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系統識別號 U0026-3107201715162700
論文名稱(中文) 雇用外籍看護工對失智症家庭照顧者負荷的影響
論文名稱(英文) Hiring migrant care workers and caregiver burden among family caregivers of dementia patients in Taiwan
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 105
學期 2
出版年 106
研究生(中文) 蕭晟儀
研究生(英文) Shen-Yi Hsiao
學號 T86041015
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-古鯉榕
口試委員-劉立凡
口試委員-范聖育
口試委員-湯麗玉
中文關鍵字 失智症家庭照顧者  外籍看護工  照顧者負荷 
英文關鍵字 dementia  family caregivers  migrant care workers  caregiver burden 
學科別分類
中文摘要 前言:全臺失智症人口現已超過26萬人,且隨著人口老化持續攀升,失智症不僅影響長者生活品質,也會影響照顧者的健康狀況,因此如何減少照顧者的負荷是目前長照體系所關注的議題。家庭照顧者為了要分擔照顧責任,最常選擇以聘用外籍家庭看護工來提供長照服務,然而,國內外研究對外籍看護工是否能減輕失智症家庭照顧者的負荷仍無定論,且過去研究大多為橫斷性研究為主,難以判定雇用和負荷的因果關係。故本研究有兩個目的:(一)、分析失智症家庭雇用外籍看護工的影響因素;(二)、分析失智症的家庭雇用外籍看護工後對照顧者負荷的影響。

材料與方法:本研究使用臺灣南部某醫學中心的失智症特約門診的一年追蹤性調查的兩波資料。目的一以第一波患者及其照顧者的特質,探討影響第二波雇用外籍看護工的因素;目的二使用隨機效果模型分析兩波持續雇用對照顧者負荷的影響。

結果與討論:研究樣本的失智症照顧者以女性居多,且非配偶照顧者居多(60%),雇用外籍看護工的比率為27%,照顧者負荷平均16.2±9.7分。羅吉斯迴歸顯示第一波的患者年齡大於85歲或巴氏量表分數60分以下者,在第二波雇用看護工的機會較高。迴歸分析比較持續雇用外籍看護工與未曾雇用者的照顧者負荷,發現在控制其他患者與照顧者特質之下,兩組的負荷並無顯著差異。

結論:本研究結果不支持雇用外籍看護工之後會降低照顧者負荷的假設,推測由於外籍看護工對於失智症照顧的訓練不足,以及家庭照顧者與外籍看護工在語言溝通上的障礙,都可能使得家庭照顧者的心理壓力無法減輕。然而,研究資料來源僅限於某間醫學中心門診,建議未來研究擴大進行全國性的照顧者負荷追蹤調查,以確立雇用外籍看護工對失智症的照顧者負荷的影響。
英文摘要 Objectives: 1) To identify factors associated with hiring of the MCW by family caregiver of elderly with dementia. 2) To assess the impact of hiring the MCW on the burden of family caregivers of elderly with dementia. We used one-year follow up data of 279 dementia patients recruited from a dementia clinic at a medical center in a southern city of Taiwan. For aim 1, patient and caregiver characteristics in wave 1 were used to predict the employment of the MCW in wave 2 by a logistic regression. For aim 2, the impact of continuous employment of hiring the MCW for both waves on the burden of family caregiver were analyzed by random effects model. Logistic regression results showed that patients in older age (85+) or with lower Barthel index (≦60) in wave1 were more likely to hire a MCW in wave 2. Random effects model results showed that the burdens of family caregivers among those who continued to hire a MCW and those who did not were not significantly different.
論文目次 目錄
中文摘要 I
Abstract III
致謝 V
表目錄 VIII
圖目錄 VIII
第壹章、 前言 1
第一節、 研究背景與重要性 1
(一)、 全球及臺灣國內老化與失智的情形 1
(二)、 我國照護提供方式 2
(三)、 我國照顧人力面臨挑戰 3
第二節、 研究目的 5
第三節、 研究假設 5
第貳章、 文獻回顧 6
第一節、 影響失智症家庭照顧者負荷的可能因素 6
第二節、 影響雇用外籍看護工因素 10
第三節、 雇用外籍看護對失智症家庭照顧者負荷及相關影響 12
(一)、 直接影響照顧者負荷 12
(二)、 間接影響照顧者負荷 13
第四節、 共同影響雇用外籍看護工以及家庭照顧者負荷的因素 15
第五節、 法規雇用外籍看護工標準 15
第六節、 文獻總結 16
第參章、 研究材料與方法 17
第一節、 研究設計及架構 17
第二節、 資料來源及樣本取得 19
第三節、 研究變項及其工具 22
第四節、 統計分析與方法 25
第肆章、 研究結果 28
第一節、 失智症患者及其家庭照顧者基本人口學特質分類 28
(一)、 失智症患者及其家庭照顧者基本人口學特質 28
(二)、 依雇用狀態區分失智症患者及其家庭照顧者基本人口學特質 30
第二節、 以羅吉斯迴歸分析影響第二波雇用外籍看護工的影響因素(目的1-1) 33
第三節、 第一波無雇用者中,預測第二波雇用影響因素(目的1-2) 35
(一)、 以羅吉斯迴歸分析第一波未雇用者在第二波雇用的影響因素 35
第四節、 雇用外籍看護工對負荷的影響(目的2-1─隨機效果模型) 37
(一)、 持續有雇用與持續無雇用外籍看護工的人口學特質比較 37
(二)、 以配對t檢定分析 40
(三)、 以隨機效果模型分析雇用外籍看護工影響負荷(目的2-1) 41
第五節、 雇用外籍看護工對負荷的影響(目的2-2─固定效果模型) 43
第伍章、 討論 45
第一節、 失智症患者及其家庭照顧者基本人口學特質 45
第二節、 雇用外籍看護工的預測因素 46
第三節、 雇用外籍看護工對影響照顧者負荷的影響 47
第四節、 研究優勢與限制 51
第陸章、 結論與建議 52
第一節、 重要研究結果總結 52
第二節、 未來研究與政策建議 52
第柒章、 參考文獻 54
附錄 60
壹、照顧者負荷量表(ZBI) 60
貳、照顧服務及支持資源使用 61

參考文獻 Adams, B., Aranda, M. P., Kemp, B., & Takagi, K. (2002). Ethnic and gender differences in distress among Anglo American, African American, Japanese American, and Mexican American spousal caregivers of persons with dementia. Journal of Clinical Geropsychology, 8(4), 279-301.
Alliance, F. C. (2006). Caregiver assessment: principles, guidelines and strategies for change: Report from a National Consensus Development Conference: Family Caregiver Alliance.
Almberg, B., Jansson, W., Grafström, M., & Winblad, B. (1998). Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non‐caregivers of non‐demented elderly people. J Adv Nurs, 28(4), 849-858.
Ankri, J., Andrieu, S., Beaufils, B., Grand, A., & Henrard, J. C. (2005). Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. Int J Geriatr Psychiatry, 20(3), 254-260.
Alzheimer’s Association, A. s. (2016). 2016 Alzheimer's disease facts and figures. (1552-5260).
Bai, X., Kwok, T. C., Chan, N. Y., & Ho, F. K. (2013). Determinants of job satisfaction in foreign domestic helpers caring for people with dementia in Hong Kong. Health & social care in the community, 21(5), 472-479.
Barbabella, F., Chiatti, C., Rimland, J. M., Melchiorre, M. G., Lamura, G., & Lattanzio, F. (2016). Socioeconomic Predictors of the Employment of Migrant Care Workers by Italian Families Assisting Older Alzheimer’s Disease Patients: Evidence From the Up-Tech Study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71(3), 514-525.
Barusch, A. S., & Spaid, W. M. (1989). Gender differences in caregiving: Why do wives report greater burden? The gerontologist, 29(5), 667-676.
Basnyat, I., & Chang, L. (2016). Examining live-in foreign domestic helpers as a coping resource for family caregivers of people with dementia in Singapore. Health Commun, 1-9.
Bergvall, N., Brinck, P., Eek, D., Gustavsson, A., Wimo, A., Winblad, B., & Jönsson, L. (2011). Relative importance of patient disease indicators on informal care and caregiver burden in Alzheimer's disease. Int Psychogeriatr, 23(01), 73-85.
Brodaty, H., & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues Clin Neurosci, 11(2), 217-228.
Brodaty, H., Woodward, M., Boundy, K., Ames, D., Balshaw, R., & Group, P. S. (2014). Prevalence and predictors of burden in caregivers of people with dementia. Am J Geriatr Psychiatry, 22(8), 756-765. doi: 10.1016/j.jagp.2013.05.004
Chau, P. H., Woo, J., Kwok, T., Chan, F., Hui, E., & Chan, K. C. (2012). Usage of community services and domestic helpers predicted institutionalization of elders having functional or cognitive impairments: a 12-month longitudinal study in Hong Kong. J Am Med Dir Assoc, 13(2), 169-175. doi: 10.1016/j.jamda.2010.07.011
Chiatti, C., Di Rosa, M., Melchiorre, M. G., Manzoli, L., Rimland, J. M., & Lamura, G. (2013). Migrant care workers as protective factor against caregiver burden: results from a longitudinal analysis of the EUROFAMCARE study in Italy. Aging Ment Health, 17(5), 609-614. doi: 10.1080/13607863.2013.765830
Chong, A. M., Kwan, C. W., Chi, I., Lou, V. W., & Leung, A. Y. (2014). Domestic helpers as moderators of spousal caregiver distress. J Gerontol B Psychol Sci Soc Sci, 69(6), 966-972. doi: 10.1093/geronb/gbu034
Chong, A. M., Kwan, C. W., Lou, V. W., & Chi, I. (2016). Can domestic helpers moderate distress of offspring caregivers of cognitively impaired older adults? Aging Ment Health, 1-8. doi: 10.1080/13607863.2016.1191059
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308-2308.
Etters, L., Goodall, D., & Harrison, B. E. (2008). Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20(8), 423-428.
Feil, D. G., Lukman, R., Simon, B., Walston, A., & Vickrey, B. (2011). Impact of dementia on caring for patients’ diabetes. Aging Ment Health, 15(7), 894-903.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189-198.
Fusco, S., Corsonello, A., Chiatti, C., Fabbietti, P., Salerno, G., De Bonis, E., . . . Lattanzio, F. (2015). Migrant care workers and rehospitalization among older patients discharged from acute care hospitals. Geriatrics & gerontology international, 15(2), 196-203.
Gort, A. M., Mingot, M., Gomez, X., Soler, T., Torres, G., Sacristán, O., . . . de Miguel, M. (2007). Use of the Zarit scale for assessing caregiver burden and collapse in caregiving at home in dementias. Int J Geriatr Psychiatry, 22(10), 957-962.
Haro, J., Kahle-Wrobleski, K., Bruno, G., Belger, M., Dell’Agnello, G., Dodel, R., . . . Wimo, A. (2014). Analysis of burden in caregivers of people with Alzheimer’s disease using self-report and supervision hours. The journal of nutrition, health & aging, 18(7), 677-684.
Hope, T., Keene, J., Gedling, K., Fairburn, C. G., & Jacoby, R. (1998). Predictors of institutionalization for people with dementia living at home with a carer. Int J Geriatr Psychiatry, 13(10), 682-690.
Hsiao, C. (1986). Analysis of Panel Data, Econometric Society Monograph No. 11: Cambridge: Cambridge University Press.
Huang, S. S., Lee, M. C., Liao, Y. C., Wang, W. F., & Lai, T. J. (2012). Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly. Arch Gerontol Geriatr, 55(1), 55-59. doi: 10.1016/j.archger.2011.04.009
Kang, H. S., Myung, W., Na, D. L., Kim, S. Y., Lee, J. H., Han, S. H., . . . Kim, D. K. (2014). Factors associated with caregiver burden in patients with Alzheimer's disease. Psychiatry Investig, 11(2), 152-159. doi: 10.4306/pi.2014.11.2.152
Kim, M.-D., Hong, S.-C., Lee, C.-I., Kim, S.-Y., Kang, I.-O., & Lee, S.-Y. (2009). Caregiver burden among caregivers of Koreans with dementia. Gerontology, 55(1), 106-113.
Ko, K.-T., Yip, P.-K., Liu, S.-I., & Huang, C.-R. (2008). Chinese version of the Zarit caregiver Burden Interview: a validation study. The American Journal of Geriatric Psychiatry, 16(6), 513-518.
Lin, W. C., Tsai, C. F., Wang, S. J., Hwang, J. P., & Fuh, J. L. (2012). Comparison of the burdens of family caregivers and foreign paid caregivers of the individuals with dementia. Int Psychogeriatr, 24(12), 1953-1961. doi: 10.1017/S1041610212001354
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology.
Ostbye, T., Malhotra, R., Malhotra, C., Arambepola, C., & Chan, A. (2013). Does support from foreign domestic workers decrease the negative impact of informal caregiving? Results from Singapore survey on informal caregiving. J Gerontol B Psychol Sci Soc Sci, 68(4), 609-621. doi: 10.1093/geronb/gbt042
Paraponaris, A., Davin, B., & Verger, P. (2012). Formal and informal care for disabled elderly living in the community: an appraisal of French care composition and costs. The european Journal of Health economics, 13(3), 327-336.
Prince, M. J. (2015). World Alzheimer Report 2015: the global impact of dementia: an analysis of prevalence, incidence, cost and trends.
Reed, C., Belger, M., Dell'agnello, G., Wimo, A., Argimon, J. M., Bruno, G., . . . Vellas, B. (2014). Caregiver Burden in Alzheimer's Disease: Differential Associations in Adult-Child and Spousal Caregivers in the GERAS Observational Study. Dement Geriatr Cogn Dis Extra, 4(1), 51-64. doi: 10.1159/000358234
Rogero-García, J., & Rosenberg, M. W. (2011). Paid and unpaid support received by co-resident informal caregivers attending to community-dwelling older adults in Spain. European Journal of Ageing, 8(2), 95.
Rosa, E., Ambrogio, M., Binetti, G., & Zanetti, O. (2004). 'Immigrant paid caregivers' and primary caregivers' burden. Int J Geriatr Psychiatry, 19(11), 1103-1104. doi: 10.1002/gps.1176
Rosa, E., Lussignoli, G., Sabbatini, F., Chiappa, A., Di Cesare, S., Lamanna, L., . . . Zanetti, O. (2008). The immigrant paid caregivers' role in the care of patients with severe dementia. Int J Geriatr Psychiatry, 23(3), 331-333. doi: 10.1002/gps.1879
Saraceno, C. (2010). Social inequalities in facing old-age dependency: a bi-generational perspective. Journal of European Social Policy, 20(1), 32-44.
Schulz, R., O'Brien, A. T., Bookwala, J., & Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. The gerontologist, 35(6), 771-791.
Terum, T. M., Andersen, J. R., Rongve, A., Aarsland, D., Svendsboe, E. J., & Testad, I. (2017). The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. Int J Geriatr Psychiatry. doi: 10.1002/gps.4704
Tolkacheva, N., Van Groenou, M. B., De Boer, A., & Van Tilburg, T. (2011). The impact of informal care-giving networks on adult children's care-giver burden. Ageing and society, 31(01), 34-51.
Torti Jr, F. M., Gwyther, L. P., Reed, S. D., Friedman, J. Y., & Schulman, K. A. (2004). A multinational review of recent trends and reports in dementia caregiver burden. Alzheimer Disease & Associated Disorders, 18(2), 99-109.
Vaingankar, J. A., Chong, S. A., Abdin, E., Picco, L., Jeyagurunathan, A., Zhang, Y., . . . Subramaniam, M. (2016). Care participation and burden among informal caregivers of older adults with care needs and associations with dementia. Int Psychogeriatr, 28(2), 221-231. doi: 10.1017/S104161021500160X
Wooldridge, J. M. (2015). Introductory econometrics: A modern approach: Nelson Education.
Yaffe, K., Fox, P., Newcomer, R., Sands, L., Lindquist, K., Dane, K., & Covinsky, K. E. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. Jama, 287(16), 2090-2097.
Zarit, S. H., Anthony, C. R., & Boutselis, M. (1987). Interventions with care givers of dementia patients: comparison of two approaches. Psychology and aging, 2(3), 225.
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. The gerontologist, 20(6), 649-655.
吳勁儫、陳雅美(2014)。失智老人家庭雇用外籍看護工之經驗。長期照護雜誌,18(1),頁 95-112
李宜、李誠、辛炳隆、王素彎(2009)。國際人口移動對我國勞動市場及經社發展之影響與因應對策。:行政院經濟建設委員會。
林青璇(2004)。失能老人家庭僱用外籍家庭監護工的決定過程--配偶照顧者的角色及參與情形之探討。臺灣大學社會工作學研究所學位論文,頁 1-152
林淑錦、白明奇(2006)。失智症病患主要照顧者的壓力-以家庭生態觀點論之。長期照護雜誌,10(4),頁 412-425
林敬程(1999)。失智老人家庭照顧者之負荷與支持性服務需求之探討。高雄醫學大學行為科學研究所學位論文,頁 1-121
高淑芳、盧孳豔、葉淑惠、劉雪娥(1999)。探討家庭功能, 社會支持與社區殘病老人照顧者負荷之關係。護理研究,7(2),頁 172-182
張慈君、徐亞瑛、陳明岐、邱逸榛、黃惠玲(2012)。失智症家庭照顧者問題處理能力預測因子之探討。護理雜誌,59(6),頁 25-35
陳昱名(2013)。老年失智症病患家庭照顧者之照顧負荷。崇仁學報(7),頁 1-22
黃志忠(2014)。居家服務使用對老人家庭照顧者照顧負荷之緩衝性影響研究。社會政策與社會工作學刊,18(1),頁 1-43
黃郁超、吳建賢、張淑惠、陳雅美(2016)。外籍看護與家庭照顧者對接受居家照顧老人住院與死亡風險之差異。台灣公共衛生雜誌,35(3),頁 304-315
黃惠玲、徐亞瑛、黃秀梨、陳獻宗(2008)。失智症照顧服務之可行模式。研考雙月刊,32(6),頁 22-33
楊嘉玲、孫惠玲(2003)。[照顧者負荷] 概念分析。馬偕護理專科學校學報(3),頁 15-27
邱銘章、陳達夫、王培寧、白明奇、黃正平、花茂棽、林克能、湯麗玉、孫瑜、林仲志、傅中玲(2013). 失智症(含輕度認知功能障礙【mild cognitive impairment,MCI】)流行病學調查及失智症照護研究(計畫編號:DOH102-TD-M-113-100001). 臺北市:衛生福利部委託科技研究計畫。
行政院衛生福利部護理及健康照護司(2014年10月27日)。.失智症防治照護政策綱領暨行動方案. 取自http://www.mohw.gov.tw/CHT/DONAHC/DM1_P.aspx?f_list_no=716&fod_list_no=0&doc_no=46372
行政院內政部統計處(2016):人口數>人口三段年齡組比率 http://www.moi.gov.tw/stat/chart.aspx
行政院勞動部(2016):勞動統計報告>統計表-外籍工作者>產業及社福外籍勞工人數
行政院衛生福利部中央健康保險署(2016):藥材專區>藥品>藥品給付規定。
取自http://www.nhi.gov.tw/Content_List.aspx?n=E70D4F1BD029DC37&topn=3FC7D09599D25979
臺灣失智症協會(2016):認識失智症。取自http://www.tada2002.org.tw/tada_know_02.html

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