從居住安排與社會支持體系檢視失能老人之ADL與IADL的未滿足需求

Examining the Unmet Needs of ADL and IADL from Living Arrangement and Social Support System for the Disabled Elderly

研究目的：為瞭解功能障礙老人之ADL與IADL未滿足需求盛行率，並探討未滿足需求的影響因素，本研究將「居住安排」視為社會支持體系的結構，將「未滿足需求的表達」當作社會支持體系功能的指標，假設老人未滿足需求的表達會因居住安排（結構因素）及社會支持體系的組成（功能因素）而有差異。研究方法：資料來自行政院衛生署家庭計畫研究所於1996年及1999年舉辦的「台灣地區中老年身心社會生活狀況長期追蹤調查」資料，以SAS 8.2版及STATA軟體進行層級邏輯迴歸模式（hierarchical logistic regression model）及邏輯複迴歸模式（logistic regression model）分析。研究結果：本研究發現居住安排為未滿足需求的顯著影響變項，獨居者乃是未滿足需求的高危險群，但其中有三分之一的老人並未表達未滿足需求，顯示獨居老人的異質性應亦被重視；其次，多數失能老人的照顧需求滿足來源為非正式社會支持網絡，但由配偶擔任照顧者時，失能老人表達未滿足需求的比例相對較高。研究結論：但從居住安排的選擇可見老人對於原居住地的留戀，如何彌補老人照顧需求與家庭照顧的落差，針對老人之未滿足需求規劃適切的社區及居家支持體系，盡可能維持國家與家庭照顧責任之平衡，乃是我國長期照顧政策規劃時必須面對的主要課題。

Purpose: In order to assess the prevalence of unmet needs in ADLs and IADLs, and identify the relevant factors of unmet needs, my study regarded “living arrangements” as the structural indicator of informal social support networks, and considered “the expression of unmet needs” as the functional indicator of the function of support networks. I supposed that living arrangements (structural indicators) and social support system (functional indicators) were the important predictors of unmet needs. Methods: The data which was conducted by National Institute of Family Planning, Department of Health, Executive Yuan, in 1996, and 1999. Hierarchical logistic regression model and logistic regression model were employed for the purposes of data analysis Results: Elderly people who lived alone were the highrisk group of unmet needs. However one third among them had not expressed unmet needs. Secondly, though most disabled elderly people received the care services provided from informal support system, it was about 30% among the elderly people in the community that had once experienced the situations of unmet needs. Especially when their spouse was the caregiver, the proportion of the disabled elderly who expressed unmet needs were relatively high. It implies that the situation of elderly-cared-by-elderly deserved more attentions. Conclusions: The government should provide supports for the family care system. Thus, the family can keep its ability and quality of service, and the elderly people can be taken care of in different living arrangements.