照管中心基本日常生活活動能力評估量表與巴氏量表評估比較:以尋求或使用長期照顧服務者為例

Abstract

背景：人口老化議題一直是台灣各界所討論的焦點，也是未來所需要面對的問題，隨著國內長期照護政策的發展，我國長期照護服務體系逐漸開始建立，至今主要有兩大體系，分別是政府補助的長期照護服務與外籍看護服務，兩種服務需求的評估方式採用不同標準，政府補助的長期照護服務用的是照管中心六項功能評估量表，而外籍看護服務是利用巴氏量表來評定使用資格。 目的：本研究目的在於探討並比較長期照顧管理中心基本日常生活活動能力評估量表之兩種編碼方式之評估結果，並使用統計方法分析長期照顧管理中心日常生活功能評估量表不同編碼方式之差異。 方法：本研究由研究者自行評估，使用長期照顧管理中心基本日常生活活動能力評估量表，分別比較量表內巴氏量表編碼之方式與六項功能評估之編碼方式評估結果之差異，研究之場所為失能者所屬機構或家中。研究對象為尋求長期照顧管理中心－南區服務站之協助，欲申請長期照顧服務之失能老人，以及台北市新北市長期照顧機構中所收容之長輩，共計100位，無排除之個案。統計方法使用斯皮曼等級相關係數(Spearman's rank correlation coefficient)與魏克森符號等級檢定(Wilcoxon sign rank test)進行兩種編碼之方式之比較。 研究結果：研究結果顯示，基本日常生活活動能力評估量表，內部兩種評估方式，巴氏評估方式與六項評估方式信、效度皆佳(Cronbach’s α＞0.7，驗證性因素分析結果，巴氏評估方式：χ2/ df =4.287、RMSEA =0.181、CFI =0.951; 六項評估方式：χ2/ df =2.26、RMSEA =0.112、CFI =0.981) 。斯皮曼等級相關係數結果顯示，六項評估方式與巴氏評估方式評估結果之相關係數為0.931(P<0.05)，達統計上顯著相關，而在六項評估方式分類為無失能者與巴氏評估方式之相關係數為1.000(P<0.05)，達統計上顯著相關；輕度失能者與巴氏評估方式之相關係數為0.453(P>0.05)，未達統計上顯著相關；中度失能者與巴氏評估方式之相關係數為0.290(P>0.05)，未達統計上顯著相關；重度失能者與巴氏評估方式之相關係數為0.827(P<0.05)，達統計上顯著相關。魏克森符號等級檢定顯示，六項評估結果與巴氏評估結果達統計上顯著差異(P<0.05)，為重症輕判，而六項評估方式分類為無失能者與巴氏評估結果未達統計上顯著差異(P>0.05)，為輕症重判；輕度失能者與巴氏評估結果未達統計上顯著差異(P>0.05)，為輕症重判；中度失能者與巴氏評估結果未達統計上顯著差異(P>0.05)，為輕症重判；重度失能者與巴氏評估結果達統計上顯著差異(P<0.05)，為重症輕判。 結論與建議：本研究結果指出在重度失能的個案，以巴氏評估方式為比較基準，六項評估方式與巴氏評估方式之評估結果達統計上顯著差異且會有重症輕判的情形發生，造成差異的原因，可能是巴氏評估方式內特定評估項目之敏感度，像是偵測早期失能階段的上下樓梯，然而六項評估方式並無此評估項目，因為台灣未來五年後將會進入高齡社會，未來台灣對於長期照護需求評估與發展一個整合性的的評估工具是相當重要的。

Background: Population aging has been widely discussed in Taiwan. As such policy for caring older adults developing, there are two authorities conducting long-term care (LTC) services to those who are eligible for disability,which are 10-year plan for LTC programs and regulations on the permission and administration of the employment of foreign workers. The standards and assessments for eligible rules between these two authorities are quite different. In the requirement of 10-year plan for LTC programs, the eligible criteria are based on 6-item functions assessments, whereas the requirement in regulations on the permission and administration of the employment foreign workers are based on Barthel Index. Purpose: The purpose of this study is to compare the context and scoring rules between 6-item functions assessment and Barthel Index.We used advanced statistic method to identify scoring rules and outcome measurements between these two assessments. Method: Samples are collected by approaching transferring cases via the southern branch of LTC management center in Taipei City and people who lived in LTC facilities in Taipei City or New Taipei City. The inclusion criteria are those who apply for LTC services. 100 cases are included in this study. Spearman's rank correlation and Wilcoxon sign rank test are used in comparing 6-item functions assessments and Barthel Index. Result: Results indicated the reliability and validity of both 6-items functions assessment and Barthel Index were Acceptable(Cronbach’s α＞0.7;Confirmatory Factor Analysis results: Barthel Index：χ2/ df =4.287、RMSEA =0.181、CFI =0.951; 6-items functions assessment：χ2/ df =2.26、RMSEA =0.112、CFI =0.981). The 6-items functions assessment and Barthel Index had a significant correlation and Spearman's rank correlation coefficient was 0.931(p <0.05). The correlation coefficient of 6-items functions assessment and Barthel Index of people who evaluated non-disable level by Barthel Index was 1.000(p < 0.05). The correlation coefficient of 6-items functions assessment and Barthel Index of people who evaluated low-disable level by Barthel Index was 0.453(p >0.05). The correlation coefficient of 6-items functions assessment and Barthel Index of people who evaluated mid-disable level by Barthel Index was 0.290(p >0.05). The correlation coefficient of 6-items functions assessment and Barthel Index of people who evaluated high-disable level by Barthel Index was 0.827(p <0.05). For the whole population, the result of Wilcoxon sign rank test between 6-items functions assessment and Barthel Index was significant(p <0.05), indicating 6-items functions assessment tended to underestimate the disability level in comparing to Barthel index. For non-disabled poeple, the result of Wilcoxon sign rank test was non-significant(p >0.05), indicating 6-items functions assessment tended to overestimate the disability level in comparing to Barthel index. For low-disabled people, The result of Wilcoxon sign rank test was non-significant(p >0.05), indicating 6-items functions assessment tended to overestimate the disability level in comparing to Barthel index.For mid-disabled people ,The result of Wilcoxon sign rank test was non-significant(p >0.05), indicating 6-items functions assessment tended to overestimate the disability level in comparing to Barthel index. For high-disabled people, the result of Wilcoxon sign rank test was significant(p <0.05), indicating 6-items functions assessment tended to underestimate the disability level in comparing to Barthel index. Conclusions and recommendations: Scoring ranking between 6-item functions assessments and Barthel Index were significantly different in those who were servely disabled. Poeple who evaluted as severely disabled by Barthel Index were tended to be evaluated as moderately diabled by 6-item functions assessment. This result might be due to the sensitivity of specific questions in Barthel Index are aiming for detecting early stage disabilities, such as climbing stairs, which were not included in 6-item functions assessment. As Taiwan enters the aged society in the next 5 years, it is important to futher investigate the tools used for evaluating long-term care needs in Taiwan and develop a single tool is strongly recommended.