從社會支持角度探討臺灣雙重老化智能障礙者家庭照顧者之照顧負荷

On the Caregiving Burden of Aging Parents Caring for Their Adult Child with Intellectual Disability from the Social Support Perspective

臺灣約有90％的智能障礙者住在家中，且大多數是由父母擔任主要照顧者，當智障者邁入中高齡階段，父母也逐漸年邁，其照顧者角色功能將逐漸衰退，就會形成雙重老化家庭的現象，雙老家庭中，老化智障者與老年照顧者的組合面臨著多重困境。過往研究鮮少以照顧者為主體進行探究，且智障者老化研究多以質性方法探索照顧者經驗，對正式、非正式社會支持與照顧負荷間的關係，臺灣目前較缺乏解釋性之實證資料。因此，本文採用調查研究法，從照顧者角度出發，運用補充模式觀點，關注不同支持來源或功能之「支持組合」對減輕照顧負荷之影響。本文採用立意抽樣，以台灣北部地區服務成年智障者或承接縣市政府雙老家庭服務方案之心智障礙服務機構為基礎（共7家服務機構），共收集74份問卷。以單因子變異數分析來驗證研究假設，並以多元線性迴歸分析探究在雙老家庭中影響照顧者之照顧負荷的相關因素。研究結果支持補充模式的研究假設，即在雙老家庭照顧者所獲得的社會支持中，若屬於非正式支持程度較高的照顧支持組合，該組合的照顧負荷較低，換言之，以「非正式支持」為主、「正式支持」為輔的支持組合，對多數雙老家庭而言應為較佳照顧模式。在照顧者方面，研究發現健康狀況可顯著預測照顧負荷，即健康狀況越低、照顧負荷越高。而在照顧者的社會支持程度與照顧負荷方面，研究發現「資訊性支持」、「情感性支持」之分數與「照顧負荷」分數有顯著負相關。再經迴歸分析發現，健康狀況、情感性支持可顯著預測照顧負荷，健康狀況越差、情感性支持程度越低，照顧負荷越高。本文最後建議，在雙老家庭的福利服務上，政府應以「非正式為主、正式支持為輔」之基礎強化照顧支持服務、應更多關注雙老家庭照顧者需求|此外，在服務過程中，情感性支持服務具重要性，而工具性支持服務則有待強化，以減低雙老家庭照顧者之照顧負荷。

In Taiwan, there are about 90% of the intellectual disabled living at home, and most of their caregivers are their parents. As the intellectual disability people get older, their parents are getting older, and the aging parents are gradually unable to take care of their children. In the past few decades, there had been few studies focused on caregivers, and most of these researches are based on qualitative research. Furthermore, empirical data on the relationship between formal social support, informal social support and caregiving burden in Taiwan are insufficient. Thus, this study used survey research and adopted the Supplemental Model to examine the effect between different support combinations and whether they can reduce the caregiving burden. This study utilized purposive sampling, and the data were gathered from the intellectual disability service agencies in northern Taiwan (total 7 institutions). Data were compiled through structured questionnaires which were interviewed by social workers. Participants were the caregivers of intellectual disability children, and a total of 74 questionnaires was received. Analysis of variance (ANOVA) was used to test the research hypothesis, and multiple regression analysis was utilized to explore the factors of caregiving burden. The results showed that the caregivers had a low level of social support and a high level of caregiving burden. In addition, the “high level of informal support” group had the lowest caregiving burden, which is consistent with the hypothesis of the Supplemental Model that the informal care system is the primary one, and the formal system is used to supplement the informal system. The study also demonstrated a significant negative correlation between “information support” and “caregiving burden,” as well as “emotional support” and “caregiving burden.” By using regression analysis, it was found that “health status” and “emotional support” can significantly predict the caregiving burden, it indicated that the poorer the caregivers' health, the lower the emotional support, and the higher the caregiving burden. According to these findings, we suggest that service providers and policy makers should improve the care support system on the basis of “mainly rely on informal system supplemented by formal system” and should pay more attention to the needs of the caregivers. In addition, service providers and policy makers should understand the importance of emotional support services. Furthermore, the instrumental support services need to be reinforced in order to reduce the caregiving burden.