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研究生:施姵宇
研究生(外文):Pei-YuShih
論文名稱:失智症疾病嚴重度對照顧者負荷的影響: 社會支持的角色
論文名稱(外文):The effect of disease severity and social support on caregiver burden of patients with dementia in Taiwan
指導教授:白明奇白明奇引用關係古鯉榕古鯉榕引用關係
指導教授(外文):Ming-Chyi PAILi-Jung Elizabeth Ku
學位類別:碩士
校院名稱:國立成功大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:55
中文關鍵詞:失智症家庭照顧者負荷社會支持正式支持服務
外文關鍵詞:dementiacaregiver burdensocial supportformal service
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研究背景:
2013年我國衛生福利部公告失智症防治照護政策綱領共七大面向,其一為建立完善社區照護網絡,可見失智症漫長病程下的照顧資源分配是現今政策的重要議題之一。跨國失智症研究追蹤失智症病人3-5年後相較收案時需更多照顧資源,又較其他慢性病的失能和依賴程度比例更高,顯示失智症病人會隨著疾病特性越趨於退化而需更多的照顧資源,整體對照顧資源的依賴程度也高,無形中也增加照顧者負荷。
研究目的:
探討失智症照顧負荷的主要影響因子為何,以及正式支持在失智症疾病特性對照顧者負荷的影響中所扮演的角色。
研究方法:
收案對象為南部地區某醫學中心失智症特別門診的病人與其家庭照顧者共計182對,病人的疾病特性測量包含-認知功能、精神行為症狀(NPI)以及日常生活功能(ADL);照顧者接受結構式問卷調查,包含其人口學變項、主觀負荷感受、非正式支持量表以及使用正式支持服務項目。
研究結果:
本研究的失智症病人疾病特性分佈:認知功能缺損輕度占40.2%、中度占38.6%、重度占21.2%;精神行為症狀(NPI)平均為18.5分(分數範圍0-120分);日常生活功能(ADL)平均值為65.9分(分數範圍0-100分),而失智症照顧者主觀負荷(ZBI)平均值28.6分(分數範圍0-88分)。階層迴歸分析可見病人疾病特性對照顧者負荷的解釋力15%最高,其次為照顧關係10%的解釋力,其中病人子女數和每週照顧時數對負荷有顯著影響。此外探討每週照顧時數作為病人疾病特性和照顧負荷的中介效果分析,顯示每週照顧時數作為病人ADL和照顧負荷的中介變項。在台南地區使用正式支持的比例占42.9%,其中監護工占最多數(28%)並且分析使用正式支持的人口學特性為:病人疾病特性趨於嚴重、女性病人、子女照顧者、未與病人同住及每週照顧時數較少者。分析不使用長照服務的原因以照顧者沒有意識到需要為主(41.9%),其次是已用監護工37.4%。另外在控制主觀感受非正式支持之下,研究並未發現正式支持的調節效果,即正式支持對於認知嚴重度、NPI以及ADL對照顧負荷的影響在統計上皆未達顯著差異。
討論:
在失智症病人漫長的病程中,除了病人疾病特性對照顧負荷的影響,照顧關係也存在舉足輕重的地位,例如每週照顧時數作為病人ADL功能和照顧負荷的中介變項,可見當病人在進入失智症晚期發生ADL失能,照顧者負荷沈重是由於投入照顧時間長,並且缺乏其他非正式支持而致。現今我國失智症家庭使用長照服務比例偏低,政策建議為應檢討現有長照服務功能是否能因應失智症家庭所需,未來研究需進一步刻畫非正式支持的網絡,分析在控制非正式支持網絡下,正式支持是否可作為調節角色,進而減輕照顧者負荷。
Summary
Compared to caregivers for patients with other illness, dementia patients are more dependent on their caregivers, and this often leads to increased caregiver burden. In my research, it focuses on two questions: (1) What are the significant determinants of subjective caregiver burden? (2) How does formal (paid) support moderate the effect of disease severity on dementia caregiver burden? We recruited 182 dementia patients and their caregivers from a dementia clinic at a Medical center in a city in southern Taiwan. We collected caregiver questionnaire which including caregiver burden measured by Zarit Burden, information on caregiver’s characteristic, care relations, and formal and informal support for caregivers. About disease severity of dementia patients, which is measured by MMSE/CDR, NPI, and ADL. Results from hierarchical regression showed that patient characteristics which is the most explanation (15%) of caregiver burden. Our analysis also found mediation of the association between patients’ ADL and caregiver burden through hours of informal care. In addition, after controlling informal support, formal support did not moderate the association between patient disease severity and caregiver burden. From the results, we suggests that as a patient’s ADL worsen while entering the later stage of dementia, the caregiver must spend more time in caregiving and may experience heavier caregiver burden for lack of informal support. Given the low rate of formal services use by dementia patients in Taiwan, health policymakers should evaluate whether the current long-term care service fit the need of families with dement patients or not. For the future, we suggest that the research should focus on informal care networks and analyze whether formal service use could reduce caregiver burden after controlling for informal care network.
中文摘要 I
ABSTRACT III
致謝 VI
第壹章 緒論 1
第一節 研究背景 1
第二節 研究動機與問題 2
1. 研究動機 2
2. 研究問題 2
第三節 研究重要性 2
第貳章 文獻回顧 4
第一節 失智症 4
1. 失智症疾病定義 4
2. 失智症疾病特性 4
第二節 照顧者負荷 6
1. 照顧者角色及其負荷 6
2. 從壓力過程理論(Stress Process Model, SPM)來看照顧者負荷 7
3. 影響照顧者負荷的因素 8
第三節 社會支持 10
1. 社會支持的定義 10
2. 社會支持來源 11
第參章 研究方法 14
第一節 研究設計與架構 14
第二節 研究參與者 15
1. 失智症病人篩選條件 15
2. 家庭照顧者篩選條件 15
第三節 研究工具 15
1. 失智症病人及家庭照顧者基本資料 15
2. 失智症病人的疾病特性測量 16
3. 照顧者負荷量表(The Zarit Burden Interview; ZBI) (問卷請見附件) 17
4. 社會支持問卷(問卷請見附件) 17
第四節 收案過程 18
第五節 資料處理與分析 18
1. 單變項分析 18
2. 雙變項分析Bivariate analyses 18
3. 階層迴歸分析Hierarchical Regression 19
4. 中介效果分析 Mediation Analysis 19
5. 調節效果分析Moderation Analysis 19
第肆章 研究結果 20
第一節 失智病人及照顧者人口學特質以及照顧關係 20
第二節 失智症照顧者負荷與各研究變項的相關性分析 22
1. 照顧負荷與失智症病人人口學及其疾病特性變項 22
2. 照顧負荷與家庭照顧者人口學變項 22
3. 照顧負荷與照顧關係 22
4. 其他連續變項之間的相關係數 22
第三節 影響照顧者負荷之預測因子分析 24
1. 失智症病人疾病特性及其嚴重度 24
2. 家庭照顧者人口學特性 25
3. 照顧關係 25
4. 社會支持 25
第四節 照顧時數的角色 26
1. 以精神行為症狀(NPI)作為失智症疾病特性的中介效果分析 26
2. 以日常生活功能(ADL)作為失智症疾病特性的中介效果分析 26
第五節 正式支持的角色 28
1. 使用與不使用正式支持服務的人口學特性 28
2. 不使用長照服務的原因 29
3. 正式支持的調節角色 31
第伍章 討論 32
第一節 失智病人及照顧者人口學特質及照顧關係的描述性 32
第二節 影響照顧負荷之因子討論 33
1. 以SPM of Pearlin探討照顧者負荷 34
2. 以SPM of Yates探討照顧者負荷 35
3. 失智症病人疾病特性 36
4. 家庭照顧者人口學特性 37
第三節 正式支持角色 38
1. 使用正式支持比例及使用與否的樣本特性 38
2. 不使用正式支持的原因 39
3. 正式支持的調節角色 40
第陸章 結論與建議 41
第一節 結論 41
1. 影響家庭照顧者主觀負荷的主要相關因素 41
2. 社會支持對每週照顧時數和負荷的影響 41
3. 失智症家庭認知及使用正式支持服務的比例及樣貌 41
4. 影響家庭照顧者是否使用正式支持服務的原因 42
第二節 研究建議 42
1. 未來研究方向與方法 42
2. 政策建議 42
第三節 研究限制 42
第柒章 附錄 43
第捌章 參考文獻 45

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1. 王增勇 (2011)。 家庭照顧者做為一種改革長期照顧的社會運動[Reforming Long Term Care through the Movement of Family Caregivers]。臺灣社會研究(85),頁 397-414。
2. 王增勇 (2011)。 家庭照顧者做為一種改革長期照顧的社會運動[Reforming Long Term Care through the Movement of Family Caregivers]。臺灣社會研究(85),頁 397-414。
3. 呂寶靜 (2005)。 支持家庭照顧者的長期照護政策之構思[Toward a More Family Caregiver-Responsive Long-Term Care Policy]。國家政策季刊, 4(4),頁 25-40。
4. 呂寶靜 (2005)。 支持家庭照顧者的長期照護政策之構思[Toward a More Family Caregiver-Responsive Long-Term Care Policy]。國家政策季刊, 4(4),頁 25-40。
5. 林淑錦、白明奇 (2006)。 失智症病患主要照顧者的壓力-以家庭生態觀點論之[The Stress of Caregivers of Alzheimer's Disease: From a Viewpoint of Family Ecology]。長期照護雜誌, 10(4),頁 412-425。
6. 林淑錦、白明奇 (2006)。 失智症病患主要照顧者的壓力-以家庭生態觀點論之[The Stress of Caregivers of Alzheimer's Disease: From a Viewpoint of Family Ecology]。長期照護雜誌, 10(4),頁 412-425。
7. 邱啟潤、許淑敏、吳瓊滿 (2002)。 主要照顧者負荷、壓力與因應之國內研究文獻回顧[Literature Review of Primary Caregivers' Burden, Stress and Coping in Taiwan Research]。醫護科技學刊, 4(4),頁 273-290。
8. 邱啟潤、許淑敏、吳瓊滿 (2002)。 主要照顧者負荷、壓力與因應之國內研究文獻回顧[Literature Review of Primary Caregivers' Burden, Stress and Coping in Taiwan Research]。醫護科技學刊, 4(4),頁 273-290。
9. 邱逸榛、何玉婷、陳婉庭、徐亞瑛 (2004)。 簡介阿茲海默氏症與其照護[Introduction to Alzheimer's Disease and Care]。長期照護雜誌, 7(4),頁 289-304。
10. 邱逸榛、何玉婷、陳婉庭、徐亞瑛 (2004)。 簡介阿茲海默氏症與其照護[Introduction to Alzheimer's Disease and Care]。長期照護雜誌, 7(4),頁 289-304。
11. 張宏哲 (2010)。 長期照護正式和非正式體系之間關係的模式--研究和實務議題的探討。社區發展季刊(132期),頁 頁264-277。
12. 張宏哲 (2010)。 長期照護正式和非正式體系之間關係的模式--研究和實務議題的探討。社區發展季刊(132期),頁 頁264-277。
13. 陳正芬 (2013)。 我國長期照顧體系欠缺的一角:照顧者支持服務。社區發展季刊, 141,頁 203-213。
14. 陳正芬 (2013)。 我國長期照顧體系欠缺的一角:照顧者支持服務。社區發展季刊, 141,頁 203-213。
15. 曾孆瑾 (2005)。 從老年的家庭照顧支持系統思考老年人口照顧問題。社區發展季刊, 110,頁 274-283。
 
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