- 學位論文
居家護理失能者之主要照顧者照顧負荷和憂鬱及其相關因素探討
Factors Associated with Caregivers' Burden and Depression in the Home Care Settings
摘要
背 景：主要照顧者是長期處在慢性壓力之下的一群，目前文獻較少針對居家護理失能者病人之主要照顧者負荷和憂鬱進行研究。 目 的：本研究之目的為探討南部某醫學中心居家護理所之主要照顧者的照顧負荷和憂鬱及其相關的因素。 方 法：本研究是橫斷式相關性研究設計，收案對象為南部某醫學中心附設居家護理所收案管理失能病人之主要照顧者共97位，排除條件為主要照顧者為聘僱的照護人員；無法以國、台語溝通者之主要照顧者，收案期間為2015年1月至10月。藉由結構式問卷進行失能者之主要照顧者訪談，問卷內容包括失能病人及主要照顧者之基本資料、照顧者負荷量表及台灣人憂鬱問卷，以描述性統計、推論性統計的卡方檢定、t檢定、變異數分析、相關性進行分析。 結 果：失能者主要照顧者照顧負荷之總分平均值（±標準差）為42.43（16.8），接受社會資源方面，只有接受居家服務者平均負荷總分（±標準差）48.43（±17.68）、接受喘息和合併服務者48.94（±13.47）分別比沒有接受服務者38.42（±16.36）高，三者間達統計上顯著差異（F(2,94)=4.62, p=.0122）。照顧者之照顧憂鬱程度，正常占74.2%、輕度占9.3%、中度占6.2%、重度占10.3%。與照顧負荷統計上有顯著的相關因素，包括照顧後工作情況（t=3.45；df=95；p=.0008）、照顧病人影響工作（t=3.03；df=95；p=.0032）、照顧病人影響收入（t=-2.91；df=95；p=.0045）、照顧病人的花費造成財務負擔（t=4.75；df=95；p< .0001）；照顧憂鬱統計上有顯著的相關因素，包括教育程度（t=-2.01；df=95；p=.0475）、照顧後工作情況（t=1.06；df=95；p=.2920）、照顧病人影響工作（t=2.45；df=95；p=.0160）、照顧病人影響收入（t=-3.35；df=95；p=.0012）、照顧病人的花費造成財務負擔（t=3.47；df=95；p= .0008），而且照顧者負荷總分與憂鬱總分呈顯著正相關（γ= .67, p <.0001）。 結論：財務上的負擔是主要照顧者的照顧負荷和憂鬱的相關因素。在接受社會資源（居家服務或是喘息服務）方面，顯示其服務尚無明顯減輕主要照顧者的負荷及憂鬱。本研究結果可以提供長期照顧服務政策推動者的參考，未來設計符合失能者之主要照顧者的保險制度，以及改善居家服務或是喘息服務的照護品質，來減輕主要照顧者的負荷和憂鬱，並促進主要照顧者的身心健康。
並列摘要
Background: The primary caregivers incurred substantial and chronic pressure for long time. It is lack of study about related- factors for caregivers’ burden and depression for patients received home care services. Objectives: The aims of this study are going to investigate the burden of primary caregivers and associated factors in home care settings. Methods: The study was cross-sectional and correlation study. The numbers of subjects are estimated to be 97 caregivers and paired patients receiving home care services provided by a home care center of the southern medical centers. Data collection was from January to September 2015. Exclusive criteria included: (1) employment of caregivers; (2) caregiver being unable to communicate in Mandarin or Taiwanese. The structured questionnaires were administered by the home care nurse. The questionnaires include patients and caregivers demographic data and caregivers’ burden and depression condition. The descriptive and inferential statistics were used to analyze data. Result：The burden score of the primary caregivers was mean (±standard deviation) of 42.43 (±16.80). There are significant differences among three groups of the caregivers, including receiving only home services, receiving both home services and respite care, and receiving nothing (F (2,94) =4.62, p =.0122). The average score of the group receiving only home services (48.43±17.68) and the group receiving both home services and respite care (48.94±13.47) were higher than the group receiving nothing (38.42±16.36). The depression levels of the caregivers were74.2% normal level, 9.3% mild level, 6.2% moderate level, and 10.3% severe level. Associated factors of caregivers' burden included work condition after taking care of patients (p=.0008), change of working status (p=.0032), incomes decrease after taking care of patients (p=.0045), and financial burden (p<.0001). Associated factors of caregivers' depression included education level (p=.0475), change of working status (p=.0160), incomes decrease after taking care of patients (p=.0012), financial burden (p=.0008). Caregivers' burden scores were significantly correlated with depression scores (r=.67, p<.0001). Conclusions：Financial burden is the important factor of primary caregivers' burden and depression. Home services and respite care cannot alleviate caregivers' burden and depression. The study results can provide policy makers of long-term care laws to develop appropriate care programs and insurance. Additionally, the governors need to improve the care quality of home services and respite care in order to relieve caregivers' burden and depression and promote their physical and mental health.