| Abstract: | 根據世界衛生組織推估，2020年全球罹患失智症的人數高達4700萬人。而我國2020年之總失智人口為28萬783人，占全國高齡者的7.78%，估計在民國154年時我國65歲以上失智症人口將高達88萬人，可見罹患失智症的人只增不減，也是目前全球高齡化後所面臨的新挑戰。為因應失智者的照顧問題，我國自2017年起執行十年長期照顧計畫2.0，將50歲以上的失智個案納入服務對象，並提供居家式、社區式以及機構式等多元的照顧服務，以因應不同的照顧需求。但在眾多的服務項目中，家屬該如何選擇適合的照顧模式則成為了另一個棘手的問題。
據此，本研究的目的在了解失智者之家屬在家人確診後的經驗，包括如何尋求長期照顧的相關資源以及如何討論並決定使用何種照顧模式。 本研究透過半結構式問卷深度訪談8位失智症家屬，了解其選擇照顧模式之歷程，本研究將其歷程分為失智確診、接觸長照資源經驗以及選擇照顧模式等三大部分，得出之結果如下：
一、失智者確診歷程：失智者是否能盡早就醫，與家屬對失智症狀的了解程度有直接關聯，而失智者往往於發病中期才確診，原因除了家屬較晚察覺異狀而未於初期送醫之外，醫師在失智者初期診斷成憂鬱症或過於重視生理疾病症狀，也是延誤確診的原因。而家屬在確診後則會開始正視失智者的疾病，並積極了解失智症相關資訊。二、接觸長期照顧資源之經驗：家屬在意識到有照顧需求後就會開始尋找長照資源，而家屬理解長照資源的面貌則因資訊管道來源而有所落差。若家屬在初期對所有照顧模式有完整了解，則會大幅減少選擇錯誤的循環狀態。三、選擇照顧模式：家庭內的照顧安排協議為選擇照顧模式歷程中的必經之路。家屬首先依據照顧需求來選擇照顧模式，並將失智者症狀、家庭內照顧人手、經濟以及交通與距離等因素納入評估，而家屬對照顧模式類型是否通盤了解則影響選擇的準確性，而失智者意願、家屬對服務提供者是否信任、環境氛圍是否讓失智者感到友善，則是影響失智者是否能穩定使用該模式的關鍵原因。
基於上述研究結果，本研究建議未來在失智症照護上，可以持續追蹤和篩檢疑似及老年憂鬱之失智症者，提早確診或治療。在後續服務上，則需強化醫事人員給予長照資訊的能力，以增加失智症家屬得知資源的機會。此外，失智與長照的個案管理需合作並互補，讓失智者在醫療以及長照上，皆能得到妥善的照顧。在整體政策方面，建議完整規劃失智症照顧服務後並納入長期照顧支付系統。在教育方面，也應普遍提升全民對失智及長期照顧的識能，才能達成失智友善以及建構完善長期照顧體系的政策目標。
Based on the World Health Organization, people who are diagnosed with Dementia reached 47,000,000 around the world in 2020 (WHO, 2018). The number of people with dementia was estimated to be 280,783, consisting of 7.78% of the elderly population in Taiwan. The number of older adults with dementia will reach 880,000 in 2065, indicating that dementia is not only more prevalent but also becomes a new challenge in global aging. In order to respond to dementia care, Taiwan implemented the Ten-Year Long-Term Care Plan 2.0 in 2017, including people who were 50 years old and with dementia to be eligible for services. The services were diverse and included home-based, community-based, institutionalized based to fulfill different care needs. However, how to choose a suitable model among the different service items became a difficult question among family caregivers.
Because Dementia is an irreversible illness, taking care of the family members who were demented became a challenge for family caregivers. In 2017, The Ten-Year Long-term Care Plan 2.0 set the rule by qualifying people who were 50 years and older with dementia to use home-based, community-based, and institutionalized care services. However, among all different service plans, how do family caregivers choose a right care model is still a burning question for people with dementia and their family caregivers.
The purpose of this research was to understand the experiences on how family caregivers sought long-term care resources and how they discussed and chose a care model. The author interviewed eight family caregivers of dementia clients in depth, trying to understand the process of choosing a care model. The process was divided into three stages: dementia diagnosis, understanding long-term care resources and choosing a care model. The results were:
1. Dementia Diagnosis: Dementia client can receive diagnosis quickly or not depending on their family caregivers’ knowledge of dementia symptoms. Most of the dementia clients received diagnosis when they were in the moderate level, not the mild level. The reasons were due to lack of awareness about dementia signs among caregivers or the doctors thought the cognitive disability was not obvious enough to qualify for dementia diagnosis. When the dementia diagnosis was confirmed, family caregivers were actively learning about dementia related information and resources.
2. Understanding Long-term Care Resources: family caregivers were aware of care needs and then started looking for care resources and information. The people who provided care resources information varied, so family members had different understanding levels of long-term care resources. When caregivers were given comprehensive care resources and information, they felt they could reduce making false choices repeatedly.
3. Choosing a Care Model: Family caregivers had to undergo a journey discussing how to choose a care model. The initial care needs had to be fulfilled and then entered the assessment of Dementia symptoms, care ability among family, economic and costs concerns, transportation and distance to care. Whether the family members had a comprehensive understanding of the care model affected the accuracy of choices. A stable care model could be reached when the dementia client, the caregivers, and the care providers trusted all another as well as the environment of the care model provided friendliness feelings.
Based on the research results, the author suggested continue monitoring of suspected or depressed older adults; pay attention to dementia screening and diagnosis in order to increase early prevention and treatment. It is necessary to strengthen the competence of medical professionals in order to increase the ability to provide dementia family caregivers accurate information. In addition, dementia care management and long-term care management need to cooperate and complement each other so that dementia client can receive proper services both in medical care and long-term care. Regarding the overall policy, it is recommended that the dementia care service should be fully planned and included in the long-term care payment system. It is also necessary to improve the people’s awareness of dementia and long-term care in order to achieve the policy goals of dementia friendliness and developing a proper long-term care system for people with dementia. |
