居家失能老人在照顧服務使用的自我選擇權之相關因素研究

Self-determination of the Home Care Service Use among Disabled home-dwelling Elders of Taiwan

紀玫如(Mei-Ju Chi) ； 吳淑瓊(Shwu-Chong Wu)

《台灣公共衛生雜誌》 27卷2期 (2008/04) Pp. 121-132

https://doi.org/10.6288/TJPH2008-27-02-04

摘要

目標：瞭解影響居家失能老人是否能夠自己選擇照顧服務的相關因素。方法：本研究對象選自嘉義市及台北縣三峽鎮。鶯歌鎮兩個實驗社區中，能夠自答問卷之65歲以上居家失能老人947名，再以SPMSQ量表經教育程度校正後取得有效樣本942人，並以多分變項邏輯斯迴歸進行相關因素之檢驗分析。結果：分析樣本中有45.9%的個案表示能夠自己選擇服務，16.8%的個案則完全不能由自己選擇服務，其餘36.3%的個案則表示自己可以選擇部分服務。多分變項邏輯斯迴歸分析結果顯示，比較完全可以自己選擇服務和完全不可以自己選擇服務兩組個案發現，具社會福利身份(OR=0.45, 95%CI=0.25-0.79)、重度身體功能障礙(OR=0.29, 95%CI=0.15-0.56)、認知功能有障礙(OR=0.40, 95%CI=0.24-0.68)、沒有個人收入(OR=0.43, 95%CI=0.24-078)、照顧者為媳婦(OR=0.36, 95%CI=0.15-0.88)，比較不是由自己選擇照顧服務；對長期照護服務認知較高(OR=1.13, 95%CI=1.01-1.27)者，則能夠由自己選擇服務的機會較高。結論：個人經齊狀況、對服務的認知、教育程度、與照顧者之照顧關係以及身體和認知功能，都是會影響失能老人能否自己選擇服務的重要因素。未來在長期照護相關政策的規劃，應加以考量上述因素的影響。

關鍵字

自我選擇 ； 照顧服務 ； 居家失能老人

並列摘要

Objectives: To examine the prevalence and correlates of self-determination of homecare service among disabled Taiwanese elders. Methods: Nine hundred forty two (942) subjects among the 2079 disabled elders from the ”Pilot Program for the Development of Long Term Care System Study” implemented in Taipei and Chiayi City were recruited. Elders with severe cognitive impairments and those with surrogate responses were excluded. Multinomial logistic regressions were applied for statistical analysis. Results: Forty-six percent of the respondents indicated that they could choose the care services by themselves, 36.3% could choose some services, and 16.8% were unable to choose services. Compared with those who could not make their own decisions, those who could not choose their services totally are more likely to have social welfare status (OR=0.45, 95%CI=0.25-0.79), severe ADL disability (OR=0.29, 95%CI=0.15-0.56), cognitive disability (OR=0.40, 95%CI=0.24-0.68), without personal income (OR=0.43, 95%CI=0.24-0.78), daughter-in-law caregivers (OR=0.36, 95%CI=0.15-0.88). Elderly with greater awareness of long-term care services exhibited higher probability of choosing their services (OR=1.13, 95%CI=1.01-1.27). Conclusions: Economic status, physical and mental functioning, the relationship with caregiver, education and the awareness of services were the important factors associated with self-determination of disabled Taiwanese elders. Our government should consider these factors when promoting relative long-term care policy for disabled elders.

並列關鍵字

self-determination ； home care services ； home-dwelling disabled elderly

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