高雄市失能老人對長期照護需求之探討--以前金區為例

本研究主要目的在於瞭解高雄市前金區失能老人的照顧需求，對於失能老人在社會人口學特質、衛生福利服務需求、社會支持系統、衛生福利服務利用、個案社會互動情形、照顧者之需求等方面的差異，並探討影響日常生活活動及工具性日常生活活動的相關因子，並依照老人失能的情況及程度，進行提供有用的指標，以做為衛政、社政單位、健保局、長期照護機構在資源分配、需求評估及決策重點的參考依據。並進一步對於照護管理模式提出建議，以讓所有失能老人皆能選擇適合自己的照護方案。本研究以Andersen（1995)醫療服務利用行為模式為理論基礎，並參考國內外關於「使用長期照護之影響因素」之相關研究，探討研究樣本之傾向、能力及需要因素對研究樣本醫療服務利用情形的影響。採用橫斷性研究，以評估問卷方式收集初級資料，內容包括失能老人之人口學特質、失能程度、健康狀況、日常生活活動能力、經濟狀況、居住情形及本身對於現有長期照護工作的需求、期使能給予建議。採用交叉表及卡方檢定得知失能老人之性別、婚姻、教育、最長職業、經濟補助來源、房子所有與感到孤獨、消遣方式、社會活動、知檢查、未檢原因與照護之適合場所，皆沒有顯著相關（P>0.05) ，而於經濟狀況、個案居住、飲食來源、交通工具等與社會支持系統之類別變相之間皆有明顯相關（P<0.05) ，可見社會人口學特質與照護適合場所沒有顯著關係。社會支持系統則除了經濟狀況、個案居住、飲食及交通工具外皆與照護適合場所沒有顯著關係。而衛生福利服務需求，則經由順向逐步淘汰複迴歸分析，得知特殊照護、年齡、重大傷病對日常生活活動及工具性日常生活活動達顯著之預測力，其可解釋日常生活活動及工具性日常生活活動之總變異數百分比各為34.8％及28.2％，而對於具有身障手冊、重大傷病和特殊照護之失能老人對日常生活活動及工具性日常生活活動，利用t-test分析結果，則有明顯的照顧上之需求，於衛生福利服務利用與照護適合場所沒有顯著關係，個案社會互動情形，則除了轉介照護外，與照護適合場所沒有顯著關係。由於研究顯示失能老人仍然是家庭承擔大部分的照護責任，故本研究建議社政相關單位能提供家屬適切的資訊及失能老人長期照護的需求，建立完善的轉介照護機制，政府及長期照護機構更應發展長期照護替代方案及充實社區中的居家支持服務，以落實連續性照顧之理念。

關鍵字

日常生活活動；工具性日常生活活動；失能老人；長期照護

並列摘要

The main purpose of this study is to understand the need of disabled old people in the Chien Chin District of Kaohsiung City for care and understand the differences of disabled old people in demographic characteristics, need for health and welfare services, social support system, utilization of health and welfare services, social interactions of cases, and needs of care givers. This study also investigates factors of influencing daily life activities and instrumental daily life activities, and provides useful indices according to the conditions and severity of disability of old people so that health administration, social administration, national health insurance administration, and long-term care institutes may have a reference when they distribute resources, evaluate the needs, make decisions. This study then offers suggestions regarding care management models so that all disabled ole people can select care plans that suit their needs. This study has its theoretical foundation on the behavior model of utilizing medical care services of Andersen (1995), and refers to international and local research related with “factors influencing the use of long-term care” to investigate the impact of the inclination, ability, and need factors of the sample on the utilization of medical care services by the sample. This study adopts cross-sectional design and collects basic data by evaluating survey questionnaire, including the demographic characteristics, severity of disability, health conditions, daily life activities, economic conditions, residence, and needs for existing long-term care of the disabled old people so as to be able to offer suggestions. By using the cross table and Chi square test, this study has found that gender, marriage, education, longest-held employment, source of economic subsidy, and possession of house of the disabled people are not significantly correlated with their feeling of loneliness, recreation, social activities, knowing check, reason for not checking, and suitable venue of care (P>0.05), while economic conditions, residence of case, source of diet, and transportation tools have significant correlations with the type variables of social support system (P<0.05), indicating that there exist no significant correlation between demographic characteristics and suitable venue of care. Except economic conditions, residence of case, diet, and transportation tools, the other variables of social support system have no significant correlations with suitable venue of care. With respect to needs for health and welfare services, it was known from forward step-by-step elimination multi-regression analysis that special care, age, and severe injury and sickness have significant predictive power for daily life activities and instrumental daily life activities, which can explain 34.8% and 28.2% of the total variance of daily life activities and instrumental daily life activities respectively. The results of t-test analysis indicate that disabled old people that have handicapped manual, suffer from severe injuries and sickness, and need special care have significant needs for care in their daily life activities and instrumental daily life activities, their utilization of health and welfare services has no significant correlations with suitable venue of care, and social interactions of case, except referral care, have no significant correlations with suitable venue of care. This study shows that family shoulders the better part of taking care of disabled old people and thus suggests that social administration authorities provide family with suitable information and needs for long-term care of disabled old people, establish complete referral care mechanism, and the government and long-term care institutes should develop long-term care substitute plans and strengthen home support services in community so as to implement the idea of continuous care.