使用長照2.0服務的獨居失能者未滿足需求與相關因子探討

Abstract

研究背景: 全球獨居人口快速攀升，臺灣獨居戶數於2022年已達199萬戶 (27.21%)，當獨居者處於失能狀態，其急診率、住院率與入住機構的風險都較有同住者高，在沒有同住者的協助下，獨居失能者的照顧依賴正式資源的協助。過去研究大都以探討獨居者或失能者的需求為主，而未滿足需求被認為能夠很明確反映出服務水平，因此本研究問題為了解在長照服務下，獨居失能者的未滿足需求情形以及影響其相關性為何? 研究目標: 目標一 探討獨居失能者的未滿足需求情形。目標二 探討獨居失能者未滿足需求的影響因子。以使獨居失能者能夠透過正式服務的協助在地安老。 研究方法: 本研究為次級資料研究，資料來源為陳雅美博士研究，依本研究的研究對象，所選取的資料為有使用長照服務的獨居者，排除居住於住宿式機構、有聘用外籍看護者以及資料缺漏者，共有220份資料樣本。本研究採第二代安德森模式，探討前傾因子，包括性別、年齡；使能因子，包括縣市別、福利身分別;需要因子，包括是否領有身心障礙證明、長照失能等級。依變項為資料裡的12個未滿足需求面向分數，未滿足需求面向包含整體、生活自理、家務處理、身體健康、心理健康、日常活動、社會支持、輔具使用或環境安全、交通接送、移動行走、取得福利與資源、取得生活資源分類。考量長照服務使用情形可能影響未滿足需求，因此將長照服務使用項目類型設為控制變項。並以安德森模型，將自變項分為傾向因素、使能因素、需要因素，來進行分析。統計分析採用描述性統計來了解人口特性分布以及回應目標一了解研究對象的未滿足需求情形。目標二為探討未滿足需求的相關因子，採用雙變項獨立樣本T檢定、多變量複迴歸分析。 研究結果:本研究有35.12%的獨居失能者表達有未滿足需求，未滿足需求平均分數最高的前三項依序為「家務處理」(mean 2.73, SD 1.26)、「交通接送」(mean 2.51, SD 1.17)、「移動行走能力」(mean 2.45, SD 1.08)。傾向因素並未對未滿足需求有顯著影響。使能因素的「縣市別」在「心理健康」面向有顯著影響，居住於「六都獨居失能者」有較高的未滿足需求(B =-0.369 ,p <0.05)。需要因素的「長照失能等級」的「中重度獨居失能者」在未滿足需求「整體」面向(B = 3.062 ,p <0.05)、「生活自理」面向(B =0.458 ,p <0.05)、「身體健康」面向(B =0.506,p <0.01)、「輔具使用或環境安全」面向(B =0.431,p <0.001)、「移動行走能力」面向(B=0.343,p <0.01)、「福利和資源」(B=0.294,p <0.01)，皆有較高的未滿足需求。需要因素的「是否領有身心障礙手冊」，顯示「領有身心障礙手冊者」在「交通接送」面向有較高的未滿足需求 (B=0.262,p <0.05)。另控制變項「長照服務項目使用類型」的確會影響未滿足需求情形，本研究結果顯示，有「使用多元服務者」在「輔具使用或環境安全」面向(B=0.194,p <0.05)、「交通面向」(B=0.615,p <0.05)、「移動行走能力」(B=0.295,p <0.05)有較高的未滿足需求。 結論與建議:居住於六都的獨居者在「心理健康」的未滿足需求較高，可能原因為都市的社會凝聚力支持較低，使得獨居失能者孤獨感較高，未來都市中獨居者的心理健康建議優先討論;領有身障證明者在「交通接送」有較高未滿足需求的可能原因為領有身障證明者多為年輕時即處於失能狀態，多為無伴侶、無子女，外出時完全無非同住者的家人協助，另本研究領有身障證明者多為64歲以下，其有工作與社交等較多的外出需求，然而長照巴士使用目的僅限於與就醫相關;「長照服務多元服務者」在「輔具使用與環境安全」、「交通安全」、「移動行走能力」皆有顯著影響，討論其可能原因為服務使用越多，服務識能越好，對於服務的標準也會越高。而需要因素裡「失能程度」為對於獨居失能者未滿足需求最重要的因子，包括「整體」、「生活自理」、「身體健康」、「輔具與環境安全」、「移動行走」的未滿足面向皆有顯著影響，本研究建議對於中重度獨居失能者增加居家專業類型的服務安排，以及加強照顧服務連結與整合。

Background: Living alone is a global trend and is rising rapidly. The number of single-person households in Taiwan has reached 1.99 million (27.21%) in 2022. When a person who lived alone and becomes disabled, the risk of emergency department visits, hospitalization, and institutionalization is higher than those living with others. The care of disabled people living alone the lack of assistance from cohabitants so relies on formal resources and the assessment of unmet needs can be crucial. Past research has focused on the needs of either the unmet need of people who lived alone or who were disabled, but the unmet needs of disabled people who lived alone have not been fully discussed. Therefore, this study aimed to understand the unmet needs of disabled people who lived alone and the related factors. Methods: This is a secondary data analysis study using data sources from Dr. Chen Ya-Mei's research study. The data selected for this study were people who had used long-term care services and living alone and a total of 220 people were included. This study used the Andersen Health behavioral model to explore predisposing factors, including gender and age; enabling factors, including county/city and welfare status; and needs factors, including proof of disabilities and long-term care disability levels. The dependent variable was the 12 unmet needs, including unmet need in overall, Self-care, Chores, Physical Health, Psychological Health, Daily Activities, Social Support, Assistive Device /Environmental Safety, Transportation, Mobility, Welfare/Benefits and Resource. Since the use of long-term care services may affect unmet needs, the type of long-term care service use was set as a control variable. Descriptive statistics were used to understand the distribution of demographic characteristics and to respond to understand the situation of unmet needs of the study population. The second objective used multiple linear regression to analyze the factors affecting unmet needs of disabled individuals living alone under long-term care services. Results : A study found that 35.12% of who live alone and have disabilities expressed unmet needs. The top three unmet needs, in order of highest average scores, were "Chores" (mean 2.73, SD±1.26), "Transportation" (mean 2.51, SD±1.17), and " Mobility " (mean 2.45, SD±1.08). The predisposing factors did not have a significant impact on unmet needs. The enabling factor of "County/City of Residence" had a significant impact on "Psychological Health." A higher level of unmet need was observed among those living in the six metropolitan areas (B=-0.369, p<0.05). Among need factors, "Disability Levels" showed that moderate-to-severe disability level were associated with higher "Overall"(B = 3.062 ,p <0.05) ," Daily Activities" (B=0.458, p<0.05), "Physical Health" (B=0.506, p<0.01), "Assistive Device/Environmental Safety" (B=0.431, p<0.001), " Mobility " (B=0.343, p<0.01), and " Welfare/Benefits " (B=0.294, p<0.01) unmet needs. Having "Disabilities certificate" was also associated with higher unmet needs in "Transportation" (B=0.262, p<0.05). Individuals who used "Multiple Services" had higher unmet needs in "Assistive Device/Environmental safety" (B=0.194, p<0.05), "Transportation" (B=0.615, p<0.05), and " Mobility " (B=0.295, p<0.05). Conclusion: Individuals who live alone in the six metropolitan areas have higher unmet needs in "Psychological Health," possibly due to lower social support in urban areas leading to increased feelings of loneliness. Therefore, psychological health of individuals who live alone in urban areas should be given priority in future discussions. The higher unmet needs in "Transportation" among those who had "Disabilities certificates" may be due to that these individuals often became disabled at a younger age, without a spouse or children, and have no family members to assist them when they go out. Furthermore, the use of long-term care buses is limited to medical appointments only. Individuals who used multiple services had higher standards of service awareness, leading to higher expectations of services in terms of "Assistive Device /Environmental Safety", "Transportation", " Mobility ". Finally, "the level of disability" was the most important factor related to unmet needs, affecting unmet needs in many areas. Therefore, this study recommended that, in particular, the needs of who live alone with disabilities have moderate-to-severe disability levels should be given more attention.