險提升了全民健康，其中老年人受惠尤多；2005年的勞工退休金條例、2008年的國民年金保險等，則是因應我國國民壽命延長的社會保險制度。對於未來費用的需求估算，需要依賴可靠的死亡率預測，但大多數預測並沒有將死亡率改善列入考量，勢必低估長壽風險的衝擊，影響個人的財務規劃、增加國家負債。 有鑑於此，本文研究常用的死亡率模型，評估哪些適合用於描述高齡死亡率的變化，且能用於計算年金商品的定價。本文考量的模型大致分成兩類：關係模型(Relational Models)及隨機模型(Stochastic Models)，第一類包括常用於高齡的Gompertz、Coale-Kisker模型，以及Discount Sequence模型，第二類則有Lee-Carter及CBD等模型。模型比較的方式以長期預測和短期預測，選用交叉驗證的方式驗證死亡率模型的預測結果與觀察值之間的差異。研究結果顯示Discount Sequence、Lee-Carter、CBD隨機模型較能準確描述台灣、日本與美國等三個國家的死亡率特性；但這三個模型在年金險保費並沒有很明顯的訂價差異。另外，若用於短期預測、長期預測比較，又以Discount Sequence的預測結果優於Lee-Carter模型的預測。 / Traditionally in Asia, families played the main role in caring their own elderly (i.e., parents and grand-parents), but the declining fertility rates and longer life expectancy make it difficult for the families to take care of the elderly alone. The elderly themselves and the government need to share the burden caused by the aging population. In fact, most Taiwan’s major social policies in the past 20 years are targeting the elderly, such as National Health Insurance, Labor Pension Act and National Pension Insurance. Their planning and financial solvency rely on reliable mortality models and their projections for the elderly population. However, many mortality models do not take into account the mortality improvements and thus underestimate the cost. In this study, we look for elderly mortality models which can reflect the mortality improvements in recent years and use them to price the annuity products. Two types of mortality models are of interest: relational models and stochastic models. The first group includes the Gompertz model, Coale-Kisker model and Discount Sequence; the other group includes the Lee-Carter and CBD models. We utilize these mortality models to project future mortality rates in Taiwan, Japan and U.S., along with the block bootstrap and ARIMA for projection. The model comparison is based on cross-validation, and both short-term and long-term projections are considered. The results show that the Discount Sequence, Lee-Carter model and CBD model have the best model fits for mortality rates and, for the short-term and long-term forecasts, the Discount Sequence is better than the Lee-Carter model.

臺灣在2015年高齡人口（65歲以上）比例超過12.5%，依照國家發展委員會的2016年人口推估，預計將於2018年正式邁入高齡社會（高齡人口比例14%），2026年更突破20%的門檻，人口老化速度持續加快。因為身體機能隨年齡增長等因素逐漸老化，高齡人口的就醫需求通常也較多，包括就醫金額、就醫次數，根據中央健康保險署2014年統計，高齡人口比例約為12.0%，但其醫療費用卻佔總費用37.6%。因此本文以探討高齡人口就醫特性為目標，透過高齡人口就醫行為去了解醫療現況，並評估因老化而引發的醫療資源。 本文以高齡人口特性及就醫需求為研究方向，探討近十年高齡人口就醫需求的基本特性，如：醫療使用率、平均就醫次數及平均醫療費用。接著以高齡人口就醫選擇集中度做為出發點，計算各疾病下的就醫集中程度，探討是否高齡人口會隨著不同疾病而有不同的就醫行為。研究結果顯示年紀越大的高齡人口，醫療使用率反而下降，但平均總醫療花費隨著年齡增加亦跟著上升；另外在不同的疾病下會有不同的就醫行為，當就醫地選擇越一致其死亡率也越低。計算依據為全民健康保險資料庫2005年百萬高齡人口抽樣檔，包括承保資料檔(ID)、門診處方及治療明細檔(CD)、住院醫療費用清單明細檔(DD)，以六十五歲以上高齡人口為研究對象，探討其醫療利用行為及就醫習性。 / The population aging is speeding up in Taiwan. The elderly population (65 years and older) is more than 12.5% in 2015 and, according to the population projection of National Development Council, it is expected to reach 14% and 20% in 2017 and 2026, respectively. The elderly usually require more medical attention, partly due to the fact that the human organs degenerate with time. For example, in 2014, the proportion of elderly is about 12.0% and they account for 37.6% of total medical expenditure (Source: National Health Insurance Administration). Taiwan’s total medical expenditure will continue to grow and we need to understand the medical needs of Taiwan’s elderly, in order to cope with the need of aging society. Therefore, we use the data from the National Health Insurance Research Database (NHIRD) to explore the medical needs and behaviors of receiving medical care of Taiwan’s elderly. The dataset used in this study is a sample (one million people aged 65 and beyond, about 46% of total population) of Taiwan’s elderly and the dataset contains the Registry for beneficiaries (ID), outpatient visits (CD), and inpatient admissions (DD). Our analyses show that almost all elderly have at least one medical visit annually and their diseases are more diverse than those of younger generations. Also, the elderly have larger inertia in medical visits and, for example, the proportion of choosing the same medical institution is higher. The results of this study can serve as a reference to future policy planning and resource allocation for the elderly.

台灣高齡者之吞嚥困難解決方案的市場分析與商機 / It has been suggested that dysphagia affects approximately 8 % of the world’s population. People may be completely unable to swallow or may have trouble in safely swallowing liquids, foods, or saliva. When that happens, eating becomes a challenge. Recent studies have identified elderly people who require the long- term care as being at increased risk for dysphagia due to changes in the swallowing mechanism as aging occurs, it may affect 30% to 40% of the population at 65 years old or more. Taiwan is on course to go from being an “aging society” to an “aged society” and is experiencing a rapid increase in the number of older adults who require long-term care. Dysphagia is a prevalent difficulty among elderly people. Though increasing age facilitates subtle physiological changes in the swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that long-term care organizations or nursing homes are also at risk for dysphagia and are associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. Living with dysphagia is challenging, but it can be managed. For elderly people with dysphagia, it's important to continue the principle of maintaining hydration, calories and nutrients, especially protein and fluids. Texture-modified foods and thickened liquids can help achieve nutritional and hydration goals. This research provides the market analysis of dysphagia solution and its market opportunities in Taiwan. It concludes with a market plan to assess the viability of such a business opportunity. Well- structured management of dysphagia can not only provide elderly people’s physical, mental and social well-being but also brings the elderly people the pleasures of eating and the dignity during the last few years of their lives.

有鑑於過去人口結構的變化，台灣已成為人口老化速度最快的國家，人口老 齡化已成為一個重大議題。而老年人比例最高的日本，卻出現廣泛的老年貧窮 （下流老人）現象。因此，本研究以日本的情況為依據，對台灣老年貧窮的整體 概況和未來趨勢的發展進行資料整合與分析。主要探討台灣“老年貧窮”問題的 出現，並找出其影響的程度及其未來的發展，後續並深入分析其造成台灣“老年 貧窮”問題之關鍵指標因素，以及政府解決老年貧窮問題的政策與措施。研究發 現，超過五成老年人口落在最低收入、最貧窮層級的家戶中，顯示台灣社會的“老 年貧窮”現象有所增加。而造成台灣老年貧窮的原因為：一、退休養老金不足（低 於基本生活開銷）; 二、就業（低薪的工作環境）; 三、家庭養老功能下降（老 人獨居比率不斷上升）; 四、太早離開勞動力市場（儲蓄不足）。研究結果顯示，弱化的社會保障制度是老年貧窮比率升高的主要原因，而老年貧窮的現象亦廣泛存在於台灣社會，因此建議需提升公眾意識，提早準備充足的退休養老金、並加 強社區老人關懷功能、以及持續關注老年貧窮的問題。本研究結果可提供未來探 討台灣老年貧窮議題之參考，相關研究值得後續做進一步的探討分析。 / In view of the change in demographic structure in the past few years, Taiwan has become the country with the fastest speed of population aging. The aging population has become a major issue. Japan has the highest ratio of aged citizens, and the widely discussed phenomena of elderly poverty (The low-living elderly). Thus, this study based on Japan's case, has systematically reviewed, analyzed, and secondary data, in order to provide the overall and future trends of elderly poverty situation in Taiwan. The study probes into the emergence of the “elderly poverty” problem and try to find out the extent of this problem and its future outlook, to explore the causes of the “elderly poverty” problem in Taiwan and the official measures for alleviating elderly poverty. The research found that more than 50% of the elderly was the poorest households with the lowest income, nearly half of the elderly population falls to the lowest and poorest level, shows “the low-living elderly” phenomenon has increasing in Taiwan’s society. The causes of the elderly poverty in Taiwan: 1. the labor pension is too low (less than the necessary living expenses); 2. unstable employment (low income work); 3. family care function are decline (the elders living alone has keep rising); 4. early to exit from the labor market (lack of deposits). The weakened social security system are the main causes for the rising old-age poverty. The elderly poverty exists widely and need to promote public awareness for prepare adequate deposit in retirement, strengthen care function of community and focus on the elderly poor issues. For overall pictures of elderly poverty in Taiwan is worthy of further investigation and discussion.