臺灣博碩士論文加值系統

失智患者隨著病程的進展，多數患者面臨進食困難問題，因本身多已失去表達意願能力，需依賴家庭照顧者代理決定是否接受人工餵食。國內目前對於家屬為失智者選擇接受人工餵食與否研究探討較少，故本研究主要目的在了解失智末期呈現永久重度昏迷狀況下，家庭照顧者為失智者選擇人工餵食相關因素。
本研究以臺北市某醫院神經內科門診及失智共照中心，招募年滿20歲且實際照顧失智者之主要家庭照顧者為研究對象，採方便取樣，樣本數為162人。以結構性問卷調查，主要內容包括家庭照顧者之社會人口學資料、失智症者行為問題及照顧困擾、對疾病與末期治療效果認知，研究資料使用SPSS for Windows 21.0軟體進行分析與檢定。以描述性統計 (人數、百分比、平均數、標準差、最大值、最小值)了解樣本分佈情形，以推論統計 (獨立樣本t檢定、單因子變異數分析、皮爾森相關係數、複迴歸分析)進行分析，以了解家庭照顧者為失智者末期人工餵食選擇，並預測影響選擇末期人工餵食之因子。
結果顯示家庭照顧者面臨失智者疾病末期呈現昏迷狀況下，選擇人工餵養方式的接受度平均值男性高於女性(1.69>0.92)、「沒有」照顧過生命末期親人經驗的家庭照顧者接受度較「有」照顧過生命末期的親人高平均值為(1.38>0.86)，失智症疾病末期與治療認知與家庭照顧者對失智症末期選擇人工餵食呈顯著負相關(r=-0.125，P<0.007)。失智症疾病末期與治療認知為選擇末期人工餵食之重要預測因子(t=-2.726，p <0.007)，表示家庭照顧者對失智症疾病末期與治療認知越高，其為末期失智者選擇人工餵食的接受度越低。
根據結果建議未來應提高家庭照顧者及失智者對失智症疾病末期與治療認知，鼓勵失智者罹患初期即先預立醫療，需涵蓋末期是否願意接受人工餵食想法，做為家庭照顧者日後面臨失智末期選擇人工餵食照顧之參考。

As dementia progresses, most patients will have difficulty eating. At this point, they have lost the ability to express their will and have to rely on their family caregivers to decide whether to accept artificial feeding. Currently, there are few studies on the decision of artificial feeding by family members of patients with dementia in Taiwan. Therefore, the main purpose of this study was to understand the factors associated with family caregivers' decision of artificial feeding for patients with permanent severe coma at the end stage of dementia.
A total of 162 primary family caregivers aged 20 years or older who actually cared for patients with dementia were recruited by convenience sampling at the neurology outpatient clinic and dementia care center of a hospital in Taipei City as the subjects of this study. A structured questionnaire was used to investigate sociodemographic data of family caregivers, behavioral problems and caregiving difficulties of patients with dementia, and the awareness of the disease and end-stage treatment outcomes. The data were analyzed and validated using SPSS 21.0 for Windows. Descriptive statistics (number, percentage, mean, standard deviation, maximum, minimum) were used to understand the sample distribution. Inferential statistics (independent sample t-test, one-way analysis of variance, Pearson's correlation coefficient, multiple regression analysis) were used to understand family caregivers' choice of artificial feeding for end-of-life dementia patients and to predict the factors affecting their decision.
The results showed that when family caregivers were faced with terminal dementia patients who were in a coma, the mean acceptance of artificial feeding was higher for men than for women (1.69>0.92), family caregivers who had "no" experience of caring for a relative at the end of life were more accepting than those who had "cared" for a relative at the end of life (mean 1.38>0.86), and the awareness of dementia disease and terminal treatment was significantly and negatively correlated with family caregivers' choice of artificial feeding for terminal dementia patients (r=-0.125, p<0.007). Awareness of dementia disease and terminal treatment was a significant predictor of choosing artificial feeding for the terminally ill (t = -2.726, p < 0.007), indicating that the higher the family caregiver's awareness of dementia disease and terminal treatment, the lower the likelihood of choosing artificial feeding for the terminal dementia patient.
Based on the results of the study, it is recommended to raise awareness among family caregivers and dementia patients about dementia and the end-of-life treatment and encourage dementia patients to make medical decisions in the early stages of dementia, which should include whether they accept artificial feeding in the end-of-life stage so that family caregivers can use it as a reference for choosing artificial feeding care when dealing with the end-of-life stage of dementia in the future.

目 次
摘 要 i
Abstract ii
目 次 iv
表 次 vi
圖 次 vii
第一章 緒論
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究問題 4
第四節 名詞解釋 5
第二章 文獻查證
第一節 失智症介紹 6
第二節 失智症吞嚥進食困難及照顧 11
第三節 影響家庭照顧者對失智症者末期人工餵食決策因素 14
第三章 研究方法
第一節 研究設計 19
第二節 研究架構 19
第三節 研究對象 20
第四節 研究工具 21
第五節 研究倫理考量 23
第六節 資料處理與分析 24
第四章 研究結果
第一節 家庭照顧者社會人口學特質、行為障礙困擾、對疾病與末期治療效果之認知及為失智末期人工餵食選擇之描述 26
第二節 家庭照顧者社會人口學特質、行為障礙困擾、疾病末期與治療效果認知與失智者末期時人工餵食選擇之關聯 34
第三節 家庭照顧者為失智末期者時人工餵食選擇的影響因子 37
第五章 討論與結論
第一節 家庭照顧者基本人口學對人工餵食選擇之影響 38
第二節 家庭照顧者對失智者行為問題及照顧困擾程度對人工餵食選擇之影響 41
第三節 家庭照顧者疾病末期與治療效果認知對人工餵食選擇之影響 42
第四節 研究結論 43
第六章 建議與研究限制
第一節 建議 44
第二節 研究限制 45
參考文獻
中文部份 46
英文部分 51
附綠
附錄一 人體試驗委員會許可書 57

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