臺灣博碩士論文加值系統

前言：主要照顧者面對家中失能或失智的病人，常面臨社交活動受限制、無法承受照顧的壓力，透過喘息服務照顧者可以得到適當的休息，使其不因照顧負荷過重而崩解，而能繼續維持照顧者的角色。但過去研究顯示國內照顧者的喘息服務使用率偏低，且先前的研究未曾以照顧者負荷作為結果評估的指標，故本研究欲利用長期照顧資料庫資料，探討使用喘息服務的影響因素並瞭解喘息服務的使用對家庭照顧者負荷的影響。
材料與方法：本研究使用南部地區某縣市長期照顧資料庫2011至2015年的資料，以居家服務的個案作為研究對象，將其分為以及無使用喘息服務兩個組別，以Andersen模式使用羅吉斯迴歸找出使用喘息服務的影響因子。為探討使用喘息服務對於照顧負荷的影響，選取患者以及照顧者特質等變項後使用傾向分數方法，以1:2的配對方式選出使用組446人以及對照組892人，分別追蹤照顧者在一年後照顧負荷的變化，並使用隨機效果模型分析。
結果與討論：相較於50歲以下的照顧者，50歲以上的照顧者使用喘息服務的勝算隨著年齡上升而遞減，女性照顧者使用喘息服務的勝算比為男性照顧者的1.3倍，可能因女性較常擔任家庭照顧者，進而對服務產生較多的需求。照顧女性個案或是當個案的教育程度越高時，使用喘息服務的勝算較高；相較於無失能以及輕度失能者，中度失能者之照顧者使用喘息服務的勝算比為1.8倍，而重度失能者之照顧者使用喘息服務的勝算比更高達3.3倍，顯示個案身體功能越差其照顧者傾向尋求正式支持的幫助；相較於認知功能完好的個案，輕度智力缺損的個案其照顧者使用服務的勝算反而較低(OR=0.817)，而照顧負荷大的照顧者對於喘息服務有較高的需求(OR=2.073)。使用喘息服務之後照顧者的照顧負荷下降 (β=-0.064)，而在控制個案人口學變項、失能程度、認知功能、照顧者特質以及有無使用居家服務之後，服務天數與照顧者負荷呈負相關，使用喘息服務天數越多的照顧者其照顧負荷較低。
結論：根據研究結果，個案的性別、教育程度以及失能程度會影響照顧者對喘息服務的需求；女性、年紀輕、照顧負荷重以及無工作狀態的照顧者較容易使用喘息服務。使用喘息服務能夠有效減輕照顧者負荷，而且使用喘息服務的天數較多者，其照顧負荷下降越多，表示如果能夠提升喘息服務使用的天數，對於緩解照顧者負荷的效果會更顯著。

The purpose of this study is to find out the factors associated with the use of respite care and the impact of the respite care on caregiver burden. The subjects of this study were disabled elders and their caregivers in the Tainan City Government Long-term Care Service Management Center Database from 2011 to 2015. The Anderson Behavioral Model of Health Care Use was used as the conceptual framework and a logistic regression model was developed to identify predictors of respite care use. The random effect models were used to evaluate the effects of home respite care on caregiver burden. The findings showed that use of respite care was higher when caregiver burdens were higher and care recipient functional status was lower. Factors related to respite care use included caregiver age, caregiver gender, care recipient gender, the educational level of care recipient, and the employment status of caregiver. According to result of the random effect models, caregiver burden scores decreased significantly for the treatment group after receiving respite care and that the caregiver burden scores were lower with more days of respite care.

第壹章 前言 1
第一節、 研究背景 1
第二節、 研究目的 3
第三節、 研究假說 3
第貳章 文獻回顧 4
第一節、 喘息服務的定義與內容 4
第二節、 使用喘息服務的影響因子 6
第三節、 照顧者角色與負荷 8
第四節、 影響照顧者負荷的因素 10
第五節、 喘息服務對照顧者負荷的效益 13
第參章 研究設計與方法 17
第一節、 研究架構 17
第二節、 資料來源 18
第三節、 研究對象 18
第四節、 研究變項 22
第五節、 資料分析 26
第肆章 研究結果 29
第一節、 居家服務個案與照顧者人口學特質 29
第二節、 使用喘息服務的影響因素 33
第三節、 使用喘息服務對照顧者負荷的影響 35
第四節、 居家喘息服務個案與照顧者人口學特質 44
第五節、 喘息服務天數對照顧者負荷的影響 47
第伍章 討論 49
第一節、 居家喘息個案與照顧者人口學特質 49
第二節、 使用喘息服務的影響因素 50
第三節、 喘息服務對照顧者負荷的影響 53
第陸章 結論與建議 56
第一節、 重要研究結果與討論 56
第二節、 研究限制 57
第三節、 未來研究與政策建議 58
第柒章 參考文獻 59
附錄 64

1.中華民國家庭照顧者關懷總會：家庭照顧者處境與支持性服務 2017。http://www.familycare.org.tw/about [6月19日, 2017 accessed]
2.吳瓊滿：居家照顧者的負荷。美和專校學報 1999﹝In press﹞：1-14。
3.黃志忠：居家服務使用對老人家庭照顧者照顧負荷之緩衝性影響研究。社會政策與社會工作學刊 2014；18：1-43。4.Zarit SH, Bangerter LR, Liu Y, Rovine MJ: Exploring the benefits of respite services to family caregivers: methodological issues and current findings. Aging Ment Health 2017;21:224-31.
5.Evans D: Exploring the concept of respite. Journal of advanced nursing 2013;69:1905-15.
6.林君黛、邱盈綺、徐宙玫、黃昱瞳：影響家庭照護者使用機構喘息服務因素之探討。澄清醫護管理雜誌 2013；9：7-14。
7.行政院性別平等會：重要性別統計資料庫 2017。http://www.gender.ey.gov.tw/gecdb/Stat_Statistics_Category.aspx?fs=EcfUJy%2fsRRPbnOe4TvO%2fJg%3d%3d＆cs1=hCxkEpWNDf9jE1dQz%2bW2sw%3d%3d [7月8日, 2017 accessed]
8.Brodaty H, Thomson C, Thompson C, Fine M: Why caregivers of people with dementia and memory loss don't use services. International journal of geriatric psychiatry 2005;20:537-46.
9.Stockwell‐Smith G, Kellett U, Moyle W: Why carers of frail older people are not using available respite services: an Australian study. Journal of clinical nursing 2010;19:2057-64.
10.Neville C, Beattie E, Fielding E, MacAndrew M: Literature review: use of respite by carers of people with dementia. Health ＆ social care in the community 2015;23:51-3.
11.黃秀梨、李逸、徐亞瑛、張媚、翁麗雀：影響北台灣家庭照顧者喘息服務利用的因素：前趨性研究 。長期照護雜誌 2007；11：51-65。
12.Chappell NL, Reid RC, Dow E: Respite reconsidered: A typology of meanings based on the caregiver's point of view. Journal of Aging Studies 2001;15:201-16.
13.Brodaty H, Gresham M: Prescribing residential respite care for dementia—effects, side‐effects, indications and dosage. International journal of geriatric psychiatry 1992;7:357-62.
14.Zarit SH, Stephens MA, Townsend A, Greene R: Stress reduction for family caregivers: effects of adult day care use. The journals of gerontology Series B, Psychological sciences and social sciences 1998;53:S267-77.
15.Gottlieb BH, Johnson J: Respite programs for caregivers of persons with dementia: A review with practice implications. Aging ＆ Mental Health 2000;4:119-29.
16.Grant I, McKibbin CL, Taylor MJ, et al: In-home respite intervention reduces plasma epinephrine in stressed Alzheimer caregivers. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 2003;11:62-72.
17.Perry J, Bontinen K: Evaluation of a weekend respite program for persons with Alzheimer disease. The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres 2001;33:81-95.
18.McNally S, Ben-Shlomo Y, Newman S: The effects of respite care on informal carers' well-being: a systematic review. Disability and rehabilitation 1999;21:1-14.
19.van Exel J, Moree M, Koopmanschap M, Goedheijt TS, Brouwer W: Respite care--an explorative study of demand and use in Dutch informal caregivers. Health policy (Amsterdam, Netherlands) 2006;78:194-208.
20.蔡啟源：老人喘息服務之探討。社區發展季刊 2009﹝In press﹞：297-312。
21.黃秀梨、張媚、余玉眉：我國機構式喘息服務政策之分析與建言。護理雜誌
2006；53：59-66。
22.衛生福利部：長期照顧十年計畫 2.0臺北市：衛生福利部，2016。
23.Aday LA、Andersen R：A framework for the study of access to medical care。Health services research 1974；9：208-20。
24.曾煥裕：退休前醫療服務使用之因素探討-以美國51歲至61歲者為例。社區發展季刊 2005﹝In press﹞。
25.邱啟潤、陳武宗、陳宜品：以 Andersen 模式探討家庭照顧者對正式支持系統的利用。長期照護雜誌 2005；9：331-48。
26.Harris M, Diminic S, Marshall C, Stockings E, Degenhardt L: Estimating service demand for respite care among informal carers of people with psychological disabilities in Australia. Australian and New Zealand journal of public health 2015;39:284-92.
27.Phillipson L, Magee C, Jones SC: Why carers of people with dementia do not utilise out-of-home respite services. Health ＆ social care in the community 2013;21:411-22.
28.Iecovich E, Carmel S: Differences Between Users and Nonusers of Day Care Centers Among Frail Older Persons in Israel. Journal of Applied Gerontology 2011;30:443-62.
29.Levesque L, Cossette S, Potvin L, Benigeri M: Community services and caregivers of a demented relative: Users and those perceiving a barrier to their use. Canadian Journal on Aging/La Revue canadienne du vieillissement 2000;19:186-209.
30.Robinson KM, Buckwalter KC, Reed D: Predictors of use of services among dementia caregivers. Western journal of nursing research 2005;27:126-40; discussion 41-7.
31.Phillipson L, Jones SC: Between the devil and the deep blue sea: the beliefs of caregivers of people with dementia regarding the use of in-home respite services. Home health care services quarterly 2011;30:43-62.
32.Jardim C, Pakenham K: Carers of adults with mental illness: Comparison of respite care users and non-users. Australian Psychologist 2010;45:50-8.
33.Phillipson L, Jones SC, Magee C: A review of the factors associated with the non-use of respite services by carers of people with dementia: implications for policy and practice. Health ＆ social care in the community 2014;22:1-12.
34.Wolfs CA, Kessels A, Severens JL, et al: Predictive factors for the objective burden of informal care in people with dementia: a systematic review. Alzheimer Disease ＆ Associated Disorders 2012;26:197-204.
35.Zarit SH, Kim K, Femia EE, Almeida DM, Klein LC: The effects of adult day services on family caregivers' daily stress, affect, and health: outcomes from the Daily Stress and Health (DaSH) study. The Gerontologist 2014;54:570-9.
36.陳昱名：老年失智症病患家庭照顧者之照顧負荷。崇仁學報 2013﹝In press﹞：1-22。
37.楊嘉玲、孫惠玲：「照顧者負荷」概念分析。馬偕護理專科學校學報 2003﹝In press﹞：15-27。
38.馬先芝：照顧者負荷之概念分析。護理雜誌 2003；50：82-6。
39.黃志忠：老人主要照顧者施虐傾向及其危險因子之研究-以中部地區居家服務老人為例。中華心理衛生學刊 2013；26：95-139。
40.沈若儀：居家服務使用與家庭照顧者負荷之關係探討 [學位論文]。台北市：國立臺灣大學，2004。
41.莊幼芬：居家失能長者照顧者照顧負荷之影響因素-以桃園縣為例 [學位論文]。新北市：國立臺北大學，2012。
42.陳美妙、陳品玲、陳靜敏、徐亞瑛：機構式喘息服務對失能老人主要照顧者負荷之影響。長庚護理 2005；16：152-66。
43.Kim MD, Hong SC, Lee CI, Kim SY, Kang IO, Lee SY: Caregiver burden among caregivers of Koreans with dementia. Gerontology 2009;55:106-13.
44.Kim H, Chang M, Rose K, Kim S: Predictors of caregiver burden in caregivers of individuals with dementia. Journal of advanced nursing 2012;68:846-55.
45.洪淑惠、張肇松、林淑媛、謝秀芳：癌末病患主要家屬照顧者照顧負荷及其影響因素之探討。護理暨健康照護研究 2009；5：163-72。
46.李英芬、蔡麗雲、張澤芸：末期癌症病人之主要照顧者的負荷相關因素探討。安寧療護雜誌 2008；13：394-410。
47.Shankar KN, Hirschman KB, Hanlon AL, Naylor MD: Burden in caregivers of cognitively impaired elderly adults at time of hospitalization: a cross-sectional analysis. Journal of the American Geriatrics Society 2014;62:276-84.
48.朱翠燕、李素卿、王祖琪、謝瑞雲、李秋玉、林秀麗：女性照顧者負荷之質性研究。北市醫學雜誌 2010；7：144-53。
49.Rinaldi P, Spazzafumo L, Mastriforti R, et al: Predictors of high level of burden and distress in caregivers of demented patients: results of an Italian multicenter study. International journal of geriatric psychiatry 2005;20:168-74.
50.Andren S, Elmstahl S: Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study. International journal of nursing studies 2007;44:435-46.
51.Molyneux GJ, McCarthy GM, McEniff S, Cryan M, Conroy RM: Prevalence and predictors of carer burden and depression in carers of patients referred to an old age psychiatric service. International psychogeriatrics 2008;20:1193-202.
52.Conde-Sala JL, Garre-Olmo J, Turro-Garriga O, Vilalta-Franch J, Lopez-Pousa S: Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: an exploratory comparative design. International journal of nursing studies 2010;47:1262-73.
53.Stirling C, Leggett S, Lloyd B, et al: Decision aids for respite service choices by carers of people with dementia: development and pilot RCT. BMC medical informatics and decision making 2012;12:21.
54.Lee D, Morgan K, Lindesay J: Effect of institutional respite care on the sleep of people with dementia and their primary caregivers. Journal of the American Geriatrics Society 2007;55:252-8.
55.Mossello E, Caleri V, Razzi E, et al: Day Care for older dementia patients: favorable effects on behavioral and psychological symptoms and caregiver stress. International journal of geriatric psychiatry 2008;23:1066-72.
56.Jeon YH, Brodaty H, Chesterson J: Respite care for caregivers and people with severe mental illness: literature review. Journal of advanced nursing 2005;49:297-306.
57.Neville C, Byrne GJ: Effect of a residential respite admission for older people on regional Queensland family carers. Collegian (Royal College of Nursing, Australia) 2008;15:159-64.
58.Chen TF, Huang LH: Caregiver efficacy and efficacy determinants for elderly care recipients who accept home respite care in Taiwan. The journal of nursing research : JNR 2010;18:18-25.
59.陳芬婷、邱啟潤：喘息服務方案對家庭照顧者之效益。護理暨健康照護研究 2015；11：53-63。
60.Mahoney FI, Barthel DW: Functional evaluation : The Barthel Index. Maryland state medical journal 1965;14:61-5.
61.Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 1969;9:179-86.
62.Pfeiffer E: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society 1975;23:433-41.
63.Radloff LS: The CES-D scale: A self-report depression scale for research in the general population. Applied psychological measurement 1977;1:385-401.
64.李庚霖、區雅倫、陳淑惠、翁儷禎：「臺灣地區中老年身心社會生活狀況長期追蹤調查」短版CES-D量表之心理計量特性。中華心理衛生學刊 2009；22：383-410。
65.戴玉慈、余玉眉、連倚南：罹患中風對家庭的衝擊。公共衛生 1990；17：171-80。
66.Wooldridge JM: Introductory econometrics : A modern approach. 6th ed. United States: Cengage Learning, 2015.
67.邱麗蓉、謝佳容、蔡欣玲：失智症病患主要照護者的壓力源、評價和因應行為與健康之相關性探討。精神衛生護理雜誌 2007；2：31-44。
68.高淑芳、盧孳豔、葉淑惠、劉雪娥：探討家庭功能、社會支持與社區殘病老人照顧者負荷之關係。護理研究 1999；7：172-82。
69.Cox C: Findings from a statewide program of respite care: a comparison of service users, stoppers, and nonusers. The Gerontologist 1997;37:511-7.
70.Hong SI: Understanding patterns of service utilization among informal caregivers of community older adults. The Gerontologist 2010;50:87-99.
71.劉淑娟: 長期照護. 第三 ed. 臺北市: 華杏, 2015.
72.de Labra C, Millan-Calenti JC, Bujan A, et al: Predictors of caregiving satisfaction in informal caregivers of people with dementia. Archives of gerontology and geriatrics 2015;60:380-8.
73.李佳苓、劉立凡、陳淑馨、林綉君：探討照顧管理服務成效與主要照顧者照顧負荷之相關性研究。護理雜誌 2014；61：64-73。