社區老人實際服務利用與自覺需要－1994～1998世代追蹤研究

The Use and Perceived Need for Services of Community Elderly Persons – a Cohort Study of 1994-1998

10.6288/TJPH2002-21-06-04

謝穎慧(Ying-Hui Hsieh)；邱亨嘉(Herng-Chia Chiu)；毛莉雯(Lih-Wen Mau)

服務利用 ； 自覺需要 ； 未滿足需要 ； 世代研究 ； 多元功能評估 ； service utilization ； perceived need ； unmet need ； cohort study ； multidimensional functional assessments

台灣公共衛生雜誌

21卷6期（2002 / 12 / 01）

411 - 419

繁體中文

目標：本研究旨在探討社區老人各項服務之實際服務利用和自覺需要之長期變化。方法：藉由為期四年之世代追蹤研究，以兩階段比例分層抽樣法選取居住在高雄市三民區65歲以上社區老人，於1994年進行第一次面訪，1998年再次面訪，初訪總計完訪1,260位社區老人，四年後成功追訪874位；其餘有218位老人死亡，168位失訪。本研究工具為「中文版老人多元功能評估問卷」。統計分析包括描述性統計分析、獨立樣本之T檢定為McNemar's test。結果：1998年完成追訪之874位老人，與1260位原始樣本相比，其各項人口學特質並無顯著差異。在1994～1998年間，社區老人對於家事服務、餐飲準備、持續性照顧、個人照護及護理照護等各項服務，無論是實際使用及自覺需要的比例皆呈現上升趨勢；在身體健康評估服務一項，由1994年實際使用之42.4%，上升至1998年之56.8%；然社會暨娛樂活動服務一項則有將近60%之受訪老人未曾使用或自覺需要該項服務。有關各項服務之未滿足需要，除個人照護項目外，其餘各項服務之未滿足需要者比例在時間上皆呈現下降趨勢，其中以家事服務、身體健康評估及社會暨娛樂活動三項服務達統計顯著差異(p＜.05)。就服務提供者而言，家人朋友鄰居仍是家事服務、餐飲準備、持續照護、個人照護及護理照護等各項服務的主要提供者，但隨年紀漸增，使用機構或受雇者所提供服務的老人比例顯著上升。結論：本研究之主要目的在於瞭解高雄市社區老人長期服務利用及自覺需要是否因老化而有所變化。透過為期四年長期觀察結果，可瞭解不同服務項目之使用變化及自覺需要趨勢，以克服橫斷性研究所無法呈現的動態改變過程，做為老人衛生和社會福利之服務提供或政策制訂者之參考。

Objectives: This study examined the longitudinal use of and perceived need for services of the community elderly people. Methods: The study design was a cohort study over a four-year period. Two-stage proportional to size sampling was used. A baseline sample of 1, 260 elderly subject, dwelling in San-Ming District in Kaohsiung city, were successfully interviewed in 1994. Among them, 874 subjects were followed; 218 subjects deceased; and 168 subjects failed to be tall awed. The measurement instrument was the Chinese-version at the Multidimensional Functional Assessment Questionnaire (CMFAQ). Descriptive analysis, independent T test, and McNemar’s test were used. Result: No demographic significance was found between the baseline sample and the follow-up sample. The included 8 items of services were homemaker-household services, meal preparation, personal care services, nursing care, continuous supervision, health-related information supplement and relocation, physical examination services, and social recreation services. During the period of 1994-1998, the use of and perceived need for homemaker-household services, meal preparation, personal care services, nursing care, continuous supervision services significantly increased. As with the example of physical examination services, the percentage of use was 42.4% in 1994, which increased to 56.8% in 1998. However, close to 60% of the-followed sample had never used of or perceived need for social recreation services. As regards the unmet need of services, the percentage of unmet need for each item of service decreased over a four-year-period; except for the persona care unmeet need for each item of service decreased over a four-year-period, except for the persona care service. Especially, the unmet need of homemaker-household services, meal preparation, physical examination services, and social recreation services were fulfilled overtime. The major provider for each Item of service remained family, friends, and neighbors. As the sample increased with age, the use of a formal care system was correspondingly increased. Conclusions: In short, the present study intended to understand whether the use of and perceived need for services had been changed over a tour-year-period in the community of elderly people. According to longitudinal observations, the limitations of a cross-sectional study can be eliminated and the changing patterns of actual service use and perceived need have been uncovered. The findings here should be helpful for health care and social service providers as well as decision markers for program development and. Policy planning on long-term care services.

1. Allen, S., Mor, V.(1997).The prevalence and consequences of unmet need: Contrasts between older and younger adults with disability.Medical Care,35
2. Biegel, D., Petchers, M., Snyder, A., Beisgen, B.(1989).Unmet needs and barriers to service delivery for the blind and visually impaired elderly.The Gerontologist,29
3. Cantor, M., Little, V.(1985).Handbook of Aging and the Social Science.New York:Van Nostand Reinhold.
4. Fillenbaum, G. G., Symer, M. A.(1981).The development, validity and reliability of the OARS multidimensional functional assessment questionnaire.Journal of Gerontology,36
5. Goins, R. T., Hobbs, G.(2001).Distribution and utilization of home- and community-based long-term care services for the elderly in North Carolina.Journal of Aging ＆ Social Policy,12
6. Honde, S. C.(1998).Predictors of elders' and family caregivers' use of formal home services.Research in Nursing ＆ Health,21
7. Kane, R. A., Kane, R. L.(1987).Long-Term Care: Principles, Program and Policies.NY:Springer Publishing Co..
8. Katz, M., Cunningham, W., Mor, V.(2000).Prevalence and predictors of unmet need for supportive services among HIV-infected persons: Impact of case management.Medical Care,38
9. Lee, T., Kovner, C. T., Mezey, M. D., Ko, I. S.(2001).Factors influencing long-term home care utilization by the older population: Implications for targeting.Public Health Nursing,18(6)
10. Mitchell, J., Krout, J. A.(1998).Discretion and service use among older adults: The behavioral model revisited.The Gerontologist,38
11. Pan, S. M., Yang, J. T., Chen, C. C.(1998).The predictors of long-term care service utilization among older Americans.Kaohsiung Journal of Medical Sciences,14(4)
12. Penning, M. J.(2002).Hydra revisited: Substituting formal for self- and informal in-home care among older adults with disabilities.The Gerontologist,42
13. Soldo, B.(1984).Project to Analyze Existing Long-Term Care Data.Washington, DC:The Urban Institute.
14. 內政部社會司。臺閩地區老人福利服務。
15. 老人生活狀況調查報告
16. 邱亨嘉 Chiu, Herng-Chia、 陳怡君 Chen, Yi-chun、 毛莉雯 Mau, Lih-Wen、 蕭世槐 Hsiao, Shih-Huai、 劉宏文 Liu, Hung-Wen、 黃明賢 Huang, Ming-Shyan(1997)。中文版多元功能評估問卷之信度考驗 An Evaluation of the Reliability and Validity of the Chinese-Version Oars Multidimensional Functional Assessment Questionnaire。中華公共衛生雜誌 Chinese Journal of Public Health，16(2)
17. 施教裕 Shih, Chaiw-Yi(1993)。社會安全問題之探討。嘉義:中華民國社會福利學會。
18. 胡幼慧 Hu, Yow-Hwey、 王孝仙 Wang, Shaw-Shain、 郭淑珍 Kuo, Shu-Chen(1995)。家人照護失能老人的困境：一項質化與量化的研究。公共衛生 Public Health Quarterly，22(2)
19. 陳亮汝(2002)。台北，國立臺灣大學衛生政策與管理研究所。

1. (2006)。營造一個讓人感到幸福健康的社區建構北投社區健康福祉網路的芻議。社區發展季刊，116，193-212。