老人接受社區型日間照護計畫之成效評估
Evaluation of the Effects of the Community-based Day Care Services
Program for the Elderly
中文摘要
老年人的照護不僅是社區醫學的挑戰，也是重要的社會議題。老年人不但希望能夠活得久，也希 望能活得有尊嚴。本研究係由衛生人員、社工人員及當地里鄰志工所組成的服務團隊，針對社區 內的老人，在該社區內提供每週2 次每次 3 小時的日間照護服務計畫，其內容包括量血壓、健 康諮詢、體適能、慶生、營養午餐、電話關懷、家庭訪視等服務。本研究主要目的是探討實施社 區型老人日間照護服務計畫之後，(一)老人的憂鬱程度改善情形及(二)老人的健康相關生活品質 提升情形。 本研究係採類實驗設計(quasi-experimental design)方式進行，研究對象為居住在台北市士 林區中央、承德二社區65 歲以上的老人，其中接受日間照護服務計畫者為實驗組，計有 82 人； 未接受者為對照組，計有92 人；實驗期間從民國 92 年 11 月 16 日至 93 年 5 月 15 日，歷時 六個月。完成實驗之有效樣本中，實驗組有77 人，對照組有 90 人。本研究所使用的結構式問 卷係先經信效度檢定後再用以收集資料；此問卷內容包括人口學特性、健康狀況、社會支持程度、 滿意度量表、憂鬱量表(CES-D)及健康相關的生活品質量表(SF-36)。實驗資料以 SPSS 10.0統計軟體進行分析，所使用的統計方法包括配對t 檢定（paired t-test）、共變數分析（analysis
of covariance，ANCOVA）、皮爾森相關分析（Pearson correlation analysis）、複迴歸分析 （regression analysis）等。 研究結果發現，實驗組的老人在參與社區型日間照護服務計畫之後，其 (一)憂鬱程度有顯著改善。實驗前原有 18 位(24%)有憂鬱傾向，實驗後降為 10 位(13.2%)， 達統計上意義。同時發現影響社區老人憂鬱之重要預測變項為有無參與日間照護服務計畫、整體 心理健康、社會支持滿意度、經濟狀況及認知功能，並可解釋憂鬱程度達50.2％的變異量。 (二)健康相關的生活品質有顯著改善。同時發現影響社區老人健康相關的生活品質改善之重要預 測變項為有無參與日間照護服務計畫、憂鬱程度、罹患慢性病數、經濟狀況及教育程度，並可解 釋健康相關生活品質達40.6％的變異量。 本實驗研究提供了具體有效的社區型日間照護服務計畫，藉以幫助社區高危險群老人降低其憂鬱 並提升其健康相關的生活品質；其結果可做為衛生及社會部門推廣健康促進及社區資源整合方案 的參考，以協助老人完成「在地老化」的理想。
英文摘要
The caring for the elderly is not only a challenge of community medicine but also an important issue in our society. The elderly hope to live longer as well as live with dignity. This study aims to offer a community-based day care services program for the elderly. In this program, the team consisting of health professionals, social welfare specialists and the volunteers living in the community provided services
including blood pressure measurements, health consulting, appropriate exercises teaching, birthday celebrations, tuition lunch, phone call concerning, and home visits twice a week with about three hours per service for the community elderly. The purposes of the study are to explore (1) the reduction of the depression of the elderly and (2) the promotion of health related quality of life for the elderly, through the program.
This research employed a quasi-experimental design. A total number of 174 elderly aged 65 or above who live in Central Community and Chen De Community in Taipei City were voluntarily selected to participate in the program. They were divided into two groups; The experimental group contained 82 participants who received the community-based day care services program, and the control group contained 92 participants who did not. The duration of the experiment lasted for 6 months from November 16, 2003 to May 15, 2004 and 167 participants have finished the experiment. A structured questionnaire consisting of demographic characteristics, health status, depression scales, social support scales, well-being scales and health related quality of life (the SF-36) were given to each participant at the beginning and at the end of the experiment. Standard statistical methods such as Paired t-test, analysis of covariance, Pearson correlation and regression analysis are used to analyze data by the software SPSS 10.0.
The results of this study are summarized as follows. After the intervention of the community-based day care services program, (1) the participants in the
experimental group showed significant reduction on the depression status, while those of the control group did not. And the predictors impacting the depression of the elderly are the engagement in this program or not, mental component summary, the satisfaction of social supports, economic status and the cognition function. Moreover, they can explain the variation of the depress status with 50.2%. And (2) the participants in the experimental group also showed more significant promotion on health-related quality of life than that of the control group did. Besides, the predictors impacting the health-related quality of life of the elderly are the
engagement in this program or not, the satisfaction of social supports, the number of chronic diseases suffered, the economic status and the education level. Moreover, they can explain the variation of the health-related quality of life with 40.6%. The result of this study offers a concrete and effective community-based day care services program to help the elderly at high risk reduce their depression and promote their health-related quality of life. The health department and the social welfare department can extend it to each community to make the dream “aging in place” come true for the elderly.
