探討南投縣中高齡失智症家庭照顧者之照顧自我效能與照顧負荷之關聯

Abstract

高齡少子化與人口流失對南投縣影響甚鉅，2024年南投縣高齡人口比例已達20.83%，提前進入超高齡社會。導致潛在被照顧者與失智人口增加，使照顧人力需求增長。然而在南投縣勞動力外移、城鄉資源不均的挑戰下，衍生照顧人力缺口，加速推進中高齡者投入失智症照顧工作。南投縣之長期照顧服務涵蓋率冠及全國，照顧者資源多依賴政府提供，但我國長期照顧服務強調社區主義，於南投地廣人稀、人口流失、多山地形、族群多元等因素下使布建社區照顧服務面臨挑戰。加上現有家庭照顧者服務多以照顧品質與持續性為關注焦點，較少獲得以照顧者為主體之支持。凸顯探討照顧者自身應對的照顧自我效能與照顧負荷情況的重要性，期望藉此了解照顧者的因應能力與負荷，並納入背景變項看見環境因素與人口特性之作用。本研究使用問卷調查法，採立意取樣，研究對象為南投縣392位中高齡失智症家庭照顧者，經SPSS統計軟體分析。研究結果顯示，照顧自我效能與照顧負荷之間呈現負相關，即當照顧自我效能越高，其照顧負荷越低。此外，照顧自我效能與照顧負荷亦受人口背景特性影響導致差異，如：性別、年齡、就業狀態、照顧時數與頻率、有無照顧替手與服務使用頻率等人口背景，皆對自我效能與負荷有顯著影響。研究發現照顧自我效能與照顧負荷受多重因素影響，單一層面的提升仍有限。建議後續政策與服務設計可進一步關注照顧者多元人口特性與支持需求，並發展以照顧者為主體之服務評估機制，透過外在支持提供照顧資源營造友善照顧環境，以利促進南投縣中高齡失智症家庭照顧者自身應對的照顧自我效能，並共同減少其照顧負荷。

The elderly population of Nantou County reaches 20.83% and enters a super-aged society due to the impacts of aging, declining birth rate, and population loss. This situation results in the rising numbers of potential care recipients and dementia patients, leading to an increasing demand for caregivers. However, to mitigate the gap between the demand for caregiving personnel and the continuous loss of labor force in Nantou, middle- or older-aged individuals are pushed to engage in caregiving work. Nantou has the highest coverage rate of long-term care services in Taiwan so the resources for caregiving mostly are provided by the government. Taiwan’s long-term care services emphasize communitarianism. However, the vast and sparsely populated area, population loss, mountainous terrain, and diverse ethnic groups in Nantou make the deployment of communitarian care services more challenging. Additionally, existing family caregiver services focus more on care quality and continuity, ignoring the caregiver-centered support. It is important to explore caregivers' self-efficacy in caregiving and their caregiving burden. By incorporating background variables, this study aims to understand the role of environmental factors and demographic characteristics in caregivers' coping abilities and burdens. This study purposively sampled 392 middle- and older-aged family caregivers of dementia patients in Nantou County with a questionnaire and analyzed the data by SPSS statistical software. The results indicated a negative correlation between caregiving self-efficacy and caregiving burden. Additionally, both caregiving self-efficacy and caregiver burden were influenced by demographic characteristics such as gender, age, employment status, the dementia severity of the care recipient, caregiving frequency, caregiving hours, availability of substitute caregivers, and service usage. The conclusion points out that while caregiving self-efficacy impacts caregiving burden, its effect is less significant than demographic characteristics. Therefore, when addressing caregivers' burden, it is crucial not only to consider the adequacy of caregivers' self-efficacy but also to emphasize the impact of the background environment. External support to provide caregiving resources and create a caregiver-friendly environment, as well as caregiver-centered services to enhance caregiving self-efficacy, should be considered.