研究背景
愈來愈多文獻資料指出銀髮族使用電腦資訊科技可降低孤獨感並增進其生活品質及幸福感。但在目前僅有少數的研究探討電腦資訊科技使用對居住於長期照護機構中老年住民之影響。
研究目的
主要在探討使用通訊型和娛樂型的電腦資訊科技介入相較於一般性照護，對於居住於長期照護機構中老年住民之生活品質、社會支持及幸福感的影響。
研究方法
本研究採用類實驗設計以電腦資訊科技教學課程介入,共收案54位來自南台灣的三個相同等級長期照護機構年齡在50歲以上、可依從指示、意識清楚、無攻擊性之中老年住民，反之則已排除。依長期照護機構所在位置隨機分為三組，第一組有19位住民，接受Line通訊型軟體介入，以撥打視訊電話和發簡訊、圖貼等教學活動為主，第二組有18位住民接受YouTube娛樂型軟體介入，搜尋喜愛的歌曲以卡拉OK歡唱、看新聞、電視劇等教學活動為主，第三組有17位住民則成為觀察組。第一、二組參與者接受:每週一次90分鐘的團體教學練習和每週二次每次20-30分鐘的個別教學指導練習，期間共有12次的教學活動介入，三組均施行前測及活動結束當日立即後測。
問卷評估包括生活品質SF-12、中國人幸福感量表、台灣版社會支持行為量表、憂鬱量表CES-D、認知功能SPMSQ、身體活動功能ADL、IADL及後測滿意度開放性問卷，統計分析以Kruskal Wallis檢定、Mann-Whiney檢定和Wilcoxon等級檢定，統計分析軟體採用SPSS 23版。
研究結果
研究前後測問卷完成率為94.74%，平均年齡為73歲(SD=11.4)、男性比率占50%,教育程度平均小學以下佔70.4%、經濟狀況普通的佔53.7%、 87%的住民無電腦學習經驗、平均入住機構為36.2個月、日常生活活動(ADL)平均分數為40.2、工具性日常生活活動(IADL)平均分數為6.6、認知功能(SPMSQ)平均分數為9.6、平均患有慢性疾病為2.3項、其中以糖尿病佔的比例最高44.4%、其次高血壓佔16.7%、自評健康狀況普通佔61.1%。
在Kruskal Wallis檢定三組的比較上，YouTube組在與健康有關的生活品質(SF-12)之生理健康和心理健康結果呈現有顯著的改善(P =.002; P =.000)；另在社會支持方面對於機構照護人員所提供的社會支持以及對所獲得社會支持的滿意度皆呈現有顯著的增加(P=.002; P =.008 )。在幸福感方面結果亦呈現明顯的提升(P=.033) 和憂鬱情緒也獲得顯著改善 (P =.000)，且在Mann-Whiney post hoc檢定三組前後測正向分數提升，結果呈現YouTube組 > Line組> 觀察組。
使用科技產品似乎可增加長期照護機構住民的生活品質和幸福感及憂鬱情緒亦可以明顯改善。
結論
本研究中使用電腦通訊溝通軟體Line對於居住於長期照護機構中老年住民的影響雖然不及於娛樂性軟體YouTube，但Line對於心理健康之生活品質、家人和朋友的社會支持及幸福感方面仍有正向的提升。
利用電腦資訊科技YouTube操作簡易兼具團體與個人化娛樂功能特性，進行卡拉OK懷念歌曲搜尋歡唱的娛樂活動，可助於住民懷舊美好時光，尤其以此與其他志趣相投的親友、住民或工作人員互動交流，可進而提升其生活品質並增進其社會支持與幸福感。

Background: Increasing literature indicated that the usage of information computer technology has positive results in decreasing older adults’ isolation and increasing the quality of life along with psychological well-being. However, few studies have evaluated the impact of ICT (Information and Computer Technology) for older adults living in long-term care facility.
Objective: This study evaluated the extent to which quality of life, social support and psychological well-being changed for participants receiving ICT intervention.
Methods: This study was conducted a quasi-experimental research design using ICT teaching intervention to 54 institutionalized residents 50 years and older, able to comply, clear consciousness and not agitated from three comparable long-term care facilities located in Southern Taiwan. This research assessment constituted randomizing three long-term care facilities into groups. Group 1 recruited 19 participants and received communication technology instructional training using the program Line, teaching them how to make video phone calls, send out text messages with attached emoticon stickers. Group 2 had 18 participants and received multi-media instructional training using the program YouTube, teaching how to search for their favorite karaoke song, news or television soap opera then how to view them. Group 3 consisted of 17 participants recruited as an observation group with usual care. Groups using Line and YouTube received intervention instructions once a week for 90 minutes each group, teaching and twice a week for 20-30 minutes/per person one on one tutorship for four weeks. Instructional sessions included visual demonstrations with hands on intervention where needed. The participants were evaluated on the measures of health-related factors such as, quality of life, well-being, social support, depression CES-D, cognitive functioning SPMSQ, physical functioning ADL and IADL at pre- and post-interventions along with post-test satisfaction survey and an open questionnaire. SPSS vision 23 was selected to conduct Kruskal Wallis test, Mann-Whiney test and Wilcoxon Signed Ranks for descriptive and inferential statistical analyses.
Results: Enrolled were 57 participants, three participants dropped out (Completed rate 94.74%). The remaining 54 participants who completed the study had a mean age of 73 years (SD=11.4), 50% were male, 70.4% had below elementary school education, 53.7% were the average financial status, 87% never obtained any computer training, the average length of stay in a long term care facility was 36.2%, the average ADL Score was 40.2, IADL Score was 6.6, cognitive score was 9.6, the average chronic disease count was 2.3, diabetes had the highest incident rate of 44.4%, the second was hypertension 16.7% and 61% had an average self-rate health status.
Comparing the Kruskal Wallis test of the three groups data, the YouTube group was rated as the most significant on the QOL SF12 in physical component summary (PCS, P=.002), mental component summary (MCS, P=.000), social support in health care worker related (P=.002), satisfaction in social support (P=.008), happiness (P=.033), along with depression CES-D (P=.000) were illustrated significant positive changes. Mann-Whiney test post hoc at pre- and post-test changes revealed positive increasing in YouTube > Line > Usual Care.
Happiness and Quality of life along with psychological well-being were significant improving the Information Computer Technology usage among residents living in long-term care facilities. Especially searching a reminiscence song using YouTube as a karaoke sing along.
Conclusion: The communication application Line was not as significant as the entertainment application YouTube among long-term care residents. However, Line is positively increasing in health related quality of life in mental component summary (MCS), social support in family/friend related and psychological well-being. Our findings demonstrated that using YouTube’s simple operation and groups or an individualized entertainment features as a karaoke sing along could be an excellent stimulus for reminiscence and social support. Singing with family, friends, other residents and health care workers through this entertainment application produces a profound effect on their quality of life and the residents mingling among each other helps maintain their social support and psychological well-being.

Chinese
衛生福利部國民健康署(2012)‧健康久久網站‧103年10月27日取自
http://health99.hpa.gov.tw/txt/HealthyHeadLineZone/HealthyHeadlineDetai.aspx?TopIcNo=6685。
內政部( 2013) ‧103年10月27日取自http://www.moi.gov.tw/stat/news_content.aspx?sn=9881&page=0
English
Alluri, V., Toiviainen, P., Jääskeläinen, I. P., Glerean, E., Sams, M., & Brattico, E. (2012). Large-scale brain networks emerge from dynamic processing of musical timbre, key and rhythm. Neuroimage, 59(4), 3677-3689.
Argyle, M., & Lu, L. (1990). The happiness of extraverts. Personality and individual differences, 11(10), 1011-1017.
Astell, A., Ellis, M., Alm, N., Dye, R., Campbell, J., & Gowans, G. (2004). Facilitating communication in dementia with multimedia technology. Brain and Language, 91(1), 80-81.
Beekman, A. T., Deeg, D., Van Limbeek, J., Braam, A., De Vries, M., & Van Tilburg, W. (1997). BRIEF COMMUNICATION. Psychological medicine, 27(01), 231-235.
Berkowsky, R. W., Cotton, S. R., Yost, E. A., & Winstead, V. P. (2013). Attitudes towards and limitations to ICT use in assisted and independent living communities: Findings from a specially-designed technological intervention. Educational gerontology, 39(11), 797-811.
Blaschke, C. M., Freddolino, P. P., & Mullen, E. E. (2009). Ageing and technology: A review of the research literature. British Journal of Social Work, 39(4), 641-656.
Boey, K. W. (1999). Cross‐validation of a short form of the CES‐D in Chinese elderly. International journal of geriatric psychiatry, 14(8), 608-617.
Boulton-Lewis, G. M., Buys, L., & Lovie-Kitchin, J. (2006). Learning and active aging. Educational gerontology, 32(4), 271-282.
Bradley, N., & Poppen, W. (2003). Assistive technology, computers and Internet may decrease sense of isolation for homebound elderly and disabled persons. Technology and disability, 15(1), 19-25.
Byrne-Davis, L., Bennett, P., & Wilcock, G. (2006). How are quality of life ratings made? Toward a model of quality of life in people with dementia. Quality of Life Research, 15(5), 855-865.
Cahill, S., & Diaz-Ponce, A. M. (2011). ‘I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment? Aging Ment Health, 15(5), 562-572.
Carpenter, B. D. (2002). Family, peer, and staff social support in nursing home patients: Contributions to psychological well-being. Journal of Applied Gerontology, 21(3), 275-293.
Chatters, L. M., Taylor, R. J., Woodward, A. T., & Nicklett, E. J. (2015). Social support from church and family members and depressive symptoms among older African Americans. The American Journal of Geriatric Psychiatry, 23(6), 559-567.
Chi, I., & Boey, K. (1993). Hong Kong validation of measuring instruments of mental health status of the elderly. Clinical Gerontologist, 13(4), 35-51.
Chida, Y., & Steptoe, A. (2008). Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosomatic medicine, 70(7), 741-756.
Choi, M., Kong, S., & Jung, D. (2012). Computer and internet interventions for loneliness and depression in older adults: a meta-analysis. Healthcare informatics research, 18(3), 191-198.
Chou, K. L., & Chi, I. (2005). Prevalence and correlates of depression in Chinese oldest‐old. International journal of geriatric psychiatry, 20(1), 41-50.
Clark, E., & McCann, T. (2003). Social capital: one source of wellness in older adults? Health Sociology Review, 12(2), 163-170.
Coget, J.-F., Yamauchi, Y., & Suman, M. (2002). The Internet, social networks and loneliness. It & Society, 1(1), 180.
Corbin, J. M., & Strauss, A. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative sociology, 13(1), 3-21.
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).
Crooks, V. C., Lubben, J., Petitti, D. B., Little, D., & Chiu, V. (2008). Social network, cognitive function, and dementia incidence among elderly women. American Journal of Public Health, 98(7), 1221.
Cutchin, M. P., Chang, P.-F. J., & Owen, S. V. (2005). Expanding our understanding of the assisted living experience. Journal of Housing for the Elderly, 19(1), 5-22.
De Waal, F. B. (2008). Putting the altruism back into altruism: the evolution of empathy. Annu. Rev. Psychol., 59, 279-300.
Fernández-Ballesteros, R. (2008). Active aging: The contribution of psychology: Hogrefe Publishing.
Fessman, N., & Lester, D. (2000). Loneliness and depression among elderly nursing home patients. The International Journal of Aging and Human Development, 51(2), 137-141.
Forgeard, M. J., Jayawickreme, E., Kern, M. L., & Seligman, M. E. (2011). Doing the right thing: Measuring wellbeing for public policy. International Journal of Wellbeing, 1(1).
Frey, M. A. (1989). Social support and health: A theoretical formulation derived from King's conceptual framework. Nursing Science Quarterly, 2(3), 138-148.
Gandek, B., & Ware, J. (1993). SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center.
George, L. K., & Fillenbaum, G. G. (1985). OARS methodology. Journal of the American Geriatrics Society, 33(9), 607-615.
González, A., Ramírez, M. P., & Viadel, V. (2012). Attitudes of the elderly toward information and communications technologies. Educational gerontology, 38(9), 585-594.
Guétin, S., Portet, F., Picot, M., Pommié, C., Messaoudi, M., Djabelkir, L., . . . Touchon, J. (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia: randomised, controlled study. Dementia and geriatric cognitive disorders, 28(1), 36-46.
Guindon, S., & Cappeliez, P. (2010). Contributions of psychological well-being and social support to an integrative model of subjective health in later adulthood. Ageing International, 35(1), 38-60.
Harel, Z. (1981). Quality of Care, Congruence and Weil-Being Among Institutionalized Aged. The Gerontologist, 21(5), 523-531.
Harley, D., & Fitzpatrick, G. (2009). YouTube and intergenerational communication: the case of Geriatric1927. Universal access in the information society, 8(1), 5-20.
Harris, N., & Grootjans, J. (2012). The application of ecological thinking to better understand the needs of communities of older people. Australasian journal on ageing, 31(1), 17-21.
Hsu, H.-C., & Tung, H.-J. (2010). What makes you good and happy? Effects of internal and external resources to adaptation and psychological well-being for the disabled elderly in Taiwan. Aging Ment Health, 14(7), 851-860.
Hunt, C. W., Sanderson, B. K., & Ellison, K. J. (2014). Support for diabetes using technology: A pilot study to improve self-management. Medsurg Nursing, 23(4), 231.
Huppert, F. A., & So, T. T. (2013). Flourishing across Europe: Application of a new conceptual framework for defining well-being. Social Indicators Research, 110(3), 837-861.
Irish, M., Cunningham, C. J., Walsh, J. B., Coakley, D., Lawlor, B. A., Robertson, I. H., & Coen, R. F. (2006). Investigating the enhancing effect of music on autobiographical memory in mild Alzheimer’s disease. Dementia and geriatric cognitive disorders, 22(1), 108-120.
Janata, P. (2009). The neural architecture of music-evoked autobiographical memories. Cerebral Cortex, bhp008.
Janata, P., Tillmann, B., & Bharucha, J. J. (2002). Listening to polyphonic music recruits domain-general attention and working memory circuits. Cognitive, Affective, & Behavioral Neuroscience, 2(2), 121-140.
Juslin, P. N., & Sloboda, J. (2011). Handbook of music and emotion: Theory, research, applications: Oxford University Press.
Katz, S. (2000). Busy bodies: Activity, aging, and the management of everyday life. Journal of aging studies, 14(2), 135-152.
Keyes, C. L. (2002). The mental health continuum: From languishing to flourishing in life. Journal of health and social behavior, 207-222.
Koelsch, S. (2010). Towards a neural basis of music-evoked emotions. Trends in cognitive sciences, 14(3), 131-137.
Koelsch, S., & Siebel, W. A. (2005). Towards a neural basis of music perception. Trends in cognitive sciences, 9(12), 578-584.
Koopman-Boyden, P. G., & Reid, S. L. (2009). Internet/E-mail usage and well-being among 65–84 year olds in New Zealand: Policy implications. Educational gerontology, 35(11), 990-1007.
Kracker, J., Kearns, K., Kier, F. J., & Christensen, K. A. (2011). Activity preferences and satisfaction among older adults in a veterans administration long-term care facility. Clinical Gerontologist, 34(2), 103-116.
Ku, P., McKenna, J., & Fox, K. R. (2007). Dimensions of subjective well-being and effects of physical activity in Chinese older adults. Journal of Ageing, 15(4), 382-397.
Kyrouz, E., & Humphreys, K. (1997). A review of research on the effectiveness of self-help mutual aid groups. International Journal of Psychosocial Rehabilitation, 2, 64-68.
Lagana, L. (2008). Enhancing the attitudes and self-efficacy of older adults toward computers and the internet: Results of a pilot study. Educational gerontology, 34(9), 831-843.
Lam, E. T., Lam, C. L., Fong, D. Y., & Huang, W. W. (2013). Is the SF‐12 version 2 Health Survey a valid and equivalent substitute for the SF‐36 version 2 Health Survey for the Chinese? Journal of evaluation in clinical practice, 19(1), 200-208.
Li, C.-P. (2013). Quality of life patterns and survival among older people. Journal of Nursing Research, 21(2), 94-109.
Lin, C.-L., Su, T., & Chang, M. (2003). Quality of sleep and its associated factors in the institutionalized elderly. Formosan Journal of Medicine, 7(2), 174-184.
Litwin, H., & Shiovitz-Ezra, S. (2006). The association between activity and wellbeing in later life: What really matters? Ageing and Society, 26(02), 225-242.
Lu, J., Tseng, H., & Tsai, Y. (2003). Assessment of health-related quality of life in Taiwan (I): development and psychometric testing of SF-36 Taiwan version. Taiwan J Public Health, 22(6), 501-511.
Lu, L., & Shih, J. (1997). Personality and happiness: Is mental health a mediator? Personality and individual differences, 22(2), 249-256.
Lubben, J. E. (1988). Assessing social networks among elderly populations. Family & Community Health, 11(3), 42-52.
Mann, W. C., Belchior, P., Tomita, M. R., & Kemp, B. J. (2005). Computer use by middle-aged and older adults with disabilities. Technology and disability, 17(1), 1-9.
Maruish, M. E. (2012). User's Manual for The SF-12V2 Health Survey
(Third ed.). USA: QualityMetric Incorporated.
Maxwell, C. J., Soo, A., Hogan, D. B., Wodchis, W. P., Gilbart, E., Amuah, J., . . . Strain, L. A. (2013). Predictors of nursing home placement from assisted living settings in Canada. Canadian Journal on Aging/La Revue canadienne du vieillissement, 32(04), 333-348.
Mitchell, J. M., & Kemp, B. J. (2000). Quality of Life in Assisted Living Homes A Multidimensional Analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55(2), P117-P127.
O'Rourke, J., Tobin, F., O'Callaghan, S., Sowman, R., & Collins, D. (2011). ‘YouTube’: a useful tool for reminiscence therapy in dementia? Age and ageing, 40(6), 742-744.
Park, N. S. (2009). The relationship of social engagement to psychological well-being of older adults in assisted living facilities. Journal of Applied Gerontology, 28(4), 461-481.
Pfeiffer, E. (1975). A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients†. Journal of the American Geriatrics Society, 23(10), 433-441.
Phelan, E. A., Anderson, L. A., Lacroix, A. Z., & Larson, E. B. (2004). Older adults' views of “successful aging”—how do they compare with researchers' definitions? Journal of the American Geriatrics Society, 52(2), 211-216.
Pollard, C., & Kennedy, P. (2007). A longitudinal analysis of emotional impact, coping strategies and post‐traumatic psychological growth following spinal cord injury: A 10‐year review. British journal of health psychology, 12(3), 347-362.
Poulin, J., Deng, R., Ingersoll, T. S., Witt, H., & Swain, M. (2012). Perceived family and friend support and the psychological well-being of American and Chinese elderly persons. Journal of cross-cultural gerontology, 27(4), 305-317.
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.
Russell, C., Campbell, A., & Hughes, I. (2008). Research: Ageing, social capital and the Internet: Findings from an exploratory study of Australian ‘silver surfers’. Australasian journal on ageing, 27(2), 78-82.
Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and psychosomatics, 83(1), 10-28.
Särkämö, T., Tervaniemi, M., Laitinen, S., Numminen, A., Kurki, M., Johnson, J. K., & Rantanen, P. (2014). Cognitive, emotional, and social benefits of regular musical activities in early dementia: Randomized controlled study. The Gerontologist, 54(4), 634-650.
Schulz, R., & Decker, S. (1985). Long-term adjustment to physical disability: the role of social support, perceived control, and self-blame. Journal of personality and social psychology, 48(5), 1162.
Seeman, T. E. (1996). Social ties and health: The benefits of social integration. Annals of epidemiology, 6(5), 442-451.
Shapira, N., Barak, A., & Gal, I. (2007). Promoting older adults’ well-being through Internet training and use.
Taylor, S. E., Sherman, D. K., Kim, H. S., Jarcho, J., Takagi, K., & Dunagan, M. S. (2004). Culture and social support: who seeks it and why? Journal of personality and social psychology, 87(3), 354.
Teresi, J., Abrams, R., Holmes, D., Ramirez, M., & Eimicke, J. (2001). Prevalence of depression and depression recognition in nursing homes. Social psychiatry and psychiatric epidemiology, 36(12), 613-620.
Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? Journal of health and social behavior, 53-79.
Trivers, R. L. (1971). The evolution of reciprocal altruism. Quarterly review of biology, 35-57.
Tsai, H.-H., Tsai, Y.-F., Wang, H.-H., Chang, Y.-C., & Chu, H. H. (2010). Videoconference program enhances social support, loneliness, and depressive status of elderly nursing home residents. Aging and Mental Health, 14(8), 947-954.
Tseng, S. Z., & Wang, R. H. (2001). Quality of life and related factors among elderly nursing home residents in Southern Taiwan. Public Health Nursing, 18(5), 304-311.
White, H., McConnell, E., Clipp, E., Branch, L. G., Sloane, R., Pieper, C., & Box, T. (2002). A randomized controlled trial of the psychosocial impact of providing internet training and access to older adults. Aging Ment Health, 6(3), 213-221.
White, H., McConnell, E., Clipp, E., Bynum, L., Teague, C., Navas, L., . . . Halbrecht, H. (1999). Surfing the net in later life: A review of the literature and pilot study of computer use and quality of life. Journal of Applied Gerontology, 18(3), 358-378.
Winstead, V., Anderson, W. A., Yost, E. A., Cotten, S. R., Warr, A., & Berkowsky, R. W. (2013). You can teach an old dog new tricks a qualitative analysis of how residents of senior living communities may use the web to overcome spatial and social barriers. Journal of Applied Gerontology, 32(5), 540-560.
Xavier, A. J., d’Orsi, E., de Oliveira, C. M., Orrell, M., Demakakos, P., Biddulph, J. P., & Marmot, M. G. (2014). English Longitudinal Study of Aging: can Internet/E-mail use reduce cognitive decline? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 69(9), 1117-1121.
Xie, B. (2008). Multimodal Computer‐Mediated Communication and Social Support among Older Chinese Internet Users. Journal of Computer‐Mediated Communication, 13(3), 728-750.
Yang, H.-C., Brothers, B. M., & Andersen, B. L. (2008). Stress and quality of life in breast cancer recurrence: moderation or mediation of coping? Annals of Behavioral Medicine, 35(2), 188-197.
Zatorre, R. J., Chen, J. L., & Penhune, V. B. (2007). When the brain plays music: auditory–motor interactions in music perception and production. Nature Reviews Neuroscience, 8(7), 547-558.
Zimmerman, S., Anderson, W. L., Brode, S., Jonas, D., Lux, L., Beeber, A. S., . . . Sloane, P. D. (2013). Systematic Review: Effective Characteristics of Nursing Homes and Other Residential Long‐Term Care Settings for People with Dementia. Journal of the American Geriatrics Society, 61(8), 1399-1409.