| 摘要: | 研究動機：截至105年，國內65歲以上人口已達13.2%，平均餘命為79.84歲，失能老人約達44萬人， 人生最後七年幾乎處於被照顧階段。「在地老化」及「活躍老化」是理想的長期照顧政策目標，然而社會快速變遷、家庭結構改變、人口結構少子化、疾病型態複雜化以及醫療科技日新月異，已造成民眾活得長壽，卻不一定有好的生活品質的現象。隨著社會型態之改變，民眾可利用機構式照護以減輕家庭照顧者的重擔，因此老人進住機構的比率有逐年增加的趨勢。
研究目的：探討嘉義及台南地區已入住長期照顧機構住民之主要聯絡家屬未來自己入住長期照顧機構之意願與其相關影響因素。
研究方法：採結構式問卷收集資料，調查時間為105年2月1日至105年3月10日止，發出420份問卷，回收238份，刪除回答不完整及無效問卷共41份，有效問卷數為197份，有效回收率為47%。資料收集整理後，使用敘述統計、獨立t檢定、單因子變異數分析、相關分析與線性迴歸模式進行統計分析。
研究結果：住民家屬的選擇機構式照顧意願平均值為3.80，標準差為0.65；機構認知、選擇障礙、孝道認知、機構觀感與選擇機構式照顧意願均有顯著相關。選擇機構式照顧意願在年齡(p=0.041)、教育程度(p=0.004)及罹患慢性病(p=0.007)變項間有顯著差異。迴歸分析中發現機構認知（β=0.446, p=0.000）、孝道認知(β=-0.140, p=0.001)以及教育程度是大學或以上學歷相對於不識字者(β=-0.534, p=0.011)是選擇機構式照顧意願的顯著影響因子。機構認知愈高其選擇機構式照顧意願愈高；孝道認知愈高其選擇機構式照顧意願愈低；教育程度是大學以上學歷者相對於不識字者其選擇機構式照顧意願愈低。結論與建議：機構認知、孝道認知與教育度是大學或以上學歷相對於不識字會影響選擇機構式照顧意願，因此長期照顧機構機營者應善加利用網路及通訊軟體達到及時溝通，以避免誤解或糾紛產生，並加強員工教育、主動關心以提升服務品質。機構機營者可以主動聯繫與關心住民家屬，以減少家人被遺棄或被指為不孝之焦慮或愧疚感。社會結構改變，高疾病嚴重程度及失能程度，以及家屬缺乏照護能力，使得機構式照顧有其必要性，而目前長照2.0政策卻缺乏這方面的策略，政府單位未來應該強化機構式照顧的相關政策。
Background: The eldery population over 65 years old was 13.2%, the average life expectancy was 79.84 years old, and the disabled elderly were estimated to reach 440 thousands in 2016. It indicates that people have to be cared in the last 7 years of theie lives. “Aging-in-Place” and “Active Aging” are ideal goals of long term care policies. However, rapid changes of society structure, family structure, population structure, and complicated patterns of disease, as well as medical technology advances, have caused people to live a long time, but do not necessarily have a good quality of life. People can select the institutional care to reduce the burden of family caregivers, so the elderly stay in institutions have increased.
Purpose: This study explores intentions of those whose families have been resided in long-term care institutions in Chiayi and Tainan areas, and investigate influencing factors of intetions.
Methods: A cross-sectional survey was implemented from February 1, 2016 to March 10, 2016. A total of 420 questionnaires were distributed and 238 were collected. After excluding 41 invalid questionnaires, valid questionnaires were 197 and the effective return rate was 47%. Data was properly analyzed by descriptive statistics, independent t test, one-way ANOVA, correlation coefficient, and linear regression analysis.
Results: The mean score of intention to select institutional long-term care is 3.80, standard deviation is 0.65. Intention of selecting institutional long-term care, the perceived attitude toward institutional care, choice obstacle, cognition of filial piety, and institutional perception are significantly correlated. Intention of selecting institutional care are significant different among variables in the age (p=0.041), the educational level (p=0.004) and the situation suffered from chronic diseases (p=0.007). Results of regression analysis find that the perceived attitude toward institutional care (β=0.446, p=0.000), cognition of filial piety (β=-0.140, p=0.001) and the education level which is a Bachelor degree or above compared to the illiterate (β=-0.534, p=0.011) are significantly influencing factors. Subjects with higher perceived attitude toward institutional care and lower cognition of filial piety have higher intentions to select institutional care. Subjects with Bachelor degree or above compared to those are illiterate have lower intentions to select institutional care. Conclusions/Implications: Results show that the perceived attitude toward institutional care, cognition of filial piety and the education level which is a Bachelor degree or above compared to the illiterate are significantly influencing factors to select long-term institutional care. Managers of long-term care institutions should use network and communication technologies to communicate with families of institutional residences for avoiding misunderstanding and debates. Managers should also strengthen the staff training to provide active care taking and improve the quality of services. Managers can actively contact and concerned residents' families to reduce their anxiety or guilt of abandoning families. Due to changes of social structure, the severity of disease and disability, and the family's caring disability, institutional care is necessary. Current policies of “Long-term Care v2.0” lack strategies of institution-based care, and these strategies should be emphasized in the future. |
