背景：身體功能障礙是老年人生活品質的關鍵預測因子之一。過去身體功能障礙發展的年齡軌跡文獻的缺口，限制我們了解跨國老年人隨年齡增長在身體功能的變化情形，導致降低了分辨不同文化下衍生的老化政策的實用性。目的：研究探討台灣人及日本人65歲以上老年人身體功能障礙隨年齡增長的退化軌跡，包括日常生活活動功能(ADL)、工具性日常生活活動功能(IADL)、上下肢活動功能(Mobility)以及衰弱(Frailty)，以探索身體功能的老化情形之跨國差異，並探討社會人口學、心理支持及社會行為等變項在兩國間身體功能障礙發展程度及變化之影響。方法：使用每三至四年追蹤一次的台灣地區中老年身心社會生活狀況長期追蹤調查(Taiwan Longitudinal Study on Aging，TLSA，1996- 2011年，共五回)和日本長壽社會生活方式調查(National Survey of the Japanese Elderly，NSJE，1996-2006年，共四回)的全國代表性資料，以1996年為起始年(baseline)選取65歲以上共3037位台灣老年人(Mean age: 73.23 years，SD:5.75 years，Range:65~97 years)及1974位日本老年人(Mean age: 74.00 years，SD:6.75 years，Range:65~103 years)為樣本，以階層線性模型(Hierarchical linear model，HLM)建構台灣與日本老年人之身體功能退化的年齡軌跡常模及檢視相關因子。結果：台灣與日本65歲以上老年人，至少有一項日常生活活動功能(ADL)障礙占9.65%及16.82%；至少有一項工具性日常生活活動功能(IADL) 障礙占30.36%及22.29%；至少有一項上下肢活動功能(Mobility) 障礙占49.82%及38.86%；衰弱前期(Prefrailty)占38.82%及35.77%；衰弱(Frailty)占25.19%及17.02%。軌跡模型分析結果亦發現(1)未控制其他變項下，隨著年齡增加，台灣比日本老年人以更快的速度顯著增加日常生活活動功能(ADL:βTaiwan × Age2= 0.0035，P=0.0005)、工具性日常生活活動功能(IADL:βTaiwan × Age=0.03745，P<.0001)、上下肢活動功能(Mobility:βTaiwan × Age=0.0375，P<.0001)以及衰弱(Frailty:βTaiwan × Age= 0.0337，P=0.0015)。(2)台灣老年女性比日本老年女性有更高程度衰弱(Frailty:βWomen × Taiwan=0.3867，p<.0001)及更快發展速度為1.7367倍(=(0.0318 -0.0168-0.0025+0.0384)/(0.0318-0.0025))之日常生活活動功能障礙(ADL:βWomen × Taiwan × Age=0.0384，p=0.0102)，且此現象被無配偶與低教育程度解釋。(3)台灣低教育程度的老年女性比日本老年女性更快發展速度為4.6042倍(=(0.0229+0.0311-0.0053+ 0.0324)/(0.0229-0.0053))之工具性日常生活活動功能障礙(IADL:βWomen × Taiwan × Age=0.0324，p=0.0191)，且有更高程度上下肢活動功能障礙及衰弱(Mobility:βLow Education × Taiwan=0.4343，p=0.0451；Frailty:βLow Education ×Taiwan=0.5732，p=0.0001、βMedian Education × Taiwan=0.2591，p=0.0152)。(4)在控制所有變項(社會人口學、心理支持及社會行為因子)之後，憂鬱、不規律運動、缺少社會參與顯著與兩國更多日常生活活動功能障礙(ADL:βCESD=0.0504，p=0.0004、βIrregular exercise=0.1105，p=0.0496、βBad engagement=0.0603，p=0.0033)、工具性日常生活活動功能障礙(IADL:βCESD=0.0446，p=0.0006、βIrregular exercise=0.1260，p=0.0123、βBad engagement=0.05853，p=0.0015)、上下肢活動功能障礙(Mobility:βCESD=0.0935，p<.0001、βIrregular exercise=0.2904，p=0.0004、βBad engagement=0.0939，p=0.0032)及衰弱(Frailty:βCESD=0.1167，p<.0001、βIrregular exercise=0.3086，p<.0001、βBad engagement=0.0646，p=0.0036)相關，其中缺少家庭及朋友支持在台灣顯著比日本有更高程度且更快增加日常生活活動功能障礙(ADL:βBad support × Taiwan=0.0394，p=0.0352、βBad support × Taiwan× Age=-0.0075，p=0.0104)。結論：台灣比日本老年人隨著年齡更快速地增加身體功能障礙，而且台灣與日本的解釋因子不盡相同。女性、憂鬱、不規律運動、缺少社會參與使兩國老年人有更高程度身體功能障礙，而台灣老年女性比日本老年女性有更高程度且更快的速度增加障礙日常生活活動功能障礙及衰弱，且此現象被無配偶及低教育程度所解釋。在控制所有變項之後，缺少家庭及朋友支持在台灣顯著比日本更高程度且更快增加日常生活活動功能障礙。建議強調以家庭及朋友支持、減少憂鬱、規律運動、社會參與減緩兩國老年人的身體功能障礙，且台灣應比日本更加重視家庭及朋友支持對老年人身體功能障礙的影響。

The purpose is to explore the transnational differences in the aging of physical function, which included activities of daily living (ADL), instrumental activities of daily living (IADL), and Mobility and Frailty, and the effects between sociodemographic, psychological support and social behavior among the two countries. Samples are based on two nationally representative surveys of elderly people in Taiwan and Japan, including the Taiwan Longitudinal Study on Aging (TLSA) 1996-2011 and The National Survey of the Japanese Elderly (NSJE) 1996-2006. Results of Hierarchical Linear Model (HLM) show that Taiwanese has significantly increased ADL (βTaiwan×Age2= 0.0035， P=0.0005), IADL (βTaiwan × Age=0.03745，P<.0001), Mobility (βTaiwan × Age=0.0375，P<.0001) and Frailty (βTaiwan × Age= 0.0337，P=0.0015) with aging. Elderly women with low education level in Taiwan are 4.6042 times faster than Japanese elderly women increase IADL impairment (βWomen × Taiwan × Age= 0.0324, p=0.0191) and higher level of Mobility(βLow Education × Taiwan=0.4343, p=0.0451) and Frailty (βLow Education × Taiwan=0.5732, p=0.0001,βMedian Education × Taiwan=0.2591,p=0.0152). After controlling all variables, the lack of family and friend support significantly increased ADL impairments in Taiwan than Japan (βBad support × Taiwan=0.0394, p=0.0352, βBad support × Taiwan× Age=-0.0075, p=0.0104). It is suggested that Taiwan and Japan should keep family and friends support, reduce depression, regular exercise, and less social engagement to alleviate the physical dysfunction on elderly. Besides, Taiwanese elderly should pay more attention on family and friends support to decline the physical dysfunction than Japanese elderly.

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