社會支持與照顧者投入等因素對失智症照顧者負荷之影響

Influence of Social Support and Caregiver Input on the Load of Dementia Caregivers

薛博文(PO-WEN HSUEH)

指導教授 ： 洪錦墩

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2020年)

摘要

臺灣失智症的人口數也隨著老化的程度而增加，失智症照顧是一件艱鉅的挑戰，特別是各方面的支持與協助。為探討失智症患者之照顧者社會支持與負荷之間各種因素的關聯，希望將此研究結果提供政府相關單位在將來超高齡化社會的接近與失智症人口增加的難題中，了解目前的社會支持是否能實際幫助照顧者降低負荷。
本研究利用台灣SRDA學術調查研究資料庫之次級資料進行的橫斷性研究(Cross-sectional studies)。資料庫收案對象是南部地區某醫學中心失智症特別門診的收案病患及其照顧提供者，一共279對雙人組。在疾病特性測量方面包含病患的認知功能(CDR, MMSE)、日常生活功能(ADL)以及神經精神行為症狀(NPI)。其照顧提供者完成結構式的調查問卷，題目包括人口學特性、與被照顧者間的關係、正式的服務使用與照顧產生的費用等等。
本研究所使用的資料檔案包括病患基本資料檔、病患日常生活功能量表、病患健康問卷、病患神經精神病評估、照顧者基本資料、照顧負荷量表、照顧者投入、社會支持、照顧者社會支持量表以及失智症家庭經濟負擔，互相串檔取得病患之各項功能評估及其照護者投入之負荷量，對照其所利用之社會資源等相關資訊。
在照顧者部分，平均年齡為59.49歲，自述照顧患者平均年數為4.52年，主要照顧者佔86.02%，非主要照顧者佔13.98%；在性別方面，男性佔35.84%，女性佔64.16%。在照顧者的社會支持之平均得分為26.38分，標準差為9.14。在照顧者投入部分，過去一周跟患者平均相處天數的平均值為6.18天，標準差為1.79；一天中協助患者執行如廁、進食、穿脫衣褲鞋襪、個人衛生清洗、走動與洗澡之時數的平均值為0.99小時，標準差為1.31；一天中協助患者執行購物、準備食物、家事、洗衣、出門交通往返、服藥、理財之時數的平均值為2.24小時，標準差為1.35；一天中監督患者以避免發生危險事件之時數的平均值為3.97小時，標準差為4.83；一天中睡眠時數的平均值為6.33小時，標準差為1.30；平均一週工作時數的平均值為37.89小時，標準差為15.94。在照顧負荷部分，照顧者的負荷平均值為17.45，標準差為10.32。
對失智症照顧者負荷之影響因素模型調整後的解釋力為0.171；各構面的部份，一天中協助患者執行如廁、進食等行為之時數、一天中監督患者之時數均達顯著水準；在一天中睡眠時數的部分，與照顧者自覺負荷呈負相關，但卻未達到顯著水準。

關鍵字： 失智症、照顧者負荷、社會支持

關鍵字

失智症 ； 照顧者負荷 ； 社會支持

並列摘要

The dementia population in Taiwan has increased in accordance with the population aging process. Dementia care poses a severe challenge, particularly in terms of support and assistance. The relationship between factors regarding the social support and caregiver burden for patients with dementia must be clarified. Therefore, this study explored whether the existing social support system mitigates caregiver burden to provide a reference for relevant government units to respond to the challenges imposed by the oncoming superaged society and the increasing population of people with dementia.
This study adopted a cross-sectional study approach and collected secondary data from the Survey Research Data Archive. Said data concerned 279 pairs of case patients and caregivers from a dementia-specialized clinical department in a medical center in the Southern Taiwan. The examination for disease characteristics included inspecting the patients’ cognitive functions (Clinical Dementia Rating & Mini-Mental State Examination), daily living functions (Activities of Daily Living), and neuropsychiatric symptoms (Neuropsychiatric Inventory). The caregivers responded to a structured questionnaire, which concerned their demographic information, their relationship with the patients, the use of formal services, and the costs of care provision.
The data used in this study included patient demographic information, Activities of Daily Living data of the patients, the patients’ health questionnaire, evaluation results of the patients’ neuropsychiatric symptoms, caregiver demographic information, the caregiver burden scale, the caregivers’ commitment, social support, the social support scale result of caregivers, and the financial burden of families of patients with dementia. The files were associated with each other to identify the assessment results on patients’ various functions and the job burden of their caregivers. The results were compared with other relevant data such as the social resources used by the patients and caregivers.
The adjusted explanatory power was 0.247. Neuropsychiatric Inventory exhibited the highest individual explanatory power out of all the variables (β distribution = 0.38; t = 3.80, p < 0.001), followed by that of out-of-pocket expenses (β distribution = 0.21; t = 2.24, p < 0.028) and knowledge of existing long-term care resources provided by the government (β distribution = 0.19; t = 2.08, p < 0.041). No statistical significance was detected in variables such as the use of government-provided resources and social support.

Keywords: dementia, caregiver burden, social support

並列關鍵字

dementia ； caregiver burden ； social support

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