探討長期照護機構之環境特徵與失智症住民行為之關係-以臺北市長期照護機構為例

Relationships between Environmental Features and Behaviors of Dementia Residents - An Example of Long-term Care Facilities in Taipei

曾建堯(Chian-Yao Tseng)

指導教授 ： 郭乃文

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00142

摘要

根據內政部統計處資料顯示，目前全國老年人口共有2,287,029人，有學者推測民國140年後，臺灣65歲以上的老人將佔總人口比例達37.0%，換句話說「高齡化」情形在台灣是相當嚴重的，而失智症的老年人口也隨之持續增加。失智症患者在語言、記憶、認知等領域會發生退化或障礙等問題，受到影響的不僅是患者本身，更嚴重增加照護者及患者家庭的負擔。過去有許多對患者異常行為進行的研究，發現環境的設計因子的確與患者行為有關，不過國內對於環境與患者行為的相關性研究是比較少的。因此本研究目的在於對國內長期照護機構環境進行瞭解，並將環境的差異與住民行為進行研究以探討其中之相關性，最後試圖提出對長期照護機構及未來研究者有益之建議。
本研究以觀察法獲得環境特徵與住民行為之資料，並以逐步迴歸及階層分析等方法對所得之資料進行統計分析。本研究之自變項，環境特徵因子分為「公共環境」與「住房環境」；公共環境中包含「安全性」、「感官刺激與活動性」、「舒適度與便利性」、「方向性及辨識性」等四個構面；住房環境則有「安全性」、「個人化」、「舒適度與便利性」、「隱私性」四個構面。「住民行為」則是本研究之自變項，包含「正向行為」及「負向行為」。
根據本研究結果顯示，機構的環境特徵的確對住民行為造成影響。首先以住房環境設計來看，「個人化」程度越高，住民的正向行為就會越多。而從公共環境設計來看，雖然其中的單一構面與住民行為都未達到顯著相關，但發現住民的負向行為會因良好的公共環境設計而減少。最後將「住房環境」及「公共環境」因子同時與住民行為進行比較，發現整體公共環境能對住民的負向行為達到顯著的負相關。此外整體環境與正向行為的比較中，住房安全性對住民的正向行為也有負相關存在，原因在於住房安全性越高，可能造成住民自主活動增加，卻減少了住民與他人互動的機會，亦顯示出機構員工往往是被動與住民接觸的，當住民有需求時才會進行協助。
最後，本研究建議機構的設計者應改善環境設計因子以增加住民正向及減少負向行為。同時機構仍應增加環境的安全性設計，而機構人員則需更主動積極對住民關心與溝通。未來的研究者也可針對安全性環境進行研究，以佐證本研究之結論。

關鍵字

環境特徵 ； 住民行為 ； 長期照護機構 ； 失智症

並列摘要

According to statistics of Ministry of the Interior, there are 2,287,029 elder people in Taiwan currently. A researcher predicted that the proportion of the elders will be over 37.0% at the year of 2051. In other words, aging is a serious problem in Taiwan, and the numbers of dementia elders are getting more and more. Patients with dementia almost have problems on speaking, memory, recognizing and so on, what influences not only the patients but also their carers and family seriously. There were many references about patients’ problem behaviors, and researcher discovered that there were relationships between environmental features and patients’ behaviors. However, most of studies in Taiwan didn’t focus on the relationships. Thus, the first aim of this study was to explore distinction of long-term care facilities’ environmental features and dementia patients’ problem behaviors between Taiwan and other contries. The second purpose was to understand the relationship between long-term care facilities’ environmental features and the residents’ behaviors. Last but not least, suggestions of this study can benefit long-term care facilities designers and future researchers.
All environmet features’ and residents’ behaviors’ data on this theory obtained by observation was analyzed by Stepwise regression and hierarchical analysis methods. Environmental features, which were independent variables, can be categorized into two groups, public environment and residential environmet. Public environment including 4 dimensions, safety, stimulation, comfort and convenience, and recognization. Residential environment including safety, personalization, comfort and convenience, and privacy. Variables of residents’ behaviors, including positive behaviors and negative behaviors, were dependent variables.
The results of this study were that environmental features can influence residents’ behaviors. First, more personalization features in residential environment did increase positive behaviors of residents. Second, although each dimension in public environment has no relationships with residents’ behaviors, residents’ negative behaviors were reduced by good public environmental designs significantly. Third, when considering both residential and public environmental features, public environmental features had negative relationship with residents’ negative behaviors. Besides, residential safety had negative relationships with their positive behaviors. The reason was that residents can do many things by themselves and had fewer chances to communicat with other residents and staff. In other words, staffs in the long-term care facilities usually do not take the initiative in communicating and helping residents.
In short, this study suggested that facilities’ designers have to improve environmental features of facilities to increase residents’ positive and to reduce negative behaviors. Designers should make environemtal features safer, and staffs should take care and communicate with residents enthusiastically. In the future, researchers can focus on ‘safety’ in the environment to prove conclusion of this theory.

並列關鍵字

Environmental Features ； Residents’ Behavior ； Long-term Care Facilities ； Dementia

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