鍾國彪臺灣大學:醫療機構管理研究所謝元賓Hsieh, Yuan-BinYuan-BinHsieh2010-05-052018-06-292010-05-052018-06-292009U0001-1708200917223600http://ntur.lib.ntu.edu.tw//handle/246246/180893中文摘要景與目的：論是全球還是台灣都已面臨因「人口結構高齡化」而到來的高齡化問題，其在人口社會問題上是具有急迫性的；而在台灣方面，65 歲以上老年人口的門診與住院花費，超過全部人口醫療花費的三分之ㄧ。如何積極因應老化所伴隨的負面效應，使國民，充分融入及參與社會，並能更健康活躍地進入老年，並降低對醫療服務與社會資源的衝擊，是當今世界各國重要課題之一。WHO於2002年更提出對保護健康與維持安適政策的名詞：”active ageing”（活躍老化），且此名詞已變成全球與全國老化政策發展的核心。因此，本研究目的由WHO（2002）所提出活躍老化的架構，以長照住民的主觀感受為出發點，比較過去與現況，以瞭解台灣地區長期照護機構住民對活躍老化的看法與觀點，以提供業界與學界規劃老人未來生活之參考。究方法：研究的研究對象為某私立安養機構的長者共27人，工作人員共4人，主要目的在探討長照住民對活躍老化的看法與觀點，共舉辦4場焦點團體座談會與4場深度訪談。究結果：養中心長者活躍老化的因素以活動進行為主要的活躍因素，其次依序調劑身心、社會事務的參與、運動與打發時間、學習、宗教信仰、關愛與付出以及心理部份。而以工作人員角度對安養中心長者活躍老化的因素以宗教信仰為主要的因素、其他依序為活動、人際關係、心理因素。議： 依據本研究結果，提出下列建議：（1）建議長期照護機構的醫療服務提供者設置老人科降低長者行動不適而舟車勞頓的情形。（2）建議長者培養一件或二件興趣，並在日常生活中持之以恆去發展，以增進主動積極的態度與生活方式，並藉此使生活有重心，降低對老化相關的負向想法。（3）多舉辦幾次戶外郊遊，不僅增加活動的機會並藉以聯絡長者間彼此的情誼，以擴大社會網絡，強化社會支持系統。ABSTRACTackground and purpose：hether global or Taiwan have been facing the “aging population structure” and the arrival of the aging problem in the population with social issues of urgency. In Taiwan, out-patient and hospitalization costs of the elderly population aged over 65 are more than one-third of medical spending of the total population. How active aging associated with the negative effects, so that citizens, fully integrated into and participate in society and more active into old age health and medical services and reduce the impact of social resources is an important issue in the world today. WHO also proposed in 2002, to protect the health and well-being policy, the term: "active ageing", and this term has become a global and national policy development in the heart of aging. Therefore, the purpose of this study by ,WHO (2002), the structure of active aging to long according to the subjective feelings of the residents as the starting point to compare the past and the present situation in order to understand the opinions of long-term care residents in Taiwan on the active aging to provide fields and the academic planning of future reference to the elderly. esearch method: This qualitative study adopted purposive sampling. This study is based on the focus groups and discussing with 27 old people participants who lived in the residential care home .In-depth interviews were used to collect data from 4 workers , and proceeded focus group by 4 and individual face to face interview by 4, to realize the subject opinions with active aging by long-term care residents in Taiwan.indings:ctive aging factor of residential care home is activity, others are to swap the physical and psychological, social affairs, sports and kill time, learning, religion, and psychological care and pay a part of. And to staff in terms of elderly nursing home to an active factor in the aging of religious belief as the main factor, followed by other activities, interpersonal relationships and psychological factors. ecommendations: Based on the results of this study, makes the following recommendations: (1) The proposed long-term care facility medical service providers to reduce the geriatric set is not applicable for senior citizens and the case of trouble. (2) the proposed elderly foster interest in one or two, and perseverance in their daily lives to the development of initiatives to promote a positive attitude and way of life, and to make the focus of life, reduction of aging-related negative thoughts. (3) more often and several outdoor picnic, not only the opportunity to increase their activities and to contact each other''s friendship among the elderly in order to expand social networks, and strengthen social support systems.目錄謝..........................................................................................................Ⅰ文摘要.. ...............................................................................................Ⅱbstract................................................................................................ Ⅳ錄..........................................................................................................Ⅵ目錄.................................................................................................... Ⅸ目錄....................................................................................................ⅩⅠ一章 緒論.......................................................................................1一節 研究背景與動機......................................................................1二節 研究目的................................................................................ .5二章 文獻探討................................................................................6一節 老化的相關理論....................................................................6二節 老人現況的需求....................................................................9三節 老人照護的發展沿革........................................................11四節 活躍老化的架構、指標與發展沿革....................................30五節 各國進行活躍老化的現況..................................................38六節 台灣長期照護機構發展活躍老化的重要性探討…………44七節 質性研究................................................................................47三章 研究方法..............................................................................50一節 研究設計..............................................................................50二節 研究對象、方法與步驟......................................................52三節 資料收集與分析....................................................................57四章 研究結果............................................................................. 60一節 參加焦點團體訪談人員的基本資料........................................ 60二節 研究結果....................................................................................65五章 討論......................................................................................82一節 研究方法學的討論....................................................................82 第二節 安養中心長者活躍情形............................................................83三節 以KAP觀點探討長者活躍老化的因素..................................94四節安養中心長者不活躍因素的探討..............................................98五節安養中心長者居住環境特色與活躍老化的探討………...…...98六節研究限制..................................................................................... 99六章 結論與建議..........................................................................100一節結論...........................................................................................100二節建議...........................................................................................100考文獻............................................................................................103 中文文獻................................................................................................103 英文文獻................................................................................................107錄....................................................................................................111 附錄一 訪談前說明會....................................................................................111 附錄二 長者座談會發放之訪談說明暨訪談題綱........................................113 附錄三 工作人員座談會發放之訪談說明暨訪談題綱................................114 附錄四 開場白................................................................................................115 附錄五 研究同意書（安養中心長者）........................................................116 附錄六 研究同意書（安養中心工作人員）................................................117 附錄七 安養中心長者訪談內容摘要整理....................................................118 附錄八 安養中心工作人員訪談內容摘要整理............................................136目錄2-2-1：老人需求分類與政策現況表.....................................................................102-3-1：臺灣社會福利政策歷史演進表.................................................................132-3-2：長期照顧服務對象人口數推估.................................................................192-3-3：台灣地區長期照護機構服務模式............................................................ 192-3-4：80年代初期台灣地區老人長期照護政策法令發展歷史……………..….…..262-3-5：80年代末期台灣地區老人長期照護政策法令發展歷史…………..…….…..272-3-6：90年代台灣地區老人長期照護政策法令發展歷史................................282-3-7：台灣老人照護模式演進表.........................................................................302-4-1：active ageing的發展沿革.......................................................................332-5-1：活躍老化的相關性研究.............................................................................382-5-2：加拿大政府各部門對推行活躍老化的貢獻.............................................402-5-3：加拿大的老化政策-已知的優缺點...........................................................412-5-4：紐西蘭正向老化的策略綱領關鍵政策主張與開始優先的目標和關鍵活動...................................................................................................................................412-5-5：紐西蘭正向老化的策略主張....................................................................422-5-6：紐西蘭的老化政策-已知的優缺點..........................................................422-5-7：瑞典的老化政策-已知的優缺點..............................................................432-5-8：英國的老化政策-已知的優缺點..............................................................432-5-9：美國的老化政策-已知的優缺點..............................................................443-1-1：本研究之長照機構安養中心住民焦點團體訪談大綱............................513-1-2：本研究之長照機構安養中心工作人員焦點團體訪談大綱……..……..523-2-1：焦點團體座談表........................................................................................553-2-2：個別訪談表................................................................................................554-1-1：焦點團體參與人員基本資料....................................................................614-1-2：個別訪談參與人員基本資料....................................................................614-1-3：焦點團體場次分配....................................................................................624-1-4：個別訪談場次分配....................................................................................624-1-5：焦點團體參加人員基本資料分析表........................................................634-1-6：個別訪談參加人員基本資料分析表........................................................644-2-1：安養中心長者對活躍老化的觀點............................................................724-2-2 ：工作人員對安養長者活躍老化的觀點.................................................. 764-2-3：對安養中心長者認知上活躍因素之觀點比較表.................................... 784-2-4：安養中心長者認知上活躍的因素與日常生活中活躍呈現部份的比較表..................................................................................................................................794-2-5 ：對安養中心長者認知上不活躍因素之觀點比較表..............................804-2-6 ：安養中心長者認知上不活躍的因素與日常生活中不活躍呈現部份比較表..................................................................................................................................815-2-1：安養中心長者自覺活躍程度彙整表........................................................835-2-2：安養中心長者活躍因素與文獻中活躍老化的理論模式內容比較表....845-2-3：安養中心長者認知的活躍因素與文獻中活躍老化的理論模式內容比較表..................................................................................................................................855-2-4：宗教信仰調查表.......................................................................................865-2-5：社會支持的主要功能................................................................................92目錄2-3-1：錯金銀鳩杖首............................................................................................122-3-2：臺閩地區長期照護機構歷年成長圖........................................................192-3-3：現階段台灣地區長期照顧體系圖............................................................192-4-1：2002年WHO活躍老化的政策性架構.........................................................342-4-2：WHO年活躍老化的決定性因素................................................................. 342-6-1 高齡化社會對策總目標..............................................................................463-2-1：本研究進行的步驟....................................................................................56application/pdf882802 bytesapplication/pdfen-US長期照護機構活躍老化質性研究long-term care facilityactive agingqualitative researchthesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/180893/1/ntu-98-P95843016-1.pdf