臺灣博碩士論文加值系統

研究背景：孤寂感是長者常見的心理健康問題，先前研究已指出孤寂感會影響老年人的身心健康，增加死亡率，是一個重要的公共衛生議題，因此瞭解長者的孤寂感狀況有其必要性，但目前台灣老年人孤寂感的相關研究仍然不足。
研究目的：本系列性研究共有三個研究目的，包括：(1)探討台灣老年人孤寂感的盛行率及其相關因素，(2)探討長期照顧機構老年住民對孤寂感的認知及感受，及(3)探討撫觸療法改善長照機構老年住民心理健康之成效。
研究方法：研究一：本研究以「國民健康署」之『中老年身心社會生活狀況長期追蹤調查』執行次級資料分析，以2015年滿65歲共計4,588的長者為研究對象進行橫斷式研究，針對社會人口學、健康狀況及社會支持等變項，以卡方檢定及多元邏輯斯回歸進行分析。研究二：本研究使用質性研究法，採半結構訪談指引，進行一對一深入訪談，共訪談台灣北部兩家長照機構共16位住民，並以內容分析法進行資料分析。研究三：採隨機分派臨床試驗研究設計，以方便取樣，針對台灣北部三家長照機構55位長者進行收案，使用區塊隨機方式將長者分派至實驗組及對照組，實驗組接受一週2 次，為期4週的手部撫觸療法，對照組則採常規照護。在介入措施前及措施後，以人口學及特質問卷、UCLA Loneliness Scale version 3、Geriatric Anxiety Inventory、Geriatric Depression Scale short form及中國人幸福感量表進行施測，另外，也會在每次撫觸的前後測量生命徵象及詢問舒適及放鬆程度，並使用Generalized Estimation Equations (GEE)分析介入措施的成效。
研究結果：研究一：台灣老年人的孤寂感盛行率為10.5%，男性、獨居、健康狀況不佳、無配偶、沒有工作及情感支持較差的長者較容易感到孤寂。研究二：共歸納四個範疇，包括持續有意義的關係被阻斷、傷痛的淚、感到孤單及缺乏歸屬感。研究三：兩組住民在介入措施前後之孤寂感、焦慮、憂鬱、幸福感、體溫、心率及舒張壓並沒有差異，但實驗組的呼吸次數、收縮壓、舒適程度及放鬆程度有顯著的改善。
結論：台灣大約有一成的長者感到孤寂，醫護人員必須特別注意男性、無偶、自評健康差、獨居、無工作及情緒支持差者，早期發現問題，及早介入，以便預防或減輕長者的孤寂感。另外，在長照機構中，醫護人員需思考如何讓老年住民感受可以自由的持續維持與家人的關係、陪伴他們並讓他們產生歸屬感。本研究也發現撫觸療法可以有效改善老年住民的呼吸次數、收縮壓、舒適程度及放鬆程度，建議之後長照機構可以推廣這個低成本、容易操作及隨時隨地都可以進行的撫觸療法。

Background: Loneliness is a common mental health problem in older population. Previous studies have shown that loneliness can affect older persons’ physical and mental health and increase mortality rates, and has become a serious public health issue. Therefore, understanding loneliness in older people is necessary, but there is little research on loneliness among older adults in Taiwan.
Aims: There are three aims in this series of studies, including: (1) to understand the prevalence and associated factors of loneliness among older people in Taiwan, (2) to explore the perceptions of loneliness among older residents in long-term care facilities (LTCFs), and (3) to evaluate the effectiveness of tactile massage in improving mental health of older residents in LTCFs.
Methods: Study 1: Data from the Taiwan Longitudinal Study of Aging collected in 2015 were analyzed and involved 4588 participants aged ≥65 years. Chi-square tests and multiple logistic regression were used to analyze the data. Study 2: A qualitative research design and purposive sampling was used. Sixteen older residents were interviewed in two LTCFs in Northern Taiwan using a semi-structured interview guide. Content analysis was used to analyze the data. Study 3: A randomized controlled clinical trial and convenience sampling was applied. Fifty-five older residents in three LTCFs were randomly assigned to the intervention group and comparison group. The intervention group received tactile massage for both hands twice a week for four weeks, and the control group received regular care. Data were collected before and after the intervention. Generalized Estimation Equations (GEE) was used to evaluate the effectiveness of the intervention.
Results: Study 1: The prevalence of loneliness among older adults in Taiwan was 10.5%. Old persons who were male, lived alone, perceived that they had poor health condition, had no spouse, had no job, and had poor emotional support felt greater loneliness. Study 2: Four themes were generated including being cut off from continually meaningful relationships, experiencing tears of pain, feeling alone, and lacking a sense of belonging. Study 3: There were no differences in loneliness, anxiety, depression, happiness, body temperature, heart rate, and diastolic blood pressure between the two groups before and after the intervention. However, the intervention group had significantly improved respiration rate, systolic blood pressure, comfort level, and relaxation level.
Conclusions: The one-tenth of older adults in Taiwan had loneliness. Healthcare professionals should pay more attention to older adults who are male, have no spouse, have poor self-reported health, live alone, are unemployed, and have poor emotional support in order to identify problems early and develop interventions to prevent or reduce the loneliness. In addition, healthcare professionals should assist older residents in maintaining relationships with their families, provide accompaniment, and promote a sense of belonging for them. . Moreover, tactile massage can effectively improve respiration rate, systolic blood pressure, comfort, and relaxation level in older residents. It is recommended that the healthcare professionals in LTCFs can promote the use of low-cost, easy-to-use, and easily accessible tactile massage in the future.
Healthcare professionals should assist older residents in maintaining relationships with their families, provide accompaniment, and promote a sense of belonging for them.

目錄
致謝………………………………………………………………………………Ⅰ
中文摘要…………………………………………………………………………Ⅱ
英文摘要…………………………………………………………………………Ⅳ
圖表目次…………………………………………………………………………Ⅸ
圖目次……………………………………………………………………………Ⅸ
表目次……………………………………………………………………………X
第一章 緒論 ……………………………………………………………………1
第一節 研究背景與動機 ………………………………………………………1
第二節 研究目的 ……………………………………………………………6
第三節 研究問題 ……………………………………………………………8
第四節 研究假說 ……………………………………………………………9
第五節 名詞界定 ……………………………………………………………10
第二章 文獻查證 ……………………………………………………………13
第一節 孤寂感及長者孤寂感盛行率 ……………………………………13
第二節 孤寂感測量 ……………………………………………………………17
第三節 孤寂感的影響及其相關因素 ……………………………………20
第四節 改善老年住民心理健康的相關研究 ……………………………26
第五節 撫觸療法之相關研究 ……………………………………………31
第三章 研究方法 ……………………………………………………………35
第一節 老年人孤寂感盛行率及其影響因素 ……………………………35
第二節 長期照顧機構老年住民對孤寂感之認知及感受 ……………………41
第三節 撫觸療法之成效 ……………………………………………………47
第四章 研究結果 ……………………………………………………………62
第一節 台灣老年人孤寂感盛行率及其影響因素 ……………………………62
第二節 長期照顧機構老年住民對孤寂感之認知及感受 ……………………69
第三節 撫觸療法之成效 ……………………………………………………80
第五章 討論 ……………………………………………………………………101
第一節 台灣老年人孤寂感盛行率及其影響因素 ……………………………101
第二節 長期照顧機構老年住民對孤寂感之認知及感受 ……………………106
第三節 撫觸療法之成效 ……………………………………………………111
第六章 結論與建議 ……………………………………………………………115
第一節 結論 ……………………………………………………………………115
第二節 研究限制 ……………………………………………………………116
第三節 應用及建議 ……………………………………………………………117
參考資料 ……………………………………………………………………119
附錄 ……………………………………………………………………………150

圖表目次
圖目次
圖 一 研究概念架構圖 ……………………………………………………49
圖 二 收案流程圖 ……………………………………………………………58
表目次
表 一 研究設計 ……………………………………………………………48
表 二 撫觸療法(Tactile massage)操作步驟 ……………………………55
表 三 基本資料 ……………………………………………………………64
表 四 基本資料變相與孤寂感之相關性 ……………………………………68
表 五 受訪者基本資料 ……………………………………………………70
表 六 長照機構長者孤寂感認知感受 ……………………………………79
表 七 人口學資料 ……………………………………………………………83
表 八 兩組孤寂感、憂鬱、焦慮及幸福感前後測分析 ……………………89
表 九 兩組生命徵象、舒適程度及放鬆程度平均前後測分析 ……………90
表 十 兩組孤寂感、憂鬱、焦慮及幸福感改變量之比較分析 ……………92
表 十一 兩組生命徵象、舒適程度及放鬆程度改變量之比較分析 ……93
表 十二 以GEE分析撫觸療法在孤寂感、焦慮、憂鬱及幸福感之成效 ……97
表 十三 以GEE分析撫觸療法在生命徵象、舒適及放鬆程度的成效 ……98

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