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Please use this identifier to cite or link to this item: http://hdl.handle.net/10285/1270

NII Resource type: Thesis or Dissertation
Title: 日本における前期高齢女性の家族以外の身近な他者との交流関係と健康認識の確認
Other Titles: Correlation between Close Social Relationships with Non-Family Members and Health Perceptions in Younger Elderly Women in Japan.
Authors: 大森, 純子
Author-transcription: オオモリ, ジュンコ
Advisor: 麻原, きよみ
Keywords: 前期高齢女性
家族以外の身近な他者
社会関係
健康認識
An investigating method or the measure : MOS 36-Items Short-Form Health Survey (SF-36 v2) バージョン2 日本語版
『気遣い合的日常交流』尺度 (DMC Scale)
Issue Date: 10-Mar-2005
Abstract: 1.研究の背景  高齢社会のわが国では、今後、団塊の世代の高齢期への移行に伴う前期高齢者人口の増大が見込まれ、自立度の高いこの人口集団に対する、人生の質の向上を支援する保健福祉活動への期待が高まっている。とりわけ、高齢期に入った女性は、年代特有の身体的、心理社会的な危機に遭遇することから、主体的な健康増進の支援が必要であると考える。  これまで、地域における保健福祉活動において仲間づくりとして活用されてきた家族以外の他者との社会関係は、高齢者の主観に基づく健康において重要であると考えられる。しかし、日常生活の中の友人や近隣者など身近な他者との具体的な交流のあり様やその意味、およびこのような社会的な側面が健康とどのように関連するかについては明らかにされていない。そのため、効果的活動のための理論的根拠が求められている。 2.研究の目的・意義  本研究では、質的および量的研究を用いて、前期高齢女性の家族以外の身近な他者との交流関係の意味と特徴を記述し、この交流関係と健康認識との関連について検討を行う。  このことにより、高齢者の保健福祉分野における教育・実践・研究活動に高齢者の主観に基づいた健康の捉え方とその必要性を提言でき、有用な理論的根拠を提示できると考える。 3.予備研究  日本における前期高齢女性の家族以外の身近な他者との交流関係の特徴を記述することにより、概念化を行うために予備研究を行った。  前期高齢女性の家族以外の身近な他者との交流関係は、『気遣い合い的日常交流』における相互行為とその目的により特徴づけることができた。前期高齢女性は、【家族の中で居場所を失う】、【生きる意欲が失せる】、【自分の老い先がわからない】という現実にありながらも、家族以外の身近な他者との【同年代の境遇を分かち合う】、【互いの日常に関心を寄せ合う】、【日常的な交流を継続させる】、【適度な距離感を保ち合う】相互行為を通じて、【自分の居場所が見出せる】、【今日を生きる意欲が得られる】、【今の自分が確かめられる】ことができ、日々を繋いで自分なりの人生を生きることができていた。  前期高齢女性にとって身近な他者との『気遣い合い的日常交流』は、社会的側面の健康認識の要素であると同時に、健康感を保持する手段と考えられた。 4.研究方法  高齢者の主観に基づく健康の概念分析、高齢者の社会関係と健康に関する文献検討、および予備研究の結果をもとに理論的枠組みを作成し、仮説モデルとした。本研究では、『気遣い合い的日常交流』を社会的側面の一要素とし、健康感を構成する身体的、精神的、社会的側面の3側面の健康認識の相互関連を検討した。  1)理論的枠組み:仮説モデル  前期高齢女性の健康感は、身体的、精神的、社会的3側面の健康認識で構成される。先行要因には、人口学的要因と個人の身体的、精神的、社会的要因があり、帰結には、自身にとっての健康の創造と獲得という行動レベルの帰結と、自分なりの人生を生きられるという認知レベルがあるとした。  2)調査  日本の人口構造を代表する大都市近郊のベッドタウンに居住する65歳から74歳までの女性1,000人を無作為抽出し、郵送法による自己記入式質問紙調査を行なった。測定用具として、社会的側面の健康認識には、予備研究から抽出された7つの構成概念をもとに作成した『気遣い合い的日常交流』尺度(DMC尺度,Cronbach'sα0.85)、および身体的、精神的側面の健康認識には、標準化された健康関連QOL尺度(MOS 36-Items Short-Form Health Survey 日本語版バージョン2, Cronbach'sα0.93)を用いた。フェイスシートには、人口学的背景、身体的、精神的、社会的背景に関する項目を含めた。  3)分析  因子分析を行い、『気遣い合い的日常交流』の構成概念を決定し、次いで、共分散構造分析を用いて、社会的側面の健康認識の一要素としての『気遣い合い的日常交流』の構成概念と、身体的、精神的側面の健康認識との関連を説明する採用モデルについて、先行要因の関連性への影響を含めて検討した。 5.結果  調査協力に対して賛同の得られた647人(回収率:64.7%)から質問紙の返信が得られた。回収された質問紙647のうち、有効回答は602で、そのうち自力で外出できない者20人、身近な他者との付き合いのない者57人を除外した525人を分析の対象とした。分析の対象者の年齢は、65歳から74歳の範囲で、平均値68.9歳(SD2.76)であった。  1)『気遣い合い的日常交流』の構成概念  因子分析から、<自己存在の確認>、<日常的相互関心>、<共感的相互理解>、<適度な距離感>の4因子が抽出された。次いで、共分散構造分析により、これらの構成概念の関係を検討した結果、互いに<適度な距離感>を維持することで、<日常的相互関心>と<共感的相互理解>の相互行為を継続させようとし、これらの相互行為を通じて、『気遣い合い的日常交流』の目的である<自己存在の確認>を行うことがきると解釈された(GFI=0.927,RMSEA=0.069)。  2)『気遣い合い的日常交流』と身体的および精神的側面の健康認識の関連  共分散構造分析における採用モデルでは、身体的側面の健康認識と精神的側面の健康認識の間には高い相関があり、<共感的相互理解>から精神的側面の健康認識と身体的側面の健康認識に向かう弱い正の影響が確認された。しかし、『気遣い合い的日常交流』の目的である<自己存在の確認>と身体的、および精神的側面の健康認識との間には、有意な関連は認められなかった(GFI=0.930,RMSEA=0.045)。また、先行要因による、これら3側面の健康認識の相互関連性への影響は認められなかった。 6.考察・結論  社会的側面の健康認識が身体的、精神的側面の健康認識を高める作用の可能性としては、同年代の同性の他者と比較することで、自分だけではないことを認識することによって、身体的、精神的側面の健康認識の現状を維持できるのではないかと推察される。また、関連が弱かった理由には、他にも家族との交流、仕事や役割に関する認識など、前期高齢女性にとって社会的側面の健康認識となる要素の存在が考えられる。  一方、交流の目的である<自己存在の確認>と身体的、および精神的側面の健康認識との間に関連がなかったことから、本研究で示された『気遣い合い的日常交流』は、自身の身体の状態や精神状態についての認識に関わりなく、他者との相互行為の円滑さの認識とそこから得ることのできる生の充足感の認識の存在を示し、高齢者の主観に基づく健康・Quality of Lifeを示す概念であると考えられた。加齢に伴い気力体力の衰えを切実に感じ始める前期高齢女性は、社会的側面の健康認識をより価値づけることによって、相補的に健康感を保持している可能性も考えられる。  本研究からは、身体、精神、社会という既存の枠組みから各側面を個別に捉えるのでなく、多側面の総体として、高齢者の主観に基づく健康を捉える必要性が示唆され、社会的側面に着目することの重要性が示された。また、日常生活の範囲内の身近な地域における近隣他者との社会的な交流そのものが高齢者の主体的な健康増進において有用であることの根拠が示された。高齢者の保健福祉分野における実践活動において、この身近な地域における社会関係を活用することの意義と、具体的な支援方略に関する示唆を得た。
Abstract-Alternative: 1. Background of the Study Japan is faced with an aging society, and hereafter as the baby boom generation becomes senior citizens the younger elderly population is expected to increase. Therefore, there are heightened expectations for health and welfare (well-being) activities that will support the improvement of the quality of life for this highly independent population group. In particular, since women who have entered their senior years encounter the physical, psychological and social crises characteristic of their age group, it is believed to be necessary to provide assistance for independent health promotion. Heretofore, the thinking behind regional health and welfare (well-being) activities has been that an important factor in the formation of elderly people's subjective perception of their own health is social relationships with non-family members, which have been used as a way of building friendship circles. Nevertheless, there has been no analysis of the state of concrete interactions with friends, neighbors and other close non-family members in one's daily life and what their significance is, and, how health is related to these social factors. It is for this reason that a theoretical basis for effective activities is needed. 2. This Study's Objective and Significance Using qualitative and quantitative research, this study describes the significance and characteristics of social relationships between younger elderly women and non-family members, and examines the correlation between this type of social relationship and health perception. Through doing so, this study will be able to suggest how elderly people's subjectively perceive their own health and the importance of this perception, and be able to present a useful theoretical basis for educational, practice and research activities in the field of health and welfare (well-being) of the elderly. 3. Preliminary Study A preliminary study was conducted to conceptualize the social relationships of younger elderly women in Japan with close non-family members by describing the characteristics of these relationships. The social relationships of younger elderly women with close non-family members can be characterized by mutual actions through "Daily Mutual Caring Interactions" and the objectives of such actions. Younger elderly women are faced with the realities of <losing their place in their families>, <the weakening of the will to live> and <not knowing what lies ahead in old age>. Nevertheless, they have <found their own places to be themselves>, <the will to live each day> and <their own identity>, allowing them to connect each day and live their own lives. They have achieved this through mutual actions with close non-family members in the form of <sharing their experiences with members of the same age group>, <being concerned for each others' daily lives>, <maintaining their daily interactions> and <maintaining an appropriate distance between each other>. It is believed that for younger elderly women "Daily Mutual Caring Interactions" with close non-family members is a component of the social aspect of health perception and at the same time a means of maintaining their own sense of health. 4. The Study's Methodology This study created a Proposal Model by preparing a theoretical framework based on the concept analysis of elderly people's subjective perception of their own health, an examination of literature concerning the social relationships of the elderly and their health, and the results of the preliminary study. This study then examined the correlation of three facets of health perception, the physical, psychological, and social aspects of a person's sense of health, by deeming "Daily Mutual Caring Interactions" to be one component of the social aspect. 1)Theoretical Framework: Proposal Model The sense of health of younger elderly women is composed of the three facets of health perception, the physical, psychological, and social aspects. The antecedents include demographic factors and individual's physical, psychological, and social factors. In addition, the consequential occurrences are at the behavioral level of creating and obtaining health as one perceives health to be and at the acknowledgement level of being able to live one's own life. 2)Survey The survey randomly selected 1,000 women between the ages of 65 and 74, living in bed town communities surrounding large cities, which are representative of the population structure of Japan. The subjects were surveyed by mailing them questionnaires that they were to fill in on their own. The tools used for measuring the social aspect of health perception were the items to measure "Daily Mutual Caring Interactions" (DMC scale, Cronbach'sα0.85). These were prepared based on the seven constructs extracted from the preliminary study. In addition, the tools used for measuring the physical and psychological aspects of health perception were the standardized health related scale (MOS 36-Item Short-Form Health Survey - Japanese Version 2, Cronbach'sα0.93). The face sheet included items related to demographic factors and physical, psychological and social factors. 3)Analysis A factor analysis was carried out to determine the construct of "Daily Mutual Caring Interactions," and followed by using structural equation modeling. The model explained the relationship between the construct of "Daily Mutual Caring Interactions," as one component of the social aspect of health perception, and the physical and psychological aspects of health perception. Then, additional analysis was included effect from antecedents in correlation on the model. 5. Results The survey obtained the cooperation of 647 people, who answered and mailed back the questionnaire (representing a recovery rate of 64.7%). Of the 647 questionnaires recovered, 602 were valid. From these, the study then eliminated as subjects of analysis the 20 people who indicated that they could not go out alone and the 57 people who replied that they had no interactions with non-family members living close by. This left 525 people as subjects of analysis. The subjects for analysis ranged in age from 65 to 74 years old, with the average age being 68.9 (SD2.76). 1)The Construct of "Daily Mutual Caring Interactions" Four factors were extracted from factor analysis: <confirmation of one' own identity>, <mutual concern for each other's daily lives>, <sympathetic mutual understanding>, and <an appropriate distance between each other>. Structural equation modeling was then used to study how these four constructs were related. As a result, it was interpreted that younger elderly women endeavor to continue to maintain the mutual actions of <mutual concern for each other's daily lives> and <sympathetic mutual understanding> by maintaining <an appropriate distance between each other>. Furthermore, it is through these mutual actions that they are able to <confirm their own identity>, which is the objective of "Daily Mutual Caring Interactions" (GFI=0.927, RMSEA=0.069). 2)Relationship between "Daily Mutual Caring Interactions" and the Physical and Psychological Aspects of Health Perception In the model that was used in structural equation modeling, there was a high correlation between the physical aspect of health perception and the psychological aspect of health perception. A weak positive effect was confirmed from <sympathetic mutual understanding> toward the psychological aspect of health perception and the physical aspect of health perception. However, no significant relationship was confirmed between <confirmation of one' own identity>, the objective of "Daily Mutual Caring Interaction," and the physical and psychological aspects of health perception (GFI=0.930, RMSEA=0.045). In addition, no effect from antecedents was confirmed in the correlation among these three aspects of health perception. 6. Examination of the Facts and Conclusions It is inferred from these results that there is the possibility that the social aspect of health perception may work to enhance the physical and psychological aspects of health perception. It might be that younger elderly women are able to maintain the existing state of the physical and psychological aspects of their health perception by comparing themselves with other women of the same age group and perceiving that they are not the only ones. In addition, a conceivable reason that the correlation was weak is that there exist other factors in the social aspect of health perception for younger elderly women, such as their interactions with family members and their perceptions concerning their jobs or roles. On the other hand, there was no relationship between <confirmation of one' own identity>, the objective of interactions, and the physical and psychological aspects of health perception. Consequently, it is conceivable that "Daily Mutual Caring Interactions," which this study pointed out, is a concept that is unrelated to people's perception of their physical or psychological conditions. Rather, it is a concept that indicates the existence of the recognition of the smoothness of mutual actions with others and of the recognition of the sense of satisfaction with life that can be obtained from that. Furthermore, it is a concept that indicates elderly people's subjective perception of their own health and quality of life. Younger elderly women seriously begin to feel the decline of their vigor and strength as they age. The possibility is conceivable that they retain their health perception in a complementary manner by placing more value on the social aspect of health perception. This study suggests that one should not look at each aspect of the existing framework: physical, psychological, and social, separately. It is necessary to view elderly people's subjective perception of their own health as a multi-faceted whole. Furthermore, this study pointed out the importance of directing one's attention to the social aspect. In addition, it indicated evidence that social interactions themselves with close non-family members living nearby within the scope of people's daily life activities are useful in elderly people enhancing their health on their own. This study indicated the significance of effectively utilizing social relations in nearby areas in practical activities in the field of health and welfare of the elderly and obtained suggestions for concrete support measures.
Official announcement place: 大森純子. 前期高齢女性の家族以外の身近な他者との交流関係に関する質的記述的研究 - 関係性の特徴:『気遣い合い的日常交流』 - .老年社会科学. 27(3):303-313. (2005)
Description: 聖路加看護大学大学院看護学研究科博士論文
Degree field : 博士(看護学)
URI: http://hdl.handle.net/10285/1270
Appears in Collections:2-3-b:博士論文(要旨あり)

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