從生命歷程觀點探討客家高齡者入住機構之適應感受

Hakka Elders' Adjustment to Long Term Care Facilities: A Life Course Perspective

本研究旨在探討客家老人入住機構後的適應感受，研究對象為入住新竹縣、市長期照顧2個月至1年的老人，共訪問11人。本研究採立意抽樣法，以質性研究的深度訪談及參與觀察蒐集資料，結果顯示受訪者平均年齡為80歲，女性占七成，半數以上為喪偶。研究發現老人進入非預期的失能歷程，因考量家庭的互惠性，入住機構成為不得不的選擇，入住後老人則表示有好有壞，初期多以哭泣抒發內心想家又回不了家的無奈心情，並寄託在家屬的來訪。入住後面對生活作息的改變則需時間來適應，自我調適策略則有睡覺、不去想事情、參加活動、外出走動散心等。研究中印證了客家文化重視家庭圓滿，以子為中心的價值觀，故家屬探視與情感性支持成為影響老人入住後的適應及生活品質的關鍵因素，機構則可藉由發展住民同儕、家屬及社區之多元資源及支持，重塑及發展老人多層級的護航角色。照顧工作應能融合客家文化與價值，發展「文化保護圈」做為老人適應之保護因子，讓老人的照顧工作能整合生活、社會與健康等多元面向，協助老人面對及回應生命歷程的重大改變。

This study aimed to explore the adjustment of Hakka elders to long term care facilities using a life course perspective. Samples of the study were Hakka elders in Hsinchu County and Hsinchu City, who had moved into long term care facilities within the range of two months to one year. This study applied qualitative research method with purposeful sampling. Data was collected from 11 elders in 3 different facilities via one-on-one in-depth interviews and participatory observation. The interviewees were 80 years old on average, with 70% being female and primarily widowed. Results showed that Hakka elders usually moved into long term care facilities unexpectedly after a process of family care struggles. Adjustment to long term care facilities took time and the frequent visits and emotional support provided by family members, especially sons, were key element to successful adjustment. Other adjustment strategies included cognitive change to accept the necessity of placement, participation in social activities, going out to switch mood, and sleeping off depressive thoughts. This study proved that cultural values may be used as a social convoy of Hakka elders while they tried to adjust to long term care facilities. Managers and professionals should apply more cultural values and materials in the design of care services and environment. Foremost is the importance of supporting family involvement in the various activities in the facilities. Social and community resources of the residents' Hakka origins also need to be incorporated in the long term care to facilitate Hakka elders' adjustment. Hakka culture and values should be integrated into daily care work. This study proposed the concept of ‘cultural convoy' as a positive force tohelp the adaptation of institutionalized elders. Culture may be applied to protect the elders while they respond to major life changes and maintain their total quality of life.