慢性病失能老人整體性照護需求探討

Exploring the Care Needs of Disabled Elders with Chronic Conditions

背景：老年人慢性病之比例不斷攀升，疾病型態由急性轉為慢性，且多重慢性病，導致日常身體功能減退與生活品質降低等；及家庭與社會結構之改變，皆致使照護需求更為複雜，研究顯示部分老人需求，呈現未滿足的情形。目的：以生、心、靈及社會整體性觀點，瞭解慢性病失能老人及家屬照護需求。方法：本研究為質性研究，立意取樣，邀請慢性疾病老人及照顧家屬，利用半結構式訪談指引，以會談及焦點團體方式收資料，全程錄音，並將訪談內容轉成逐字稿進行內容分析與歸納。結果：共完成十位慢性病失能老人訪談以及一組家屬焦點團體。老人訪談內容分析共整理出八大主題，分別為疾病纏身、居家生活輔助、飲食營養、經濟貧乏與福利申請缺乏彈性、社交活動缺乏、無奈苦悶，不如歸去、就醫便利性及醫療資訊來源與處理。家屬焦點團體訪談內容分析共整理出三項主題，分別為面對的困難與因應方式、對醫療處置的建議及健康保健資訊的來源。結論：慢性病失能老人照護需求包含身、心、靈及社會方面，最迫切需要為醫療服務需求及社會經濟福利。另外提供照護服務資源時應同時考慮到家屬、服務多樣性及可及性等。

Background: An increasing number of elders is suffering from chronic conditions. Because the pattern of chronic disease is changing, care needs of elders and families are becoming more complex. Studies showed that the needs of elders with chronic conditions were often unmet. Purpose: The purpose of this study was to investigate the care needs of disabled elders with chronic conditions through a holistic perspective. Method: This was a qualitative study. Subjects were diagnosed disabled elders with chronic conditions were recruited using purposive sampling approach. Ten disabled elders with chronic conditions were interviewed individually with an interview guide to explore care needs. Meanwhile, a focus group with 6 family members was led by the investigator to explore the needs of family members taking care of disabled elders with chronic conditions. Data were analyzed through content analysis method along with constant comparison technique. Result: A total of eight themes was found from individual interviews?: distressed disease problems, support of home life, diet and nutrition, insufficient finance and inflexible welfare, lacking of social activities, helpless and depressed, medical convenience and medical resources. Three themes were sorted out from the focus group discussion, problem response and resolving, medical treatment recommendations and the sources of health care information. Conclusion: The needs of disabled elders with chronic conditions include physical, psychosocial and spiritual aspects. More important issues were the use of medical resources and social welfare. Providing resources for family members to take care of disabled elders with chronic conditions need to be considered. In designing for care of disabled elders with chronic condition, we need to consider the following important issues: diversity of care services and accesses of care services.