機構失能老人之社會支持、調適與憂鬱症狀

Social support, coping strategies and depressive symptoms among the institutionalized disabled elderly in Taiwan

徐珮珊(Pei-Shan Hsu)

指導教授 ： 徐慧娟

亞洲大學/健康學院/健康管理研究所/碩士(2009年)

摘要

研究背景：憂鬱一直是老年人常見的心理問題。在我國過去研究中，大多是針對影響老年人的心理健康之因素作探討，較少針對影響老年人的心理健康之中介因素與調節因素進行分析。研究目的: 本研究目的在採用路徑分析方式，探討失能老人不同的壓力程度、不同的社會支持程度對於選擇調適策略的情形以及減緩憂鬱症狀之效果。方法: 本研究利用2008年國科會計畫「失能者之成功老化：內在適應與外在資源」問卷調查資料進行分析。該資料針對社區樣本與機構樣本之ADL或IADL失能一項以上且為55歲以上者進行訪問，本研究只選取居住機構之樣本共444人，以路徑分析方法進行資料分析。結果：(1)當失能老人之壓力程度越高時，直接提高憂鬱症狀；同時也較易採取情緒發洩及逃避策略調適方式，並間接提高憂鬱症狀。(2)當失能老人採取問題解決調適方式與情緒發洩及逃避策略時，憂鬱症狀越高，而採取尋求支持策略對於直接減緩失能老人憂鬱症狀則不顯著。(3)失能老人所獲得的社會支持可直接降低失能老人之憂鬱症狀。(4)當失能老人獲得較高社會支持時，可減少因失能產生的壓力與較少採取情緒發洩與逃避策略，因而間接減少憂鬱症狀。討論：社會支持是對於降低機構失能老人憂鬱情形產生的相當重要的策略之一，也是避免失能老人採取不適當的調適策略，進而降低憂鬱情形的產生之重要因素之一。建議正式照護者與家屬多引導失能老年人，表達內心的想法以及所需要的支持。另外，機構應定期透過舉辦團康活動，以促進院民之間的關係，機構也應多鼓勵家人陪伴，使失能老年人感受社會的關懷與支持，使失能老人以建立積極正向的調適行為來面對老年的失能。

關鍵字

失能老人 ； 社會支持 ； 調適策略 ； 憂鬱症狀

並列摘要

Backgrounds: Depression has been a common psychological problem for the elderly, and disability is one of the risk factor of depressive symptoms. However, the mechanism of the mediators and moderators to depressive symptoms for the disabled elder people was less explored for Taiwanese elderly. Purpose: The objective of this study is to explore the association of coping strategies and social support to depressive symptoms for the disabled Taiwanese elderly. The direct and indirect effects were examined by structural equation model. Method：Data were from the 2008 National Science Council project “Successful aging for the disabled elderly: Internal adaptation and external resources”. The face-to-face survey from long term care institution users who were aged 55 or over with physical disabilities of the elderly in middle Taiwan was conducted. Totally 444 persons were analyzed in this study. Descriptive analysis and path analysis were used for analysis. Result：(1) Stress showed the direct effect in enhancing depressive symptoms, and the elderly having more stress were more likely to use venting and avoidance coping strategies, and thus increased their depressive symptoms. (2) Using problem solving coping and venting and avoidance coping strategies showed the direct effect of increasing depressive symptoms, while the seeking support coping was non-significatly related to depressive symptoms. (3) Social support may directly reduce the depressive symptoms. (4) When the disabled elderly received higher social support, their stress due to disability may be reduced and the use of venting and avoidance copoing strategies was less, and thus the depressive symptoms would be lower. Discussion：Social support is an important strategy to reduce depressive symptoms of institutionalized disabled elderly, also an important factor to avoid using inappropriate coping strategies and thereby reducing depressive symptoms. We suggest that the formal caregivers and the families should encourage the disabled elder to express their feelings and the social support that they need. In addition, the long-term care institutions should hold social activities regularly to promote the relationship among the disabled elderly, and encourage the family provide more company. Thus the older people may receive appropriate social support, and help them to perform the positive coping to deal with diablity in the old age.

並列關鍵字

disabled elderly ； Social support ； coping strategies ； depressive symptoms

參考文獻

林怡君、余豎文、張宏哲(2004)。新店地區機構和非機構老人憂鬱情形及相關因素之調查。台灣家庭醫學雜誌，14(2)，81- 93。

吳淑瓊、徐慧娟、莊瑛智、張明正(1996)。功能評估在估計台灣社區老人長期照護需要之應用。中華衛誌，15(6)，533-545。

徐慧娟、吳淑瓊、江東亮(1996)。跌倒對社區老人健康生活品質的影響。中華衛誌，15(6)，525-532。

吳淑瓊(1995)。民眾對老人長期照護安排之態度：1994 年台灣社會意向調查之發現。中華衛誌，14，369-382。

施春華、侯淑英、楊明仁、張麗珍、張自強、黃俊仁 (2005)。社區老人憂鬱症狀的流行病學及活動參與介入之成效。實證護理，1(1)， 29-34。