從機構化、社區化的社區類型探討老人需求之研究

The Study of Exploring the Needs of the Elderly Based on Institutionalization and Communization

余啟文(Chi-Wen Yu)

指導教授 ： 張晴翔

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2013年)

https://doi.org/10.6833/CJCU.2013.00163

摘要

近年來台灣面臨人口高齡化、低生育率和平均壽命延長，加上家庭結構的改變，老人長期照護的問題日益重要。目前國內長期照護方式以機構式照護為主，與未來長照政策擬採社區式照護為主相異，在兩種照護方式之相關研究中，多針對老人引發之相關福利措施問題所進行的研究。本研究係從人類發展各項需求中，進一步探討老人原始需求層面，了解老人真實之需求性，期能提供日後老人長期照護政策之參考。

本研究目的在探討不同類型社區老人人口學變項在不同層次需求之相關性。在各家需求理論派別中，選擇Maslow需求層次理論為研究基礎，設計老人需求調查問卷。問卷內容第一部分為老人對五大需求層次之量表，第二部份為人口學變項，並經由專家學者進行信效度分析。研究對象以立意取樣方式選擇二個不同類型之社區，並設籍65歲以上老人，其中A社區是由數個眷村因改建搬遷至同一個社區，形同大量老人集中居住在同一機構內，研究者定義為「社區機構化」模式；另一個B社區是社區內有老人公寓，為其增加使用率，積極與社區交流互動，故研究者定義為「機構社區化」模式。自2011年5月至10月以問卷調查方式實施普測，扣除設籍但未入住之居民，在總人數為1,052人，計發出900份，實際回收382份，回收率為42.4％。統計方式以描述性統計、t 檢定、單因子變異數分析及相關分析方式，利用SPSS 12.0版統計軟體進行資料分析。

研究結果顯示，在A社區（社區機構化）類型中，教育程度、退休前職業類別、退休前職務層級等因素與尊重需求層次有相關；教育程度、居住情形、健康狀況等因素與自我實現需求層次有相關。在B社區（機構社區化）類型中，性別因素與生理需求層次有相關；經濟來源因素與安全需求層次有相關；性別、婚姻狀況、居住情形、經濟來源等因素與愛與歸屬需求層次有相關；性別因素與尊重需求層次有相關；健康狀況因素與自我實現層次有相關。另外年齡及省籍之變項，在二社區類型中均與老人需求無影響。從整體來看，年齡、經濟來源等因素與生理需求層次有相關；退休前職業類別、經濟來源等因素與安全需求層次有相關；教育程度、退休前職業類別等因素與愛與歸屬需求層次有相關；教育程度、退休前職業類別、退休前職務層級等因素與尊重需求層次有相關；教育程度、退休前職業類別、健康狀況等因素與自我實現需求層次有相關。

研究建議在未來老人照護上，應多從女性角度去思考，重視女性情感寄託、受尊重方面之措施，特別是有婚姻關係。政府應該鼓勵老人積極參與社會，賦與老人新角色，運用其專長參與社會服務，尤其是教育程度高、公職體系退休、擔任主管退休之老人。並且建置完整老人經濟安全保障，解決老年所得維持的不安全問題，滿足其基本生存需求。另外應積極推動健康促進、照顧預防工作，整合社區現有的各項資源，提供老人友善環境、舉辦相關健康促進活動，讓老人活得長壽，更要活得健康，延緩失能的發生。社會應以正向的態度來看待性問題，對老人的愛和依附情感需求做正確、更貼心的回應，讓老年人的身心發展更健康、更平衡。

關鍵字

需求理論 ； 老人需求 ； 社區化 ； 機構化

並列摘要

Recently in Taiwan due to aging population, lower-birth rate, longer life expectancy on average, and the change in family structure, the problem of long-term care for the elderly has increasingly been important. Currently, long-term care program in Taiwan is primarily focused on institutional-based long-term care for the elderly, different from community-based long-term care program that will be carried out in accordance with long-term care policy in the future. It can be found that related researches for both long-term care programs are conducted to explore the issue of well-beings mainly for the elderly. This study reveals that from all the needs of human development basic needs for the elderly are further explored and identified so as to meet their needs, which helps provide references for long-term care policy in the future.

The purpose of this study is to explore the correlation of the needs at different levels based on the demographic variables of the elderly. In this study, the questionnaires were designed for the elderly on the basis of Maslow's hierarchy of needs. The first part of this questionnaire is the scale of five hierarchy of needs for the elderly. The second part is the demographic variables. As for the target group, the elderly are over the age of 65 and have a registered household in the surveyed area, from which several military communities were moved to the same community, which is A community due to the reconstruction. A lot of elderly people were gathered to live in the A community, defined as the model of Institutionalized community by the researchers. Another community is B community, where there are apartments for the elderly. In order to raise the occupancy rate, habitants there were encouraged to actively interact with the community. Therefore, this kind of community is defined as the model of institutional communization by the researchers. This survey was conducted from May 2011 to October with a simple random sampling method. A total sample of 1052 personnel excluding residents without living there have registered household were selected. The returned samples are 382 people, with the response rate to the survey 42.4%. In this survey, the descriptive statistics was presented. Besides, data was collected through some statistic analysis such as T-test, one-way ANOVA analysis and correlation analysis and was analyzed by using the SPSS 12.0 software.

The research results show that in type A community, which is Institutionalized community, are education level, occupational categories before retirement, the position before retirement and other factors associated with the need for self-esteem and self-respect; such factors as the level of education, living and health condition etc are associated with the need of self-actualization. While the correlation between various factors and the needs of different levels can be found as follows in type B, which is institutional communization, such as gender related to physiological need, economy sources related to safety needs, gender, marital status, living condition and economy sources related to the need of love and belonging, gender related to the need for self-esteem and self-respect, health condition related to the need of self-actualization. As for age and ethnicity variables, both in the A and B community show no impact on the needs of the elderly. Overall, different factors such as age, economy sources etc are associated with Maslow's hierarchy of needs. It can be identified that factors such as age, economy sources etc are related to physiological need, occupational categories before retirement and economy sources and other factors are related to safety needs, such factors as education level and the position before retirement etc are related to the need of love and belonging, factors such as education level, occupational categories before retirement, the position before retirement etc are related to the need for self-esteem and self-respect, and finally such factors as education level, occupational categories, health condition etc are related to the need of self-acutalizaiton.

It is suggested that the measures for the elderly care in the future should be reflected from the women’s perspectives over their reliance on emotion and being respected, especially for the women still in a martial relationship. In addition, our government should encourage elderly people to be actively involved in the society, assign them new roles, and have them participate in the volunteering with their specialty, particularly for those who have higher education, get retired from public sectors or from the management. Meanwhile, the government helps to solve income insecurity for the elderly by providing integrated financial security, which can fulfill their basic needs. Furthermore, it is expected that the elderly can live longer and healthier and delay the occurrence of disability if such actions are taken such as actively promoting health and health care prevention, integrating existing resources of the community, providing an elderly-friendly environment and holding health promotion events. Finally, the society should take a positive attitude toward the sex and provide accurate and more considerate feedback in response to the love and feelings of independence for the elderly, which can make their physical and mental development healthier and more balanced.

並列關鍵字

theory of needs ； the needs of the elderly ； communization ； institutionalization

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