夫妻照顧失智症長輩的韌力研究

進入超高齡社會的台灣不僅老年人口快速變化，失智症人口也快速增加，預估從2021年12月底的300,842人增加到2065年的880,000人。這個趨勢帶來大量的照顧需求，從政策準備到服務佈建，無不考驗每個失智症的家庭，特別是夫妻間對照顧失智症長輩的韌力、默契與安排。照顧失智症長輩對於照顧者是一條漫長的道路，許多必須平衡工作、生活、家庭與照顧以及克服個人的照顧壓力源，如、生理、心理、時間、情緒、經濟與家庭關係的壓力源。對照顧者而言最重要的是如何應對照顧處境中的生活、改變。據此，本研究目的為探討夫妻照顧失智症長輩之韌力，其中分為夫的個人韌力、妻的個人韌力以及夫妻的家庭韌力等三大部分。透過招募，本研究作者於2021至2022年六個月期間，進行五對夫妻照顧者的半結構式訪談，了解其照顧歷程與生命經驗，並以逐字稿和反思紀錄為資料進行主題式分析。研究結果發現，夫照顧者與妻照顧者的個人韌力可以分為覺察照顧的過程與心境、支撐照顧動力的念頭、與他人互動的過程與經驗、多重問題與應對策略等四個面向；夫妻照顧者的家庭韌力分成夫妻互動、夫妻關係、家人協助及社會資源與環境等四個面向。這些面向統整後得以解釋過去的學者所說之家庭韌力是由信念、溝通、組織所組成。同時，家庭韌力也與個人的生命經驗有關，韌力也是個體經由長時間與環境、他人的互動產生，並且是一個動態的過程。本研究的研究結果有下列發現: (一)藉由互相的理解而得知各自對於照顧的壓力與狀況如何掌握；(二)對照顧上的意見與想法不同時可以進行溝通與澄清；(三)同理對方的動機換位思考避免摩擦或誤解；(四)在經歷照顧事件後，與家人一起反思照顧事件帶來的收穫；(五)妥善使用社會資源並積極求助。另外，針對未來在夫妻照顧者韌力上的研究、實務與政策也有所建議。在研究層面，針對夫妻韌力的形成以及對其照顧壓力或調適的影響；照顧失智症與非失智症的夫妻韌力是否有差異、夫妻的性別對於韌力有何影響，是未來可以再探索的議題。針對實務工作者，對照顧失智症之夫妻照顧者，可以給與適時的給予稱讚與肯定；協助照顧者連結適當的長期照顧資源；協助家庭成員之間溝通並連結同理。最後，針對政策層面，隨著需求大量增加但家庭結構可能更為薄弱的未來，應更積極(一)提升民眾對於失智症的友善態度與基本認識；(二)建立友善的社區環境；(三)發展科技為導向的照顧者互助網路平台。雖然這個研究有許多的研究限制，但最後發現內在的優勢能、心理情緒覺察與調整，以及外在的支持與資源可讓夫妻增加韌力一起來照顧她們逐漸老化的失智症長者。

The aging and dementia population is rapidly increasing after Taiwan became an aged society as people with dementia will increase from 300,842 to 880,000 between 2021 and 2065。This trend will require lots of caregiving needs and challenges, from policy to service preparedness, as dementia families faced couples trying to care for aging dementia loved ones with resilience, conpremise and different arrangements. Caring for people with dementia is a long journey and must balance work, life, family, caregiving and many stresses. To the caregivers, the most im-portant thing is to confront different scenarios and long-term care changes during the process.Based on this situation, this research focuses on the resilience of caregivers for older adults with dementia. The purpose of the research will focus on three parts：resilience of the hus-bands, resilience of the wives, and resilience of the couples in their families. We selected 5 cou-ples who needed to care for dementia patient and conducted interviews separately during 6 months, with the focus to understanding their caring experience and life journey. Furthermore, we did theme-based analysis from the interviews made into transcribed records.The results of the analysis suggested that personal resilience of husbands can be catego-rized into four aspects, including awareness of the process and mood of caring, thoughts that support caring motivation, the process and experience of interacting with others, and multiple problems and coping strategies. On the other hand, personal resilience of wives involved addi-tional aspect, which is previous contact with dementia patients. In addition, resilience of the couples in their family consisted of interactions between wife and husband, marital relation, family assistance and social resources. Considering all aspects, we can reaffirm previous theo-ries proposed by experts claiming that resilience in a family is composed of belief, communica-tion and association, and at the same time it is associated with one’s life experience. Individual resilience is developed by interactions with the environment and others in a dynamic process. In conclusion, this research found several important facts about resilience on caregivers especially between married couples caring for demented parents. 1. How to comprehend the stress of family members depended upon mutual understanding between husband and wife. 2. Clearly understand the different roles that couples played and communicated when different opinions towards care-giving occurred. 3. Understanding the motives of the partners can avoid conflicts and misunderstandings 4. After the care-giving process, one can reflect on what he or she obtained from the process with family members. 5.How to take advantage of social re-sources and asking for assistance can result in empowerment. Finally, this research has generated several implications for future studies, care-giving sce-narios and policy making. On the research, how resilience develops and what kind of influences it has on alleviating the stress, and if difference exists between those caring for people of de-mentia, can be further investigated. For caregivers, especially for those couples responsible for the tasks, praises and encouragement are indispensable. Necessary resources of long-term care can also be provided to caregivers to lessen their burden, and appropriate assistance to help them communicate between each other is also of importance. On the policies, as the needs for caregiving increase and family structure becomes more fragile in the future. First, the society should try to create dementia friendly communities. Secondly, to raise the awaresness on de-mentia among its citizens. Thirdly, develop a technology-oriented online platform for carers’ mutual assistance. Nevertheless, although there are several limitations in this research, this thesis did bring some insight to caregiving and resilience literature. That is, both internal strengths of individuals, collaboration between couples, and adding external support from friends, social service organizations and long-term care resources, can build resilience for couples to take care of their aging and demented parents.