養護中心聽損住民的功能性溝通活動及相關因素之研究：以高雄市為例

國內人口急遽老化，安置在長照機構的年長者不斷增加，而年長者隨年紀的增長，在聽知覺與認知功能會出現漸進性的退化現象。本研究旨在探討養護中心聽損長者（以下簡稱聽損住民）在功能性溝通的需求重要性與表現獨立性，分別與聽損程度、認知障礙程度以及入住機構時長之間的關聯性，並分析聽損住民填答功能性溝通活動量表結果與溝通夥伴（護理師和社工師）填答結果之間的相關情形。本研究採用問卷調查法，研究對象為高雄市養護中心65歲以上的聽損住民，正式樣本人數為100名，研究工具包含耳鏡、音壓計、純音聽力檢查儀、聽覺障礙篩檢量表、簡易心智量表，以及功能性溝通活動量表。「功能性溝通活動量表」，包含八項溝通活動領域及兩個評分機制。在溝通活動領域方面，包含「基本溝通需求」、「社交性溝通」、「電話使用」、「家庭活動與計畫」、「購物及金錢管理」、「交通」、「書寫能力」及「休閒活動」；在評分機制方面，包含功能性溝通的「需求重要性」與「表現獨立性」。本研究結果如下：其一，聽損住民在功能性溝通的需求重要性與表現獨立性之現況描述：(1)在基本溝通需求、社交性溝通、電話使用、家庭活動與計畫、休閒活動等五項溝通活動領域，其需求重要性及表現獨立性較高；(2)在交通、購物及金錢管理、書寫能力等三項溝通活動領域，其需求重要性及表現獨立性較低。其二、聽損住民在功能性溝通的需求重要性與相關因素間之關聯情形：(1)聽損程度僅與溝通活動領域中的「購物及金錢管理」達顯著正相關，表示聽損程度較嚴重的年長住民，對購物及金錢管理的溝通需求重要性較高；(2)聽損住民的認知障礙程度越嚴重，其溝通重要性越低；(3)聽損住民入住機構時長的長短與溝通需求的重要性沒有顯著相關。其三、聽損住民在功能性溝通的表現獨立性與相關因素間之關聯情形：(1)不同聽損程度的年長住民在各項及總體溝通活動領域中的表現獨立性無顯著差異；(2)聽損程度越嚴重的聽損住民，在「基本溝通需求」、「交通」、「購物及金錢管理」及「休閒活動」領域中，其溝通表現獨立性會較低；(3)越無認知障礙的聽損住民，其溝通表現獨立性越高；(4)聽損住民入住機構時長越長，其溝通表現之獨立性越高。其四、聽損住民在功能性溝通活動量表的填答結果與護理師和社工師填答結果之間有中至高度的正相關。整體而言，聽損住民在功能性溝通活動需求及表現上，分別與聽損程度、認知障礙程度及入住機構時長有關聯，故臨床工作者與聽損住民溝通或設計活動時，應將上述相關因子納入。。

關鍵字

功能性溝通需求；功能性溝通表現；養護中心；聽損長者；認知障礙；入住機構時長

並列摘要

The aging population in Taiwan increased rapidly and the elderly living in long-term care institutions was growing. In addition, as the older-age adults were ageing, their auditory perception and cognitive function declined progressively. The purposes of this study were to explore the importance of functional communication needs and the independence of functional communication performance for the hearing-impaired elderly people residing in care institutions (also called residents with hearing loss), and to investigate the relations respectively with the degree of hearing loss, the degree of cognitive impairment, and the residing duration in care institutions. Besides, the pairwise correlations among the results of Functional Communication Activities Questionnaire (FCAQ) completed by residents with hearing loss and communication partners (nurses and social workers) were analyzed. The study method adopted the questionnaire survey. Participants aged above 65 years old, with hearing loss, and lived in Kaohsiung care institutions were recruited. The formal sample size was 100 participants. The study materials and tools included an otoscopy, a sound level meter, a pure-tone audiometer, the Hearing Handicap Inventory for the Elderly (HHIE), the Mini-Mental State Exam (MMSE), and the FCAQ. The FCAQ used in this study was constructed with 8 communication activity domains and 2 rating mechanisms. The communication activity domains included basic communication needs, social communication, telephone usage, family activities and plans, shopping and money management, traffic, writing ability, and leisure activities. The rating mechanisms differentiated the functional communication as the importance of needs and the independence of performance. The study results were as follows: First, the descriptive results of residents with hearing loss in the functional communication were that: (1) importance of needs and independence of performance were higher in 5 communication activities domains: basic communication needs, social communication, telephone usage, family activities and plans, and leisure activities; (2) importance of needs and independence of performance were lower in 3 communication activities domains: traffic, shopping and money arrangement, and writing ability. Second, the relations between the importance of needs and relevant factors for the residents with hearing loss in functional communication were that: (1) the degree of hearing loss only showed significantly positive correlation with one communication activity domain: the shopping and money arrangement domain, which meant that the poorer the hearing loss level of elderly residents, the higher the functional communication importance of needs in shopping and money arrangement domain; (2) the more serious the level of cognitive impairment, the lower the importance of communication needs; (3) the residing duration in care institutions was not significantly correlated with the importance of communication needs. Third, the relations between the independence of performance and relevant factors for the residents with hearing loss in functional communication were that: (1) different hearing loss levels of elder residents were not significantly different in subscale and total scores of the independence of communication performance; (2) the poorer the hearing loss level of elderly residents, the lower the independence of communication performance in basic communication needs, traffic, shopping and money arrangement, and casual activities domains; (3) the less serious the level of cognitive impairment, the higher the independence of communication performance; (4) the longer the residing duration in care institutions, the higher the independence of communication performance. Forth, the results of FCAQ among residents with hearing loss, nurses, and social workers had moderate to high positive correlations in pairwise. To sum up, the needs and performance of residents with hearing loss in functional communication activities were correlated with the hearing loss level, the cognitive impairment level, and the institution-residing duration. The practical workers should took the relevant factors into account when designing activities or communicating with hearing loss residents.

並列關鍵字

functional communication needs ； functional communication performance ； care institution ； the elderly with hearing loss ； cognitive impairment ； institution-residing duration