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系統識別號 U0026-1707201816124300
論文名稱(中文) 台灣長照機構推動生活自立支援對能力回復與生活品質之成效探討
論文名稱(英文) The effect of reablement in long-term care facilities in Taiwan
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 106
學期 2
出版年 107
研究生(中文) 王俞樺
研究生(英文) Yu-Hua Wang
學號 TC6054068
學位類別 碩士
語文別 中文
論文頁數 61頁
口試委員 指導教授-劉立凡
口試委員-張玲慧
口試委員-林金立
中文關鍵字 長照機構  自立支援  成效 
英文關鍵字 Long-term care facility  Reablement  Effect 
學科別分類
中文摘要 目的:
台灣機構的照護方式常因便宜行事而未顧及老年人自主與選擇權,不僅使老年人無尊嚴感、也使得失能與依賴程度變高,形成惡性循環。國外文獻指出,於機構設置中實施生活自立支援可改善此狀況。因此本研究欲了解近年引進台灣的生活自立支援於各長照機構內的介入方式以及介入初期個案之身、心功能與生活品質狀況,並進一步探討生活自立支援對能力回復與生活品質之介入成效及相關之影響因素。
材料方法:
本研究設計採用單組前後測之長期追蹤與非參與觀察法,以24家長照機構為介入場域,挑選其中符合65歲以上、目前至少有約束、使用尿布或臥床其中之一狀態者為對象。研究追蹤期間,參與對象於基期與開始介入第六個月做數據收集,以巴氏量表(ADL)、工具性日常生活活動能力(IADL)、簡易智能量表(MMSE)、老人憂鬱量表(GDS-15)、歐洲生活品質(EQ-5D)、社會支持量表(ISSI)評估身、心功能與社會支持成效。六個月追蹤期間另有一份督導表,每兩個月督導一次並紀錄照顧計劃的細節。本研究最終收案人數期初310人(T0)、六個月共收集到210人(T1)之再測資料。
研究結果:
機構人員對於生活自立支援參與個案之挑選並未忌諱狀態較差(如:插管)的個案,但身心功能較差、家屬探訪頻率高的個案容易退出介入。成效方面,生活自力支援於機構介入六個月後,可改善日常生活活動量表中穿脫衣服、洗澡、床椅間的移位、行走平地、上下樓梯、個人衛生、大便控制、小便控制八個項目。整體量表來看,日常生活活動能力、工具性日常生活活動能力、憂鬱情形、社會支持情形、自覺健康相關生活品質與二不目標(不尿布、不約束)的達成率皆有顯著改善,並可維持工具性日常生活活動能力與認知功能,且多數成效受社會支持變化顯著影響。
研究結論:
本研究觀察得知,機構人員仍會將日常生活活動功能重度依賴、重度認知障礙,甚至有約束、插管的住民視為有潛力進行生活自立支援照顧的對象;在基本照顧方面的介入,機構人員已獲得足夠的正確資訊與知識改善機構化照顧不足帶來的依賴情形,在實行策略與內容上四元素(飲水、飲食、排泄、運動)的運用十分普遍,半年觀察成效包含日常生活活動能力、工具性日常生活活動能力、憂鬱情形、自覺生活品質狀況皆顯著改善,期間個案感受到機構人員的社會支持亦會增加,生活品質整體評價指標和認知功能則維持現況。另外,自立支援介入的健康相關成效效果幾乎都與納入條件(僅能使用輪椅)負相關;初始認知狀態、時間與社會支持度變化因素正相關,而家屬探訪頻率則與生活品質整體評價指標與認知狀態負相關。
英文摘要 SUMMARY
The aim of this study was to analyze how reablement was implemented in long-term care facilities in Taiwan and identified the residents’ outcomes and factors that affect them.One-group pretest-posttest design and nonparticipant observation were adopted in this study. The participants were those residents aged 65 and over, meeting at least one of the conditions of being constrained, using diapers, or bedridden. During the 6 months follow-up period, their physical and mental function, social support were measured using ADLs, IADLs, MMSE, GDS-15, EQ-5D and ISSI at baseline (T0) and 6 months (T1). There are also intervention notes for recording the plans caregivers giving to participants. Positive effects of reablement were found in residents’ physical function and social support, and results show that reablement also helps maintain the mental function. The important factors affect outcomes were the social support from caregiver in institutions, and sufficient communication with family before the intervention was also indispensable for a successful intervention. Given that there were no control group in this study, the evident effect could be small, but take the human right in consider, this could be just the right thing to do in long-term care facilities.
Key words:Long-term care facility、Reablement、Effect
論文目次 第一章.緒論
1-1研究背景 1
1-2研究動機 2
1-3研究目的 4
第二章.文獻探討
2-1自立支援的定義與概念 5
2-2自立支援的源起與發展 6
2-2.1自主權的提升 6
2-2.2從機構到社區 7
2-3自立支援的理論 7
2-3.1身心障礙者的人-境互動 7
2-3.2社會生態模型 9
2-4自立支援介入與成效相關研究 11
2-4.1介入的概念與方法 11
2-4.1.1機構介入 11
2-4.1.2居家、社區介入 12
2-4.2各國介入模式 14
2-4.2.1紐西蘭 14
2-4.2.2澳洲 15
2-4.2.3北歐-以挪威為例 16
2-4.2.4英國 17
2-4.2.5日本模式 18
2-4.3介入成效的實證 23
2-4.3.1機構介入 23
2-4.3.2居家、社區介入 23
第三章.材料與方法
3-1研究方案說明 25
3-2研究對象與樣本 29
3-2.1參與機構 29
3-2.2參與個案納入條件 29
3-2.3收案樣本與流失情形 29
3-3研究方法 30
3-4研究架構與假設 31
3-5研究步驟 31
3-6研究工具 32
3-7統計分析 35
第四章.研究結果
4-1生活自立支援介入之收案特性 36
4-2生活自立支援介入內容與變化 37
4-3退出個案特性比較 41
4-4成效評估前後測 42
4-5成效指標影響因子 43
第五章.研究討論
5-1自立支援介入之收案特性 45
5-1.1收案特性與台灣住宿式機構住民狀態比較 45
5-1.2收案符合自立支援之精神 45
5-1.3收案特性與西方文獻差異 46
5-2自立支援介入模式與內容 46
5-2.1介入策略集中於四元素 46
5-2.2與國外介入策略比較之異同 47
5-3自立支援介入成效 48
5-3.1自立支援各指標成效 48
5-3.2與常規照顧下個案ADL軌跡的比較 48
5-3.3以督導表彌補評估工具之限制 49
5-4退出個案特性比較 50
5-4.1家屬頻繁探訪對介入的負面影響 50
5-4.2結案的選擇 51
5-5成效指標影響因子 51
5-5.1社會支持在自立支援中的重要性 51
5-5.2介入內容分類 52
第六章.研究限制 54
第七章.結論 55
參考文獻 56
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