失智症家庭照護需求評估表之發展與信效度測試

Development and Psychometric Validation of a Tool for Assessing the Care Needs of Families of Patients With Dementia

背景：全球人口快速高齡化導致失智症的高盛行率。多數失智症者居住於家中且由家庭照顧者提供照護。因此，失智症個案及家庭需要跨領域整體評估與服務支援以滿足其複雜的照護需求。目的：從跨專業領域角度建構「失智症家庭照護需求評估表」之題項並檢驗信效度。方法：依據文獻查證及臨床經驗擬定初步題項並實際於失智照護諮詢門診進行個案家庭照顧者的測試，幾經跨領域團隊討論修正後付諸專家檢定內容效度。再於台灣南部某醫學中心神經科門診進行問卷調查，以全國失智嚴重程度的比例配額取樣，共收集200對失智症者及其主要家庭照顧者，最後進行信效度分析。結果：本工具共基本資料21題及照護需求31題題項分布於八個次量表，含語言與溝通、日常生活功能、睡眠、活動安排、營養及飲食、行為精神症狀、照顧者壓力、照顧資源協助。整體專家內容效度為.99|各次量表之內在一致性信度α值介於.625至.905。其中，日常生活功能次量表與巴氏日常生活活動量表（Barthel Index）、行為精神症狀次量表與簡短版神經精神行為評估表（Neuropsychiatric Inventory Questionnaire）之同時效度分別為r = -.889及.750（p < .001）。結論／實務應用：本評估表具良好的信效度，內容簡潔易懂且照顧者能快速填答，有利於跨專業失智照護人員在門診、失智症共照中心或出院準備服務中快速獲得失智症個案與家庭照護需求資訊，作為擬定跨領域照護計畫的參考，期能提升失智症家庭照顧及生活品質。

Background: The rapid aging of the global population has sharply increased the prevalence of dementia. Most people with dementia (PwD) live at home and are cared for by family caregivers. The complicated care needs of PwD and family caregivers necessitate the provision of comprehensive and transdisciplinary assessment and service support. Purpose: The purpose of this study was to construct the contents of the ''Assessment Tool for Family Care Needs of People with Dementia'' using a transdisciplinary perspective and to establish the reliability and validity of this tool. Methods: Based on a literature review and clinical experience, the preliminary items of the assessment tool were drawn up and pilot tests of the case were conducted in the Clinic for Dementia Care. The transdisciplinary research team discussed the pilot tests and verified the preliminary items, and then experts were invited to assess the content validity of the assessment tool. Next, quota sampling was conducted in accordance with the national proportion of the severity of dementia and the questionnaire surveys were administered in an outpatient department of neurology at a medical center in southern Taiwan. Two hundred dyads of PwD and their family caregivers participated in the survey. Reliability and validity analysis of the data were completed. Results: The assessment tool contains 21 items of demographic data and 31 items in the eight subscales of ''language and communication'', ''activities of daily living'', ''sleep'', ''activity arrangements'', ''nutrition and diet'', ''behavioral and psychological symptoms of dementia'', ''care stress'', and ''obtaining resources''. The overall content validity of the assessment tool was .99 and the Cronbach's alpha of each subscale ranged between .625 and .905. The concurrent validities of the ''activities of daily living'' subscale and the ''behavioral and psychological symptoms of dementia'' subscale were, respectively, correlated with the Barthel Index (r = -.889, p < .001) and the Neuropsychiatric Inventory Questionnaire (r = .750, p < .001). Conclusions/ Implications for Practice: The assessment tool was assessed as having satisfactory validity and reliability. Moreover, the tool was clear and concise, and was able to be completed quickly by the caregivers. Transdisciplinary professionals involved in dementia care may use this assessment tool in outpatient departments, centers for integrated dementia care, and discharge preparation services to acquire information related to family care needs. The results of the assessment tool may be used as a reference in developing appropriate transdisciplinary care plans to improve the quality of care and quality of life of families of patients with dementia.