臺灣博碩士論文加值系統

本研究主要目的在了解社區中功能障礙老人的主要家庭照顧者對於支持性服務之需求狀況，並進一步探討各類服務需求之影響因子。研究資料來自1997年台灣大學公共衛生研究所與台北市衛生局共同合作的「台北市都會型長期照護試辦計畫」，本研究計畫之樣本為居住在北市信義、內湖區之65歲以上功能障礙老人及其主要家庭照顧者共483對。
研究結果顯示：照顧者約有七成為女性，平均年齡為57歲，有近四成的照顧者為65歲以上老人、四分之三的照顧者目前並無就業。分析照顧者需求，需求最高的三項服務分別為：需要交通接送老人服務（42.4﹪）、需要醫師往診探視老人（38.7﹪）、需要喘息服務（35.6﹪）。
本研究架構以功能障礙老人之健康特質、照顧者之社會人口、健康特質、照顧者負荷、以及照顧者獲得之照護支持作為照顧者對各類支持性服務需求之影響因子，以次序性對數複迴歸模式以及對數複迴歸模式分析資料，發現：（1）老人身體功能障礙愈嚴重、照顧者身體負荷程度高者，有較高的居家醫療服務需求。（2）照顧者需同時兼顧工作與照顧老人、照顧者身體負荷程度高、與照護支持程度較低者，有較多的社會服務需求。（3）老人身體功能障礙程度愈嚴重、照顧者籍貫為外省人、照顧者家庭平均月收入較高、照顧者身體負荷與家庭關係負荷程度高者，易對個人照顧服務有所需求。（4）老人認知功能障礙程度為重度、照顧者年齡較輕、教育程度較高、時間限制程度高者，有較多的社區式服務需求。
本研究發現，家庭照顧者對於各類服務均有相當高的需求，而對於各式服務需求程度會因照顧者與老人之特質而異，面對此多樣性之族群，長期照護安排需要依其特質給予不同之服務。而照顧者的負荷明顯引發照顧者對於各類照護服務有較高的需求，因此，在發展照顧管理制度之時，首要目標應在減輕照顧者負荷、提供合宜的服務以支持照顧者繼續提供老人居家式的照護模式。

This study aims to investigate the supportive service needs among the primary family caregivers of disabled elderly, and the factors affecting the service needs. The data came from "Taipei City－Long Term Care Plan" cooperated by Public Health Institution of National Taiwan University and Health Bureau of Taipei City in 1997.The sample were elders who were older than 65 living in Shinyi area and Neihu area in Taipei, and their family caregivers, totally 483 pairs.
The data showed: approximately 70 percent of the caregivers were female; the average age of them was 57 years old; about 40 percent of them were over 65 years of age, and three-fourths of them did not have a job at that time. The highest need of caregivers was transportation for the elders（42.4%）, followed by doctor visiting the elders（38.7%）, and respite care（35.6%）.
We used ordinal logistic regression and multiple logistic regression to analysis the data. The important conclusions showed:（1）The worse the elders’ physical functional status, the more the caregivers need home
medical services. The higher the caregivers’ physical burden, the more the caregivers need home medical services.（2）The higher the caregivers’ physical burden, the more the caregivers need social services. The lower the caregivers’ caring support, the more the caregivers need social services. Caregivers who have jobs need more social services.（3）The worse the elders’ physical functional status, the more the caregivers need personal care. The higher the caregivers’ family income, physical burden and family burden, the more the caregivers need personal care. In ethnicity, mainlanders need more personal care.（4）The worse the elders’ mental status, the more the caregivers need community services. The higher the caregivers’ education and time restrain degree, the more the caregivers need community services. The younger the caregivers, the more the caregivers need community services.
We found, family caregivers had high degree needs among each
service category. The data revealed the needs would correspond to the caregivers and elders'' characters, when we face this diversity group, long term care arrangement should be changed by their discrepancy. The burden of family caregivers is obvious involve high extent needs. Hence, when we develop our care management system, first purpose is to alleviate the caregivers'' burden, and offer suitable services to support them continue caring for the elders in their home and community.

【目錄】
第一章 緒論
第一節 研究背景 1
第二節 研究動機及目的 4
第二章 文獻探討
第一節 家庭照顧者之需求 7
第二節 台灣與其他國家之家庭照護支持方案 10
第三節 未來趨勢－照顧管理 19
第四節 家庭照顧者支持性服務需求之影響因子 23
第三章 材料與方法
第一節 研究架構與假設 27
第二節 研究變項操作型定義與測量 29
第三節 研究材料 33
第四節 資料處理與分析 35
第五節 缺失值的處理方法 38
第四章 研究結果
第一節 服務需求狀況與研究對象特性 4
第二節 服務需求狀況與自變項之雙變項關係分析 48
第三節 影響服務需求狀況之多變項分析 59
第五章 討論
第一節 重要結果與討論 101
第二節 政策啟示 107
第三節 研究限制 111
第四節 建議未來研究方向 112

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