背景： 2012年歐盟提出活躍老化指標，在社會參與層面中包含照顧老人及照顧孫子女兩項指標。過去研究發現，不同的照顧對象有不同的照顧經驗、照顧原因以及照顧心境，對於健康結果的影響也不相同。然而，有關照顧老人及照顧孫子女，其照顧者的幸福感差異的文獻非常稀少，此外隨著社會變遷，照顧老人及照顧孫子女的老年人持續增加，越來越多老年人需同時肩負照顧老人及照顧小孩的雙重責任，然而我國對於雙重照顧者的資料仍然相當缺乏。

目的：本研究目的有三個：第一，呼應歐盟活躍老化指標，了解老人照顧老人與照顧孫子女的現況與比例；第二，比較三種照顧者對幸福感短期的影響和變化；第三，比較長期照顧者對幸福感的長期影響和變化。本研究的幸福感採用認知幸福感作為結果測量。

方法：使用台灣地區中老年身心社會生活狀況長期追蹤 (TLSA)1996年、1999年、2003年及2007年四波調查，排除1996年身體功能狀況不好(包括住機構、代答及ADL>0)的50歲以上老人後，最後樣本人數共4217人。照顧狀態可以分為三部分，第一部份曾經照顧者包含四組：照顧老人、照顧孫子女、雙重照顧者以及非照顧者。第二部份曾經照顧者包含五組：照顧ADL老人、照顧IADL老人、照顧孫子女、雙重照顧者以及非照顧者。第三部分長期照顧者則是將照顧老人、孫子女、雙重照顧依其1996及1999年兩波照顧狀態區分為持續照顧、後來停止照顧、後來開始照顧以及非照顧者四組。認知幸福感的測量使用生活滿意度10題(同意/不同意)，分數越高代表認知幸福感越好。分析方式使用Generalized Estimation Equations (GEE)來處理重複測量的資料型態。

結果：照顧狀態描述性結果顯示，照顧老人從1999年3.2%開始，隨著年代增加照顧老人的比例至2007年增加到7.9%；雙重照顧者也隨年代增有比例上升的趨勢(從1999年0.8%到2007年變成3.3%)；非照顧者從1996年70.2%隨著年代增加，至2003年78.8%後，2007年又微微下降至77.6%。而照顧孫子女的比例則是隨著年代下降，從1996年23.7%一路下滑至2007年只剩14.5%。進行多變量分析結果：第一部份曾經照顧者(四組)：以非照顧者為參考組，結果發現僅有雙重照顧者對認知幸福感有顯著正向的影響(b=0.56, 95%CI：0.14 to 0.99)。第二部分將照顧老人進一步分為照顧ADL老人及IADL老人後，共五組照顧狀態：以非照顧者為參考組，照顧ADL老人有顯著負向的認知幸福感(b=-0.41, 95%CI：-0.78 to -0.05)。第三部分長期照顧者：發現持續照顧孫子女有顯著正向認知幸福感(b=0.23, 95%CI：0.04 to 0.42)，後來停止雙重照顧者也有顯著的正向認知幸福感(b=0.47, 95%CI：0.11 to 0.84)，但在照顧老人的部分無論是持續照顧、後來開始照顧或是後來停止照顧相比於非照顧者皆不具顯著性。

討論：照顧ADL老人有顯著負向的認知幸福感，持續照顧孫子女有顯著正向的認知幸福感，曾經雙重照顧及停止雙重照顧的照顧者皆有顯著正向的認知幸福感。不同照顧對象對於認知幸福感有不同的影響，可能與照顧者提供照顧的原因、內容及心境上的差異有關。未來政策制定者應該多關注照顧ADL老人的照顧者。

INTRODUCTION: According to active ageing index, caring family member is a positive index of social participation in older adults. However, different care subjects always let caregivers have different experiences and feelings, and the information of different caregiver on well-being is limited. Therefore, the study aimed to compare whether elder caregivers felt less well-being than grandchild caregivers?

METHODS: This study used the dataset of nationally representative samples from Taiwan Longitudinal Study of Aging, and four waves of survey were analyzed, including 1996, 1999, 2003, and 2007. After excluding institutional older adults and poor physical functions (ADL>0), a total of 4217 samples was recruited. Caregiver status were divided into 3 parts: (1) four groups of ever-caregivers, (2) five groups of ever-caregivers (3) long-term caregivers, and Cognitive well-being was measured by 10 items of life satisfaction (yes/no). The generalized estimation equations (GEE) was used to analyze the long-term effects of repeated measured data.

RESULTS: In the four groups of ever-caregivers , comparing with non-caregivers, dual caregivers had significantly positive cognitive well-being (b=0.56, 95%CI：0.14 to 0.99). In the five groups of ever-caregivers, elder caregivers who provided ADL assistants had significantly negative cognitive well-being(b=-0.42, 95%CI：-0.79 to -0.05). In the part of long-term caregivers, long-term grandchildren caregivers had significantly positive cognitive well-being(b=0.23, 95%CI：0.03 to 0.42), stop dual caregiving had better cognitive well-being (b=0.47, 95%CI：0.11 to 0.84)

DISCUSSION: Taking care of older adults who needed ADL assistants is significantly associated with negative cognitive well-being. Therefore, future policy should pay more attention on elder caregivers who provided ADL assistants

內政部統計處(2013)。人口統計資料：我國生命表。
內政部統計處(2015)。人口統計資料：人口結構分析。
內政部統計處(2013)。老人狀況調查報告。
內政部統計處(2013)。婦女生活調查報告。
經建會人力規劃處(2013)。歐盟活躍老化指數
蔡錫清（2006）碩士論文：自由主義之正義與平等理論--其思想發展軌跡初探
呂寶靜. (2001). 老人照顧-老人, 家庭, 正式服務. 臺北: 五南.
陳景寧. (1996). 女性照顧者角色之成因, 處境及其福利政策分析--以失能老人的家庭照顧為例. 國立政治大學社會學研究所碩士論文. 臺北: 政治大學.
徐慧娟. (2003). 成功老化: 老年健康的正向觀點.
張桂霖 & 張金鶚. (2010). 老人居住安排與居住偏好之轉換: 家庭價值與交換理論觀點的探討. 人口學刊, (40), 41-90.
柯瓊芳. (2002). 誰來照顧老人? 歐盟各國奉養態度的比較分析. 人口學刊》(24), 1-32.
楊雅嵐(2005)碩士論文：老幼兼顧之經驗初探: 以兼顧失能配偶與年幼孫兒的女性照顧者為例
蔡文輝. (2007). 婚姻與家庭-家庭社會學. 五南圖書出版股份有限公司.
WHO(2012) Active Ageing：A Policy Framework
United Nations Economic Commission For Europe(2015)：Active Ageing Index 2014 Analytical Report
Aassve, A., Arpino, B., & Goisis, A. (2012). Grandparenting and mothers' labour force participation: A comparative analysis using the generations and gender survey. Demographic Research, 27, 53.
Ballinger, G. A. (2004). Using generalized estimating equations for longitudinal data analysis. Organizational research methods, 7(2), 127-150.
Brandon, P. (2000). An Analysis of Kin‐Provided Child Care in the Context of Intrafamily Exchanges. American Journal of Economics and Sociology,59(2), 191-216.
Busseri, M. A., & Sadava, S. W. (2010). A review of the tripartite structure of subjective well-being: Implications for conceptualization, operationalization, analysis, and synthesis. Personality and Social Psychology Review, 1088868310391271.
Connidis, I. A., & McMullin, J. A. (2002). Sociological ambivalence and family ties: A critical perspective. Journal of marriage and family, 64(3), 558-567
Cochran, W. G. (1954). Some methods for strengthening the common χ 2 tests. Biometrics, 10(4), 417-451.
Crowther, M. R., Parker, M. W., Achenbaum, W. A., Larimore, W. L., & Koenig, H. G. (2002). Rowe and Kahn's model of successful aging revisited positive spirituality—the forgotten factor. The Gerontologist, 42(5), 613-620.
Cook, K. S., Cheshire, C., Rice, E. R., & Nakagawa, S. (2013). Social exchange theory. In Handbook of social psychology (pp. 61-88). Springer Netherlands.
Call, K. T., Finch, M. A., Huck, S. M., & Kane, R. A. (1999). Caregiver burden from a social exchange perspective: Caring for older people after hospital discharge. Journal of Marriage and the Family, 688-699.
Dunne, E. G., & Kettler, L. J. (2008). Grandparents raising grandchildren in Australia: Exploring psychological health and grandparents’ experience of providing kinship care. International Journal of Social Welfare, 17(4), 333-345.
Dahlrup, B., Ekström, H., Nordell, E., & Elmståhl, S. (2015). Coping as a caregiver: A question of strain and its consequences on life satisfaction and health-related quality of life. Archives of gerontology and geriatrics, 61(2), 261-270.
Eid, M., & Diener, E. (2004). Global judgments of subjective well-being: Situational variability and long-term stability. Social indicators research,65(3), 245-277.
Freedman, V. A., Cornman, J. C., & Carr, D. (2014). Is spousal caregiving associated with enhanced well-being? New evidence from the panel study of income dynamics. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, gbu004.
Goodman, C. C. (2012). Caregiving grandmothers and their grandchildren: Well-being nine years later. Children and Youth Services Review, 34(4), 648-654.
Graham Horwitz, A. V., Reinhard, S. C., & Howell-White, S. (1996). Caregiving as reciprocal exchange in families with seriously mentally ill members. Journal of Health and Social Behavior, 149-162.
Hajek, A., & König, H. H. (2016)a. Informal caregiving and subjective well-being: Evidence of a population-based longitudinal study of older adults in Germany. Journal of the American Medical Directors Association, 17(4), 300-305.
Hajek, A., & König, H. H. (2016)b. The Effect of Intra-and Intergenerational Caregiving on Subjective Well-Being–Evidence of a Population Based Longitudinal Study among Older Adults in Germany. PloS one, 11(2), e0148916.
Horwitz, A. V., Reinhard, S. C., & Howell-White, S. (1996). Caregiving as reciprocal exchange in families with seriously mentally ill members. Journal of Health and Social Behavior, 149-162.
Ku, L. J. E., Stearns, S. C., Van Houtven, C. H., Lee, S. Y. D., Dilworth-Anderson, P., & Konrad, T. R. (2013). Impact of caring for grandchildren on the health of grandparents in Taiwan. The Journals of Gerontology Series B: Psychological sciences and social sciences, 68(6), 1009-1021.
Mackenzie, A. E., & Holroyd, E. E. (1996). An exploration of the carers' perceptions of caregiving and caring responsibilities in Chinese families.International journal of nursing studies, 33(1), 1-12.
Mahne, K., & Huxhold, O. (2015). Grandparenthood and Subjective Well-Being: Moderating Effects of Educational Level. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(5), 782-792.
Neugarten, B. L., Havighurst, R. J., & Tobin, S. S. (1961). The measurement of life satisfaction. Journal of gerontology.
Neuberger, F. S., & Haberkern, K. (2014). Structured ambivalence in grandchild care and the quality of life among European grandparents.European Journal of Ageing, 11(2), 171-181.
Nordbakke, S., & Schwanen, T. (2014). Well-being and mobility: A theoretical framework and literature review focusing on older people.Mobilities, 9(1), 104-129.
Oliveira, G. R., Neto, J. F., Camargo, S. M., Lucchetti, A. L. G., Espinha, D. C. M., & Lucchetti, G. (2015). Caregiving across the lifespan: comparing caregiver burden, mental health, and quality of life. Psychogeriatrics, 15(2), 123-132.
Pearson, V., & Ning, S. P. (1997). Family care in schizophrenia: An undervalued resource. Social work intervention in health care: The Hong Kong scene, 317-336.
Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The gerontologist, 30(5), 583-594.
Phillips, D. (2006). Quality of life: Concept, policy and practice. Routledge.
Rafnsson, S. B., Shankar, A., & Steptoe, A. (2015). Informal caregiving transitions, subjective well-being and depressed mood: Findings from the English Longitudinal Study of Ageing. Aging & Mental Health, 1-9.
Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The gerontologist,37(4), 433-440.
Shin, D. C., & Johnson, D. M. (1978). Avowed happiness as an overall assessment of the quality of life. Social indicators research, 5(1-4), 475-492.
Tsai, F. J., Motamed, S., Elia, N., & Rougemont, A. C. (2011). Evolution in intergenerational exchanges between elderly people and their grandchildren in Taiwan; data from a multiple round cross-sectional study from 1993 to 2007. BMC public health, 11(1), 1.
Wang, Y. N., Shyu, Y. I. L., Chen, M. C., & Yang, P. S. (2011). Reconciling work and family caregiving among adult-child family caregivers of older people with dementia: Effects on role strain and depressive symptoms. Journal of Advanced Nursing, 67(4), 829-840.
Xu, L., & Chi, I. (2011). Life satisfaction among rural Chinese grandparents: the roles of intergenerational family relationship and support exchange with grandchildren. International Journal of Social Welfare, 20(s1), S148-S159.
Zehner Ourada, V. E., & Walker, A. J. (2014). A comparison of physical health outcomes for caregiving parents and caregiving adult children. Family Relations, 63(1), 163-177.