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題名：一九九○年代台灣能障礙老人的家庭照顧之影響因素及其變遷
作者：謝聖哲 引用關係
作者(外文)：Sheng-Jer Hsieh
校院名稱：國立中正大學
系所名稱：社會福利所
指導教授：鄭文輝
學位類別：博士
出版日期：2005
主題關鍵詞：照顧安排；家庭照顧；老人照顧；能障礙；照顧資源；eldercare；family caregiving；care arrangement；functional disability；caretaker pool
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本論文主要針對台灣 能障礙老人的家庭照顧及其變遷進行探討，利用1989年至1999年所進行的「台灣地區中老年身心社會生活狀況長期追蹤調查」之65歲以上 能障礙老人作為研究資料來源，以邏輯迴歸模型分析影響老人照顧安排之相關因素，並追蹤觀察當老人發生 能障礙變化時，其照顧安排的變動狀況。
研究發現，1990年代台灣 能障礙老人以女性、本省族群、年齡愈高及教育程度愈低者， 能障礙盛行率愈高，且以五至六項與輕度 能障礙為主。家庭照顧者主要仍由女性擔任，但比率已逐年緩慢地下降。由配偶及子女提供照顧的比率無太大的變動，但無人照顧逐年降低。換言之，整體的 能障礙老人受到照顧有逐年增加的趨勢。但是，隨 能障礙程度惡化，轉由其他人提供照顧的比率則大幅增加。邏輯迴歸分析結果發現， 能障礙老人的人口社經特質將影響其照顧安排。當其年齡愈高或喪偶，由配偶轉為子女媳婿照顧的機率愈高。男性 能障礙老人多由其女性配偶提供照顧，女性 能障礙老人則多由子女媳婿照顧。住在都市化程度較高地區者，由子女媳婿照顧的機率明顯較高。再者，家庭照顧者的特質亦會影響照顧的提供。女性照顧者遠較男性為多，子女數量愈少，愈可能由配偶提供照顧，但是子女數量的多寡對於是否由子女媳婿提供照顧的影響則不明顯。此外，在有子娶女未嫁的家庭照顧資源較高之情況下，較可能由子女媳婿和家庭提供照顧。子女的就業狀況對於照顧提供的影響及其方向，應該與老人的 能障礙類別有關。照顧安排變化的動態追蹤分析發現，當 能障礙程度惡化及喪偶時，多數老人會尋求較多及替代的照顧資源，家庭照顧者的就業狀況由有工作轉變為無工作的比率較高。
本論文研究結果的政策意涵即是，家庭照顧資源的可利用性正逐漸降低，對於以「在地老化」為目標的我國長期照護制度規劃而言，如何避免對原有的照顧資源造成排擠，甚至進一步強化家庭提供照顧的可欲能力，提供有效且適切的照顧支持，必須是政策規劃者不得輕忽的重要課題。
The dissertation mainly aims to do the research on the family caregiving and its changes for the functionally disabled elderly in Taiwan. The research data comes from “Taiwan Survey of Health and Living Status of the Elderly” in 1989 to 1999, which occupy the logistic regression model to analyze the factors that influence the care arrangement, and also traced and observed the changes of care arrangement when the elderly were functionally disabled and became declined.
The research finds that the older and the less educated the elder groups of female, Taiwan-born Taiwanese were the higher rate the prevalence of the disabilities of activities of daily life (ADLs) was. The family caregivers were mostly female, but the gender inequality was declined gradually. The proportion of family caregiving done by their spouses and children for the disabled elderly hasn’t changed much. In other words, the overall caregiving for the disabled elderly is rising increasingly. However, as the elderly persons’ functional abilities declined more serious, the rate of cargiving done by non-family-member persons has expanded enormously.
The result of logistic regression analysis shows that the socio-economic characteristics of disabled elderly also influenced their care arrangements. When the disabled elderly got older or widow, the children and children’s spouse would replace for giving care. The male disabled elderly were often cared by their female spouses, but the female ones were cared by their children or children’s spouses. At more urbanized area, the possibility that care by the children and children’s spouses were higher significantly. The more declined the elderly functional abilities were, the more possible it was for them to co-reside with their spouses or with their offspring. Thus, it’s also more possible for them to receive the family care. Furthermore, the characteristics of the family caregivers affected the caregiving for the disabled elderly. Female family members care the disabled elderly more often than male ones. For the elderly with fewer children, it’s more possible to be cared by the spouses than by the children. However, the amounts of children didn’t have much influence on the possibilities that gave care to their disabled parents. Beside, under the higher family caregiveing resources which some children has married, the cargiving is more likely offered by the married children and their family. The employment situation of children which influences the caregiving and it direction is also related to the category of disabled elders. The dynamic analysis about the change of care arrangement which shows that when the elderly persons’ functional abilities declined seriously or bereft of their spouses, most of the elders would seek for more and replaced care resources, and the proportion of the caregivers’ employment situation would become unemployment instead.
The policy implications of the research are that the availability of the family cargiving resource is decreasing. As for the scheme of long-term care system which is to achieve the goal of “aging in place”, this is a very important and cannot be neglected lesson for the policy planners to avoid the original family cargiving resources be edged out, to enhance the desirability of family caretaker and to offer the effective and suitable support.
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