探討家庭照顧者對於失智患者之照顧負荷、問題行為處理效能及個案管理介入之成效

The Care Burden, Self-Efficacy in Managing Behavioral Problems of Family Caregivers for Demented Patients, and Effects of Case Management Intervention

韋淑玲(Shu-Lin Uei)

指導教授 ： 楊美賞

高雄醫學大學/護理學院/護理學系研究所/博士(2013年)

https://doi.org/10.6832/KMU.2013.00023

摘要

隨著台灣失智人口數增加，大量且長期的照護需求對家庭及社會造成莫大衝擊。尤其，失智患者照護型態有別於其他疾病，照顧者身心往往承受著難以負荷的壓力。有鑑於此，本研究分成兩部份，第一階段為調查性研究，以社區中的居家失智患者及家庭照顧者為對象，樣本數共162對；目的為探討家庭照顧者的照顧負擔、對於問題行為處理自我效能及其相關影響因素。第二階段為類實驗性研究，目的為檢測個案管理介入對於失智症家庭照顧者在照顧負擔、問題行為處理自我效能及失智患者在入住機構率之成效。採立意取樣；實驗組及控制組各40對。實驗組接受個案管理相關介入措施為期12週，控制組則只接受一般門診指導；實驗組及控制組於同一時間點接受前測，並於介入後第12週及第24週各接受一次後測。本研究採用描述性及推論性統計分析，研究工具以「家庭照顧者基本資料表」、「照顧者負擔量表(CZBI)」、「失智問題行為處理自我效能評估表(DBD Self-efficacy Scale)」，來評量家庭照顧者的負擔及問題行為處理概況。以「失智患者基本資料表」、「日常生活活動功能評估表（ADL）」、「工具性日常生活活動功能評估表（IADL）」、「簡易智能評估量表（MMSE）」及「失智問題行為評估表(DBDS)」來評量失智患者日常活動、認知及行為功能；並以失智患者入住長期照護機構率來評值個案管理的成效。
結果顯示失智患者問題行為出現頻率較高者、照顧者為女性、照顧者為失智患者之子女、照顧者教育程度為國中(含)以下及每週照顧時數較高者，其照顧負擔顯著較高，且達統計上顯著相關；解釋變異量為38.7%。除此之外，失智患者問題行為出現頻率較高及照顧者教育程度較低者，會影響家庭照顧者對於失智患者行為問題的處理效能，且達統計上顯著相關；解釋變異量為26.7%。而家庭照顧者對於失智患者行為問題的處理效能和照顧者負擔，有統計上的顯著相關(p < .001)。失智問題行為出現頻率較高者於整合性個案管理模式介入後，實驗組之家庭照顧者對於問題行為處理自我效能高於控制組、在照顧負擔則低於控制組，且有統計上顯著差異(p < .05)。其他如失智患者的日常功能、認知功能、問題行為出現頻率及入住長期照護機構狀況兩組皆無統計上之差異。本研究顯示，整合性個案管理模式確能提升失智家庭照顧者處理患者問題行為之效能並減輕照顧者負擔，此實證性結果期能提供政府規劃本土失智整合照顧模式之參考。

關鍵字

失智症 ； 家庭照顧者 ； 照顧負荷 ； 問題行為處理效能 ； 個案管理成效

並列摘要

As the dementia population increases in Taiwan, the long-term and immense care needs for patients with dementia will bring great challenges to family and the society. Family caregivers of relatives with dementia generally endure intolerable stress; in particular differ from those for people with other illnesses. A total of 162 pairs of patients with dementia and their family caregivers were recruited into this study. This study included two stages. The purpose in the first stage was to measure the family caregiver’s self-efficacy of managing the disturbed behavioral and psychological symptoms in their relatives with dementia (BPSD) and to measure the caregiving burdens they have taken. The purpose in the second stage was to assess the effects of integrated case management for patients with dementia at home. A quasi-experimental design and a purposive sampling approach with 40 pairs of dementia patients and their family caregivers in each of the experimental and control groups were conducted. The experimental group received case management strategies for 12 weeks, while the control group only received routine outpatient services. Both groups received a pre-test as well as two waves of post-test in the twelfth and twenty-fourth weeks, respectively.
Descriptive and inferential statistics were used in this research. Instruments of evaluation were used in this study included: the Chinese version of the Zarit’s Burden Interview (CZBI) and DBD Self-efficacy Scale was used to assess the self-efficacy level in caring Dementia Behaviors Disturbance (DBD) of family caregivers. Structured questionnaires including the caregivers’ characteristics and dementia patients’ characteristics, the Barthel’s index of Activities of Daily Living (BADL), the Instrumental Activities of Daily Living Scale (IADL), the Chinese version of the Mini Mental Status Examination (MMSE) and the DBD Scale (DBDS), were used to assess dementia patients’ activities of daily living, cognitive function and behavioral disturbance levels. The rate of admission in long-term care institutions of dementia patients also served as the indicator for evaluating the effects of case management model.
The results revealed that the patients they took care with higher frequency of DBD, family caregiver with female gender, caregiver with education < 9 years, with a parent-child relationship, with higher hours of care per week were more likely to have significantly higher caregiver burden, which explained up to 38.7% of the variance. In addition, patients with higher frequency of behavior disturbances and family caregivers’ education < 9 years were likely to have significantly less self-efficacy level in DBD management, which explained up to 26.7% of the variance. However, family caregiver’s level of self-efficacy in DBD management was significantly associated with caregiver burden (p < .001). In the second stage, after integrated case management model conducted, the experimental group have higher self-efficacy in DBD management (p < .05) and less caregivig burden compared to that of control group (p < .05). But no significantly differences were found in patients’ functional status, frequency of DBD and the rate of admission in long-term care institutions. The evidence gained from this research can provide government with useful references in designing integrated dementia long-term care policy in the future.

並列關鍵字

Dementia ； Family caregiver ； Care burden ； DBD Self-efficacy ； Effects of case management

參考文獻

于漱、吳淑瓊、楊桂鳳(2003)•失智症患者的長期照護服務模式•長期照護雜誌，7(3)，251-264。

邱逸榛、何玉婷、陳婉庭、徐亞瑛(2004)•簡介阿茲海默氏症與其照護•長期照護雜誌，7(4)，289-304。

參考文獻

中文部份

內政部統計資訊服務網(2011)•2012年1月30日取自http://www.moi.gov.tw/stat/index.asp