臺灣博碩士論文加值系統

有關工具性日常生活活動（Instrumental Activities of Daily Living, IADL）需求之評估，以長期照護機構老人為研究對象雖然重要但是非常缺乏。本研究目的在於瞭解機構老人IADL需求情形及其影響因子。主要評量工具為「IADL需求量表」，其需求程度含括：IADL需求滿足且明顯無問題、需求滿足但有潛在問題、需求未滿足且有現存問題、及不確定等四類。老人IADL需求程度由兩方面探討：（1）所有機構老人中IADL需求之現存問題；（2）排除IADL需求之現存問題後，老人IADL需求有潛在問題之情形。並且為了全面評量老人IADL需求狀況，以整體IADL需求與個别IADL需求二部分分析之。
透過台北地區一所自費安養中心之173位老人接受問卷訪談。結果發現：（1）老人平均年齡約80歲，身體功能良好；（2）僅少數老人呈現整體IADL需求有現存問題（15%），以輕勞動家務及財務管理等二項之現存需求較多（分別為5.2%、4.0%）；（3）約近1/3老人呈現整體IADL需求有潛在問題，則以準備餐點及重勞動家務等二項之潛在需求居多（分別為18.5%、16.2%）；（4）與個別IADL需求有現存問題之相關因子，含括婚姻狀況、零用錢、交通便利、及接近生活相關設施皆與操作勞動家事呈顯著相關；自覺健康狀況與財務管理呈顯著相關；（5）與整體IADL需求有現存問題之相關因子，含婚姻狀況、接近與生活相關之設施等變項；（6）與個別IADL需求有潛在問題之相關因子，含括年齡、性別、及腫瘤等皆與操作勞動家事呈顯著相關，而高血脂及IADL功能等與財務管理亦呈顯著相關；宗教信仰與準備餐點呈顯著相關；（7）與整體IADL需求有潛在問題之相關因子，含括IADL功能、糖尿病、氣喘、及入住機構時間長短等變項。
以上研究顯示：約1/3的受訪老人具有IADL現存或潛在需求，而受訪對象雖然年紀大但功能良好，所以本研究結果可視為機構老人IADL需求之最低估計。因此，本研究結果有助於服務計劃之擬定，以提供更適切的服務。

Assessment of the needs of Instrumental Activities of Daily Living（IADL）is an important topic for the elder in long-term care facilities, but the needs of IADL have rarely been examined. The purpose of this study was to examine the status and related factors of IADL needs among long-term care facilities. Measurement of IADL needs was based on the IADL needs assessment scale. The needs status includes four categories: needs met without apparent problem, needs met with potential problem, needs unmet with current problem, and uncertainties. IADL needs status was divided into two categories. For the first category, we assessed the current problems of the IADL needs for all the elderly in all institutions. Second, the potential problems of IADL needs were assessed after excluding current problems of IADL needs. Furthermore, we analyzed both the whole and individual IADL needs to make a complete assessment.
We interviewed 173 elder habitants in a private domiciliary care facility in Taipei . The results showed: （a）Mean age of the elderly was about 80 years and most of them were in good physical function condition（b）Only a few elder subjects had current problems of the whole IADL needs(15%). Among which the light housekeeping works and finances consist two of the most common current needs（5.2% and 4.0% respectively）.（c）About one third of the subjects had potential problems of the whole IADL needs, and the leading cases were preparing meals and heavy housekeeping works（18.5% and 16.2% respectively）.（d）Among the predicting factors of the current problems of individual IADL needs, marriage, the allowance, transportation convenience and amenity of living were in statistically significant correlation with housekeeping. Self-rated health was in statistically significant correlation with finances.（e）Marriage and the amenity of living were the variables correlated with the current problems of the whole IADL needs.（f）Among the predicting factors of the potential problems of individual IADL needs, age, sex, and tumor of the subjects were significantly correlated with housekeeping; hyperlipidemia and IADL were correlated with finances; religion was correlated significantly with preparing meals.（g）The factors related to the potential problems of the whole IADL needs include IADL, diabetes, asthma and the staying span in the institutions.
In conclusion, our study presents that one third of the elder subjects had current or potential problems of IADL needs. Although the subjects were elder in age, they were in good physical function condition. The results shown are considered as an minimum estimate of IADL needs for the elder in long-term care facilities. These results can be useful for better service planning and provision.

壹、目錄 ………………………………………………………… I
貳、圖目錄…………………………………………………………III
參、表目錄…………………………………………………………IV
肆、論文內容
第一章 緒論………………………………………………… 1
第一節 研究動機…………………………………………… 1
第二節 研究目的 …………………………………………2
第三節 研究重要性………………………………………………2
第四節 名詞解釋 ………………………………………………2
第二章 文獻回顧 ………………………………………………4
第一節 IADL ………………………………………………4
第二節 需求理論架構 ………………………………………6
第三節 長期照護機構老人之IADL需求 ………………………8
第四節 研究主題之預期貢獻………………………………… 11
第三章 研究方法 ………………………………………………12
第一節 研究架構 ………………………………………………12
第二節 研究問題 ………………………………………………13
第三節 研究假設 ………………………………………………13
第四節 變項之操作型定義 ……………………………………13
第五節 材料與方法 ……………………………………………16
第四章 研究結果 ……………………………………………21
第一節 IADL需求量表之再測信度檢定 ………………………21
第二節 描述性分析 ……………………………………………21
第三節 推論性分析 ……………………………………………23
第五章 討論 ………………………………………………… 27
第一節 機構老人之IADL需求及其影響因子……………… 27
第二節 IADL需求量表……………………………………… 31
第三節 研究限制 ……………………………………………33
第六章 結論與建議 ……………………………………………34
第一節 結論 ………………………………………………… 34
第二節 建議 ………………………………………………… 35
第三節 研究貢獻……………………………………………… 35
圖表目錄 ……………………………………………………… 37
圖表二 老人整體IADL之需求程度………………………………37
圖表三 排除整體IADL需求有現存問題後之老人其他IADL需求程度
………………………………………………………… 37
附表 ………………………………………………………… 38
表1 IADL每項反應型態 ……………………………………… 38
表2 IADL需求量表各項目之再測信度檢定 …………………38
表3 研究對象之人口學基本屬性 ……………………………39
表4 居住環境……………………………………………………40
表5 研究對象之慢性病數目……………………………………40
表6 研究對象之慢性病診斷……………………………………41
表7 IADL個別項目之需求程度 ………………………………41
表8 老人個別IADL需求具有現存問題的可能影響因子χ2檢定之p值
……………………………………………………………42
表9-1 整體IADL需求程度之可能影響因子-以需求具有現存問題與需求滿足、需求有潛在問題及不確定兩組之χ2檢定 …………………43
表9-2 整體IADL需求程度之可能影響因子-以需求具有現存問題與需求滿足、需求有潛在問題及不確定兩組之χ2檢定（續） ……………44
表9-3 整體IADL需求程度之可能影響因子-以需求具有現存問題與需求滿足、需求有潛在問題及不確定兩組之χ2檢定（續） ……………45
表10 排除個別IADL需求有現存問題之老人後，其他老人於IADL個別項目需求具有潛在問題之可能影響因子χ2檢定之 p 值……………46
表11-1排除整體IADL需求程度有現存問題之老人後，其他老人IADL的需求程度之χ2檢定 ……………………………………………………47
表11-2排除整體IADL需求程度有現存問題之老人後，其他老人IADL的需求程度之χ2檢定（續） ……………………………………………48
表11-3排除整體IADL需求程度有現存問題之老人後，其他老人IADL的需求程度之χ2檢定（續） ……………………………………………49
表12 影響老人準備餐點之需求有現存問題之羅吉斯迴歸分析…50
表13 影響老人操作輕勞動家事之需求有現存問題之羅吉斯迴歸分析
…………………………………………………………………50
表14 影響老人操作重勞動家事之需求有現存問題之羅吉斯迴歸分析
…………………………………………………………………51
表15 影響老人財務管理之需求有現存問題之羅吉斯迴歸分析
…………………………………………………………………51
表16 老人整體IADL需求有現存問題之羅吉斯迴歸分析
…………………………………………………………………52
表17 排除整體IADL需求有現存問題之老人後，影響其他老人於操作輕勞動家事之需求有潛在問題之羅吉斯迴歸分………………………52
表18 排除整體IADL需求有現存問題之老人後，影響其他老人於操作重勞動家事之需求有潛在問題之羅吉斯迴歸分析……………………53
表19 排除整體IADL需求有現存問題之老人後，影響其他老人於財務管理之需求有潛在問題之羅吉斯迴歸分析……………………………53
表20 排除整體IADL需求有現存問題之老人後，影響其他老人於準備餐點之需求有潛在問題之羅吉斯迴歸分析……………………………53
表21 排除整體IADL需求有現存問題之老人後，影響其他老人於整體IADL需求具有潛在問題之羅吉斯迴歸分析 ………………………53
參考文獻………………………………………………………………54
中文部份………………………………………………………………54
英文部分………………………………………………………………55
附錄一 全民健康保險慢性病種類 ………………………………61
附錄二 IADL需求量表………………………………………………62
附錄三 巴氏量表……………………………………………………67
附錄四 OARS-IADL 量表……………………………………………68
附錄五 SPMSQ量表 …………………………………………………69

中文部份
內政部統計處（2000）．中華民國八十九年臺閩地區老人狀況調查摘要分析
．摘自http://www.moi.gov.tw/W3/stat/Survey/old89.htm。
內政部社會司（2002）．台北市公私立老人安養、養護、長期照護機構一覽表．摘自http://volnet.moi.gov. tw/sowf/04/12/3.doc。
內政部社會司（2002）．台北縣公私立老人安養、養護、長期照護機構一覽表．摘自http://volnet.moi.gov.tw/sowf/04/12/A.doc。
中央健康保險局 （2003）．基層醫療院所門診常見疾病ICD-9-CM彙編 (2001 vs. 1992版) ．摘自http://www.nhi.gov.tw/02hospital/hospital_5_03-1.htm。
李世代（2000）．長期照護需求推估之探討．社區發展季刊．92，143-188。
張媚、吳淑瓊、呂寶靜、戴玉慈（2001）‧長期照護需求評估工具發展與測試之研究（修正本）（MOI-DSA-089-011）‧內政部委託研究。
曾思瑜（1995）．我國自費老人安養設施與日本的高齡者住宅制度‧空間雜誌，72‧76-81.
楊培珊（1999）．臺北市獨居老人生活暨需求概況調查--以文山區為例．國立臺灣大學社會學刊，27．143-188。
謝美娥（1997）．從失能老人社區照顧的需求初探服務網絡之建立．國立政治大學社會學報，27．47-88。
謝清麟（1997）．芙蘭切活動量表之信度及效度驗證．慈濟醫學雜誌．9(2) 123-130.
英文部分
CDC (2003, January ). from http://www.cdc.gov/drugresistance/ miscellaneous/glossary.htm#L.
Institute of Medicine (2003, January). from http://www.iom.edu/IOM/
IOMHoome.nsf. /Pages/IOM+ProgramsAustralian Institute of Health and Welfare (AIHW) (2003, January ). Chronic Diseases and Associated Risk Factors in Australia 2001 (ISBN 11-74024-153-153).
Allen, S. M., Mor, V., Raveis, V.,& Houts, P. (1993). Measurement of need for assistance with daily activities: quantifying the influence of gender roles. Journal of Gerontology, 48(4),S204-211.
Allen, S. M., & Mor, V. (1997). The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability. Medical Care, 35(11),1132-1148.
Aller, L. J., & Van Ess Coeling, H. ( 1995).Quality of life: Its meaning to the long-term care resident. Journal of Gerontological nursing,21(2),20-25.
Branch, L. G. (2000). Assessment of chronic care need and use. Grontologist,40
(4), 390 -396.
Carvette, M.E., Hayes, E. B.,Schwartz, R. H., Bogdan, G..F.,Bartlett, N. W., & Graham, L.B. (1996). Chronic Disease Mortality in Maine: Assessing the Targets for Prevention. Journal of Public Health Management and Practice, 2(3),25-31.
Chong, D. K. (1995). Measurement of instrumental activities of daily living in stroke. Stroke, 26(6),1119-1122.
David, A., Cromwell, D.A., Eagar, K.& Poulos,R.G. (2003).The performance of instrumental activities of daily living scale in screening for cognitive impairment in elderly community residents. Journal of Clinical Epidemiology, 56(2) ,131—
137.
Dill, A. (1993). Defining needs, defining systems: a critical analysis. Gerontologist
,33(4),453-460.
Elizabeth, H. B., Sidney, T. B., Carol, V. D., Christianna, S. W., Emily, C. M., & Sharon, K. I. (2000). Goals in geriatric assessment: Are we measuring the right outcomes? Gerontologist, 40(2), 191-196.
Fillenbaum, G. G. (1985). Screening the elderly. A brief instrumental activities of
daily living measure. Journal of the American Geriatrics Society, 33(10),698
-706.
Fricke, J., & Unsworth, C. (2001). Time use and importance of instrumental activities of daily living. Australian Occupational Therapy Journal, 48(3), 118—131.
Gama, E.V., Damian, J.E., Perez de Molino, J., Lopez, M.R., Lopez Perez, M.,& Gavira Iglesias, F. J., (2000).Association of individual activities of daily living with self-rated health in older people. Age & Ageing, 29(3),267-270.
Golant, M., Altman, T. & Martin, C.（2003）. Managing cancer side effects to improve quality of life: a cancer psychoeducation program. Cancer Nursing
,26(1),37-44.
Hallberb, I .R. (1998). Needs assessment in elderly people suffering from communication difficulties and/or cognitive impairment. In S.Baldwin (Eds.), Needs assessment (pp.73-88). London:Butterworth.
Harding, K., Baldwin, S., Baser, C. (1987). Towards multi-level needs assessment. Behavioural Psychotherapy, 15(1),134-143.
Henderson, V. (1964). I.C.N. Basic Principles of Nursing Care. London:
International Council of Nursing House.
Hellstrom, Y., & Hallberg, I. R. (2001). Perspectives of elderly people receiving home help on health, care and quality of life. Health & Social Care in the Community, 9(2),61-71.
Holbrook, M., & Skilbeck. C. E. (1983). An activities index for use with stroke patients. Age Ageing, 12(2), 166-170.
Hsueh, I. P., Lee, M. M., & Hsieh, C. L. (2001). Psychometric characteristics of the Barthel activities of daily living index in stroke patients. Journal of the Formosan Medical Association, 100(8),526-532.
Kane, R., & Boult, C. (1998).Defining the service needs of frail older persons. In S.
Allen & V. Mor (Eds.), Living in the community with disability: Service needs,use,and systems (pp.15-41). New York: Springer.
Kane, R., A. (2001). Long-Term Care and a Good Quality of Life: Bringing Them Closer Together. Gerontologist, 41(3), 293-304.
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Taffe, M.W.(1963). Studies of illness in the aged: The index of ADL: A standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185(12 ), 914-918.
Kennedy, J. (2001). Unmet and undermet need for activities of daily living and instrumental activities of daily living assistance among adults with disabilities: estimates from the 1994 and 1995 disability follow-back surveys. Medical Care,39 (12), 1305-1312.
Kent, R. M., Chandler, B. J.,& Barnes, M. P. (2000). An epidemiological survey of the health needs of disabled people in a rural community. Clinical Rehabilitation, 14(5),481-490.
Kimmel, W. A. (1977).Needs Assessment: a Critical Perspective. Office of program systems OPS for Planning and Evaluation, Department of Health, Education and Welfare, Washington DC.
Koyano, W., Shibata, H., Nakazato, K., Haga, H., & Suyama, Y. (1988). Prevalence of disability in instrumental activities of daily living among elderly Japanese. Journals of Gerontology, 43( 2), S41-45.
Lawton, M. P., & Brady, E. M. (1969). Assessment of Older People：Self-
Maintaining and Instrumental Activities of Daily Living. Gerontologist,9(3)
,179-186.
Lee, Y., & Choi, K. (2001).Functional disability of older persons in long-term care facilities in Korea. Archives of Gerontology and eriatrics,34(2002),93-106.
Lim, H. S. & Lip, G.Y.（2003）. A case of breathlessness. Practitioner,247(1644
),199-207.
Lima, J. C.& Allen, S.M. (2001). Targeting risk for unmet need: not enough help versus no help at all. Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 56(5),S302-310.
Mahoney, F. I. Barthel, D. W. (1965). Functional evaluation: Barthel index. Maryland State Medical Journal, 14(1), 61-65.
Maslow, A.H. (1954). Motivation and Personality. New York:Harper.
Mili, F., Helmick, C.G. & Moriarty, D.G. （2003）. Health related quality of life among adults reporting arthritis: analysis of data from the Behavioral Risk Factor Surveillance System, US, 1996-99. Journal Rheumat,30(1),160-166.
Moore, E.G., Rosenberg, M.W. & Fitzgibbon, S. H.（1999）. Activity limitation
and chronic conditions in Canada''s elderly, 1986-2011. Disability &
Rehabilitation, 21(5-6),196-210.
Mor, V., Allen, S.M., Siegel, K., & Houts, P.(1992). Determinants of need and unmet need among cancer patients residing at home. Health Services Research, 27(3), 337-360.
Nourhashemi, F., Andrieu, S., Gillette-Guyonnet, S., Vellas, B., Albarede, J. L., Grandjean, H. (2001). Instrumental Activities of Daily Living as a Potential Marker of Frailty: A Study of 7364 Community-Dwelling Elderly Women (the EPIDOS Study). Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56A(7), M448-453.
Nouri, F. M., & Lincoln, N. B. (1987). An extended activities of daily living scale for Stroke Patients. Clinical Rehabilitation , 1(3) , 301-305.
Per-Erik, L. (1998). Needs assessment in elderly people suffering from communication difficulties and/or cognitive impairment. In S.Baldwin (Eds.), Needs assessment (pp.10-24). London:Butterworth.
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),33-41.
Rejeski ,W. J., & Mihalko, S. L. (2001). Physical activity and quality of life in older adults. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 56A (2), 23-35.
Reuben, D. B., Laliberte, L., Hiris, J., & MoR, V. A. (1990). A hierarchical exercise scale to measure at the Advanced Activities of Daily Living（AADL）level. Journal of American Geriatrics Society, 38(8), 855-861.
Roccaforte, W. H., Burke, W. J., Bayer, B. L.,& Wengel, S. P.(1994). Reliability and validity of the Short Portable Mental Status Questionnaire administered by telephone. Journal of Geriatric Psychiatry & Neurology, l7(1),33-38.
Saliba, D., Orlando, M., Wenger, N.S., Hays, R.D., &Rubenstein, L.Z. (2000).
Identifying a short functional disability screen for older persons. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 5(12),M750-
756.
Schuling, J., de Haan, R., Limburg, M., & Groenier, K.H. (1993). The Frenchay Activities Index. Assessment of functional status in stroke patients. Stroke,24(8), 1173-1173.
Shetterly, S.M., Baxter, J., Morgenstern, N.E., Grigsby, J., & Hamman, R.F. (1998). Higher instrumental activities of daily living disability in Hispanics compared with non-Hispanic whites in rural Colorado. The San Luis Valley Health and Aging Study. American Journal of Epidemiolog, 147(11),1019-1027.
Tennstedt, S., McKinlay, J., & Kasten, L.（1994）. Unmet need among disabled elders: a problem in access to community long term care?. Social Science & Medicine, 38(7),915-24.
Wade, D. T., Legh-Smith, J., Hewer, R. L. (1985). Social Activities after stroke: measurement and Natural History using the Frenchay Activities Index. International Rehabilitation Medical, 7(4), 176-181.
Wandell, P. E. & Tovi, J.（2000）. The quality of life of elderly diabetic patients. Journal Diabetes Complications,14(1),25-30.
Ward, G., Jagger, C. & Harper, W. (1998). A review of instrumental ADL assessments for use with elderly people. Reviews in Clinical Gerontology, 8 (1), 65- 71.
Williams, J., Lyons, B., & Rowland, D. (1997). Unmet long-term care needs of elderly people in the community: a review of the literature. Home Health Care Service Quqrterly, 16(1-2),93-119.