Growing evidence suggests that chronic health conditions and disability act as reliable predictors of complementary/ alternative medicine (CAM) use. Such use may have the potential for some to increase independence and quality of life. Moreover, research indicates that older people are significant consumers of CAM services. Yet, understanding profiles of older individuals of these services continues to remain under researched. Here, a widely used type of CAM was considered – massage therapy (MT). Towards better understanding MT user profiles, this study tested a modified version of the Andersen Health Behavior Model to help ascertain if it is useful towards understanding factors associated with massage therapy (MT) utilization. Respondents represented an elderly sample (aged 60+) that resided within a large urban city in Ontario Canada (Toronto). Eligible respondents at the time of the study were non-institutionalized and self-reported having one of more current chronic illness conditions which they have had for six months or more, and had been diagnosed by a medical doctor. Using a quantitative method, retrospective data were gathered using a pre-tested English-only mail questionnaire, developed specifically for this study. Data were gathered over a period of 6 months, between late 2000 to mid 2001. Bivariate analysis suggests that inequity exists whereby the ability to access massage therapy varies according to one’s socioeconomic status. This is further supported using backwards step-wise regression analysis, whereby one’s total annual household income was a strong predictor of MT use status. One’s CAM-related health and social network as well as having back problems also emerged as strong predictors of MT use. Overall findings suggest that a modified Andersen model as used in this study does have utility in relation to helping to identify potential factors associated with the utilization of massage therapy. Based on regression analysis, findings here suggest, for example, that those with higher incomes are 1.5 times more likely to use MT. This provides support that there are existing inequities regarding access to rehabilitation-oriented health care services. With population aging and rising numbers of people needing restorative and rehabilitation services, study findings will increasingly have important public health as well as health care policy related implications.

Growing evidence suggests that chronic health conditions and disability act as reliable predictors of complementary/ alternative medicine (CAM) use. Such use may have the potential for some to increase independence and quality of life. Moreover, research indicates that older people are significant consumers of CAM services. Yet, understanding profiles of older individuals of these services continues to remain under researched. Here, a widely used type of CAM was considered – massage therapy (MT). Towards better understanding MT user profiles, this study tested a modified version of the Andersen Health Behavior Model to help ascertain if it is useful towards understanding factors associated with massage therapy (MT) utilization. Respondents represented an elderly sample (aged 60+) that resided within a large urban city in Ontario Canada (Toronto). Eligible respondents at the time of the study were non-institutionalized and self-reported having one of more current chronic illness conditions which they have had for six months or more, and had been diagnosed by a medical doctor. Using a quantitative method, retrospective data were gathered using a pre-tested English-only mail questionnaire, developed specifically for this study. Data were gathered over a period of 6 months, between late 2000 to mid 2001. Bivariate analysis suggests that inequity exists whereby the ability to access massage therapy varies according to one’s socioeconomic status. This is further supported using backwards step-wise regression analysis, whereby one’s total annual household income was a strong predictor of MT use status. One’s CAM-related health and social network as well as having back problems also emerged as strong predictors of MT use. Overall findings suggest that a modified Andersen model as used in this study does have utility in relation to helping to identify potential factors associated with the utilization of massage therapy. Based on regression analysis, findings here suggest, for example, that those with higher incomes are 1.5 times more likely to use MT. This provides support that there are existing inequities regarding access to rehabilitation-oriented health care services. With population aging and rising numbers of people needing restorative and rehabilitation services, study findings will increasingly have important public health as well as health care policy related implications.

Objective: The aim of this study was to investigate the longitudinal impact of depressive symptoms on utilization of healthcare in terms of GP visits as well as specialist visits and hospital admission in late life among community-dwelling individuals. Methods: Longitudinal data (baseline and follow-up) were derived from the German multicentre, prospective cohort study “Late-life depression in primary care: needs, health care utilization and costs” study (AgeMooDe). At baseline, n = 1,230 patients aged 75 years and older were recruited from primary care practices. Main outcomes of interest were use of health care services: the number of GP visits, the number ofmedical specialist visits, and hospital admission. We used the Geriatric Depression Scale (GDS-15) to measure depression. Outcomes were analyzed with multilevel random intercept negative binominal regression and logistic random-effects models. Results: At baseline (n = 1,191), mean age was 80.7 (SD 4.6) years, 62.9% were female, and 196 individuals (16.5%) had depression (GDS-15 6). Our longitudinal analyses indicated that older individuals with more depressive symptoms visited their GP more often (IRR=1.03; CI [1.01-1.04], p < 0.001), were visiting medical specialists more frequently (IRR=1.03; CI [1.01-1.04], p < 0.01), and had higher odds of being hospitalized (OR=1.08; CI [1.02-1.13], p < 0.01). Conclusions: Based on this large longitudinal study we showed that, after adjustment for important covariates, older individuals with more depressive symptoms had higher health care utilization over time. They visited their GP and specialists more frequently and they had higher odds of being hospitalized. This may suggest that higher utilization of specialist care and increased likelihood of being hospitalized may be also attributable to unspecific symptoms or symptoms that are elevated through depressive symptoms

As ruin theory evolves in recent years, there has been a variety of quantities pertaining to an insurer's bankruptcy at the centre of focus in the literature. Despite the fact that these quantities are distinct from each other, it was brought to our attention that many solution methods apply to nearly all ruin-related quantities. Such a peculiar similarity among their solution methods inspired us to search for a general form that reconciles those seemingly different ruin-related quantities. The stochastic approach proposed in the thesis addresses such issues and contributes to the current literature in three major directions. (1) It provides a new function that unifies many existing ruin-related quantities and that produces more new quantities of potential use in both practice and academia. (2) It applies generally to a vast majority of risk processes and permits the consideration of combined effects of investment strategies, policy modifications, etc, which were either impossible or difficult tasks using traditional approaches. (3) It gives a shortcut to the derivation of intermediate solution equations. In addition to the efficiency, the new approach also leads to a standardized procedure to cope with various situations. The thesis covers a wide range of ruin-related and financial topics while developing the unifying stochastic approach. Not only does it attempt to provide insights into the unification of quantities in ruin theory, the thesis also seeks to extend its applications in other related areas.

As ruin theory evolves in recent years, there has been a variety of quantities pertaining to an insurer's bankruptcy at the centre of focus in the literature. Despite the fact that these quantities are distinct from each other, it was brought to our attention that many solution methods apply to nearly all ruin-related quantities. Such a peculiar similarity among their solution methods inspired us to search for a general form that reconciles those seemingly different ruin-related quantities. The stochastic approach proposed in the thesis addresses such issues and contributes to the current literature in three major directions. (1) It provides a new function that unifies many existing ruin-related quantities and that produces more new quantities of potential use in both practice and academia. (2) It applies generally to a vast majority of risk processes and permits the consideration of combined effects of investment strategies, policy modifications, etc, which were either impossible or difficult tasks using traditional approaches. (3) It gives a shortcut to the derivation of intermediate solution equations. In addition to the efficiency, the new approach also leads to a standardized procedure to cope with various situations. The thesis covers a wide range of ruin-related and financial topics while developing the unifying stochastic approach. Not only does it attempt to provide insights into the unification of quantities in ruin theory, the thesis also seeks to extend its applications in other related areas.

台灣地區由於國民平均壽命延長，加速了人口結構轉型、老人人口快速增加，因此衍生許多老人居住安養之課題。為探討影響都會區民眾選擇老人住宅之因素，本研究以台北縣永和市為研究範圍。透過問卷調查收集所需資料，以安德遜服務使用行為模式之個人因素及影響服務使用之限制因素為基礎，透過卡方檢定、因子分析、羅吉特迴歸分析及交叉分析等量化分析方法，實證影響台北縣永和市50歲以上人中、老年人選擇老人住宅服務的相關因素。 本研究結果發現，在個人決定方面，性別、年齡、健康情況、現有子女數、家庭總收入、目前居住型態及理想居住型態等變項對入住老人住宅之意願有顯著影響。在限制因素方面，老人住宅之資訊、可近性、租金及老人住宅類型等變項對入住老人住宅之意願有顯著影響。大部份受訪者認為複合化、多機能的老人住宅及降低收費最能提高入住老人住宅之意願。另最廣為受訪者接受之老人住宅類型為規模在50戶以內、與醫療保健設施或社會教育設施以分棟型態複合開發之老人住宅。 本研究建議老人住宅開發業者以複合化、多樣化、小型化的開發模式興建老人住宅；建議政府應重視老人住宅出租市場，加強宣導鼓勵民眾居住老人住宅，建立老人住宅資訊平台，以活絡老人住宅出租市場，增加需求量，吸引更多優質廠商投資。在對台北縣永和市老人住宅政策之建議方面，建議老人住宅服務對象應從選擇性服務擴大到全民性服務，中興社區安養堂應轉型為多機能、複合化的老人住宅。 / In Taiwan, with the advances of medical technology, the life span of people has been extended. As a result, the population of senior people has increased dramatically; therefore, their accommodation and domiciliary care became a big issue in modern society.This research studies the middle-aged and senior people whose age over 50 and live in Yonghe City,Taipei County. Collecting data by questionnaire and using quantity methodology of Andersen model, Chi-square test, Factor Analysis, Logistic Regression and Cross Analysis to understand the factors that affect senior people to choose elderly housing. The result shows, in term of personal decision, the factors of gender, age, healthy conditions, number of children, household income, current living pattern and ideal living pattern etc. will affect senior people to choose elderly housing. In term of limiting factors, the information of elderly housing, residence distance with relatives, a rental and type of elderly housing etc. will affect senior people’s choices. Most interviewers think composite and multifunctional elderly housing as well as cheaper charge would increase the desire to live in elderly housing. Meanwhile, the most popular elderly housing type is less than 50 apartments with medicinal facilities or educational services in the community. This research suggests house building company should develop composite and multifunctional elderly housing in a small community for senior people. In addition, government should think seriously of elderly housing letting market by publicizing the information to encourage senior people to live in elderly housing. Once the house demand increased, it will attract more decent building companies developing more elderly housing to promote for senior people. Furthermore, this research suggests the housing policy in Yonghe City, Taipei County should broaden elderly housing service from selectivity senior people to general elderly. And the Jhong-sing Elderly Community Shelter should be transformed into composite and multifunctional elderly housing.