輕中度失智症老人家庭主要照顧者照顧酬賞之長期變化及相關因素探討

Influencing Factors and Longitudinal Changes in Caregiving Rewards for Family Caregivers of Older Persons with Mild and Moderate Dementia

10.6386/CGN.202012_31(4).0001

黃春惠(Chun-Hui Huang)；徐亞瑛(Yea-Ing Lotus Shyu)；邱逸榛(Yi-Chen Chiu)；陳明岐(Min-Chi Chen)

失智症 ； 老人 ； 家庭主要照顧者 ； 精神生活 ； 照顧酬賞 ； dementia ； elderly ； family caregivers ； spiritual life ； rewards

長庚護理

31卷4期（2020 / 12 / 01）

449 - 464

繁體中文

背景：近年來隨著老年失智症患者日益增多，照顧失智症患者重擔常落在家庭主要照顧者身上。家庭照顧者之正向經驗，如照顧酬賞是指家庭主要照顧者於照顧過程所獲得之個人成長、互惠、物質、報酬、關係層面及精神上安慰，可以減少照顧負荷，然而國內外普遍缺少家庭照顧者酬賞，特別是照顧酬賞隨長時間之變化之相關研究。目的：探討家庭照顧者照顧酬賞隨長時間之變化及其相關因素。方法：採量性研究縱貫性調查法資料分析，研究對象取自北台灣某醫學中心門診，依研究目的篩選152對輕中度失智症患者與家庭主要照顧者的資料加以分析。研究時間長達四年分四階段進行，每階段相隔一年，以廣義估計方程式進行分析照顧酬賞之長期變化。結果：家庭照顧者精神生活較佳者，其整體照顧酬賞（β=22.519, p＜.001）、及其量表中對自我感到有意義（β=24.865, p＜.001）、學習酬賞（p＜.05）、同在酬賞（β=2.893, p＜.001）均較佳。此外失智症患者年齡越大，照顧者整體照顧酬賞越佳（β=.025, p＜.01）、次量表中對自我感到有意義（β=.019, p＜.05）、學習（β=.028, p＜.05）、同在照顧酬賞（β=.025, p＜.05）均越好，而照顧者年齡越大其對自我感到有意義（β=.013, p＜.05）及同在酬賞越佳（β=.013, p＜.05）。整體而言，學習酬賞平均分數在第四時間點明顯較其他時間點來得好。結論：失智症患者與照顧者年齡越輕，整體照顧酬賞越低，需要特別予以關注與關懷。此外，照顧者本身精神生活越好，在長時間之照顧酬賞感受越好，所以需發展幫助照顧者建立良好精神生活之介入措施。

Background: The number of patients with dementia is increasing rapidly in recent years. The burden of care for these patients often falls on their family caregivers. Positive caregiving experiences, such as caregiving rewards which refer to personal growth, reciprocity, material reward, relationship and spiritual comfort that the family caregivers obtain during the care process are able to decrease the caregiver burden. However, there is a lack of related studies on caregiving rewards, especially the longitudinal changes of caregiving rewards. Purpose: The purpose of this study was to investigate the influencing factors and longitudinal changes in caregiving rewards for family caregivers of older persons with mild and moderate dementia. Methods: Secondary analysis using generalized estimating equations was conducted to analyze a subsample of a 4-year, with each wave 1 year apart, longitudinal study on family caregivers of patients with mild and moderate dementia (N=152) from a medical center in Northern Taiwan. Results: After controlling for time variables, caregivers with a better spiritual life had better overall caregiving rewards (р＜ .001), rewards of caregiver learning (р＜ .05), rewards of being there (р＜ .001) and rewards of meaning for oneself (р＜ .001). In addition, the older the patient with dementia, the better the overall rewards (β= .025, (р＜ .05), rewards of caregiver learning (β= .028, (р＜ .05), rewards of being there (β= .025, (р＜ .05), and rewards of meaning for oneself (β= .019, (р＜ .05) was found. At the same time, the older the family caregiver, the better the rewards of meaning (β= .013, (р＜ .05) and rewards of being there (β= .013, (р＜ .05) was found. In terms of the longitudinal changes, rewards of learning had highest score at the fourth time point than the other time points. Conclusion: Specific attention and care are needed for family caregivers who are younger and with younger patients with dementia. In addition, due to the reason that caregivers with a better spiritual life can achieve better caregiving rewards, interventions that help caregivers establish good spiritual life need to be developed.

1. Shyu, Y.-I. L.,Yang, C.-T.,Huang, C.-C.,Kuo, H.-C.,Chen, S.-T.,Hsu, W.-C.(2010).Influences of mutuality, preparedness and balance on caregivers of patients with dementia.The Journal of Nursing Research,18(3),155-163.
   連結：
2. 徐亞瑛, Y. I.,楊清姿, C.T.,黃錦章, C.C.,郭弘周, H. C.,陳獻宗, S.T.,徐文俊, W.C.(2010)。相互關係、準備度及平衡對失智症照顧者之影響。護理研究，18(3)，155-163。
   連結：
3. 高家常, J. C.,林佑樺, Y.H.(2018)。鬱症病人之靈性照護。護理雜誌，65(3)，17-21。
   連結：
4. 楊星瑜, X. Y.(2018)。急重症單位病患及家屬的靈性護理。護理雜誌，65(3)，5-10。
   連結：
5. Archbold, P. G.,Stewart, B. J.,Greenlick, M. R.,Harvath, T. A.(1990).Mutuality and preparedness as predictors of caregiver role strain.Research in Nursing & Health,13(6),375-384.
6. Coon, D. W.(Ed.),Gallagher-Thompson, D.(Ed.),Thompson, L. W.(Ed.)(2003).Innorative interventions to reduce dementia caregiver distress-A Clinical guide.Springer.
7. Gaugler, J. E.,Kane, R. L.,Kane, R. A.,Newcomer, R.(2005).Unmet care needs and key outcomes in dementia.Journal of the American Geriatrics Society,53,2098-2105.
8. Gonzalez, Elizabeth W.,Polansky, Marcia,Lippa, Carol F.,Gitlin, Laura N.,Zauszniewski, Jaclene A.(2014).Enhancing resourcefulness to improve outcomes in family caregivers and persons with Alzheimer’s disease: A pilot randommized trial.International Journal of Alzheimer’s Disease
9. Hsu, H. C.,Shyu, Y. I. L.(2003).Implicit exchanges in family caregiving for frail eldersin Taiwan.Qualitative Health Research,13(8),1078-1093.
10. Hughes, T. B.,Black, B. S.,Albert, M.(2014).Correlates of objective and subjective measures of caregiver burden among dementia caregivers influence of unmet patient and caregiver dementia-related care needs.International Psychogeriatrics,26,1875-83.
11. Jacklin, K.,Pace, J. E.,Warry, W.(2015).Informal dementia among indigenous communities in Ontario Canada.The Journal of Long Term Home Health Care,16(2),106-120.
12. Kramer, B. J.(1997).Gain in the caregiving experience: Where are we? what next?.The Gerontiologist,37(2),219-232.
13. Lin, Y. l.,Ran, K. M.,Liu, Y. H.,Lin, Y. U.,Ying, J.,Kao, C. C.(2015).Development and validation of the Chinese version of spiritual interests related illness tool for patients with cancer in Taiwan.European Journal of Oncology Nursing,19(5),589-594.
14. Michael Worth. (null 2015). Care giving in the U.S. ‧Available at: http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf.
15. Michael, R.,Berit, I. D.(2004).The costs and rewards of caregiving among aging spouses and adult children.Family Relations,53(3),317-325.
16. Moreira-Almeida, A.,Koenig, H. G.,Lucchetti, G.(2014).Clinical implications of spirituality to mental health: Review of evidence and practical guidelines.Revisa Brasileira de Psigiatria,36(2),176-182.
17. Olsen, C.,Pedersen, I.,Bergland, A.,Marie-Jose Enders-Slegers,Joranson, Nina,Calogiuri, G.,Inlebak, C.(2016).Differences in quality of life in home- dwelling persons and nursing home residents with dementia a cross-sectional study.Bio Med Central Geriatrics,16,137.
18. Picot, S. J.(1995).Rewards, cxosts, and coping of African American caregivers.Nursing Research,44(3),147-152.
19. Roy, C.(1971).A basis for nursing practice.Nursing,21(2),79-87.
20. Samus, Quincy M.,Black, Betty Smith,Laura, Diane Bovenkam,Buckley, Michael,Callahan, Christopher,Davis, Karen,Gitlin, Laura N,Hodgson, Nancy,Johnston, Deirdre,Kales, Helen C,Karel, Michele,Kenney, John Jay,Ling, Shari M,Panchal, Mai,Reuland, Melissa,Willink, Amber,Lyketsos, Constantine G(2017).Home is where the future is: The bright focus foundation consensus panel on dementia care.Alzheimer’s & Dementia,14,104-114.
21. Schaller, S.,Mauskopf, J.,Kriza, C.,Wahlster, P.,Kolominsky-Rabas, P. L.(2015).The main cost drivers in dementia: a systematic review.International Geriatr Psychiatry,30,111-129.
22. Stansfeld, J.,Stoner, C. R.,Wenborn, J.,Vernooij Dassen, M.,Moniz-Cook, E.,Qrrell, M.(2017).Positive psychology outcome measures for family caregivers of people living with dementia: A systematic review.International Psychogeriatrics,29(8),1281-1296.
23. Wimo, A.,Prince, M.,Guerchet, M.,Gemma-Claire, A.,Wu, Y. T.,Prina, M.(2015).The global impact of dementia An analysis of prevalence, incidence, cost and trends.London:Alzheimer’s Disease International.
24. Wolf, J., Spillman, B., & Freedman, V. (2016). A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Intern 2016. Retrieved fromhttp://jamanetworkCom/journals/jamainternalmedicine/fullarticle/2491683
25. Yaffe, K.,Fox, P.,Newcomer, R.,Sands, L.,Lindquist, K.,Dane, K.(2002).Patient and caregiver characteristics and nursing home placement in patients with dementia.Journal of the American Medical Association,287,2090-2097+2153-2154.
26. Yamashita, M.,Amagai, M.(2008).Family caregiving in dementia in Japan.Nursing Research,21,227-231.
27. 內政部統計處(2018，12月)‧10年底人口結構分析 ‧取自http://www.sowf.moi.gov.tw/stat/week/list.htm [Ministry of the Interior Department. (2018 December). End 103 demographic analysis. Retrieved from http://www.sowf.moi.gov.tw/stat/week/list.htm]
28. 王世俊, S. F.(2008).老年護理學.華杏=Chinese apricot.
29. 台灣失智症協會(2018，7月)‧台灣失智症人口推估 ‧取自http://www.tada2002.org.tw/About/Isrt Dementia [Taiwan Dementia Association. (2018, July). Taiwan dementia population estimate. Retrieved from http://www.tada2002.org.tw/About/Isrt Dementia]
30. 行政院經濟建設委員會(2018，3月)‧2010年至 2060年台灣人推計：老年人口 ‧取自http://www.cepd.gov.tw/me.aspx? sNo=0000455[Council for Economic Planning and Development. (2018 March). 2010 Taiwan's population in 2060 to push the plan: The elderly population. Retrieved from http://www.cepd.gov.tw/me.aspx?sNo=0000455]
31. 何瓊芳, Q. F.(1999)。桃園縣=Taoyuan County，長庚大學護理研究所=Nursing Institute, Chang Gung University。
32. 李瑞慈, J. T.,陳淑銘, S. M.,周傳姜, C. C.,顧雅利, Y. L.(2013)。探索加護病房護理人員的靈性本質。長庚護理，24(4)，366-378。
33. 張珍珍,徐亞瑛,邱逸榛,陳明岐(2009)。影響失智症家庭照顧者其照顧酬賞與照顧品質的相關因素之探討。長庚護理雜誌，20(2)，155-166。
34. 張珍珍, C. C.(2007)。桃園縣=Taoyuan County Taiwan，長庚大學護理研究所=Chang Gung University。
35. 陳昱名, Y. M.(2013)。老年失智症病患家庭照顧者之照顧負荷。崇仁學報，7，1-22。
36. 黃惠玲, W. L.,劉錦螢, J. Y,徐亞瑛, Y. I.(2006)。以家庭為基礎之社區失智症照顧模式簡介。長期照護雜誌，10(4)，333-342。

1. (2023)。探討放鬆技巧介入於輕、中度失智症病人之主要照顧者憂鬱情緒與睡眠品質的成效。源遠護理，17(3)，35-43。