臺灣博碩士論文加值系統

背景：智能障礙者老化為當前重要的公共衛生議題，隨著智能障礙者的平均壽命上升，其罹患失智症風險與日常生活功能依賴性也比一般人更嚴重。在台灣過去探討智能障礙者的失智狀況與日常生活功能情形的相關文獻較缺乏，因此期盼本研究結果能提供衛生政策制定者作為擬訂政策的方向。目的：探討台灣中高齡智能障礙者的失智狀況與日常生活功能，並進一步分析其影響因素。方法：本研究採橫斷性調查，母群體來源為內政部的統計資料，以45歲以上的智能障礙者作為研究對象，共20,201人。利用樣本計算公式計算出有效樣本數為377名，並參考過去智能障礙群體相關調查之郵寄問卷回收率，最後以15%為預估問卷回收率，並隨機選取2,550名智能障礙者進行問卷調查。由於智能障礙者本身可能有認知障礙，故由其主要照顧者來填答問卷。調查進行方式為郵寄式結構問卷，使用DSQIID量表來調查失智狀況，使用巴氏量表來評估日常生活功能。有效問卷共回收485份，回收率約為19%，並以SPSS 20.0版統計套裝軟體進行統計分析。結果：本研究之智能障礙者的平均年齡為55歲，其中以男性比例較多（51.1%）；障礙等級以重度最多（34.7%），6.7%的人有合併唐氏症，25.8%的人有合併神經系統疾病或精神疾病；有16.5%的人可能罹患失智症；49.8%的人屬於完全獨立，2.3%的人屬於完全依賴。在羅吉斯迴歸分析後發現，影響智能障礙者罹患失智症的主要因素為「年齡」與「共病情形」。智能障礙者年齡在55歲以上者，罹患失智症的風險是45−54歲者的2.594倍( 95% CI = 1.438−4.679)；有合併精神疾病或神經系統疾病相較於無合併疾病者，罹患失智症的風險為2.826倍( 95% CI = 1.593−5.012)。複迴歸分析的結果顯示，控制人口學變項與其它合併疾病後發現，失智狀況（β= -9.245）是日常生活功能的預測因子。結論：由本研究結果可知，智能障礙者可能因為年齡的增加或是合併其它疾病，會有較多風險罹患失智症，且進一步影響日常生活功能變得較差。因此政策制定者應規劃符合智能障礙者及其照顧者需求的策略，以協助與解決因老化所面臨的照顧問題。

Background: Aging in people with intellectual disabilities (ID) is an important public health issue. As the medical technology improves, their life expectancy increases. People with ID are more likely to have high risk for dementia and worse functioning of activities of daily living (ADL) than general population. Therefore, the need of medical treatment and care are an important problem. Objectives: The aim of this study was to describe the dementia conditions and the functioning of ADL and to examine the possible factors toward dementia conditions and ADL capabilities in middle-aged and aging people with ID. Methods: A national survey was conducted to recruit 485 community residents with ID and aged 45 years or older in Taiwan, and analyzed using SPSS 20.0. Results: Results show that the mean age of ID adults was 55 years, and 51.1 % were male respondents. In our sample, Severe disability accounting for 34.8% of the sample, 6.7% had a comorbid diagnosis of Down’s syndrome, and 25.8% were reported to be diagnosed with neurological disease or mental illness currently. Besides, 16.5% of the adults with ID might have dementia conditions, and 49.8% were totally independent, 2.3% were totally dependent. After controlling for other factors in a multiple logistic regression analysis, the older adults with ID (OR = 2.594, 95% CI = 1.438–4.679) and those individuals with a comorbid diagnosis of mental illness or neurological disease (OR = 2.826, 95% CI = 1.593–5.012) had a higher risk of dementia than their counterparts. The multiple linear regression model reported that factors of gender, marital status, education level, Down’s syndrome, severe or profound disability level, comorbid condition and dementia conditions were variables that were able to significantly predict the ADL score after controlling for age. Conclusions: The study highlights that adults with ID had a higher risk of dementia because of aging and comorbid. In addition, it might influence ADL capabilities. Therefore, this study suggests that it is important to develop appropriate strategies for adults with ID and their caregiver.

目錄
摘要 Ⅵ
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究之重要性 2
第三節 研究目的 3
第二章 文獻探討 4
第一節 智能障礙者之定義與健康特質 4
第二節 智能障礙者之失智狀況與日常生活功能情形 5
第三節 失智狀況與日常生活功能之評估量表 7
第三章 研究方法與步驟 10
第一節 研究架構 10
第二節 研究假設 11
第三節 研究對象 12
第四節 研究工具 14
第五節 資料收集方法與步驟 16
第六節 資料處理與分析 17
第四章 結果 19
第一節 人口學特質、失智狀況與日常生活功能情形之分布 19
第二節 失智狀況與日常生活功能之單變項分析 21
第三節 失智狀況與日常生活功能之相關因素分析 23
第五章 討論 26
第一節 人口學特質、失智狀況與日常生活功能情形之探討 26
第二節 失智狀況之影響因素探討 31
第三節 日常生活功能情形之影響因素探討 32
第四節 研究限制 34
第六章 結論與建議 35
第一節 結論 35
第二節 建議 36
第七章 參考文獻 40

表目錄
表1、智能障礙者基本資料之描述 48
表2、智能障礙者DSQIID量表之分布－失智現象發生情形 49
表3、智能障礙者DSQIID量表之分布－是否有下列行為發生 51
表4、智能障礙者DSQIID分數之分布 52
表5、智能障礙者巴氏量表分數之分布 53
表6、智能障礙者日常生活功能情形之分布 54
表7、智能障礙者人口學特質對失智狀況之單變項分析 55
表8、智能障礙者年齡對失智狀況之單變項分析 56
表9、智能障礙者合併神經系統疾病或精神疾病對失智狀況之單變項分析 57
表10、智能障礙者基本人口學特質對日常生活功能情形之單變項分析 58
表11、智能障礙者健康特質對日常生活功能情形之單變項分析 59
表12、智能障礙者人口學特質與失智狀況之羅吉斯迴歸 60
表13、智能障礙者人口學特質與日常生活功能情形之線性迴歸 61
表14、智能障礙者失智狀況與日常生活功能之相關分析 62

圖目錄
圖1、研究架構 10
圖2、樣本計算公式 13
圖3、樣本計算程式之網頁 13
圖4、研究執行步驟圖 17
圖5、智能障礙者失智狀況與日常生活功能之散佈圖 63

附錄目錄
附錄1、內政部核准智能障礙者資料申請之同意函 64
附錄2、本研究使用之調查問卷及同意書 65
附錄3、DSQIID量表之作者授權信函 75
附錄4、人體試驗計畫同意函 76
附錄5、問卷譯碼簿 77

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