長期照顧機構住民住院時照顧者負荷、 生活品質及情緒變化之探討

背景: 台灣已為高齡化社會，人口快速老化帶來相關的長照問題，但因社會變遷、少子化的情況下，家庭照顧者也面臨許多照顧困境，機構式的長期照顧成為許多家庭的選擇，但機構住民若因急性健康問需就醫治療，此時家庭照顧者會面對許多未知的情況，住院治療期間對家庭照顧者所帶來的影響為何，值得我們進一步思考。目的:本研究旨在探討長照機構住民住院期間對家庭照顧者的影響。方法: 本研究採縱貫性調查研究設計(longitudinal research design)，以中部某區域教學醫院之長照機構住民家屬作為收案對象，共收案50位家庭照顧者，分別在入院時及出院時收集資料，若住院中發生特殊事件會增加一次資料收集，使用研究工具為: (1)個人背景屬性基本資料調查表;(2)照顧者反應量表;(3)台灣簡明版世界衛生組織生活品質問卷; (4)流行病學研究中心憂鬱量表，並以描述性統計、卡方檢定以及GEE廣義估計方程式進行資料整理及分析結果。結果: 描述性統計在家庭主要照顧者性別男性與女性比例差不多，年齡屬於中壯年族群，與被照顧者關係為子女最多(84%)，皆為主要醫療決策者，採共同討論的主要決策者佔66%，單獨做決策者34%，選擇共同討論的對象以被照顧者子女最多(72.5%)，利用卡方檢定分析發現長照機構住民年齡與家庭主要照顧者決策有顯著相關(χ2=8.440，p=.010)。GEE分析結果發現家庭照顧者在機構住民入院時的「日常計畫被干擾」及「健康問題」有顯著的壓力負荷。結論: 長照機構住民因急性健康問題住院治療對家庭照顧者來說是突發狀況，剛入院時家庭照顧者會需要將原本可用的時間重新分配，至醫院照顧家人，奔波勞累也對健康造成影響，臨床實務工作者若能及早發現照顧者壓力，了解照顧者之需求，並協助其緩解，將有助於避免家庭照顧者在住院期間引發更負向之照顧經驗。

Background: Taiwan has already become an aging society, and the rapid aging of the population has brought about related long-term care issues. However, due to societal changes and low birth rates, family caregivers also face many caregiving challenges. Institutional long-term care has become a choice for many families. When residents of such institutions require hospitalization for acute health issues, family caregivers face many uncertainties. The impact of hospitalization on family caregivers during the treatment period is a matter worthy of further consideration.Objective: This study aims to explore the impact of the hospitalization of residents in long-term care institutions on family caregivers.Methods: This study adopts a longitudinal research design, targeting the family caregivers of residents in long-term care institutions affiliated with a regional teaching hospital in Taichung. Total 50 family caregivers were recruited for the study, and data were collected at admission and discharge, with an additional data collection if any special events occurred during hospitalization. The research tools utilized include: (1) Demographic questionnaire (2) Caregiver Reaction Assessments scale(CRA) (3) WHOQOL-BREF (4) Center for Epidemiologic Studies Depression Scale(CESD). Data was analyzed using descriptive statistics, Chi-square tests and Generalized Estimating Equations(GEE).Results: Descriptive statistics indicate that the gender distribution of primary family caregivers is nearly equal between males and females, and they predominantly belong to the middle-aged group. The majority of caregivers are the children of the care recipients (84%) and serve as the primary medical decision-makers. Among them, 66% make decisions collaboratively, while 34% make decisions independently. The most common collaborators in decision-making are the children of the care recipients (72.5%). Chi-square test analysis reveals a significant correlation between the age of long-term care institution residents and the decision-making of primary family caregivers(χ2=8.440, p=.010).GEE analysis results indicate that family caregivers experienced significant stress related to " disruptions daily schedule " and " impact on health " when the institution residents were admitted to the hospital.Conclusion: Hospitalization of long-term care institution residents due to acute health issues is an unexpected event for family caregivers. Upon admission, family caregivers need to reallocate their available time to care for their hospitalized family members, this can lead to fatigue and affect their own health. Early identification of caregiver stress and understanding their needs by clinical practitioners can help mitigate these stresses, thereby preventing more negative caregiving experiences during the hospitalization period.