本研究探討護理之家和安養機構內的失智症老人住民，其主要照顧者持續使用機構式照顧的相關因素，本研究引用Andersen 健康行為模式，探討前驅因素、使能因素、需求因素與使用機構式照顧服務的相關性。 本研究採橫斷性、立意取樣的方式進行研究，研究對象分別來自雲林縣1個安養長照機構及台南市的2個護理之家，共113個機構內失智症老人的照顧者，由機構內的資深護理師為訪員進行問卷調查。 研究結果顯示：(1)前驅因素、需求因素是持續使用機構式照顧，較重要的預測因子。(2)進行對數複迴歸分析，控制其他重要變項後，前傾因素包括：失智症老人年齡及教育程度、主要照顧者教育程度及對照顧責任的認知，使能因素包括：照顧者對機構照顧品質的認知，需求因素包括：失智症老人身體功能障礙程度及情緒行為障礙總程度、主要照顧者身體疲憊負荷程度及情緒和經濟負荷程度，為影響照顧者持續使用機構式照顧服務的關鍵因素。(3)而且，家庭照顧者表示他們以前在家中照顧失智長輩時，很少使用到社區的照顧資源。 根據上述研究結論，提出具體建議，政府應該發展更多的社區及居家式的照顧資源，以減少失能者及照顧者的生活負擔；為了協助及支持照顧者繼續在家中照顧認知障礙者，在社區中提供更多有關失智症教育、指導及社區資源，這樣不僅幫助照顧者可以讓失智老人在家照顧的時間久一些，也可以達在地老化的目的。 Based on Andersen’s behavior model of health service use, this study aims to investigate factors affecting caregivers of person with dementia who are now staying in nursing homes and long-term care institutions to choose institutional long-term care services, and to explore the relationships among predisposing factors, enabling factors, need factors and the utilization of institutional long-term care services. This study uses a cross-sectional survey with structured questionnaire. The sample includes 113 residents in one long-term care institution in Yunlin County and two nursing homes in Tainan City. The major findings of this study are as following: (1) Both predisposing factors and need factors are more important predictors for using institutional long-term care services. (2) The analyses of multiple logistic regressions controlling other variables indicate that predisposing factors such as age and education level of elders with dementia, education level and care responsibility recognition of caregivers; enabling factors such as the perception of quality of institutional care services; need factors such as physical disability and emotion-behavior disturbance of elders with dementia and care and emotion loading and economic burden of caregivers are the most important predictors of institutional care service utilization. (3)However, the caregivers of institutional residents with dementia received few assistance from formal community care services when they cared elders with dementia at home. Based on these findings, this study suggests that the government should develop various community care resources to support the disabled elders and their caregivers to mitigate their living burdens. More information, guidance and community resources regarding dementia care should be provided to assist elders with dementia staying at home for a longer time that the purpose of aging in place can be achieved.
