探討失智社區服務據點使用者的未滿足需求

Abstract

研究背景：隨著高齡人口比例持續攀升，失智症已被視為我國長期照顧體系中重要之公共衛生議題。為回應失智症者及其家庭之照護需求，中央政府自長期照顧政策中推動失智社區服務據點，期透過社區型服務延緩功能退化並支持在地生活。然而，失智症者即使已使用相關服務，是否仍存在未滿足需求，以及其影響因素為何，仍有進一步探討之必要。本研究旨在探討失智社區服務據點使用者之未滿足需求樣態，並分析影響其未滿足需求之相關因子。

研究目的：1)探討失智社區服務據點使用者的未滿足需求、2)探討影響失智社區服務據點使用者的未滿足需求相關因子。

研究方法：本研究採橫斷面研究設計，以宜蘭縣8家失智社區服務據點之使用者為研究對象，由主要照顧者代填問卷蒐集資料。研究工具採用陳雅美教授研究團隊所發展之「長期照顧未滿足需求評估量表」，涵蓋14項未滿足需求面向，並依二階段填答方式評估需求存在與未滿足程度。自變項包含前傾因素（性別、年齡、教育程度）、使能因素（福利身分別、居住狀況、長照服務使用情形）及需要因素（疾病數），並納入「是否有需要幫忙」作為控制變項。資料分析依序進行描述性統計分析、雙變項分析及多變項分析，以探討各影響因素與未滿足需求之關聯情形。

研究結果：失智社區服務據點使用者之未滿足需求前五名為「身體健康」（83.77%）、「交通接送」（80.52%）、「心理健康」（79.87%）、「家務處理」（75.97%）及「外出活動」(75.97%)；進一步分析未滿足需求程度之整體平均數為2.04分（SD = 0.59）。各題中以「交通接送」（M = 2.63，SD = 0.99）及「身體健康」（M = 2.52，SD = 0.90）之未滿足需求程度最高，其次為「外出活動」（M = 2.45，SD = 0.98）、「家務處理」（M = 2.42，SD = 1.00）及「心理健康」（M = 2.40，SD = 0.91）；前傾因素中，相較於男性，女性在整體未滿足需求數上明顯較低（B = －1.010，p＜.05），且年齡較低之失智症者，於未滿足需求「困擾行為」面向達顯著影響，年齡每增加1歲，其困擾行為未滿足需求程度平均降低 0.013分（B = －0.013，p＜.05）；教育程度與未滿足需求之間未達統計顯著。使能因素方面，福利身分別於各項未滿足需求模型中均未達統計上顯著；居住狀況則於未滿足需求「家務處理」面向達統計上顯著（B =0.302，p＜.05），顯示與家屬同住或其他居住型態之失智者，其家務協助相關未滿足需求較高；此外，長照服務使用數與整體未滿足需求數（B = 0.775，p＜.01）、整體未滿足需求程度（B = 2.156，p＜.001）及多項需求面向呈正向關聯。需要因素中，疾病數與生活資源（B = 0.118，p＜.01）及通訊軟體（B = 0.088，p＜.05）達顯著影響；控制變項「是否有需要幫忙」於整體及各面向未滿足需求中皆呈現顯著影響。

結論與建議：本研究顯示，失智社區服務據點使用者即使已接受社區型失智照護服務，仍普遍存在多面向未滿足需求，顯示單一社區據點服務模式尚難全面回應這些輕度失智症者複雜且多元之照護需求。其中，以「交通接送」、「身體健康」、「外出活動」、「家務處理」及「心理健康」等面向之需求最為突出，反映現行社區型服務在健康管理、行動支持與生活功能協助上，仍有進一步強化空間。在影響因素方面，性別、年齡、居住狀況、長照服務使用情形、疾病數及是否有需要幫忙，均與未滿足需求呈現不同程度之關聯，顯示失智症者之未滿足需求並非僅由個人健康狀態所致，而係前傾因素、使能因素與需要因素在制度性照護資源與實際照顧支持情境中共同作用之結果。基於上述發現，建議未來失智症照護政策應依據未滿足需求之實證結果，檢視並調整失智社區服務據點之服務內容與功能定位，強化健康管理之跨專業合作之整合照護模式，並將交通支持視為促進社區生活連結與醫療銜接的重要配套。

Background：With the rapid acceleration of population aging, dementia has become a critical public health issue within Taiwan’s long-term care system. In response to the care needs of people with dementia and their families, the central government has promoted dementia community care centers as part of long-term care policy, aiming to delay functional decline and support aging in place through community-based services. However, whether people with dementia continue to experience unmet needs despite using such services, and what factors influence these unmet needs, remain insufficiently explored. This study aimed to examine the patterns of unmet needs among users of dementia community care centers and to analyze factors associated with these unmet needs. Study Purposes：1) To identify unmet care needs among users of dementia community care centers、2) To examine factors associated with unmet needs among users of dementia community care centers. Method：This study employed a cross-sectional design. Participants were users of eight dementia community care centers in Yilan County, Taiwan, with data collected through proxy questionnaires completed by primary caregivers. The study instrument was the Long-Term Care Unmet Needs Assessment Scale developed by Professor Ya-Mei Chen’s research team, which covers 14 domains of unmet needs and adopts a two-stage response format to assess both the presence of needs and the degree to which those needs remain unmet. Independent variables included predisposing factors (sex, age, and educational level), enabling factors (welfare status, living arrangement, and long-term care service utilization), and need factors (number of chronic conditions). The variable “need for assistance” was included as a control variable. Data analyses were conducted sequentially using descriptive statistics, bivariate analyses, and multivariable analyses to examine associations between influencing factors and unmet needs. Results：The top five unmet needs among users of Dementia Community Care Centers were physical health (83.77%), transportation services (80.52%), mental health (79.87%), household management (75.97%), and outdoor activities (75.97%). The overall mean level of unmet needs was 2.04 (SD = 0.59). At the item level, unmet need severity was highest for transportation services (M = 2.63, SD = 0.99) and physical health (M = 2.52, SD = 0.90), followed by outdoor activities (M = 2.45, SD = 0.98), household management (M = 2.42, SD = 1.00), and mental health (M = 2.40, SD = 0.91). Regarding predisposing factors, females had significantly fewer overall unmet needs than males (B = −1.010, p < .05). In addition, younger individuals with dementia demonstrated significantly higher unmet needs in the domain of behavioral disturbances. For each one-year increase in age, unmet needs related to behavioral disturbances decreased by 0.013 points on average (B = −0.013, p < .05). Educational level was not significantly associated with unmet needs. With respect to enabling factors, welfare status was not significantly associated with any unmet need models. However, living arrangement was significantly associated with unmet needs in household management (B = 0.302, p < .05), indicating that individuals living with family members or in non-alone living arrangements had higher unmet needs related to household assistance. Furthermore, the number of long-term care services utilized was positively associated with the total number of unmet needs (B = 0.775, p < .01), the overall level of unmet need severity (B = 2.156, p < .001), and several specific need domains. Among need factors, the number of comorbid diseases was significantly associated with unmet needs in living resources (B = 0.118, p < .01) and communication technology use (B = 0.088, p < .05). The control variable “need for assistance” showed significant effects across both overall and domain-specific unmet need models. Discussion and Conclusions：This study demonstrates that even though service users of dementia community care centers had already received community-based dementia care, multiple unmet needs remained prevalent. These findings suggest that a single community service model may be insufficient to comprehensively address the complex and multidimensional care needs of individuals with mild dementia. The most prominent unmet needs were identified in the domains of transportation services, physical health, outdoor activities, household management, and psychological health. This pattern indicates that current community-based services may require further strengthening in the areas of health management, mobility support, and assistance with daily functioning. Regarding influencing factors, sex, age, living arrangement, utilization of long-term care services, number of chronic conditions, and need for assistance were associated with unmet needs to varying degrees. These findings suggest that unmet needs among individuals with dementia are not solely attributable to personal health status. Rather, they result from the combined influence of predisposing, enabling, and need factors operating within the broader context of institutional care resources and real-world caregiving environments. Based on these findings, future dementia care policies should incorporate empirical evidence on unmet needs to reassess and refine the service scope and functional positioning of dementia community care centers. Strengthening interdisciplinary collaboration in health management and promoting integrated care models may enhance service responsiveness. In addition, transportation support should be recognized as a critical enabling component for maintaining community engagement and facilitating continuity of medical care. Study Purposes：1) To identify unmet care needs among users of dementia community service centers、2) To examine factors associated with unmet needs among users of dementia community service centers. Method：This study employed a cross-sectional design. Participants were users of eight dementia community service centers in Yilan County, Taiwan, with data collected through proxy questionnaires completed by primary caregivers. The study instrument was the Long-Term Care Unmet Needs Assessment Scale developed by Professor Ya-Mei Chen’s research team, which covers 14 domains of unmet needs and adopts a two-stage response format to assess both the presence of needs and the degree to which those needs remain unmet. Independent variables included predisposing factors (sex, age, and educational level), enabling factors (welfare status, living arrangement, and long-term care service utilization), and need factors (number of chronic conditions). The variable “need for assistance” was included as a control variable. Data analyses were conducted sequentially using descriptive statistics, bivariate analyses, and multivariable analyses to examine associations between influencing factors and unmet needs. Results：Among service users of dementia community service centers, the five most prevalent unmet needs were physical health (83.77%), transportation services (80.52%), psychological health (79.87%), household management (75.97%), and outdoor activities (75.97%). Further analysis of unmet need severity indicated that the overall mean unmet need score was 2.04 (SD = 0.59). At the item level, unmet need severity was highest for transportation services (M = 2.63, SD = 0.99) and physical health (M = 2.52, SD = 0.90), followed by outdoor activities (M = 2.45, SD = 0.98), household management (M = 2.42, SD = 1.00), and psychological health (M = 2.40, SD = 0.91).With respect to predisposing factors, females had significantly fewer overall unmet needs than males (B = −1.010, p < .05). Younger age was significantly associated with unmet needs in the domain of behavioral and psychological symptoms, such that each additional year of age was associated with a 0.013-point decrease in unmet need severity (B = −0.013, p < .05). Educational attainment was not significantly associated with unmet needs.Regarding enabling factors, service users’ social-welfare status was not significantly associated with unmet needs in any of the regression models. Living arrangement was significantly associated with unmet needs in household management (B = 0.302, p < .05), indicating that individuals living with family members or in alternative living arrangements reported higher unmet needs related to household assistance. In addition, the number of long-term care services utilized was positively associated with overall unmet need counts (B = 0.775, p < .01), overall unmet need severity (B = 2.156, p < .001), and several specific unmet need domains.Among need factors, the number of chronic conditions was significantly associated with unmet needs in community resources (B = 0.118, p < .01) and communication technology use (B = 0.088, p < .05). The control variable, need for assistance, showed significant associations across both overall and domain-specific unmet need outcomes. Discussion and Conclusions：This study demonstrates that even though service users of dementia community service centers had already received community-based dementia care, multiple unmet needs remained prevalent. These findings suggest that a single community service model may be insufficient to comprehensively address the complex and multidimensional care needs of individuals with mild dementia. The most prominent unmet needs were identified in the domains of transportation services, physical health, outdoor activities, household management, and psychological health. This pattern indicates that current community-based services may require further strengthening in the areas of health management, mobility support, and assistance with daily functioning. Regarding influencing factors, sex, age, living arrangement, utilization of long-term care services, number of chronic conditions, and need for assistance were associated with unmet needs to varying degrees. These findings suggest that unmet needs among individuals with dementia are not solely attributable to personal health status. Rather, they result from the combined influence of predisposing, enabling, and need factors operating within the broader context of institutional care resources and real-world caregiving environments. Based on these findings, future dementia care policies should incorporate empirical evidence on unmet needs to reassess and refine the service scope and functional positioning of dementia community service centers. Strengthening interdisciplinary collaboration in health management and promoting integrated care models may enhance service responsiveness. In addition, transportation support should be recognized as a critical enabling component for maintaining community engagement and facilitating continuity of medical care.