老化觀念的詮釋與實踐-以新北市社區照顧關懷據點為例

在2000年之後許多歐美學者與國際組織相繼提出正向老化觀點，以一種嶄新的正向老化視野引領高齡政策的發展。從成功老化、活躍老化、生產性老化與在地老化觀點為基礎，鼓勵高齡者積極投入社會參與，發展生產力，擁有自我實現的機會，以賦權的觀點看待老年議題，發展高齡服務與政策。我國為了因應人口高齡議題，在政策發展上針對健康、亞健康長者服務中，推動社區照顧關懷據點為主要發展的方向。因此本研究運用質性訪談了解新北市9位據點工作者的服務觀點，了解目前據點服務回應重要老化觀點的內涵、困境與發展，期待提供相關服務與政策規劃的方向。研究發現如下：壹、據點長者、服務與社區一、據點長者：訪談的據點長者以女性長者、健康與亞健康長者、青老年長者為多數，國小教育程度以下長者約達半數。二、據點服務：據點活動帶給長者心理情緒、認知、社會關係與行為層面的效益。三、據點與社區資源發展：據點會運用內部資源與社區資源推展服務，當內部資源不足時，可能傾向尋求資源、自行開發、自辦相關服務以面對服務困境。貳、據點服務回應重要老化觀點內涵一、成功老化：據點提供長者健康知識訊息與活動參與，可降低疾病發生與失能情形。在心理層面，長者可能因為早年經驗或面臨老化狀態有負向情緒，透過據點活動參與，據點工作者言詞鼓勵、同儕支持引導下，許多長者開始學習調適自我，發展復原力，從中找到自信。二、活躍老化：以WHO的三大基礎檢視，於健康促進面向，據點安排健康促進活動，提供健康與醫療保健資源，長者學習保養身體、調整生活習慣，另外長者與據點建立的社會關係網絡，同儕自發性的互助關懷，提供長者高度的社會支持，據點服務有益於長者的生理與心理健康發展。而在社會參與面向，許多長者積極投入據點活動，找到生活重心與舞台。惟在安全維護面向可能因為據點大多服務健康、亞健康長者，此面向較少提到。三、生產性老化：據點長者仍維持許多生產活動，例如種菜、照顧家人、志願服務等活動，或是有據點發展文創品與長者特色小吃，發揮長者的專長。目前據點皆有安排課程，依據長者興趣與需求規劃課程，讓長者多元學習。四、在地老化：據點服務作為在地老化政策中社區資源網絡的一員，據點可擴大服務對象，廣納社會與人力資源，協助更多社會弱勢者。另偏鄉地區因為受限於長照資源的不足，在地無住宿式長照機構較難實現在地老化。

關鍵字

高齡者；成功老化；活躍老化；生產性老化；在地老化；社區照顧關懷據點

並列摘要

Since the year 2000, many European and American scholars, as well as various international organizations, have been continuously proposing concepts of positive aging, driving the development of aging policy with a brand-new viewpoint of positive aging. Based on the perspectives of successful aging, active aging, productive aging, and aging in place, senior citizens are encouraged to actively participate in society, develop their productivity, and be given the opportunities for self-actualization. Senior services and policies are developed with a perspective of empowerment on aging issues. To cope with the issues of an aging population, the major direction of policy development in our country is to promote community care stations to service the healthy and sub-healthy elderly. Therefore, this study adopts qualitative interviews to understand the service perspectives of nine care stations workers in New Taipei City, and to learn about the care stations' current service contents, difficulties and development, when responding to these important aging perspectives, and their expected directions for providing these relevant services and policy planning. Findings in this research are as follows: I. Elderly, Services and Community of Care Stations 1. Care Station Elderly: A majority of the interviewees from the care stations are female elderly, healthy and sub-healthy elderly, young-old elderly, with about half of these seniors having a primary education or less. 2. Care Station Service: The activities of care stations bring psycho-emotional, cognitive, social relationship and behavioral benefits to the elderly. 3. Care Station and Community Resource Development: These care stations utilize internal and community resources to facilitate services; when internal resources are insufficient, they are inclined to adopt activities such as, seeking outside resources, developing such services themselves, or organizing relevant services on their own to overcome this quandary. II. Care Stations' Response, in Essence, to Important Aging Perspectives 1. Successful aging: Care stations provide health information and encourage activity participation for the elderly to reduce the possibilities of disease and disability incidence. On the psychological level, elderly may have negative emotions due to their past experiences or the challenges of facing aging. Through participation in the station activities, with the encouragement of the station workers and the guidance of peer support, many elderly learn to adapt to their situation, develop resilience, and find self-confidence. 2. Active aging: In terms of health promotion, from the viewpoint of WHO's three basic constructs, the care stations arrange health promoting activities that provide health and medical care resources, which help the elderly to learn to nurture their bodies and adjust living habits. In addition, the social relationship networks established between the elderly and the care stations, and the self-initiated mutual-care with peers, provide a high level of social support for the elderly. These care stations services are beneficial to the physical and mental health development of the elderly. In terms of social participation, many elderly are actively involved in their care station's activities to help find their focus and an arena for life. However, perhaps because most of the seniors serviced by the care stations are healthy and sub-healthy elderly, there is less discussion about safety maintenance. 3. Productive aging: Many elderly of these care stations still maintain a variety of productive activities, such as gardening, caring for family members, volunteering, etc.; some stations help the elderly develop cultural and creative products and specialty snacks, allowing them to fully express their skills. Currently, there are various courses available at all care stations. Courses are planned according to the interests and needs of the relevant elderly, allowing them to learn in a variety of ways. 4. Aging in place: As members of the community resource networks developed under the aging-in-place policy, care stations can expand their service targets and incorporate social and human resources to help the more socially disadvantaged people. In addition, due to the lack of long-term care resources in rural areas, it is difficult to implement an aging in place policy, without the support of residential long-term care facilities.