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系統識別號 U0026-1507202013261200
論文名稱(中文) 疑似失智者遭財務濫用的風險: 臨櫃行員的調查研究
論文名稱(英文) The risk of financial abuse among people suspected with dementia: a survey study of bank tellers
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 108
學期 2
出版年 109
研究生(中文) 黃乙芹
研究生(英文) Yi-Chin Huang
學號 T86074050
學位類別 碩士
語文別 中文
論文頁數 69頁
口試委員 指導教授-古鯉榕
口試委員-莊佳蓉
口試委員-白明奇
口試委員-林軒竹
中文關鍵字 失智症  銀行  財務濫用  決策 
英文關鍵字 Dementia  Bank  Financial abuse  Decision making 
學科別分類
中文摘要 背景:據英國調查報告中指出,有65%的失智患者到銀行需要協助;若患者的家人或外人趁其記性不好加以濫用其存款,就會產生財務濫用(financial abuse)的問題。臨櫃行員(以下簡稱行員)需要對失智症有一定了解,因他們可能第一個發現顧客患有失智症。行員若能夠及早發現顧客的情況,或許能夠阻止財務濫用事件的發生。為此,本研究探討臺灣的銀行行員對於失智症的知識程度,其對於疑似認知障礙的顧客遇到財務濫用案例的風險評估以及行動決策,進一步分析其失智症知識程度與其行動決策之間的相關性。
方法:本研究為橫斷性研究,使用結構式問卷進行調查,以某銀行的行員為研究對象,一共發
放200份問卷。分析變項包含社會人口學基本資料、失智症知識與財務濫用的臨櫃情境題。臨櫃情境題按照當事人的屬性分為本人濫用、家人濫用與外人濫用三種類型。使用SAS 9.4統計軟體,以線性迴歸分析行員的失智症知識及相關影響因素;使用多元邏輯斯迴歸與多項邏輯模型分析行員臨櫃情境的風險評估與行動決策及相關影響因素。在失智症知識分析中,控制行員基本資料、與失智者互動的經驗;在臨櫃情境的風險評估以及行動決策之分析則控制行員基本資料、與失智者互動的經驗及行員的失智症知識。本研究的假說有三:(1)若行員的失智症知識分數越高,所填答的臨櫃情境風險分數也應該要越高;(2)在外人濫用的題型上,行員所填答的臨櫃情境風險分數應該要最高;(3)若行員的臨櫃情境風險分數越高,在臨櫃情境的行動決策會傾向選擇拒絕受理業務。
結果:本研究共回收190份有效問卷。首先在失智症知識的分析中,行員的失智症知識分數平
均分數為7.9分,知識水平約為中等。分析結果發現行員的年齡、教育程度、服務分行所在地、服務年資、是否有服務過疑似失智症之顧客,家人、朋友是否罹患失智症都不會影響他行員在失智症知識題的分數。其次在臨櫃情境風險評估的分析中,在三種情境當中,外人濫用之情境風險分數為最高(8.6分),其次為家人濫用(7.9分),最後是本人濫用(7.2分)。研究也發現在多數情境中,超過半數的行員比起選擇受理業務,較傾向選擇拒絕受理業務。雖然失智症知識分數與情境風險分數呈現負相關,但多元邏輯斯迴歸結果顯示七題中僅三題的失智症知識分數有統計上顯著性,而其他控制變項對於臨櫃情境的風險評估的影響並不一致。最後分析影響行員在臨櫃情境題行動決策的因素,唯有情境風險分數此變項在每個臨櫃情境題中都有統計上顯著性。若行員所填的情境風險分數越高,則有較高的勝算比(大約為2倍)選擇拒絕受理業務。
結論:歸納主要結果如下:(1)在控制其他基本人口學變項後,行員的失智症知識與其對於疑似失智症顧客之財務濫用風險呈現負相關的趨勢,不支持研究假說第一點。(2)在財務濫用的臨櫃情境類型中,行員評估以外人濫用的風險分數最高,其次為家人濫用,顧客本人自己濫用的風險分數最低,支持研究假說第二點。(3)在控制其他基本人口學變項和失智症知識程度後,唯有臨櫃情境的風險分數會影響行員的行動決策,行員臨櫃情境風險分數填答越高分,越傾向選擇拒絕受理業務,支持研究假說第三點。本研究的樣本人數不多且來自於同一間銀行,建議未來研究可以在樣本代表性與問卷測量工具等方法學上加以改進,以增加結果的可信度,並促成臺灣的金融機構達成失智友善的目標。
英文摘要 SUMMARY
According to a report from the United Kingdom, 65% of people with dementia need assistance as they go to banks. However, if the helpers repeatedly misuse their money due to their poor memory, it will cause the problem of financial abuse. Bank tellers need to understand more about dementia, as they may be the first person to find out when their customers have dementia. This study aimed to know Taiwan bank tellers’ dementia knowledge, risk assessment and their decision-making as they face the customers with suspected cognitive impairment encountering financial abuse; the correlation between bank teller’s dementia knowledge and decision-making was also analyzed. This was a cross-sectional study using data from structural questionnaire. Data were collected from one bank, with total of 190 valid questionnaires. Bank tellers responded to the dementia knowledge questionnaire with a mean score of 7.9. Controlling for all other variables, bank tellers’ dementia knowledge score had negative correlation with the risk score of financial abuse in bank case scenarios. In bank tellers’ risk assessment of financial abuse of people suspected with dementia, scenario with stranger abuse had the highest score, the second was family abuse, and the lowest was self-misuse. Controlling for bank tellers’ demographic variables and dementia knowledge, only the risk score of financial abuse would affect bank tellers’ decision-making. As the risk score of financial abuse was higher, there was a higher odds ratio (approximately 2 times) for the bank tellers to choose decline services.
論文目次 表目錄 ................................VII
圖目錄 ................................VIII
第壹章 前言.............................1
第一節 研究背景..........................1
第二節 研究目的..........................6
第貳章 文獻回顧.........................7
第一節 失智症知識量表的發展.............7
第二節 ㄧ般大眾對於失智症知識的研究..........11
第三節 金融業員工對於疑似認知障礙顧客遭遇財務濫用風險與行動決策相關的研究..........13
第四節 金融業員工面對疑似認知障礙顧客的行動決策.......14
第參章 研究方法......19
第一節 收案流程......19
第二節 測量工具......19
第三節 研究架構......23
第四節 資料分析......25
第五節 研究倫理......27
第肆章 研究結果 ......28
第一節 基本人口學變項......28
第二節 失智症知識題分析......31
第三節 臨櫃情境題分析......37
第伍章 討論......52
第一節 臺灣行員的失智症知識及相關影響因素......52
第二節 行員處理疑似認知障礙的顧客遭遇財務濫用的案件......53
第三節 行員對於疑似認知障礙顧客遭遇財務濫用風險與行動決策的相關性......56
第四節 研究優勢、限制與對未來研究之建議......59
第五節 結論......61
第陸章 參考文獻......62
附件..................66
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