臺灣老人使用照顧服務決定因子之探討

Factors Impacting Long-term Care Use of Elderly Taiwanese

童雁鈴(Yen-Ling Tung)

指導教授 ： 蔡仲弘

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2011年)

摘要

背景與目的：近年來國人平均餘命延長，人口老化導致照護需求升高；家庭結構的變遷已使家庭人力無法負荷老人照護需求。為因應現況，國家長照政策積極規劃，使照護服務方式多元。本研究目的在於探討臺灣老人使用照護服務的情形及決定因子。
方法：本研究以國民健康局2007年「臺灣地區中老年身心社會生活狀況長期追蹤調查」為研究資料。分析第一樣本群(皆≥78歲)的資料。以二元邏吉斯迴歸(Binary logistic regression analysis)分析使用照護服務的決定因子。以α=0.05界定顯著意義。
結果：1268名個案中，於過去一年，24名曾使用居家服務、109名雇用居家看護、92名使用照護機構。使用居家服務的決定因子為高齢及ADL (Activities of Daily Living) (輕/中度障礙OR=3.16, 95%CI=0.96-10.48, p=0.06)。雇用居家看護的主要決定因子為ADL障礙(輕/中度=7.59, 3.94-14.61, p<0.001及重/極重度障礙=14.23, 6.18-32.8, p<0.001)；高齡、女性、受較高教育、有≥3子女及有偶亦為顯著因子。進住機構的主要決定因子為ADL障礙(輕/中度=7.56, 2.46-23.27, p<0.001；及重/極重度障礙=43.36, 11.97-157, p<0.001)；男性、有≤2子女、無偶、後期移民、過去一年曾住院、小便失禁、低社會支持、為家庭經濟主要負擔者亦為顯著因子；過去一年曾跌倒、曾急診亦呈負關聯。
結論：「ADL障礙程度」為老人使用照顧服務方式最主要的決定因子。且隨功能障礙的惡化，所需的照護服務時間與方式就越趨全面性，越可能進住機構。因此推遲ADL功能障礙的發生或惡化，為減緩老人進住機構式照護的策略。本研究為首次在同狀況下分析三種照顧服務，可方便比較其顯著關聯或影響因子。

關鍵字

使用照護服務 ； 居家服務 ； 居家看護 ； 機構式照護

並列摘要

Background and Objective: Recent increase in life expectancy has led to increased care needs in Taiwan. At the same time, the change in family structure has aggravated care needs. To relieve the demand, policy makers have established new types of care and have allowed the introduction of foreign carers to enter the country. Thus, today there are several types of care ranging from part time in-home assistance to institutional full-time care available. This study aimed to investigate the factors that impact the use of care services by elderly Taiwanese.
Methods: This study analyzed the 2007 data of the original cohort of the "Survey of Health and Living Status of the Elderly in Taiwan". All subjects were 78 years-old or older. Binary logistic regression analysis was used to determine the factors impacting long-term care use. Statistical significance was accepted at alpha=0.05.
Results: Of 1268 elderly, 24 used home visits, 109 used private carer, and 92 used institutional care during the past year. Old age was the only significant variable associated with use of home visit. Mild or moderate ADL (Activities of Daily Living) impairment (OR=3.16, 95%CI=0.96-10.48, p=0.06) was close to be significantly associated with increased use of home-visits. ADL impairment (mild or moderate impairment =7.59, 3.94-14.61, p<0.001 and severe/very severe impairment=14.23, 6.18-32.8, p<0.001) was associated with the major variable associated with increased use of private home-care. Old age, being female, more years of education, having ≥3 children, and have a spouse were also associated with increased likelihood home care use. ADL impairment was also the major predictor of institutionalization. Being male, having ≤ 2 children, no spouse, later immigrants, hospitalization, incontinence, low social support, being the main source of family income were also significant predictors of institutionalization.
Conclusion: "ADL status" is the main determinant of care service use. The more the dependency is, the greater the likelihood in using a more comprehensive care service. Results suggest that preventing ADL impairment is the key to delay the onset of care use.

並列關鍵字

Use care services ； Home visits ； Private carer ； Institutional care

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