在高齡化社會中，老人居住安養的議題愈形重要。長久以來，「與子女同住」一直是國人心目中最理想的老年居住安排方式，但隨著老年人生活自主性與教育程度的提升，傾向不與子女同住的比例亦逐年上升，而選擇「自費安養」型態的老年人口也逐漸增加。本研究希望藉由入住自費安養機構老人本身的觀點，深入瞭解他們與此一居住環境的互動經驗及情感依附，並思考如何使居住環境有「像家」的感受。據此，本論文之研究目的在於：一、探討老人遷住自費安養機構的決策過程。二、分析入住自費安養機構老人與居住環境的互動關係。三、探索入住自費安養機構老人對居住環境的依附情形。四、依據研究結果，提供建議作為推動老人住宅政策與實務工作之參考。 本研究使用質性取向的研究方法，以台北市某家自費安養機構作為研究場域，採用半結構式的深度訪談法進行資料蒐集，共計訪談十三位老人，年齡介於七十一至九十二歲之間。主要的研究結果如下： 一、老人入住自費安養機構是一連串的過程，包括需求的引發、資訊的取得、貨比三家與考量要件、以及最終的決定，而其中遷居過程的參與程度和做決定的自主程度愈高之老人，對於新居的看法愈為正面。 二、在實質環境方面，安養機構最大的特色在於具有多元化的空間設施，老年住民可在個人寢室空間從事獨立活動，在公共空間有較多人際接觸的活動，至於機構外部的活動則受限於老人的行動能力、害怕外部環境潛藏的危險性或是擔心跌倒意外。此外，安養機構經常安排各種休閒活動和社會活動，是入住老人相當有利之處，並為老人帶來許多正面的功能與感受。在社會環境方面，「功能距離的鄰近性」與「社會人口背景的同質性」是老年住民互動關係之主要影響因素；而工作人員是協助老年住民維持獨立生活的支持者；原先的社會支持網絡則是提供老年住民情感支持的主要來源。 三、老年住民對於居住環境多數感到喜歡和滿意，但是否將居住環境視同為「家」，則受到「老人對家的定義或觀念」以及「是否仍擁有原本的住家」兩個因素所影響。綜合而論，老年住民的依附類型主要可歸納為三類：（1）我找到一個理想的地方，將在這裡終老餘生；（2）這裡是一個適合居住的地方，可以協助我維持獨立生活；（3）缺乏情感，希望將來有機會重新安排居住環境。 / On an aging society, it has become an important issue that how people live in their old age. For a long time, “living with children,” to Taiwanese people, has been the best way of living arrangement in later life. However, with the enhancement of autonomy and the upgrading of educational level, more and more elderly tend not to live with their children, and some of them choose to live in congregate housing. From the viewpoint of the elderly living in congregate housing, this study aims to understand their interaction with the living environment, their emotional attachment to it, and how to make the environment feel like a home. Accordingly, the purposes of this study are as following: first, examine the decision-making processes of older adults relocating from home to congregate housing; second, analyze the interactive relationship between the elderly residents and their living environment; third, explore the emotional attachment of the elderly residents to their living environment; forth, based on research findings, provide suggestions for the elderly housing policy and the practitioners. This study employs qualitative research approach, and data collection is gotten from a congregate housing in Taipei, including semi-structured in-depth interviews with thirteen elderly residents aging from 71 to 92. The study findings are listed below: First, relocation is a series of process, including the demand for initiation, information acquisition, comparison, consideration, and the final decision. In this process, the more participation and the more autonomy the elderly have, the more positive their comments for the new residence will be. Second, in physical environment, a wide range of space is the most prominent feature of congregate housing. The elderly residents could engage in independent activities in the individual dwelling units. They would have more interpersonal contacts in the public space. As for outdoor activities, the elderly might be restricted by their mobility, for fear of the potential dangers of the external environment, or falling accidents. Besides, the elderly get many benefits from the leisure and social activities in congregate housing. In the social environment, the interactive relationship between the elderly is influenced by the vicinity of the functional distance and the homogeneity of residents. Staff members of congregate housing help the elderly maintain independence, and original social support networks provide main emotional support to them. Third, most elderly residents are fond of and satisfied with their living environment. Nevertheless, not all of them consider this environment as their home. Viewing it as a home depends on how they define the meaning of home and whether they have self-owned housing. Overall, the attachment type of these elderly residents can be divided into three categories: (1) I found an ideal place to stay throughout my lifetime; (2) this is a suitable place for me to live, and it can help me maintain independence; (3) I have no affection for this place. If given the opportunity, I will try to rearrange my dwelling place.

Locational decisions based on stigma and low funding have handicapped the efficiency of community based mental healthcare in the United States since 1963. However, the pattern of services in the 21st century American South remains largely unknown. This thesis addresses this gap in knowledge by using a mixed methodology including location allocation, descriptive statistics, and qualitative site visits to explore the geography of community clinics offering both physical and mental health services. The City of Houston has proposed using these facilities to anchor new supportive housing, but introducing more fixed costs to a mismatched system could create more problems than solutions. The findings of this study suggest the presence of an unnecessary concentration of services in the central city and a spatial mismatch between accessible clinics and the poor, sick people in need. Furthermore, this research reveals a new suburban pattern of vulnerability, calling into question long-held assumptions about the vulnerability of the inner city. Building supportive housing around existing community clinics, especially in the central city, may further concentrate vulnerable people thereby contributing to intensifying patterns of service-seeking drift and the continued traumatization of mentally ill homeless persons in Houston.

國立政治大學社會學系八十七學年度第一學期碩士論文摘要 研究生：黃秀玲 撰 指導教授：林佳瑩博士 論文名稱：銀髮小家庭居型態之比較研究 基於研究主題，本研究把不與子女同住的「獨居」或「夫妻同住」之老人的家庭歸納為「銀髮小家庭」，乃以高雄縣內60歲以上銀髮小家庭老人164人（居住家中不與子女同住83人、居住高縣老人公寓81人為樣本）為樣本，探討銀髮小家庭老人對居住需求的考量、比較不同居住型態（居住在自己家中、居住在老人公寓）對銀髮小家庭老人生活滿意度是否有差異存在。 整體而言，銀髮小家庭老人的共同特點是：多數老人主觀認為晚年的生活該由「自己」來負責任，且這群銀髮小家庭老人的教育程度跟一般非銀髮小家庭老人相比明顯很高，而退休前的職業也多是以軍公教人員為多，故老人們退休後也有穩定的經濟來源---退休金終身俸，或是由兒子供養為主。而比較不同的是我們可以由分析中發現：在「婚姻狀況」方面有明顯分佈上的差異，公寓中的老人婚姻狀態最多為喪偶，佔了半數以上；而居住在社區中的老人卻半數以上多為已婚與配偶同住。 銀髮小家庭老人居住需求前十名依序為：「尊嚴自主的生活」、「無障礙生活空間」、「附近有公園」、「專門的空間設計」、「交通方便」、「24小時緊急送醫」、「親情圍繞」、「訪視巡邏」、「親友聯絡」、「專人三餐服務」、「拓展人際關係」。可見對銀髮小家庭老人而言，有一個舒適、安全的生活空間對他們而言是很重要的考量項目，且居住的地點最好還是能兼顧與子女親友的聯繫，讓老人的情感支持不至於因獨居或夫妻同住而減少；加上若有專人幫忙老人準備三餐，對銀髮小家庭老人來說是一項很貼心的福利服務。經過整個研究的結果，我們可以發現居住在老人公寓的老人其整體生活滿意度、實際居住滿意度均不會比社區不與子女同住老人的結果來的遜色，甚至還比社區不與子女同住老人的反應還要好。這一方面是因為居住在老人公寓的老人一般而言教育程度較高、職業以公務員、軍警人員、教職人員為多，這些公務員體系的老人一直都有穩定的退休制度可以保障他們的晚年生活，再加上他們提早規畫老年生涯、且對子女的觀念能夠隨著社會的變遷做適度的調整，使得他們在面對老年這項事實時能以較開朗的態度來生活，並積極參與社會活動，主動運用社會資源、多方面吸收新知、發展興趣，依舊過的坦然自在。 目 錄 第一章 緒論 第一節 研究緣起……………………………………………………1 第二節 問題陳述……………………………………………………2 第三節 研究目的……………………………………………………4 第二章 文獻探討 第一節 台灣老人居住安排的變遷…………………….……………6 第二節 老人居住型態………………………………………..…..11 第三節 老人公寓………..………………….………………..….15 第四節 老人生活需求面面觀……………………………………..19 第三章 研究設計 第一節 研究架構…………….…………………………………..25 第二節 研究假設………………………………………………….26 第三節 操作性定義…………………………………………….…27 第四節 研究樣本………………………………………………….28 第五節 問卷設計………………………………………………….30 第六節 資料蒐集與分析方法……………………………………..32 第四章 受訪老人資料基本變項分析 ………………………..33 第五章 影響老人居住需求之相關因素分析 第一節 銀髮小家庭老人對居住需求考量的優先順序………………….41 第二節 銀髮小家庭老人個人基本特性對居住需求之分析…………….44 第三節 居住需求對居住型態之相關分析………………………………46 第六章 居住型態之分析 第一節 居住型態對個人基本特性之交叉分析……………………….48 第二節 銀髮小家庭居住滿意情形變項分析………………………….53 第三節 居住型態與居住需求各項滿意之相關分析………………….57 第四節 居住型態對整體生活滿意、經濟情況滿意、居住需求滿意之比較分析……………………………………..…………………60 第七章 結論與建議 第一節 結論………………………………………………………….63 第二節 建議………………………………………………………….70 附表 表1-6 ………………………………………………………………….76 附錄一 參考書目 中文書目…………………..…………………………………………….84 英文書目………………………………..……………………………….90 附錄二 問卷……………………………….…………………..93 表 目 錄 表1 台灣地區及美國65歲以上兩性人口之居住型態……………………………14 表2 受訪老人居住需求依平均分數排行……………………….……………….42 表3 銀髮小家庭老人個人基本特性對居住需求之單因子變異數分析………….45 表4 居住需求與居住型態之相關分析…………………………………………..47 表5 老人個人基本特性對居住型態、居住安排方式的卡方分析……………….51 表6 老人公寓老人與社區老人實際居住需求滿意程度的平均分數比較……….54 表7 老人公寓老人、社區不與子女同住老人之居住需求滿意度前十名比較…..56 表8 居住型態與居住滿意需求各項之相關分析…………………………………59 表9 居住型態對整體生活滿意度、經濟情況、子女、親友來往頻率之單因子 變異數分析…….………………………………………………………….61 表10 居住型態對心理社會適應、社會參與、專業諮詢與服務、設備環境需求 滿意之單因子變異數分析…………………………………………………61 表11 居住型態對居住需求、居住需求滿意之單因子變異數分析……………….61 圖 目 錄 圖1 受訪老人之居住安排方式比較長條圖…………………………………….34 圖2 受訪老人之性別比較長條圖………………………………………………34 圖3 受訪老人之籍貫比較長條圖………………………………………………34 圖4 受訪老人之教育程度比較長條圖………………………………………….34 圖5 受訪老人之宗教信仰比較長條圖………………………………………….34 圖6 受訪老人之婚姻狀況比較長條圖…………………………………..…….35 圖7 受訪老人之子女來往頻率比較長條圖…………………………………….35 圖8 受訪老人之親友來往頻率比較長條圖…………………………………….35 圖9 受訪老人之主要經濟來源比較長條圖…………………………………….36 圖10 受訪老人之一個月生活花費比較長條圖………………………………….36 圖11 受訪老人之生活費夠不夠用比較長條圖………………………………….37 圖12 受訪老人之經濟狀況比較長條圖………………………………………….37 圖13 受訪老人之健康狀況比較長條圖……..………………………………….38 圖14 受訪老人之主觀認為晚年該由誰負責比較長條圖…….………………..38 圖15 受訪老人之理想居住安排方式比較長條圖……………………………….38 圖16 受訪老人之整體生活滿意度比較長條圖………………………………….38 圖17 老人公寓老人得知老人公寓這項訊息之管道長條圖…………………….39 附 表 附表1 老人公寓老人個人基本特性資料次數分配表………………………………76 附表2 社區老人個人基本特性資料次數分配表…..………………………………78 附表3 老人公寓老人在選擇居住型態時的需求次數分配表…….…………………80 附表4 社區老人在選擇居住型態時的需求次數分配表……………………………81 附表5 老人公寓老人實際居住需求滿意次數分配表………………………………82 附表6 社區老人實際居住需求滿意次數分配表…………………………..………83 / Abstract This study explores housing and living arrangements of independent living elders and the differences in life satisfaction among citizens of independent living arrangements. The samples include 83 elderly people (over 60 years old) living in their own house and 81 elderly people (over 60 years old) living in congregate housing in Kaohsiung. The research result shows that independent living elders in congregate housing are higher level of life satisfaction than in their own house. According to overall statistics , the differences between elderly people living in their own house and elderly people living in congregate housing are the status of higher education and steadier income ( because most of them are soldiers or public servants ). Past researches always focus on community care needs of the disabled elderly , and I hope that after my study the authorities concerned can lay emphasis on the housing of all independent living elders in the future.

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred and forty older adults residing in 14 assisted living facilities in the Portland, Oregon metropolitan area were interviewed about the frequency and types of social interactions they experienced with members of their facility-based social networks, as well as depression, mood, loneliness, self-esteem, and self-rated health. A 12-item, two-factor model of humor-related social exchanges was identified through confirmatory factor analysis, including both positive and negative humor-related social exchange factors. The newly developed scale displayed evidence of adequate reliability and validly in the current sample. Results indicated that both positive and negative humor-related exchanges were associated with various aspects of mental health, although negative humor-related exchanges appeared to be a stronger predictor of mental health than positive humor-related exchanges. Both positive and negative humor-related exchanges also served as mediators between resident and facility characteristics and indicators of mental health. Cultivating a better understanding of the relationships between humor-related social exchanges and mental health may be beneficial for researchers interested in the way humor impacts older adults' ability to cope with stress. This research may also be of value to long-term care providers who create interventions designed at improving residents' mental health and overall quality of life.

This research project aims to clarify the factors that impact successful aging in Assisted Living facilities (ALFs) in Denton County, Texas. We hypothesize that social disengagement decreases physical and mental components of quality of life. This exploratory research project employed standardized questionnaires to assess residents in the following domains; HRQOL, social engagement status, level of cognition, depression, and the level of functioning. This study collected data from 75 participants living in five ALFs. The average of Physical Component Scale (PCS) and Mental Component Scale (MCS) was 35.33, and 53.62 respectively. None of the participants had five or more social contacts out of facilities, and two-third of them had two or less social contacts. On average, those participants who were more socially engaged had higher score of MCS compared with disengaged counterparts. The level of physical function significantly affects social engagement, when people with more disabilities are more likely to be socially disengaged. Social engagement and depression significantly impact MCS, when depression is a mediating factor between social engagement and mental component of quality of life. Considering the expansion in aging population in the United States within the next three decades, the demand for high quality long-term care will skyrocket consequently. This study reveals that external social engagement can sustain HRQOL of residents in assisted living facilities.