失智症在老年人口中是極常見的,失智症帶給居家照顧家屬之影響更勝於其他慢性疾病,是極具壓力的。本研究之目的即在瞭解居家失智老人家屬照顧者之照顧負荷與照顧需求及其相關因素。本研究採橫斷性相關性研究設計,於台中兩家醫院精神科門診收案,採方便取樣,以面對面方式訪談108位失智老人之家屬照顧者,平均年齡為53.53歲,主要是女性。研究結果發現:(1)居家失智老人以輕度失智者最多,佔51.8﹪。(2)居家失智老人家屬照顧者之照顧負荷相關因素包括失智嚴重度、症狀及問題行為數目、家屬照顧者自覺健康狀況、每天照顧時數、在病患生病後與病患的關係。照顧負荷各單項得分最高的前三項分別為「我對家人和工作負有重責,而其中最重的就是照顧患者」、「我覺得病患希望我照顧他(她),好像我是他(她)唯一可依賴的人」以及「在與病患的互動中,我覺得自己很有用」。不同失智嚴重度以及不同照顧者自覺健康情形組別其照顧負荷是有差異的,而不同問題行為數之照顧者其與失智老人間關係之負荷顯現差異。家屬照顧者每天照顧時數、在病患生病後與病患的關係、中度失智、重度失智、自覺健康情形好以及自覺健康情形可為照顧負荷的重要因素,共可解釋45﹪照顧負荷變異量。(3)居家失智老人家屬照顧者之照顧需求程度最高之前三項為「有人照顧病患讓您有時間辨事情」、「有人照顧病患讓您喘口氣」、「有人提供有關照顧的知識與技巧」三項需求。在照顧需求被滿足之情形方面,以制度化需求之被滿足程度普遍偏低。(4)不同失智嚴重度之家屬照顧者其需求是有差異的,而不同問題行為數目之失智老人家屬照顧者在私人需求上顯現差異。重度失智、每天照顧時數以及家屬教育年數是預測照顧需求的重要因子,共可解釋24﹪照顧需求變異量。(5)照顧負荷與照顧需求成正相關,也就是說,照顧負荷越大之照顧者,其照顧需求也越多。基於本研究之結果,失智老人之家屬照顧者的確承擔了許多的照顧負荷,健康專業人員應該提供相關服務,以減少照顧者之負荷。另外,應加強對照顧者照顧需求之評估,才能提供所需要服務,滿足其需求。
Dementia is a commonly seen disorder in older persons. Dementia has more impacts on family caregivers than other chronic diseases. Caring the persons with dementia is a stressful task. The purpose of the study was to understand the caregivers’ burdens and needs and their related factors. A cross-sectional correlational research design was employed. Data were collected at psychiatric out patient department of two hospitals in Taichung. Convenience sampling was used to recruit subjects. Subjects were interviewed face-to-face. A sample of 108 caregivers participated in this study. The average age of the caregivers was 53.53 and most of them were females. The findings of the study were: (1) The majority (51.8%) of older persons with dementia were mild cognitive impairment. (2) Caregivers’ burdens were related to cognitive impairment level, numbers of problem behaviors, perceived health status of caregivers, caring hours per day, relationships with the care receivers after dementia onset. The first three burdens of caregivers were “the responsibility for my family, my other family members, my job etc. and on top of it the responsibility for the patient is a heavy burden on me” “I feel that the patient seems to expect me to take care of him/her as if I were the only one he/she could depend on” “I never feel free from the care for the patient” Caregiving burdens were found to be different among severity of cognitive impairment and perceived health status of caregivers. The burdens of the relationships with the patients were found to be different between two groups of numbers of problem behaviors. Caring hours per day, relationship between caregivers and patient after dementia onset, moderate cognitive impairment, severe cognitive impairment, perceived health status as good and perceived health status as fair were predictors of caregiver burdens and could explain 45﹪variance of caregiving burdens. (3)The top three of caregivers’ needs were “Someone may take care of the patient to make you free to manage something” “Someone may take care of the patient to make you free to take a breath” “Someone may offer you some knowledge and skill about dementia” The formal needs were not satisfied. (4) Caregiving needs were found to be different among cognitive impairment levels. The personal needs were found to be different between the two groups of the numbers of problem behaviors. Severe cognitive impairment, caring hours per day and education years of caregivers were significant predictors of caregivers’ needs and could explain 24﹪variance of caregivers’ needs. (5) Burdens and needs of caregivers were positively correlated, that is, the heavier caregiving burdens were, the more care needs caregivers have. The finding of the study revealed that caregivers indeed suffered from caregiving burdens. Health professionals should provide services to decrease caregivers’ burdens. Furthermore, health professionals should assess caregivers’ needs, so specific services could be provided to satisfy caregivers.