老年失智主要照顧者失落經驗之探討

我國老年失智人口逐年攀升，主要照顧者在照顧歷程中除需承受極大的照顧負荷外，其所經驗到的失落感受更是需要被關注與理解的；因此，相關服務領域的工作者對此議題之了解，更能有效的協助照顧者走過這段艱苦的照顧歷程。本研究目的在於了解老年失智之主要照顧者在照顧過程裡，經驗失落的樣貌、因應方式及需求。依據本研究之目的採質性研究方法，以立意取樣找尋適合的研究參與者，經取得其同意後運用半結構式深度訪談、採全程錄音之方式蒐集資料，共完成7位訪談。研究結果發現如下：一、老年失智主要照顧者失落的面向包含：記憶失落、關係失落上分為：與長者間及與其它家庭成員間、自由失落、角色失落、社交失落、永遠的失落等六大失落經驗；而失落對於主要照顧者的影響，在老年失智症病程為中度的影響最為劇烈，隨著主要照顧者漸漸可以因應及適應失落、長者的病情加重，失落對於主要照顧者的影響會隨之降低。二、老年失智主要照顧者因應失落的方法：自我調適、接受失落、順應現實、內外在支持系統的介入、主要照顧者自我照顧信念的支持、保留自我空間、尋求宗教信仰支持等都是老年失智主要照顧者有效因應失落的方法。三、老年失智主要照顧者福利服務的需求與建議如下：（一）對照顧政策規劃上的建議：失智症宣導全面性的規劃、長期照顧機構人員的在職訓練、增加長期照顧服務的彈性及整合性。（二）對實務工作上的建議：運用家庭系統的觀點評估失落與處遇、保持多元及開放的服務態度、陪伴及媒介的角色定位、廣為辨理失智症主要照顧者支持性團體。（三）對主要照顧者建議：增加自我對於失智症的了解、接受長者的失功能及自我在照顧工作中的無能與無力、擴展自我的支持系統（四）對未來學術及研究之建議：進行不同關係的主要照顧者失落經驗之研究、發展「老年失智主要照顧者失落」測量之量表

關鍵字

老年失智者；主要照顧者；失落經驗；因應失落；福利需求

並列摘要

In Taiwan the number of dementia population has become increasingly larger. It is understandable that the primary caregivers not only suffer from massive care giving burdens, but also experience huge losses through the care giving procedure. Under this circumstance, a solid grasp of caregivers’ hardship will definitely assist them to go through the interval of care giving. The purpose of this study is to explore the aspects of the loss experience the primary caregivers, while taking care of people living with dementia, encounter, their coping strategies they apply to solve problems, and the assistance they need in dealing with the dementia people. The current study uses qualitative research method, and adopts purposive sampling to recruit participants. By tape-recording semi-structured in-depth interviews, a total of seven interviews was collected. Our investigation shows that (1) the aspects of the loss experience our participants encountered include memory loss, the loss of relationship -- with the elderly and other family members, loss of freedom, roles and social life, and eternal loss. These losses brought about severe impacts on the caregivers especially when the dementia patients they were taking care of were in the moderate degree of their disease. However, with their increasing adjustment of their losses and the exacerbations of the dementia people, the caregivers gradually detached the influences urged by their original losses. (2) The coping strategies helpful to the primary caregivers to elderly dementia patients to cope with their loss experience are self-adjustment, acceptance of losses, compliance with reality, intervention from inner or/and outer supportive system, self-space maintenance, and religious quests. (3) Suggestions and the welfare needs for the primary caregivers to elderly dementia people are as follows. (a) In terms of making policies of caregiving, a comprehensive program of dementia disease guidance, on-job training for the long term care institute workers, the increase the flexibility and the integrity of our long term care service are recommended. (b) In terms of clinical workers, the use of family system as the perspective to evaluate and assess caregivers’ losses is suggested. An open-minded and multi-dimentional attitude is advised to keep when working in the service. Identifying oneself as an accompany or/and a media is recommended in practical working situations. Supportive groups are suggested to hold for primary caregivers. (c) For primary caregivers, we suggest them to gain knowledge and deeper understanding of dementia. Accept dysfunction of elder dementia people. Accept their impotence and powerlessness in care taking process. Expend their self-supportive system. (d) For further research, studies are suggested to be done on the loss experience of the caregivers who are in different relationship to the dementia people, and the loss inventory of primary caregivers for dementia people is suggested to develop.