The Health Concepts among Community-dwelling Elderly in Taipei

• Main Authors: Oi-I Chio, 趙靄儀
• Other Authors: Hui-Fen Mao
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/45689926560520034162

碩士 === 國立臺灣大學 === 職能治療研究所 === 97 === As the population is aging, elderly is now the prime customer group of health care services. Under the concept of client-centeredness, it is important for health professionals to understand the health concepts of lay elderly which may reflect their expectation and need for health care, in order to improve the effectiveness of services provided. The review of health concepts studies among elderly in the past ten years revealed that health concepts of elderly could be organized into a holistic and multidimensional construct. The ever identified dimensions include physical, functional, behavioral, psychological, spiritual and social ones. As can be seen from these studies, not only differences in combination of dimensions were discovered, different details were also identified in each of the six dimensions. Culture and lived experiences were then proposed to be the moderators of health concepts. Few studies have been conducted to explore the health concepts among elderly in Taiwan. Yet, similar results of multidimensional construct were drawn. The contribution made by such study results for the understanding of current health concepts, nevertheless, can be further extended by incorporating the contemporary social context as well as the Taiwanese cultural background and the unique experiences of each elder person. This gives rise to the objective of this study—to explore the health concepts among elderly living in Taipei City within their specific cultural context and lived experiences. In this exploratory stage of study, qualitative study methods of narrative interviewing and ethnographical observations were recruited. The collected data were then subjected to the reciprocal application of context analysis and categorical analysis which helped to identify the interaction of Taiwanese culture and life-course lived experience and unvail the meaning within every story narrated. Supplementary information was also provided by the collection of quantitative data. By having enrolled eight elderly participants aged 65 and above, this study has discovered a similar multidimensional model of health concept as in past studies, while with the emphasis placed on the effect of family relationship to overall health, a cultural-specific family dimension has been insolated from the general social dimension. Another interesting finding was that though an ideal physical health state (physical dimension) was the most frequently mentioned health indicator, functional and other dimensions of health were ready to be the substitute(s) when the physical health declined with age. This can be viewed as an adaptation process enabled by the flexibility inscribed in the multidimensional health model, and directed by individual experiences and cultural values. Such process may involve the consecutive steps of goal selection or reidentification, skills and resources optimization as well as compensation, just as described in the model of Selection, Optimization, and Compensation (SOC). Nevertheless, one should also observed the influence of cultural background, personal experience and values in order to better under the adaptation process and other health related issues, as well as some other special findings of this study (such as the scarce mentioning of using compensation stretigies in adaptation). In the current study, it was found that the history of Taiwan being colonized and going through the continued conflicts among population groups has given rise to the elder people’s expectation of being respected and their need for a well-represented self image. This discovery showed that elder people expect to be connected with the outside world, but in various ways depending on how they value such connection and their corresponding position on the continuum reflecting the constitution of individuality and sociality—a concept proposed to signify the development of Taiwanese consciousness. By perceiving such importance of culture and experiences, health care professionals are able to observe more sensitively the cultural specificity and individuality within one’s health concepts during health care service provision. Furthermore, it is found that life review was able to act as the bridge between personal motive and current environmental resources. This meaning making process can then produce a sense of self continuity which helps to generate and maintain the self concept, sense of integrity, and positive attidutes toward life and future. The integration of the above findings provides an important basis for the collaboration between health professional and elder people so as to fulfill a truly client-centered service.