臺灣博碩士論文加值系統

目的：本研究旨於了解大湖鄉獨居老人之生理、心理及社會健康狀況及首要關切之健康議題及需求，讓大湖鄉衛生所在未來組織動員時，利用本研究的歷程與結果，針對大湖鄉獨居老人的健康需求，釐清未來政策方針，建構有利於大湖鄉獨居老人健康、安全、參與及終身學習之友善環境，促進大湖鄉獨居老人身、心、社會健康，進而提升其生活品質。
方法：運用Bradshaw(1972)四種需求概念，進行大湖鄉獨居老人之健康需求評估，透過規範性需求、比較性需求、呈現性需求及感覺性需求之評估，了解大湖鄉獨居老人首要關切之健康議題及需求，並提出對於鄉內獨居老人提升生活品質介入方案之相關建議。
結果：大湖鄉獨居老人所罹患之慢性病主要為「高血壓」、「糖尿病」及「心臟疾病」為主，日常生活中感到較為困擾的是「睡不安穩」；對日常生活活動自理有困難者，以「上下樓梯」有困難者為最多；工具性日常生活活動中對「使用電話」、「服用藥物」及「處理財務能力」的需求最高；過去一年曾經跌倒者，跌倒的場所皆為居家環境中；對於目前健康與身心功能狀況，覺得「普通」者最多；對目前整體生活表示「滿意」者最多；對「自己的健康問題」感到擔心者最多；對於政府辦理老人福利措施項目中，以知道「國民年金」的人數最多。
大湖鄉獨居老人的生活品質以環境範疇最佳，社會關係範疇次之，生理健康及心理範疇最差。女性獨居老人心理範疇及環境範疇的生活品質優於男性獨居老人；自覺健康程度愈佳之獨居老人，四個範疇的生活品質都愈佳；自覺生活滿意度愈高的獨居老人，生理健康範疇之生活品質則愈好。
建議：本研究依據大湖鄉獨居老人的健康需求評估結果，提出「健康照護」、「心理健康」及「居家安全」三方面之健康促進優先行動建議，且於健康促進實際行動前，因地制宜規劃介入策略與模式。另建議衛生所的公共衛生護理人員應著重於家庭訪視及個案管理之工作內容，除了強調疾病的預防外，也提倡健康的促進，唯有長時間深耕社區的家庭訪視及個案管理服務，衛生所才能了解社區民眾的實際需求，提供社區民眾更多元的服務及照護，達到全鄉民眾健康促進、長者樂齡活力、健康老化與在地老化的願景。

Purpose: This study investigated the physiopsychological and social health status of solitary older adults in Dahu Township (Miaoli County, Taiwan) to determine their primary health concerns and needs. Through emphasizing the health demands of this population, the course and results of this study clarify prospective policies for potential dispatch at the Dahu Township Public Health Center. Accordingly, a friendly environment can be constructed to benefit the health, safety, participatory, and lifelong learning facets of older adults living alone in Dahu in order to improve their physiopsychological and social health, thereby enhancing their quality of life.
Method: Four social needs identified by Bradshaw in 1972 were applied to assess the health needs of a sample of solitary older adults living in Dahu. Through evaluating the normative, comparative, expressed, and felt needs, their primary health concerns and needs were determined. Additionally, relevant recommendations, such as intervention programs for enhancing the quality of life of the study population, were proposed.
Results: Hypertension, diabetes, and heart disease were common chronic conditions diagnosed in the study population. These people also expressed trouble sleeping. Additionally, most people who experienced difficulty managing their daily activities had the highest difficulty in climbing and descending stairs among their daily activities. Regarding instrumental activities of daily living, high emphasis was placed on using telephones, taking medication, and managing finances. Most falling incidents occurred in home environments. Regarding the study population’s health and physiopsychological status, most of them expressed no particular cause of concern (average). Furthermore, most participants were generally satisfied with their current living situation, were concerned about personal health problems, and were informed on the national pension system. The quality of life aspects of the study population (ranked in the descending order) are the environment, social relations, and physiopsychological health. Psychological health and the environmental aspects were of greater concern among the women than among the men. Satisfactory self-perceived health was positively reflected in the four aspects of living quality, and high self-perceived living satisfaction was associated with increased physiological health.
Recommendations: According to the assessment results on the health requirements of older adults living alone in Dahu, priority action is recommended in promoting health care, psychological health, and home safety. Intervention strategies and models must be planned prior to implementing health promotion activities and according to specific local conditions. Additionally, public health care personnel from the Dahu Township Public Health Center should resume family visits and emphasize case management services including promoting health and emphasizing disease prevention. Only through long-term family visits and case management services can the Dahu Township Public Health Center learn the actual needs of the people living in the community. Based on this knowledge, providing diverse care services can facilitate achieving the goal of promoting a healthy community for older citizens to maintain an active and healthy attitude toward aging as well as facilitate aging in place.

口試審定書
誌謝 …………………………………………………………ⅰ
中文摘要 …………………………………………………… ⅱ
英文摘要 …………………………………………………… ⅲ
第一章 緒論 ……………………………………………… 1
第一節 實習單位簡介 …………………………………… 1
第二節 大湖鄉社區概況 ………………………………… 3
第三節 研究動機 ………………………………………… 6
第四節 研究目的 ……………………………………… 7
第二章 文獻探討 ……………………………………… 8
第一節 人口老化問題 ………………………………… 8
第二節 獨居老人現況 …………………………………10
第三節 獨居老人所面臨的問題 ………………………13
第四節 獨居老人的健康需求 …………………………16
第五節 需求評估 ………………………………………18
第三章 研究方法 ………………………………………… 20
第一節 研究方法 ………………………………….... 20
第二節 資料收集與分析 ……………………………… 22
第三節 研究對象 ……………………………………… 23
第四節 研究工具 ……………………………………… 23
第四章 結果 ………………………………………… 27
第一節 研究對象的人口學現況分析 ………………… 27
第二節 規範性需求 ………………………………… 29
第三節 感覺性需求 …………………………………… 42
第四節 呈現性需求 …………………………………… 54
第五節 比較性需求 …………………………………… 58
第五章 結論 …………………………………………… 70
第六章 討論與建議 …………………………………… 73
資源與限制 …………………………………………… 77
參考文獻 ……………………………………………… 78
附錄 …………………………………………………… 81

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