亞急性腦中風病人照顧者之生活品質探討

Abstract

背景：腦中風為全球人口死亡及失能要因之一，且多年來皆為我國十大死因之前幾位，腦中風意外倖存後造成病人失能與家庭社會的沉重疾病負擔，中風病人的照顧者亦面臨重大挑戰，醫療專業人員亟需理解中風病人之照顧者需求與負荷，以便提供更為適切的延續性照護計畫，降低中風帶給病人與家庭社會的巨大負擔。 方法：於台灣北部某醫學中心復健科病房收案亞急性中風病人之主要照顧者，追蹤六個月，問卷收案共四次，使用具有良好信效度之工具評估照顧者生活品質、照顧負荷、照顧者性格、照顧者焦慮憂鬱狀況及中風病人日常活動功能等，運用廣義估計方程式（Generalized Estimating Equations, GEE）探討影響照顧者生活品質之相關因素。 結果：共納入40位亞急性腦中風病人之非雇傭關係的照顧者，六個月中收案四次後，運用廣義估計方程式進行分析，發現照顧者之生活品質與性格特質無顯著相關；照顧者較佳的生活品質相關因素包含過去曾有照顧經驗、家庭經濟較寬裕及中風病人日常生活功能分數較佳；而照顧者生活品質較差的相關因素則有教育程度較低（高中學歷或以下）或年紀較高（超過66歲）、照顧者自覺照顧負荷大或生活受影響大、照顧者有身心症狀（例如失眠、感覺失去希望、緊張不安、手腳抖或麻等），GEE模型的整體解釋力為85%（Multiple R2 = 0.8507）。 結論：本研究發現照顧者若為社會經濟背景較弱勢者，其生活品質較差，建議可優先提供協助；照顧者過去沒有照顧經驗、感到照顧負荷沉重者、出現身心症狀者，均需要更多的關注與資源挹注，例如順利銜接長照或轉介社福資源、精準評估個別照護需求、積極教導嚴重日常生活依賴之中風者的返家照護技巧等，方能提供腦中風病人照顧者較佳的生活品質，永續提供亞急性中風病人之長期陪伴與照顧支援。

Background: Stroke is one of the leading causes of death and disability worldwide and has been among the top ten causes of death in Taiwan for years. Stroke survivors often experience disability, leading to a heavy burden on patients and their families. Caregivers of stroke patients also face significant challenges. Healthcare professionals must understand the needs and burden of caregivers of stroke patients to provide appropriate continuity of care plans and reduce the immense burden on patients, families, and society. Method: This study recruited 40 primary caregivers of stroke patients admitted to the rehabilitation department of a medical center in northern Taiwan. A six-month follow-up was conducted with four data collection points. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) was used to assess the caregivers' quality of life. The Zarit Burden Interview (ZBI) was used to assess caregiver burden, the Eysenck Personality Questionnaire-Revised Short Scale (EPQR-S) was used to assess caregiver personality traits, and the Chinese Health Questionnaire-12 (CHQ-12) was used to assess anxiety and depression symptoms. Primary demographic data of the caregivers and daily activity functional scores of the stroke patients were collected. Generalized Estimating Equations (GEE) were used to explore the factors influencing caregivers' quality of life. Results: A total of 40 non-employment caregivers of stroke patients were included in the study. The GEE analysis revealed no association between caregivers' quality of life and personality traits. Factors associated with better caregiver quality of life are prior caregiving experience, higher family economic status, and better daily life functional scores of stroke patients. On the other hand, lower educational level (high school degree or below), age over 66 years, perceived caregiving burden or significant impact on daily life, and presence of physical and mental symptoms (such as insomnia, loss of hope, anxiety, tremors, or numbness) was negatively correlated with caregiver quality of life. The overall model explained 85% of the variance (Multiple R2 = 0.8507). Conclusion: The study found that when caregivers of stroke patients at a socioeconomic disadvantage have poorer quality of life and thus need prioritized assistance. Caregivers with no prior caring experience, those who experience significant caregiving burden, and those who exhibit physical and mental symptoms require more support resources, such as smooth access to long-term care or referrals to social welfare resources, accurate assessment of individual needs, and teaching of caregiving skills for patients with severe dependence in daily activities. These measures can provide a better quality of life for caregivers of stroke patients and enable sustainable long-term support and care for stroke patients.