社會支持對老人靈性健康影響之研究：中介效果的驗證

Effect of Social Support on the Spiritual Health of Older Adults: Evaluation of the Mediation Effect

社會支持是老年生活中的重要資源之一，過去研究證實社會支持對老年生活品質有正向的直接影響。靈性健康為健康的一部分，在超高齡社會中，被視為全人關懷的重要觀點之一。本研究主要針對不同特質老人，藉由各類社會支持內涵（包括資訊支持、尊重支持、實質支持、情感支持），瞭解其對靈性健康的影響，並探討社會支持是否在個人特質及靈性健康間存在中介效果。研究對象為居住臺北市65歲以上社區老人，研究工具包括社會支持量表，修改自Iwasaki與Mannell（2000）量表，及臺灣老人靈性健康量表（石泱、李孟芬，2021）。資料收集期間為2019年9月至11月，共收回325份有效問卷，回收率為76.5%。採用結構方程模型及中介效果進行資料分析。研究結果顯示，本研究社會支持量表及老人靈性健康量表具有良好的信、效度，結構模型配適度符合標準。路徑分析結果顯示影響老人靈性健康的主要因素為社會支持、宗教信仰。整體社會支持介於自評經濟狀況、健康狀況與老人靈性健康間具有中介效果，社會支持各子構面以尊重支持具完全中介效果，但對宗教信仰具部分中介效果。最後，研究者針對老人、家人親友、專業服務提供者及未來研究，提出具體建議。

The average life expectancy of humans is on the rise; however, the quality of life is more important than the length of life. Spiritual health is a part of an individual's health and spiritual state; it refers to the dynamic process of balancing the internal and external states of an individual. The internal aspect of spiritual health refers to the integration of an individual's past, present, and future and the balancing of the body, mind, and spirit. The external aspect of spiritual health is related to harmonious coexistence with other people, objects, and nature. The present study focused on the spiritual health status of older adults, which refers to the harmonious coexistence of person, community, and environment as well as transcendence. Establishing a harmony spiritual status is particularly important, while older adults may face many life events, such retirement, disease, disability, widowhood,... etc. during their old age life. In a near future super-aged society, spiritual health is regarded as a key aspect of holistic care. Social support is a vital resource for older adults. It is the state in which individuals feel, perceive, accept care, or receive assistance from others in their support network. The main effects model suggests that regardless of the level of pressure, such as disease, retirement, widowhood, social support confers certain benefits in terms of improved physical and mental well-being. Relevant studies have validated that social support exerts a positive and direct effect on the quality of life of older adults. In this study, social support was categorized into four types: emotional, tangible, informational, and esteem support. Older adults were requested to self-assess their subjective feelings about each of the aforementioned types of social support. Social support reportedly enhances well-being in older adults. Studies have been conducted focusing primarily on the effect of social support on physical or mental health. Some studies have highlighted that a social support network functions as a mediator that affects the life satisfaction of older adults; it also reduces depression among these people, particularly due to the emotional support entailed by social support. The study was conducted because of the lack of relevant studies on the effect of social support on the spiritual health of older adults in Taiwan. We further evaluated the possible mediation effect of social support on factors influencing the spiritual health of older adults. This study included community-dwelling older adults aged ≥ 65 years who were living in Taipei City. Stratified random sampling was performed in 12 administrative districts. A total of 24 community senior care centers were randomly selected in consideration of the proportion of such centers in each district. For each of these centers, a particular number of samples was determined based on the total number of participants. The participants provided signed informed consent before the commencement of this study. Basic personal variables-independent variables-included the following influential parameters identified through a review of the empirical literature: religious beliefs, self-evaluated economic status, and perceived health status. Social support was used as a mediation variable to investigate its possible mediation effect. The survey was conducted between September and November 2019. A total of 425 questionnaires were distributed and 325 valid ovies were returned (recovery rate, 76.5%). A structural equation model was used in this study to evaluate the possible mediation effect of social support on factors influencing the spiritual health of older adults. The Social Support Scale, which is a modified version of the scale developed by Iwasaki and Mannel (2000), was used in the present study to assess the level of social support received by the study participants. This scale is divided into four dimensions-informational, esteem, tangible, and emotional support-and comprises a total of 14 questions. The responses are recorded on a 7-point scale, where a score of 1 indicates the strongest disagreement and that of 7 indicates the strongest agreement. Total mean scores were calculated for each dimension; a higher score indicated a higher level of social support. The results of confirmatory factor analysis revealed that the average variance extracted (AVE) value of each subscale was .63- .80, with an overall score of .78, and the composite reliability (CR) value was .84- .94, with an overall score of .93. Spiritual Health Scale for the Taiwanese Elderly (Li & Shih, 2021), which has four dimensions (personal, communal, environmental, and transcendental domains), was used in this study to evaluate the spiritual health of the study participants. The results of confirmatory factor analysis revealed that the AVE value of each subscale was between .61 and .79, with an overall score of .77, and the CR value was between .82 and .92, with an overall score of .93. Both of the aforementioned scales exhibited good reliability and validity. The results of the study demonstrated that the structural model fit appropriately and met the standard. The results of path analysis revealed that the primary factors influencing the spiritual health of perceived older adults were social support and religious belief. Overall social support exerted a positive effect on the spiritual health of older adults; it completely mediated the effect of self-evaluated economic status on spiritual health and partially mediated that of perceived health status. Future studies must give special consideration to economic status when investigating the spiritual health of older adults. Furthermore, esteem support, which is a sub-dimension of social support, exerted the highest level of effect on spiritual health. It completely mediated the effect of self-evaluated economic status on spiritual health and partially mediated those of perceived health status and religious belief. Finally, having or not having a religious belief directly affected the spiritual health of older adults. Only esteem support partially mediated the effect of religious belief on the spiritual health of older adults. This study suggests that older adults, who receive esteem, emotional, and informational supports from their social network, can have better spiritual health. Gerontological and family education for family members, professional elder service providers, and volunteers, can emphasize on the importance, the meaning, and value of social supports for older adults. The community senior care centers can provide a friendly climate and environment through an understanding of older adults' life experience with multidimensional supports. As noted, religious belief directly affects the spiritual health of older adults; however, it exerts no significant effect on the sub-dimensions of social support, except for esteem support. Therefore, older adults could be encouraged to cultivate a religious belief and participate spiritual activities that accord with their worldview. In addition, they could be motivated to explore the deeper meaning of life and death, which will help improve their spiritual health. Future studies should include older adults from both urban and rural communities and compare these communities in terms of the effects of social support on the spiritual health of older adults. Furthermore, whether the reciprocity of social support affects the spiritual health of community-dwelling older adults must be investigated.