失智症家庭使用長期照顧服務的情形與不使用的原因

Long-term care services use and reasons for non-use by elders with dementia and their families

目標：分析失智症家庭使用長期照顧服務的情形與影響使用的因素，並探討家庭照顧者不使用長照服務的原因。方法：收案對象為台南某醫學中心失智症門診之病人及家庭照顧者共231組；以結構式的問卷與照顧者進行電話訪談。結果：失智者使用長照服務的比率僅8%，遠低於使用看護工的35%，或未使用任何服務的57%。失智者未使用服務的主因是照顧者不覺得失智者有需要使用服務（64%）、其次是照顧者表示服務項目不適合患者（20%）。至於未曾使用家庭照顧者支持服務的主因，是照顧者缺少相關服務的資訊（56%）。邏輯斯迴歸分析顯示使用服務的照顧者的長照資源相關資訊顯著高於未使用者（OR=1.76,95%CI=1.19-2.61），但失智者特性包括認知功能和身體功能嚴重度皆與使用看護工顯著相關。結論：本研究的失智者和其家庭照顧者使用長照服務的比率皆偏低，由於照顧者缺少相關服務的資訊，建議政府應加強宣導，並提供更多給家庭照顧者的支持服務，才能在雇用看護工的方式之外，以多元的服務來滿足失智症全家照護的需求。

Objectives: The goals of this study were to describe the pattern and predictors of long-term care (LTC) services utilization elders with dementia and their families, and to determine reasons for non-use of LTC services. Methods: The study sample included 231 elders with dementia and caregiver dyads recruited from a dementia clinic at a medical center in Tainan. Caregivers were interviewed via telephone using a structured questionnaire. Results: The LTC services use rate was 8% among the sample, 35% hired foreign care workers, and 57% did not use any LTC services. The main reasons given for families not using LTC services were the perceived lack of need (64%), followed by the service not meeting the patient’s needs (20%). The main reason for not using caregiver support services was caregivers being unaware of the availability of services (56%). Logistic regression results showed that knowledge about LTC resources (OR=1.76, 95% CI=1.19-2.61) was the only significant predictor of LTC services use, while the patient’s level of cognitive impairment and physical disability were significant predictors of hiring a foreign care worker. Conclusions: Because the utilization rates of LTC services by elders with dementia and their caregivers were low, and the main reason for non-use was due to caregivers being unaware of services, we recommend that the government strengthen educational campaigns for family caregivers and provide caregiver support services. There should be more choices regarding LTC services available to families caring for an elder with dementia in addition to hiring a foreign care worker.