以孝道價值觀及心理壓力論年長者及其家屬對使用住宿式照顧服務的影響

臺灣將於2025年進入超高齡社會，長期照顧需求與家庭照顧壓力同步上升。住宿式長照服務雖能提供專業照護，但在華人社會中，孝道價值觀與心理壓力常影響其使用決策。本研究希望針對使用住宿式長照服務的年長者及成年子女作為研究的主要方向，探討讓年長者使用機構式長照服務時，會如何受到孝道觀念以及心理壓力上的影響。本研究採質性敘事探究法，訪談臺灣中部地區養護機構內4位年長者與4位家庭照顧者，探討孝道觀念與心理壓力對機構照顧選擇的影響。透過資料閱讀、逐字稿撰寫及主題式編碼的方式，將描述性的訪談內容整理成具有分析性的資料。依照研究問題依照相近的編碼集結整合成主題與範疇，在歸納不清楚時也進行三角驗證。本研究的結果共歸納7個範疇與16個次主題。有關年長者及家庭照顧者對孝順的想法，三個範疇分別為：（一）年長者的孝順想法趨於單純（二）照顧者對孝順長輩的做法（三）年長者與照顧者的差異。次主題有七個，分別為：情感支持的孝順、滿足生理的孝順、關懷及陪伴、照顧者滿足長輩需求、照顧者在乎年長者的安全、權威性孝道已漸漸瓦解、情感連結或孝順實踐。有關年長者及家庭照顧者的心理壓力想法，兩個範疇分別為：（一）年長者的心理壓力源自多方影響家庭照顧者的壓力（二）不可控的意外導致心理壓力。次主題有五個，分別為：內在的壓力-無法習慣機構及對生死的議題感到焦慮、外在的因素-不得已須入住機構產生的憂鬱、機構亦是減輕心理壓力的來源、意料之內卻又無可避免的變故、坦然面對年長者的離世。有關孝道及心理壓力對年長者及家庭照顧者的交互影響，兩個範疇分別為：（一）希望不要造成子女的負擔（二）多陪伴的照顧方式可以盡孝，也能降低壓力。次主題有四個，分別為：不要讓孝順名義變成一種被迫的壓力、兒女的事業為重、機構是孝順的捷徑，陪伴才是孝順的本質、外界的質疑聲浪。年長者的孝順想法趨於單純，顯示年長者重視情感關懷與陪伴，家庭照顧者則偏向滿足長輩需求，即便是透過機構照護，亦視為盡孝的一種方式。心理壓力在雙方皆具多重面向，年長者之心理壓力來自多方因素，包括適應陌生環境、失去自主感及面對死亡的議題，照顧者則認為年長者發生突如其來的意外事件會導致壓力。研究結論指出現代孝道已趨向多元化與利益平衡，住宿式照顧在特定情境下亦可視為盡孝，只是從年長者或照顧者的視角與脈絡會有差異。年長者及照顧者的心理壓力則分別來自對機構的不適應及長輩突發的健康狀況。孝道與心理壓力對於選擇住宿型機構，對長者與照顧者的差異是，年長者希望不要造成子女的孝順壓力，而選擇入住機構，而照顧者認為機構照顧是一種孝順方式，也可以減輕自己的壓力。雖然本研究的收案量成為一個研究限制，無法較多元的訪談女兒照顧者或是互相比對長者與照顧者雙方是否想法有差異，但是針對研究目的完成了探討年長者及照顧者在使用機構式長照服務時，會如何受到孝道觀念以及心理壓力上的影響。未來研究針對家庭動力如何影響孝道與心理壓力、政策上的意涵如何影響長照3.0發展住宿型照護以及臨床工作者如何平衡長輩與照顧者的需求等皆是此論文後續可延伸的方向。

Taiwan will officially enter a super-aged society in 2025, leading to a simultaneous rise in long-term care (LTC) needs and family caregiving burdens. Although institutional LTC services provide professional care, decisions regarding their use are often influenced by the cultural value of filial piety and psychological stress in Chinese societies. This study focuses on older adults utilizing institutional LTC services and their adult children, exploring how filial piety and psychological stress affect the decision to place elders in such facilities.A qualitative narrative inquiry was adopted as the research method which involved interviews with four older adults and four family caregivers in LTC institutions located in central Taiwan. Through data reading, verbatim transcription, and thematic coding, descriptive interview content was transformed into analytical findings. Themes and categories were inductively derived based on the research questions, with triangulation applied when ambiguities arose.The study identified seven categories and sixteen subthemes. Regarding perspectives on filial piety, three categories were found: (1) older adults’ simpler views of filial piety, (2) caregivers’ practices of filial piety toward elders, and (3) differences between older adults and caregivers. Sub-themes included emotional support, meeting physical needs, care and companionship, fulfilling elders’ needs, prioritizing elders’ safety, the decline of authoritarian filial piety, and emotional bonds or filial practices. Concerning psychological stress, two categories were found: (1) stress stemming from multiple influences on older adults and caregivers, and (2) uncontrollable incidents leading to stress. Sub-themes included internal stress (difficulty adapting to institutions, anxiety about death), external factors (depression due to forced institutionalization), institutions as a means of stress relief, inevitable yet unavoidable changes, and accepting elders’ passing with composure. Regarding the interaction between filial piety and psychological stress, two categories were found: (1) the wish not to become a burden on children, and (2) companionship as both a way of fulfilling filial piety and reducing stress. Sub-themes included avoiding filial piety becoming coercive pressure, prioritizing children’s careers, institutions as a shortcut to filial piety while companionship remains its essence, and social criticism from outsiders.Findings showed that older adults generally emphasized emotional care and companionship while caregivers focused on fulfilling elders’ needs, including institutional care as a form of filial piety. Psychological stress was multifaceted for older adults: stress stemmed from environmental adaptation, loss of autonomy, and confronting death. On the other hand, caregivers’ stress arose mainly from unexpected health events of the elders.The study concludes that modern filial piety has evolved toward pluralism and pragmatic balance. Institutional care, in specific contexts, may also be considered an act of filial piety, though perspectives differ between older adults and caregivers. Older adults tend to view institutionalization as a way to avoid burdening their children, whereas caregivers perceive institutional care as both a filial practice and a way to relieve personal stress. A limitation of this study lies in its small sample size, which restricted the diversity of participants, particularly female caregivers, and limited comparative analysis between elders and caregivers. Nonetheless, the study fulfills its objective of exploring how filial piety and psychological stress shape the decision to utilize institutional LTC services.Future research may further examine: (1) how family dynamics influence the interplay between filial piety and stress, (2) the policy implications for the development of Taiwan’s LTC 3.0 system, and (3) how practitioners can balance the needs of both older adults and caregivers.