臺灣博碩士論文加值系統

近年來失智症人數攀升，照顧任務多由家屬擔任。對於失智症家庭而言，除重視失智者的照護，支持照顧者能應對其照顧任務與滿足其自身需求也同樣重要。過去文獻多著重於了解照顧者的經驗與照顧任務對生理、心理、社會層面的影響，較少探討照顧者需求。但了解其需求，才能協助照顧者在照顧過程中獲得適切服務。失智症中，額顳葉型失智症病人初期並非記憶損失，而是行為問題與語言障礙為主，且額顳葉型失智症多為早發性失智症，照顧者所面對問題與自身需求可能有所不同，並承受更多的負荷。本研究目的為探討(1)額顳葉型失智症照顧者需求有哪些，(2)其需求與阿茲海默症照顧者在需求與情緒壓力的差異，以及(3)失智者疾病狀況與照顧者需求、情緒壓力的相關。
　　研究採橫斷式量性問卷調查，根據疾病嚴重程度進行配對，以額顳葉型失智症(n = 21)、阿茲海默症(n = 21)主要照顧者為研究對象。資料收集包括：(1)主要照顧者：人口學資料與照顧工作、照顧者需求、情緒壓力。(2)失智者：人口學資料與疾病特性、疾病嚴重度、日常生活功能、精神行為症狀。以描述性統計、曼恩-惠尼U檢定、斯皮爾曼等級相關、績差相關進行資料分析。
　　研究結果，在控制額顳葉型失智者與阿茲海默症失智者疾病嚴重度後，額顳葉型失智者年紀較輕(U = 140.00, p = .04)、行為症狀較嚴重(U = 133.00, p = .03)，且其照顧者未滿足需求程度較高(U = 123.00, p = .01)，但照顧者情緒壓力並無差異(U = 207.00, p = .73)。在18項需求領域中，額顳葉型失智症照顧者「溝通困難或無法處理病人的行為」(χ2 = 6.22, p = .01)和「疾病診斷和症狀」(χ2 = 7.00, p = .01)的未滿足需求比例顯著高於阿茲海默症照顧者。額顳葉型失智症照顧者未滿足需求項目最高比例前三項為情緒灰心與失落(76.19%)、溝通困難或無法處理病人的行為(76.19%)與個人時間不足(76.19%)。當額顳葉型失智症照顧者的未滿足需求越多，情緒壓力也會越高(r = .56, p 〈.01)；而照顧者的情緒壓力也與病人的問題行為嚴重度(r = .52, p 〈.05)，和因病人問題行為產生的困擾感(r = .69, p 〈.01)呈正相關。　　
未來針對額顳葉型失智症照顧者，尤其是照顧對象年紀較輕的族群，協助照顧者(1)了解額顳葉型失智症相關知識；(2)照顧技巧，教導與病人溝通的技巧與處理問題行為；(3)情緒支持，陪伴其面對失落情緒。

Frontotemporal lobar degeneration (FTLD) is one of main dementia that the clinical features begin with behavior problem, speech and language impairment, rather than memory loss. But there is little known about needs of frontotemporal caregivers. The purposes of the research were to explore the differences in needs and emotional distress between caregivers of FTLD and those of Alzheimer’s disease (AD), and the correlations between symptoms of dementia, unmet needs of caregiver and the emotional distress in FTLD. Participants were caregivers of patients with FTLD (n = 21) and AD (n = 21) who were matched based on dementia severity. Data collection included (1) caregivers: demographics, needs, emotional distress; and (2) patients: demographics, severity of dementia, activities of daily living, neuropsychiatric symptoms and behavioral problems. The caregivers of FTLD reported significant higher unmet needs than the caregivers of AD (U = 123.00, p = .01) but no significant difference in emotional distress (U = 207.00, p = .73). The most common unmet needs of the caregivers of FTLD included disappointment (76.19%), communication problems (76.19%) and no enough time for themselves (76.19%).Unmet needs related to emotional distress positively among the caregiver of FTLD (r = .56, p 〈.01); and emotional distress positively related to severity (r = .52, p 〈.05) and disturbance (r = .69, p 〈.01) of behavioral and psychological symptoms. In future, the medical system needs to provide (1) frontotemporal lobar degeneration related knowledge, (2) care skills training, and (3) emotional support to meet unique needs for caregiver of patients with FTLD.

摘要 I
Abstract III
致謝 VI
目錄 VII
第一章　緒論 1
第一節　研究背景與動機 1
第二章　文獻回顧 3
第一節　額顳葉型失智症 3
第二節　失智症照顧者 4
第三節　需求 9
第四節　研究目的與問題 14
第五節　研究假設 14
第三章　研究方法 15
第一節　研究對象 15
第二節　研究工具 15
第三節　資料處理與統計分析 19
第四節　研究倫理 20
第四章 研究結果 21
第一節　照顧者人口學變項 21
第二節　失智者人口學變項 24
第三節　需求類型 25
第四節　照顧者需求與情緒壓力 27
第五節　額顳葉型失智者疾病狀況與照顧者需求、情緒壓力的相關 28
第五章 討論與結論 29
第一節 照顧者與照顧對象之特性 29
第二節 照顧者需求與情緒壓力討論 32
第三節 額顳葉型失智者疾病表現與照顧者需求、情緒壓力的相關 35
第四節 結論與建議 37
參考文獻 39
附錄一、研究所使用量表 49
附錄二、同意人體研究證明書 63

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