居家失能老人在照顧服務使用的自我選擇權之相關因素研究

Self-determination of the Home Care Service Use among Disabled home-dwelling Elders of Taiwan

10.6288/TJPH2008-27-02-04

紀玫如(Mei-Ju Chi)；吳淑瓊(Shwu-Chong Wu)

自我選擇 ； 照顧服務 ； 居家失能老人 ； self-determination ； home care services ； home-dwelling disabled elderly

台灣公共衛生雜誌

27卷2期（2008 / 04 / 01）

121 - 132

繁體中文

目標：瞭解影響居家失能老人是否能夠自己選擇照顧服務的相關因素。方法：本研究對象選自嘉義市及台北縣三峽鎮。鶯歌鎮兩個實驗社區中，能夠自答問卷之65歲以上居家失能老人947名，再以SPMSQ量表經教育程度校正後取得有效樣本942人，並以多分變項邏輯斯迴歸進行相關因素之檢驗分析。結果：分析樣本中有45.9%的個案表示能夠自己選擇服務，16.8%的個案則完全不能由自己選擇服務，其餘36.3%的個案則表示自己可以選擇部分服務。多分變項邏輯斯迴歸分析結果顯示，比較完全可以自己選擇服務和完全不可以自己選擇服務兩組個案發現，具社會福利身份(OR=0.45, 95%CI=0.25-0.79)、重度身體功能障礙(OR=0.29, 95%CI=0.15-0.56)、認知功能有障礙(OR=0.40, 95%CI=0.24-0.68)、沒有個人收入(OR=0.43, 95%CI=0.24-078)、照顧者為媳婦(OR=0.36, 95%CI=0.15-0.88)，比較不是由自己選擇照顧服務；對長期照護服務認知較高(OR=1.13, 95%CI=1.01-1.27)者，則能夠由自己選擇服務的機會較高。結論：個人經齊狀況、對服務的認知、教育程度、與照顧者之照顧關係以及身體和認知功能，都是會影響失能老人能否自己選擇服務的重要因素。未來在長期照護相關政策的規劃，應加以考量上述因素的影響。

Objectives: To examine the prevalence and correlates of self-determination of homecare service among disabled Taiwanese elders. Methods: Nine hundred forty two (942) subjects among the 2079 disabled elders from the ”Pilot Program for the Development of Long Term Care System Study” implemented in Taipei and Chiayi City were recruited. Elders with severe cognitive impairments and those with surrogate responses were excluded. Multinomial logistic regressions were applied for statistical analysis. Results: Forty-six percent of the respondents indicated that they could choose the care services by themselves, 36.3% could choose some services, and 16.8% were unable to choose services. Compared with those who could not make their own decisions, those who could not choose their services totally are more likely to have social welfare status (OR=0.45, 95%CI=0.25-0.79), severe ADL disability (OR=0.29, 95%CI=0.15-0.56), cognitive disability (OR=0.40, 95%CI=0.24-0.68), without personal income (OR=0.43, 95%CI=0.24-0.78), daughter-in-law caregivers (OR=0.36, 95%CI=0.15-0.88). Elderly with greater awareness of long-term care services exhibited higher probability of choosing their services (OR=1.13, 95%CI=1.01-1.27). Conclusions: Economic status, physical and mental functioning, the relationship with caregiver, education and the awareness of services were the important factors associated with self-determination of disabled Taiwanese elders. Our government should consider these factors when promoting relative long-term care policy for disabled elders.

1. 謝美娥(2003)。失能老人的資源、居住安排、居住決定的掌控力和生活品質：一個量化的初探。社會政策與社會工作學刊，8，1-49。
   連結：
2. Bannerman DJ,Sheldon JB,Sherman JA,Harchik AE(1990).Balancing the right to habilitation with the right to personal liberties: the rights of people with developmental disabilities to eat too many doughnuts and take a nap.J Appl Behav Anal,23,79-89.
3. Brocklehurst J,Dickinson E(1996).Autonomy for elderly people in long-term care.Age Ageing,25,329-332.
4. Cicirelli VG(1992).Family Caregiving: Autonomous and Paternalistic Decision Making.Newbury park:Sage.
5. Crisp N(2005).Creating a Patient-led NHS-Delivering the NHS Improvement Plan.London:Department of Health.
6. Duncan-Myers AM,Huebner RA(2000).Relationship between choice and quality of life among residents in long-term-care facilities.Am J Occup Ther,54,504-508.
7. Feinberg LF,Whitlatch CJ(2002).Decision-making for persons with cognitive impairment and their family caregivers.Am J Alzheimers Dis Other Demen,17,237-244.
8. Feinberg LF,Whitlatch CJ(2001).Are persons with cognitive impairment able to state consistent choices.Gerontologist,41,374-382.
9. Fillenbaum GG(1985).Screening the elderly. A brief instrumental activities of daily living measure.J Am Geriatr Soc,33,698-706.
10. Frytak J,Kane RA (ed.)(2000).Assessing Older Persons: Measures, Meaning, and Practical Applications.NY:Oxford University Press.
11. Grimley Evans J(1984).Prevention of age-associated loss of autonomy: epidemiological approachs.J Chronic Dis,37,353-363.
12. Horowitz A,Silverstone BM,Reinhardt JP(1991).A conceptual and empirical exploration of personal autonomy issues within family caregiving relationships.Gerontologist,31,23-31.
13. Hwang HL,Lin HS(2004).Perceived enactment of autonomy and related sociodemographic factors among non-institutionalized elders.Kaohsiung J Med Sci,20,166-173.
14. Kalda R,Polluste K,Lember M(2003).Patient satisfaction with care is associated with personal choice of physician.Health Policy,64,55-62.
15. Katz S,Ford AB,Moskowitz RW,Jackson BA,Jaffe MW(1963).Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function.JAMA,185,914-919.
16. Kautzer K,Reinharz S,Rowles G (eds.)(1988).Qualitative Gerontology.NY:Springer.
17. Kishi G,Teelucksingh B,Zollers N(1988).Daily decisionmaking in community residences: a social comparison of adults with or without mental retardation.Am J Ment Retard,92,430-435.
18. Madson SK(1993).Patient self-determination act: implication for long-term care.J Gerontol Nurs,19,15-18.
19. McWilliam CL,Brown JB,Carmichael JL(1994).A new perspective on threatened autonomy in elderly persons: the disempowering process.Soc Sci Med,38,327-338.
20. Metz DH,Labrooy SJ(2005).Future of geriatric medicine in an era of patient choice.Age Ageing,34,553-555.
21. Pfeiffer E(1975).A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.J Am Geriatr Soc,23,433-441.
22. Pratt CC,Jones LL,Shin HY,Walker AJ(1989).Autonomy and decision making between single older women and their caregiving daughters.Gerontologist,29,792-797.
23. Reinardy J(1999).Autonomy, choice, and decision making: how nursing home social worker view their role.Soc Work Health Care,29,59-77.
24. Reinardy J,Kane RA(1999).Choosing an adult foster home or a nursing home: residents` perceptions about decision making and control.Soc Work,44,571-585.
25. Schur CL,Berk ML(1998).Choice of health plan: implications for access and satisfaction.Health Care Financ Rev,20,29-43.
26. Stancliffe RJ(2001).Living with support in the community: predictors of choice and self-determination.Ment Retard Dev Disabil Res Rev,7,91-98.
27. Stancliffe RJ,Abery BH,Smith J(2000).Personal control and the ecology of community living settings: beyond living-unit size and type.Am J Ment Retard,105,431-454.
28. Treece A,Gregory S,Ayres B,Mendis K(1999)."I always do what they tell me to do": choice-making opportunities in the lives of two older persons with severe learning difficulties living in a community setting.Disabil Soc,14,791-804.
29. Ullman R,Hill JW,Scheye EC,Spoeri RK(1997).Satisfaction and choice: a view from the plans.Health Aff,16,209-217.
30. Wetle T,Birren JE,Lubben JE,Rowe JC,Deutchman DE,Birren J,Lubben J,Rowe J (eds.)(1991).The Concept and Measurement of Quality of Life in the Frail Elderly.San Diego:Academic Press.
31. Williams S(1998).An organizational model of choice: a theoretical analysis differentiating choice, personal control, and self-determination.Genet Soc Gen Psychol Monogr,124,465-491.
32. Xu KT(2002).Choice of and overall satisfaction with pharmacies among a community-dwelling elderly population.Med Care,40,1283-1293.
33. Zweibel NR,Cassel CK(1989).Treatment choices at the end of life: a comparision of decisions by older patients and their physician-selected proxyies.Gerontologist,29,615-621.
34. 吳肖琪(1999)。論台灣長期照護特質與西方之差異。長期照護，3，1-8。
35. 吳淑瓊、張明正(1997)。台灣老人健康照護之現況分析。台北:台灣省家庭計畫研究所。
36. 呂寶靜(1999)。老人使用日間照護服務的決定過程：誰的需求？誰的決定？。台大社會工作學刊，11，181-229。
37. 呂寶靜(2000)。老人照顧：老人、家庭、正式服務。台北:五南。
38. 林志傑(2002)。國防管理學院法律研究所碩士論文。台北:國防管理學院法律研究所。
39. 林靜湄(2000)。碩士論文(碩士論文)。台北，國立台灣大學社會學研究所。
40. 林靜瑩(1999)。碩士論文(碩士論文)。台中，東海大學社會工作學系。
41. 邱清榮(1997)。碩士論文(碩士論文)。台北，國立政治大學社會學研究所。
42. 連賢明(1993)。碩士論文(碩士論文)。台北，國立台灣大學經濟學研究所。
43. 陳妙盡(1995)。碩士論文(碩士論文)。嘉義，國立中正大學社會福利學系。

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2. 林麗芬,李佳珂(2019)。民眾長期照護需求與商業保險選擇之研究。Journal of Data Analysis，14(1)，13-32。
3. 薛承泰、鄧志松、詹慶恩、楊培珊、陳信木、王雲東(2012)。我國失能與失智人口及其所需照顧服務員人力之推估。臺大社工學刊，25，51-102。
4. (2012)。回應高齡化社會當代社區工作：建構社區化長期照顧服務之探討。社區發展季刊，138，166-179。
5. (2021)。北部某區域教學醫院出院準備銜接長照2.0之現況探討。社區發展季刊，173，432-441。
6. (2024)。探討臺灣長期照顧之人力資源：居家服務員工作感受與壓力因應之研究。管理實務與理論研究，18(2)，17-26。