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

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 (p< .001), rewards of caregiver learning (p< .05), rewards of being there (p< .001) and rewards of meaning for oneself (p< .001). In addition, the older the patient with dementia, the better the overall rewards (β= .025, (p< .05), rewards of caregiver learning (β= .028, (p< .05), rewards of being there (β= .025, (p< .05), and rewards of meaning for oneself (β= .019, (p< .05) was found. At the same time, the older the family caregiver, the better the rewards of meaning (β= .013, (p< .05) and rewards of being there (β= .013, (p< .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.