背景：孤獨感包含情緒性與社會性構面，日常生活活動能力（activities of daily living, ADL）受限可能限制線下互動與社會參與。本研究使用臺灣中老年身心社會生活狀況長期追蹤調查（Taiwan Longitudinal Study on Aging, TLSA）2019 年與 2023 年資料，檢驗ADL受限題數、數位健康識能、線上聯絡、線下社會連結與情緒性孤獨、社會性孤獨及孤獨總分之縱貫關聯，並檢驗2019年ADL受限題數經由2023年線下社會參與，對2023年孤獨之可能路徑、線上聯絡與數位健康識能對2023年孤獨之緩衝作用，以及線上聯絡與線下社會連結對2023年孤獨之交互作用。
方法：納入2019年滿50歲、完成兩波資料收集完整者1,995人；年齡中位數平均64.64 ± 6.69歲，男性52.3%。採成對樣本t檢定、階層線性迴歸、bootstrap可能路徑、交互作用及敏感性分析；模型控制背景變項，未加權且未納入基線孤獨感。
結果：自2019到2023年間，研究參與者的情緒性孤獨顯著減少，而社會性孤獨與孤獨總分顯著增加。2019年ADL障礙數越多者，其2023年情緒性孤獨與孤獨總分顯著較高；2019年ADL受限題數經由2023年線下社會參與，與2023年社會性孤獨及孤獨總分呈顯著間接關聯；2019年線上聯絡愈頻繁及線下社會連結愈強，與2023年較低的社會性孤獨及孤獨總分相關；2019年數位健康識能與2023年情緒性孤獨、社會性孤獨及孤獨總分之直接關聯均未達顯著；其與ADL受限題數之交互作用對上述三項孤獨結果亦均未達顯著。
結論： 2019 年 ADL的障礙數與 2023 年情緒性孤獨及孤獨總分呈正向關聯，功能受限越多其情緒性孤獨越高。較低的2023年線下社會參與及較弱的2019年線下社會連結，分別與較高的2023年社會性孤獨相關。2019年線上聯絡與2023年較低的社會性孤獨及孤獨總分相關，可能提供補充性連結；然而，線上聯絡與線下社會連結之交互作用未達顯著，未支持兩者具有明確的互補或替代效果。數位健康識能亦未呈現顯著的跨期預測或調節作用。

Loneliness includes emotional and social dimensions, and limitations in activities of daily living (ADL) may restrict social interaction and participation. This study used the 2019 and 2023 waves of the Taiwan Longitudinal Study on Aging (TLSA) to examine the longitudinal associations of ADL limitations, digital health literacy, online contact, and offline social connectedness with emotional loneliness, social loneliness, and total loneliness. It also examined whether 2023 offline social participation formed a possible indirect pathway between ADL limitations and loneliness, whether digital health literacy predicted later online contact, whether online contact and digital health literacy buffered associations between ADL limitations and loneliness, and whether online contact interacted with offline social connectedness in relation to loneliness.The main analytic sample included 1,995 adults aged 50 years or older who completed both waves. Emotional loneliness decreased from 2019 to 2023, whereas social loneliness and total loneliness increased. More ADL limitations were associated with higher emotional loneliness and total loneliness. Significant indirect effects through offline social participation were found for social loneliness and total loneliness, but not for emotional loneliness. More frequent online contact and stronger offline social connectedness were associated with lower social loneliness and total loneliness. Digital health literacy in 2019 was not significantly associated with loneliness in 2023 and did not predict online contact in 2023. The interactions between ADL limitations and digital health literacy and online/offline social connectedness were not significant for loneliness

Adler, N. E., Epel, E. S., Castellazzo, G., & Ickovics, J. R. (2000). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy White women. Health Psychology, 19(6), 586–592. https://doi.org/10.1037/0278-6133.19.6.586
Akhter-Khan, S. C., & Au, R. (2020). Why loneliness interventions are unsuccessful: A call for precision health. Advances in Geriatric Medicine and Research, 2(3), e200016. https://doi.org/10.20900/agmr20200016
Akhter-Khan, S. C., Ell, T., Buck, L., Haucke, M., Luchetti, M., Li, L., Ong, A., Chua, K.-C., Mayston, R., Prina, M., Liu, S., & Wong, G. (2025). Development of the social relationship expectations scale: Protocol for a multi-country, multi-method observational study. BMJ Open, 15(11), Article e101319. https://doi.org/10.1136/bmjopen-2025-101319
Akhter-Khan, S. C., Prina, M., Wong, G. H.-Y., Mayston, R., & Li, L. (2023). Understanding and addressing older adults’ loneliness: The social relationship expectations framework. Perspectives on Psychological Science, 18(4), 762–777. https://doi.org/10.1177/17456916221127218
Arcury, T. A., Sandberg, J. C., Melius, K. P., Quandt, S. A., Leng, X., Latulipe, C., Miller, D. P., Jr., Smith, D. A., & Bertoni, A. G. (2020). Older adult Internet use and eHealth literacy. Journal of Applied Gerontology, 39(2), 141–150. https://doi.org/10.1177/0733464818807468
Arias López, M. del P., Ong, B. A., Borrat Frigola, X., Fernández, A. L., Hicklent, R. S., Obeles, A. J. T., Rocimo, A. M., & Celi, L. A. (2023). Digital literacy as a new determinant of health: A scoping review. PLOS Digital Health, 2(10), e0000279. https://doi.org/10.1371/journal.pdig.0000279
Aroogh, M. D., & Shahboulaghi, F. M. (2020). Social participation of older adults: A concept analysis. International Journal of Community Based Nursing and Midwifery, 8(1), 55–72. https://doi.org/10.30476/ijcbnm.2019.82222.1055
Ayalon, L. (2019). Subjective social status as a predictor of loneliness: The moderating effect of the type of long-term care setting. Research on Aging, 41(10), 915–935. https://doi.org/10.1177/0164027519871674
Bai, Z., Wang, Z., Shao, T., Qin, X., & Hu, Z. (2021). Association between social capital and loneliness among older adults: A cross-sectional study in Anhui Province, China. BMC Geriatrics, 21(1), 26. https://doi.org/10.1186/s12877-020-01973-2
Balder, J. A. (2007). Social support and the extraversion-introversion continuum (Graduate Research Papers, 1312). University of Northern Iowa. https://scholarworks.uni.edu/grp/1312
Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1–34). Cambridge University Press. https://doi.org/10.1017/CBO9780511665684.003
Barakat, C., & Konstantinidis, T. A. (2023). A review of the relationship between socioeconomic status change and health. International Journal of Environmental Research and Public Health, 20, 6249. https://doi.org/10.3390/ijerph20136249
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
Birati, Y., & Tzemah-Shahar, R. (2026). Barriers to digital health adoption in older adults: Scoping review informed by innovation resistance theory. Journal of Medical Internet Research, 28, e75591. https://doi.org/10.2196/75591
Boss, L., Kang, D.-H., & Branson, S. (2015). Loneliness and cognitive function in the older adult: A systematic review. International Psychogeriatrics, 27(4), 541–553. https://doi.org/10.1017/S1041610214002749
Bourdieu, P. (1986). The forms of capital. In J. G. Richardson (Ed.), Handbook of theory and research for the sociology of education (pp. 241–258). Greenwood.
Buecker, S., Horstmann, K. T., Krasko, J., Kritzler, S., Terwiel, S., Kaiser, T., & Luhmann, M. (2020). Changes in daily loneliness for German residents during the first four weeks of the COVID-19 pandemic. Social Science & Medicine, 265, Article 113541. https://doi.org/10.1016/j.socscimed.2020.113541
Buffel, T., Handler, S., & Phillipson, C. (2018). Developing age-friendly cities and communities: A manifesto for change. In T. Buffel, S. Handler, & C. Phillipson (Eds.), Age-friendly cities and communities: A global perspective (1st ed., pp. 273–288). Policy Press. https://doi.org/10.2307/j.ctt1zrvhc4.21
Cacioppo, J. T., Hawkley, L. C., & Thisted, R. A. (2010). Perceived social isolation makes me sad: Five-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging, 25(2), 453–463. https://doi.org/10.1037/a0017216
Cao, C., Cao, W., Zheng, X., Ji, K., Wu, Y., Hu, Z., Chen, R., & Bai, Z. (2023). Association of social capital with self-perceived eHealth literacy among community-dwelling older people: Age and gender differences. Frontiers in Public Health, 11, 1088863. https://doi.org/10.3389/fpubh.2023.1088863
Card, N. A. (2023). Social connections and loneliness: A nuanced view of introversion. Frontiers in Psychology, 14, 1032804. https://doi.org/10.3389/fpsyg.2023.1032804
Chan, S. C. Y., Huang, Q. L., & Fung, C. K. (2024). Associations among social participation types, mental and subjective well-being in Chinese older adults during the COVID-19 pandemic. Geriatrics & Gerontology International, 24 (Suppl 1), 364–369. https://doi.org/10.1111/ggi.14675
Chao, S.-F., Yu, M.-H., & Tung, Y.-H. (2024). Environment profiles, social participation patterns, depressive symptoms, and quality of life of disabled older adults: A longitudinal investigation. Aging & Mental Health, 28(1), 62–72. https://doi.org/10.1080/13607863.2023.2249834
Chen, B., Covinsky, K. E., Stijacic Cenzer, I., Adler, N., & Williams, B. A. (2012). Subjective social status and functional decline in older adults. Journal of General Internal Medicine, 27(6), 693–699. https://doi.org/10.1007/s11606-011-1963-7
Chen, Y.-R. R., & Schulz, P. J. (2016). The effect of information communication technology interventions on reducing social isolation in the elderly: A systematic review. Journal of Medical Internet Research, 18(1), e18. https://doi.org/10.2196/jmir.4596
Chiao, C., Weng, L.-J., & Botticello, A. L. (2011). Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan. BMC Public Health, 11, 292. https://doi.org/10.1186/1471-2458-11-292
Chiu, C.-J., Hou, S.-Y., Kobayashi, E., Lin, Y.-C., Chen, Y.-A., Murayama, H., Okamoto, S., Chen, Y.-H., & Huang, Y.-J. (2025). Reversed loneliness development after age 65 for men and women: Modeling of the age trajectories of loneliness using national cohorts in Taiwan and Japan. Geriatrics & Gerontology International, 25(4), 620–627. https://doi.org/10.1111/ggi.70022
Chiu, C.-J., Hsieh, S., & Li, C.-W. (2021). Needs and preferences of middle-aged and older adults in Taiwan for companion robots and pets: Survey study. Journal of Medical Internet Research, 23(6), e23471. https://doi.org/10.2196/23471
Chiu, C.-J., Lo, Y.-H., Ho, M.-H., Montayre, J., & Zhao, I. Y. (2022). Association between loneliness and acceptance of using robots and pets as companions among older Chinese immigrants during the COVID-19 pandemic. Australasian Journal on Ageing, 41(3), 414–423. https://doi.org/10.1111/ajag.13075
Chiu, C.-J., Yang, M.-C., Huang, C.-C., & Chang, C.-M. (2021). From disability to death: A 20-year follow-up from the Taiwan Longitudinal Study on Aging. Clinical Interventions in Aging, 16, 1813–1823. https://doi.org/10.2147/CIA.S321640
Choi, N. G., Choi, B. Y., & Marti, C. N. (2025). Digital divide among homebound and semi-homebound older adults. Journal of Applied Gerontology, 44(6), 970–980. https://doi.org/10.1177/07334648241292971
Choi, N. G., & DiNitto, D. M. (2013). The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use. Journal of Medical Internet Research, 15(5), e93. https://doi.org/10.2196/jmir.2645
Chopik, W. J. (2016). The benefits of social technology use among older adults are mediated by reduced loneliness. Cyberpsychology, Behavior, and Social Networking, 19(9), 551–556. https://doi.org/10.1089/cyber.2016.0151
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310
Cohen-Mansfield, J., Hazan, H., Lerman, Y., & Shalom, V. (2016). Correlates and predictors of loneliness in older-adults: A review of quantitative results informed by qualitative insights. International Psychogeriatrics, 28(4), 557–576. https://doi.org/10.1017/S1041610215001532
Cotten, S. R., Anderson, W. A., & McCullough, B. M. (2013). Impact of internet use on loneliness and contact with others among older adults: Cross-sectional analysis. Journal of Medical Internet Research, 15(2), e39. https://doi.org/10.2196/jmir.2306
Cullen, E. (2021). Digital literacy as a predictor of health literacy [Master’s thesis, National Taiwan University]. National Taiwan University Institutional Repository. https://doi.org/10.6342/NTU202104044
Cundiff, J. M., & Matthews, K. A. (2017). Is subjective social status a unique correlate of physical health? A meta-analysis. Health Psychology, 36(12), 1109–1125. https://doi.org/10.1037/hea0000534
Dahlberg, L., & McKee, K. J. (2014). Correlates of social and emotional loneliness in older people: Evidence from an English community study. Aging & Mental Health, 18(4), 504–514. https://doi.org/10.1080/13607863.2013.856863
De Jong Gierveld, J., Broese van Groenou, M., Hoogendoorn, A. W., & Smit, J. H. (2009). Quality of marriages in later life and emotional and social loneliness. Journal of Gerontology: Social Sciences, 64B(4), 497–506. https://doi.org/10.1093/geronb/gbn043
De Jong Gierveld, J., Dykstra, P. A., & Schenk, N. (2012). Living arrangements, intergenerational support types and older adult loneliness in Eastern and Western Europe. Demographic Research, 27(7), 167–200. https://doi.org/10.4054/DemRes.2012.27.7
De Jong Gierveld, J., & Van Tilburg, T. (2006). A 6-item scale for overall, emotional, and social loneliness: Confirmatory tests on survey data. Research on Aging, 28(5), 582–598. https://doi.org/10.1177/0164027506289723
De Jong Gierveld, J., & Van Tilburg, T. (2010). The De Jong Gierveld short scales for emotional and social loneliness: Tested on data from 7 countries in the UN Generations and Gender Surveys. European Journal of Ageing, 7(2), 121–130. https://doi.org/10.1007/s10433-010-0144-6
Demakakos, P., Nazroo, J., Breeze, E., & Marmot, M. (2008). Socioeconomic status and health: The role of subjective social status. Social Science & Medicine, 67(2), 330–340. https://doi.org/10.1016/j.socscimed.2008.03.038
Douglas, H., Georgiou, A., & Westbrook, J. (2017). Social participation as an indicator of successful ageing: An overview of concepts and their associations with health. Australian Health Review, 41(4), 455–462. https://doi.org/10.1071/AH16038
Drost, M. A., Snyder, A. R., Betz, M., & Loibl, C. (2024). Financial strain and loneliness in older adults. Applied Economics Letters, 31(9), 845–848. https://doi.org/10.1080/13504851.2022.2152421
Duppen, D., Lambotte, D., Dury, S., Smetcoren, A.-S., Pan, H., & De Donder, L.; D-SCOPE Consortium. (2020). Social participation in the daily lives of frail older adults: Types of participation and influencing factors. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 75(9), 2062–2071. https://doi.org/10.1093/geronb/gbz045
Eto, M., & Yamatsu, K. (2024). Associations of eHealth literacy with social activity among community-dwelling older adults: A cross-sectional study. European Journal of Investigation in Health, Psychology and Education, 14(5), 1279–1294. https://doi.org/10.3390/ejihpe14050084
Feng, Z. (2018). Childlessness and vulnerability of older people in China. Age and Ageing, 47(2), 275–281. https://doi.org/10.1093/ageing/afx137
Flett, G. L. (2022). An introduction, review, and conceptual analysis of mattering as an essential construct and an essential way of life. Journal of Psychoeducational Assessment, 40(1), 3–36. https://doi.org/10.1177/07342829211057640
Freund, A. M., & Baltes, P. B. (2002). Life-management strategies of selection, optimization, and compensation: Measurement by self-report and construct validity. Journal of Personality and Social Psychology, 82(4), 642–662. https://doi.org/10.1037/0022-3514.82.4.642
Fuller, H. R., Huseth-Zosel, A., Hofmann, B., Van Vleet, B., Kinkade, E., Carlson, S. L., & Sturn, E. (2022). Shifts in older adults’ social connections throughout the initial year of the COVID-19 pandemic. The Gerontologist, 62(8), 1160–1172. https://doi.org/10.1093/geront/gnac030
Galobardes, B., Shaw, M., Lawlor, D. A., Lynch, J. W., & Davey Smith, G. (2006). Indicators of socioeconomic position (part 1). Journal of Epidemiology and Community Health, 60(1), 7–12. https://doi.org/10.1136/jech.2004.023531
Goldman, N., Cornman, J. C., & Chang, M.-C. (2006). Measuring subjective social status: A case study of older Taiwanese. Journal of Cross-Cultural Gerontology, 21, 71–89. https://doi.org/10.1007/s10823-006-9020-4
Graf, C. (2008). The Lawton Instrumental Activities of Daily Living Scale. The American Journal of Nursing, 108(4), 52–62. https://doi.org/10.1097/01.NAJ.0000314810.46029.74
Green, M. J., Whitley, E., Niedzwiedz, C. L., Shaw, R. J., & Katikireddi, S. V. (2021). Social contact and inequalities in depressive symptoms and loneliness among older adults: A mediation analysis of the English Longitudinal Study of Ageing. SSM - Population Health, 13, 100726. https://doi.org/10.1016/j.ssmph.2021.100726
Gunnes, M., Løe, I.-C., & Kalseth, J. (2024). Exploring the impact of information and communication technologies on loneliness and social isolation in community-dwelling older adults: A scoping review of reviews. BMC Geriatrics, 24, 215. https://doi.org/10.1186/s12877-024-04837-1
Hagani, N., Clare, P. J., Luo, M., Merom, D., Smith, B. J., & Ding, D. (2024). Effect of retirement on loneliness: A longitudinal comparative analysis across Australia, China and the USA. Journal of Epidemiology and Community Health, 78(10), 602–608. https://doi.org/10.1136/jech-2023-221606
Hajek, A., Kretzler, B., & König, H.-H. (2020). Multimorbidity, loneliness, and social isolation: A systematic review. International Journal of Environmental Research and Public Health, 17(22), 8688. https://doi.org/10.3390/ijerph17228688
Hanass-Hancock, J., Kamalakannan, S., Murthy, G. V. S., Palmer, M., Pinilla-Roncancio, M., Rivas Velarde, M., Tetali, S., & Mitra, S. (2023). What cut-off(s) to use with the Washington Group short set of questions? Disability and Health Journal, 16, 101499. https://doi.org/10.1016/j.dhjo.2023.101499
Harpham, T., Grant, E., & Thomas, E. (2002). Measuring social capital within health surveys: Key issues. Health Policy and Planning, 17(1), 106–111. https://doi.org/10.1093/heapol/17.1.106
Hawkley, L. C., Zheng, B., & Song, X. (2020). Negative financial shock increases loneliness in older adults, 2006–2016: Reduced effect during the Great Recession (2008–2010). Social Science & Medicine, 255, 113000. https://doi.org/10.1016/j.socscimed.2020.113000
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford Press.
Heo, J., Chun, S., Lee, S., Lee, K. H., & Kim, J. (2015). Internet use and well-being in older adults. Cyberpsychology, Behavior, and Social Networking, 18(5), 268–272. https://doi.org/10.1089/cyber.2014.0549
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352
Hsu, H.-C. (2020). Typologies of loneliness, isolation and living alone are associated with psychological well-being among older adults in Taipei: A cross-sectional study. International Journal of Environmental Research and Public Health, 17(24), 9181. https://doi.org/10.3390/ijerph17249181
Huang, P.-H., Chi, M.-J., Kuo, C.-L., Wu, S.-F. V., & Chuang, Y.-H. (2021). Prevalence of loneliness and related factors among older adults in Taiwan: Evidence from a nationally representative survey. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 1–8. https://doi.org/10.1177/00469580211035745
Hunsaker, A., & Hargittai, E. (2018). A review of Internet use among older adults. New Media & Society, 20(10), 3937–3954. https://doi.org/10.1177/1461444818787348
Hwang, M., Kim, G., Lee, S., & Park, Y.-H. (2025). Loneliness, social isolation, and digital health literacy among older women living alone in South Korea during the COVID-19 pandemic. Psychiatry Investigation, 22(1), 75–83. https://doi.org/10.30773/pi.2024.0210
Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37. https://www.jstor.org/stable/2955359
Jiang, M., Li, X., & Lu, Y. (2024). Social isolation, loneliness, and functional disability in Chinese older women and men: A longitudinal cross-lag analysis. BMC Psychology, 12, 674. https://doi.org/10.1186/s40359-024-02192-9
Jiang, X., Wang, L., Leng, Y., Xie, R., Li, C., Nie, Z., Liu, D., & Wang, G. (2024). The level of electronic health literacy among older adults: A systematic review and meta-analysis. Archives of Public Health, 82, 204. https://doi.org/10.1186/s13690-024-01428-9
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185(12), 914–919. https://doi.org/10.1001/jama.1963.03060120024016
Khosravi, P., Rezvani, A., & Wiewiora, A. (2016). The impact of technology on older adults’ social isolation. Computers in Human Behavior, 63, 594–603. https://doi.org/10.1016/j.chb.2016.05.092
Ko, D. W., Lee, J.-Y., & Kim, H. (2022). Loneliness, implicit-self and digital literacy. Frontiers in Psychology, 13, 701856. https://doi.org/10.3389/fpsyg.2022.701856
Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378. https://doi.org/10.1146/annurev.publhealth.18.1.341
Kusumota, L., Diniz, M. A. A., Ribeiro, R. M., Silva, I. L. C. da, Figueira, A. L. G., Rodrigues, F. R., & Rodrigues, R. A. P. (2022). Impact of digital social media on the perception of loneliness and social isolation in older adults. Revista Latino-Americana de Enfermagem, 30, Article e3573. https://doi.org/10.1590/1518-8345.5641.3573
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3_Part_1), 179–186. https://doi.org/10.1093/geront/9.3_Part_1.179
Lee, C. (2018). Adult children’s education and physiological dysregulation among older parents. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 73(6), 1143–1154. https://doi.org/10.1093/geronb/gbx044
Lee, C., Glei, D. A., Goldman, N., & Weinstein, M. (2017). Children’s education and parents’ trajectories of depressive symptoms. Journal of Health and Social Behavior, 58(1), 86–101. https://doi.org/10.1177/0022146517690200
Lee, J., Lee, E.-H., & Chae, D. (2021). eHealth literacy instruments: Systematic review of measurement properties. Journal of Medical Internet Research, 23(11), e30644. https://doi.org/10.2196/30644
Lee, P.-H., Yeh, T.-T., Yen, H.-Y., Hsu, W.-L., Chiu, V. J.-Y., & Lee, S.-C. (2021). Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan Longitudinal Study on Aging. Scientific Reports, 11, 12199. https://doi.org/10.1038/s41598-021-91838-4
Lee, S. Y., Kim, J. H., & Heo, J. (2020). Internet use, social connectedness, and depressive symptoms among older adults: A cross-sectional analysis. Aging & Mental Health, 24(9), 1432–1440.
Leung, G. T. Y., de Jong Gierveld, J., & Lam, L. C. W. (2008). Validation of the Chinese translation of the 6-item De Jong Gierveld Loneliness Scale in elderly Chinese. International Psychogeriatrics, 20(6), 1262–1272. https://doi.org/10.1017/S1041610208007552
Levasseur, M., Richard, L., Gauvin, L., & Raymond, É. (2010). Inventory and analysis of definitions of social participation found in the aging literature: Proposed taxonomy of social activities. Social Science & Medicine, 71(12), 2141–2149. https://doi.org/10.1016/j.socscimed.2010.09.041
Li, C., Mo, W., & Wei, Q. (2023). The role of Internet use and offline social engagement in the health of Chinese older adults: Evidence from nationally representative samples. Healthcare, 11, 653. https://doi.org/10.3390/healthcare11050653
Li, S., Cui, G., Yin, Y., & Xu, H. (2023). Associations between health literacy, digital skill, and eHealth literacy among older Chinese adults: A cross-sectional study. Digital Health, 9, 20552076231178431. https://doi.org/10.1177/20552076231178431
Liao, M.-Y., Yeh, C.-J., Lee, S.-H., Liao, C.-C., & Lee, M.-C. (2018). Association of providing/receiving support on the mortality of older adults with different living arrangements in Taiwan: A longitudinal study on ageing. Ageing & Society, 38, 2082–2096. https://doi.org/10.1017/S0144686X17000484
Lim, C., & Burr, J. A. (2023). The association between number of friends and loneliness for older men and women: Using the Health and Retirement Study. Innovation in Aging, 7(Suppl 1), 662. https://doi.org/10.1093/geroni/igad104.2582
Litwin, H., & Levinsky, M. (2022). Social networks and mental health change in older adults after the Covid-19 outbreak. Aging & Mental Health, 26(5), 925–931. https://doi.org/10.1080/13607863.2021.1902468
Löfgren, M., Larsson, E., Isaksson, G., & Nyman, A. (2022). Older adults’ experiences of maintaining social participation: Creating opportunities and striving to adapt to changing situations. Scandinavian Journal of Occupational Therapy, 29(7), 587–597. https://doi.org/10.1080/11038128.2021.1974550
Loibl, C., Drost, M. A., Huisman, M., Suanet, B., Bruine de Bruin, W., McNair, S., & Summers, B. (2022). Worry about debt is related to social loneliness in older adults in the Netherlands. Ageing & Society, 42, 2869–2891. https://doi.org/10.1017/S0144686X21000325
Lu, X., Jiang, J., Head, M., Kahai, S. S., & Yang, J. (2024). Synergistic impacts of online and offline social participation on older adults’ subjective well-being: Evidence from the Canadian Longitudinal Study on Aging. European Journal of Information Systems, 33(5), 699–716. https://doi.org/10.1080/0960085X.2023.2229283
Madans, J. H., Loeb, M. E., & Altman, B. M. (2011). Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: The work of the Washington Group on Disability Statistics. BMC Public Health, 11(Suppl 4), S4. https://doi.org/10.1186/1471-2458-11-S4-S4
Mano, R., & Rosenberg, D. (2021). Online and offline social activity and sociability effects on wellbeing and social influence: A “spillover” effect. Advances in Applied Sociology, 11(1), 48–63. https://doi.org/10.4236/aasoci.2021.111005
Marshall, G. L., & Tucker-Seeley, R. (2018). The association between hardship and self-rated health: Does the choice of indicator matter? Annals of Epidemiology, 28, 462–467. https://doi.org/10.1016/j.annepidem.2018.03.013
Milanti, A., Norman, C., Chan, D. N. S., So, W. K. W., & Skinner, H. (2025). eHealth literacy 3.0: Updating the Norman and Skinner 2006 model. Journal of Medical Internet Research, 27, e70112. https://doi.org/10.2196/70112
Mitsutake, S., Shibata, A., Ishii, K., & Oka, K. (2016). Associations of eHealth literacy with health behavior among adult Internet users. Journal of Medical Internet Research, 18(7), e192. https://doi.org/10.2196/jmir.5413
Naudé, B., Rigaud, A.-S., & Pino, M. (2022). Video calls for older adults: A narrative review of experiments involving older adults in elderly care institutions. Frontiers in Public Health, 9, 751150. https://doi.org/10.3389/fpubh.2021.751150
Neter, E., & Brainin, E. (2012). eHealth literacy: Extending the digital divide to the realm of health information. Journal of Medical Internet Research, 14(1), e19. https://doi.org/10.2196/jmir.1619
Norman, C. D., & Skinner, H. A. (2006a). eHealth literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research, 8(2), e9. https://doi.org/10.2196/jmir.8.2.e9
Norman, C. D., & Skinner, H. A. (2006b). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4), e27. https://doi.org/10.2196/jmir.8.4.e27
Nowland, R., Necka, E. A., & Cacioppo, J. T. (2018). Loneliness and social internet use: Pathways to reconnection in a digital world? Perspectives on Psychological Science, 13(1), 70–87. https://doi.org/10.1177/1745691617713052
Nummela, O., Seppänen, M., & Uutela, A. (2011). The effect of loneliness and change in loneliness on self-rated health (SRH): A longitudinal study among aging people. Archives of Gerontology and Geriatrics, 53, 163–167. https://doi.org/10.1016/j.archger.2010.10.023
Office of Disease Prevention and Health Promotion. (2024). Health literacy in Healthy People 2030. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030
Oh, S. S., Kim, K.-A., Kim, M., Oh, J., Chu, S. H., & Choi, J. (2021). Measurement of digital literacy among older adults: Systematic review. Journal of Medical Internet Research, 23(2), e26145. https://doi.org/10.2196/26145
Organisation for Economic Co-operation and Development, European Union, & European Commission, Joint Research Centre. (2008). Handbook on constructing composite indicators: Methodology and user guide. OECD Publishing. https://doi.org/10.1787/9789264043466-en
Palmer, A. D., Newsom, J. T., & Rook, K. S. (2016). How does difficulty communicating affect the social relationships of older adults? An exploration using data from a national survey. Journal of Communication Disorders, 62, 131–146. https://doi.org/10.1016/j.jcomdis.2016.06.002
Pan, H., De Donder, L., Dury, S., Wang, R., De Witte, N., & Verté, D. (2019). Social participation among older adults in Belgium’s Flanders region: Exploring the roles of both new and old media usage. Information, Communication & Society, 22(13), 1956–1972. https://doi.org/10.1080/1369118X.2018.1473460
Pan, H., Fokkema, T., Switsers, L., Dury, S., Hoens, S., & De Donder, L. (2021). Older Chinese migrants in coronavirus pandemic: Exploring risk and protective factors to increased loneliness. European Journal of Ageing, 18(2), 207–215. https://doi.org/10.1007/s10433-021-00625-7
Pan, H., Qualter, P., Barreto, M., Stegen, H., & Dury, S. (2023). Loneliness in older migrants: Exploring the role of cultural differences in their loneliness experience. International Journal of Environmental Research and Public Health, 20(4), 2785. https://doi.org/10.3390/ijerph20042785
Penning, M. J., Wu, Z., & Hou, F. (2024). Childlessness and social and emotional loneliness in middle and later life. Ageing & Society, 44, 1551–1578. https://doi.org/10.1017/S0144686X22000824
Perissinotto, C. M., Cenzer, I. S., & Covinsky, K. E. (2012). Loneliness in older persons: A predictor of functional decline and death. Archives of Internal Medicine, 172(14), 1078–1083. https://doi.org/10.1001/archinternmed.2012.1993
Phang, J. K., Kwan, Y. H., Yoon, S., Goh, H., Yee, W. Q., Tan, C. S., & Low, L. L. (2023). Digital intergenerational program to reduce loneliness and social isolation among older adults: Realist review. JMIR Aging, 6, e39848. https://doi.org/10.2196/39848
Pinquart, M., & Sörensen, S. (2001). Influences on loneliness in older adults: A meta-analysis. Basic and Applied Social Psychology, 23(4), 245–266. https://doi.org/10.1207/S15324834BASP2304_2
Portes, A. (1998). Social capital: Its origins and applications in modern sociology. Annual Review of Sociology, 24, 1–24. https://doi.org/10.1146/annurev.soc.24.1.1
Prag, P., Mills, M. C., & Wittek, R. (2016). Subjective socioeconomic status and health in cross-national comparison. Social Science & Medicine, 149, 84–92. https://doi.org/10.1016/j.socscimed.2015.11.044
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731. https://doi.org/10.3758/BF03206553
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. https://doi.org/10.3758/BRM.40.3.879
Putnam, R. D. (2000). Bowling alone: The collapse and revival of American community. Simon & Schuster.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Rataj, A. C., Alberth, A., Su, Y.-J., Stam, E. J., & Stokes, J. E. (2025). The association between childlessness and loneliness in later life: Does friendship play a moderating role? The Gerontologist, 65(11), gnaf204. https://doi.org/10.1093/geront/gnaf204
Rook, K. S. (1984). The negative side of social interaction: Impact on psychological well-being. Journal of Personality and Social Psychology, 46(5), 1097–1108. https://doi.org/10.1037/0022-3514.46.5.1097
Russell, D., Cutrona, C. E., Rose, J., & Yurko, K. (1984). Social and emotional loneliness: An examination of Weiss’s typology of loneliness. Journal of Personality and Social Psychology, 46(6), 1313–1321. https://doi.org/10.1037/0022-3514.46.6.1313
Sala, E., Terraneo, M., Cretazzo, F., & Zaccaria, D. (2025). Does internet use worsen old-age loneliness during pandemics? A gendered analysis of the SHARE data. Ageing & Society, 45(12), 2564–2586. https://doi.org/10.1017/S0144686X2500011X
Samuel, L. J., Saylor, M. A., Choe, M. Y., Wright, R. S., Kim, B., Nkimbeng, M., Mena-Carrasco, F., Beak, J., & Szanton, S. L. (2025). Financial strain measures and associations with adult health: A systematic literature review. Social Science & Medicine, 364, 117531. https://doi.org/10.1016/j.socscimed.2024.117531
Schisterman, E. F., Cole, S. R., & Platt, R. W. (2009). Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology, 20(4), 488–495. https://doi.org/10.1097/EDE.0b013e3181a819a1
Schroeder, T., Dodds, L., Georgiou, A., Gewald, H., & Siette, J. (2023). Older adults and new technology: Mapping review of the factors associated with older adults’ intention to adopt digital technologies. JMIR Aging, 6, e44564. https://doi.org/10.2196/44564
Shah, S. G. S., Nogueras, D., van Woerden, H. C., & Kiparoglou, V. (2021). Evaluation of the effectiveness of digital technology interventions to reduce loneliness in older adults: Systematic review and meta-analysis. Journal of Medical Internet Research, 23(6), e24712. https://doi.org/10.2196/24712
Shankar, A., Rafnsson, S. B., & Steptoe, A. (2015). Longitudinal associations between social connections and subjective well-being in the English Longitudinal Study of Ageing. Psychology & Health, 30(6), 686–698. https://doi.org/10.1080/08870446.2014.979823
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science & Medicine, 32(6), 705–714. https://doi.org/10.1016/0277-9536(91)90150-B
Shih, Y.-L., Hsieh, C.-J., Li, P.-S., & Liu, C.-Y. (2021). Psychometric properties of the health literacy scale used in the Taiwan Longitudinal Study on Middle-Aged and Older People. Healthcare, 9(10), 1391. https://doi.org/10.3390/healthcare9101391
Shukla, A., Harper, M., Pedersen, E., Goman, A., Suen, J. J., Price, C., Applebaum, J., Hoyer, M., Lin, F. R., & Reed, N. S. (2020). Hearing loss, loneliness, and social isolation: A systematic review. Otolaryngology–Head and Neck Surgery, 162(5), 622–633. https://doi.org/10.1177/0194599820910377
Sol, K., Brauer, S., & Antonucci, T. C. (2023). Longitudinal associations between loneliness and self-rated health among Black and White older adults. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 78(4), 639–648. https://doi.org/10.1093/geronb/gbac200
Soundararajan, A., Lim, J. X., Ngiam, N. H. W., Tey, A. J.-Y., Tang, A. K. W., Lim, H. A., Yow, K. S., Cheng, L. J., Ho, J., Teo, Q. X. N., Yee, W. Q., Yoon, S., Low, L. L., & Ng, K. Y. Y. (2023). Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore. PLOS ONE, 18(8), e0290557. https://doi.org/10.1371/journal.pone.0290557
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J. M., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12, 80. https://doi.org/10.1186/1471-2458-12-80
Su, Y. P., Hsu, H. C., & Chao, S. F. (2024). Changes in health and social relationships on loneliness among older adults. Educational Gerontology, 50(2), 114–128. https://doi.org/10.1080/03601277.2023.2226504
Teerawichitchainan, B., Knodel, J., & Pothisiri, W. (2015). What does living alone really mean for older persons? A comparative study of Myanmar, Vietnam, and Thailand. Demographic Research, 32, 1329–1360. https://doi.org/10.4054/DemRes.2015.32.48
Tennant, B., Stellefson, M., Dodd, V., Chaney, B., Chaney, D., Paige, S., & Alber, J. (2015). eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. Journal of Medical Internet Research, 17(3), e70. https://doi.org/10.2196/jmir.3992
Thompson, R., Swift, H. J., & Wynn, J. (2024). Friendships, loneliness and psychological well-being in older adults: A limit to the benefit of the number of friends? Ageing & Society, 44(3), 567–586. https://doi.org/10.1017/S0144686X23000487
Torres, Z., Tomás, J. M., Sentandreu-Mañó, T., Fernández, I., & Pla-Sanz, N. (2024). Social participation, loneliness, and physical inactivity over time: Evidence from SHARE. International Psychogeriatrics. https://doi.org/10.1017/S1041610224000504
Tsai, T.-Y., Chiu, C.-J., Wang, T.-Y., Tseng, H.-H., Chen, K.-C., Chen, P.-S., & Yang, Y.-K. (2022). Loneliness and isolated living status in middle-aged and older adults in Taiwan: Exploration on stress-related biomarkers, depressive symptoms, and disability. BMC Psychiatry, 22(1), Article 177. https://doi.org/10.1186/s12888-022-03824-3
Tuovinen, S., Tang, X., & Salmela-Aro, K. (2020). Introversion and social engagement: Scale validation, their interaction, and positive association with self-esteem. Frontiers in Psychology, 11, 590748. https://doi.org/10.3389/fpsyg.2020.590748
Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: A systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13), 1009–1016. https://doi.org/10.1136/heartjnl-2015-308790
van der Vaart, R., & Drossaert, C. (2017). Development of the Digital Health Literacy Instrument: Measuring a broad spectrum of Health 1.0 and Health 2.0 skills. Journal of Medical Internet Research, 19(1), e27. https://doi.org/10.2196/jmir.6709
van Tilburg, T. G., Steinmetz, S., Stolte, E., van der Roest, H., & de Vries, D. H. (2021). Loneliness and mental health during the COVID-19 pandemic: A study among Dutch older adults. The Journals of Gerontology: Series B, 76(7), e249–e255. https://doi.org/10.1093/geronb/gbaa111
Wang, Y.-L., Chen, Y.-J., & Liu, C.-C. (2024). The relationship between social media usage and loneliness among younger and older adults: The moderating effect of shyness. BMC Psychology, 12, 343. https://doi.org/10.1186/s40359-024-01727-4
Washington Group on Disability Statistics. (2020, May 12). Analytic guidelines: Creating disability identifiers using the Washington Group Short Set on Functioning (WG-SS) SPSS syntax.
Washington Group on Disability Statistics. (2023, February 8). The Washington Group short set on functioning–enhanced: Question specifications.
Weiss, R. S. (1973). Loneliness: The experience of emotional and social isolation. MIT Press.
Welch, V., Ghogomu, E. T., Barbeau, V. I., Dowling, S., Doyle, R., Beveridge, E., Boulton, E., Desai, P., Huang, J., Elmestekawy, N., Hussain, T., Wadhwani, A., Boutin, S., Haitas, N., Kneale, D., Salzwedel, D. M., Simard, R., Hébert, P., & Mikton, C. (2023). Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map. Campbell Systematic Reviews, 19(4), Article e1369. https://doi.org/10.1002/cl2.1369
Winkleby, M. A., Jatulis, D. E., Frank, E., & Fortmann, S. P. (1992). Socioeconomic status and health: How education, income, and occupation contribute to risk factors for cardiovascular disease. American Journal of Public Health, 82(6), 816–820. https://doi.org/10.2105/AJPH.82.6.816
World Health Organization. (2001). International classification of functioning, disability and health (ICF). World Health Organization.
Yoon, H., Jang, Y., Vaughan, P. W., & Garcia, M. (2020). Older adults’ Internet use for health information: Digital divide by race/ethnicity and socioeconomic status. Journal of Applied Gerontology, 39(1), 105–110. https://doi.org/10.1177/0733464818770772
Yoon, J., Lee, M., & Cho, J. (2024). Concept of digital health literacy: A scoping review. Public Health Weekly Report, 17(48), 2095–2133. https://doi.org/10.56786/PHWR.2024.17.48.2
Zhang, C., Mohamad, E., Azlan, A. A., Wu, A., Ma, Y., & Qi, Y. (2025). Social media and eHealth literacy among older adults: Systematic literature review. Journal of Medical Internet Research, 27, e66058. https://doi.org/10.2196/66058
Zhang, K., Burr, J. A., Mutchler, J. E., & Lu, J. (2024). Internet use and loneliness among urban and non-urban Chinese older adults: The roles of family support, friend support, and social participation. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 79(7), gbae081. https://doi.org/10.1093/geronb/gbae081
Zhang, K., Song, Q., & Burr, J. A. (2024). Internet use and loneliness among older Chinese adults. Aging & Mental Health, 28(6), 866–873. https://doi.org/10.1080/13607863.2023.2278713
Zhou, Z., Mao, F., Zhang, W., Towne, S. D., Jr., Wang, P., & Fang, Y. (2019). The association between loneliness and cognitive impairment among older men and women in China: A nationwide longitudinal study. International Journal of Environmental Research and Public Health, 16(16), Article 2877. https://doi.org/10.3390/ijerph16162877
王冠今、苗迺芳、陳鳳音、張玉梅、陳靜敏（2009）。台灣社區老人的健康行為及其相關因素研究。健康促進暨衛生教育雜誌，29，73–94。https://www.airitilibrary.com/Article/Detail/15613852-200912-201105180006-201105180006-73-94
王冠今、張元玫、葉明莉、張玉梅、白瑞聰（2010）。台灣社區老人之飲食行為與其營養健康狀況改變之研究。健康促進暨衛生教育雜誌，30，63–85。https://www.airitilibrary.com/Article/Detail/15613852-201012-201105120013-201105120013-63-85
林千立、林美珍（2007）。中文版寂寞量表之效度與信度研究－以老年人為例。輔導與諮商學報，29(2)，41–50。https://doi.org/10.7040/JGC.200711.0041
徐婕、徐慧娟、周真貞（2024）。高齡友善和老年人孤獨感的相關性：以臺北市信義區老年人為例。老年學研究，3，26–51。https://doi.org/10.29703/JGS.202406_(3).0002
劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義（2006）。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊，4(1)，1–22。https://doi.org/10.29805/JHM.200606.0001
劉珈彣、楊尚育、李雅珍、簡慧雯（2022）。四週線上課程介入對社區高齡者孤獨感、生活品質與社會支持之成效初探。台灣職能治療研究與實務，18(2)，125–136。https://doi.org/10.6534/jtotrp.202212_18(2).0003
陳怡瑄（2022）。新冠疫情之下中高齡者遠距學習之疫情焦慮、科技焦慮與學習滿意度之關聯：外向性、開放性與社會支持之調節效果〔碩士論文，國立臺灣師範大學〕。臺灣博碩士論文知識加值系統。https://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi?o=dnclcdr&s=id=%22110NTNU5205031%22.&searchmode=basic