台東縣長期照護居家照護服務利用之探討

動機和背景人口老化面臨最大的問題，就是慢性病及長期照護需求。台東縣93年底總人口數有242,842人，65歲以上老年人口達28,548人佔11.76﹪，屬成熟型高齡化社會。因醫療資源缺乏，經濟狀況不佳，傳統觀念保守老舊，居家照護需求遠較機構式照護需求來得迫切。為確認長期照護居家個案健康狀況及特性，了解其需求及資源是否足夠與均衡，進而推估其可能之遞變趨勢，故迫切需要整體性長期照護居家需求，建立即時且有實證之推估資料，掌握其走向，研擬照護模式。方法本研究採用橫斷性研究，以MDS-HC2.0問卷收集初級資料，樣本為截至94年1月底台東縣長期照護居家個案收案名冊，去除居住外縣市及居住在機構內的個案資料，收集期間為94年2月至94年3月，進行家庭訪視，共取得487份問卷。於收集後先行編碼及登錄，運用SPSS 10.0 for Windows電腦套裝軟體，依據研究變項及目的進行統計分析，以描述性統計及相關統計方式（T-test、Pearson Chi-Square、線性回歸）。結果研究顯示居家照護個案相關特質：平均年齡71歲，以女性、不識字者、65歲以上、原住民居多；個案與人同住佔多數（67.4﹪），其中以兒女/女婿/媳婦同住最高（31.6﹪），配偶次之（22.8﹪）：個案疾病型態以腦血管疾病、心血管疾病、糖尿病為前三高。在族群方面、非正式服務者與個案關係方面、疼痛劇烈足以影響日常活動、過去30天內體重增加5%以上、曾接受居家護理服務方面、IADL及ADL分數等變項，同時對預測使用正式性及非正式性服務，有顯著性之相關(P<0.05)。討論疾病發生以生活型態影響最巨，本縣長期照護個案以原住民佔多數（52﹪），故原住民的特異性健康議題應深入探討。獨居個案應定期關懷以適時發覺健康問題及提供健康照護。居家照護資源使用與個案身體健康狀況及其他因素而有不同之需求，故完整的長期照護服務網路更應涵蓋多元化（醫療照護、生活照顧、社會服務、住宅服務、輔具提供、緊急醫療回應、交通服務等）連續性（因慢性病症所造成之不可逆之功能缺損）社區化，享有長期照護服務是人權而非特權，故需依社區需求規劃服務的種類與數量，使得資源均衡分布，以達服務的可近性與公平性。

關鍵字

長期照護；居家照護資源

並列摘要

Background and objectives The first question for the aging population is the demand of long term care services. From the last year, in the Tai-Dong country 11.76% of the population are elders, that is the aging country. Due to the empty of medical sources, poor economic condition, and traditional role in society, the demand for home care service is more imperative than institutional ones. For this purpose, it is important to realize the comprehensive long-term home care services in order to evaluate the prompt and actual demands and finally to plan its trends and models. Methods This is a cross-sectional study design. These secondary data was conducted from February 2005 to March 2005 using MDS-HC 2.0 home visiting to collect the sample. In total, there have 487 cases qualified for this study. After coding and login, this study employed T-test, Pearson Chi-square, and linear regression analyses by following the study objects. Discussion Results The result shown that average age was 71 years old, and most of the people were female, illiteracy, over 65 year-old elders, and aborigines. According to staying with related persons, 31.6% were children, a son-in-low, or daughter-in-law, and 22.8% were their husbands or wives. For the style of disease, the top three were cerebrovascular diseases, cardiovascular system diseases, and diabetes. Generally, the group variable, the relationship with informal servicewomen and subjects, heavy pain function effected daily activities, the weight increasing 5% in past 30 days, having previous home care services, IADL and ADL had a statistically association in predicting formal or informal institutional services simultaneously (P<0.05). Conclusion This study found that there had 52% long-term care cases were the aborigine and their specific health issues deserved for further discussion. On the other hand, we need pay more attention on those who lived alone and need long-term home care services. The comprehensive long-term home care should contain multiple (medical care, life care, social service, home care, affiliated supports, emergency medical response, traffic services, and so on), and continuous services, because it is the right not privilege for those who needed long-term home care services in order to plan medical services, to balance medical resources, and finally to be accessible and be equitable.