從失能老人社區照顧的需求初探服務網絡之建立

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(1)46 ,*-1~. *" ~ >'. ~~~.~. (l!:it!ilfr*fU> '. ~J[a .. e:t .!L ».x.. 10. '. 1986b. (1!:it!trt!~AD~HII¥JJJjOt;I!JiHa. *>, (AG~frJ}' 9, 1l1-23. ' 1993. ( rp. 30:8/9 ' 1l15-34. -.. ."... "TI. ~~~~A~~~_~~*. 0. ~~.--~~~~. i!Mf,;IJf.!l • ~lli* ' 1994. (j8loJ=+-fl:l:*cHitiiitif!J;;~~JJt.W~13 ::f3AiiiIHrJfm*:fJJWlfIS1t¥IH"'r) , j7qaiJG~~t;fiffJ't:¥IH"'r ' I!:~t : j7qi!& j1~*. /\.... 37:4 ' J[ 166-174·. ~X!t. .:E1!!li .. •••• ~~A~~.W~t. ~X'§'~ 1*itlUIl~. ~ fiffJ't:. ),. (A$~:@.}. • J.. ,. ~.. 0. f~~j.. ~;t~1~. •• la4~~~a&~~~~'At'~ •• A$ ~~~·~»~la-M~.8 •• *~.~~t~ •• A~' .W.~ •• S~~~~MI'A.6.M~ •• A.ffl~~.~~ ~.t.A. Clausen, John A. 1986. The Life Course: A Sociological Perspective. Englewood Cliffs, New Jersey: Prentice-HalL. ••. •• W~~o-~oo4~*~ •• A.~~~~.~t~~·~-~. ,'.,. George, Linda K. 1993. "Sociological Perspectives on Life Transitions." Annual Review o/Sociology 19:353-73.. -E.f4:f~'A4.tfi.t.~1t:.-t.b~tt, it~~fidaAt8~rd1#t:fti:.~. IUI~.t!. Hayward, Mark D. 1986. "The Influence of Occupational Characteristics on Men's Early Retirement." Social Forces 64(4):1032-45.. 0. o.. ••. •••. ~~MI.~~ A~.t~ ·~.~I~.t.~.~. t,~ • • it ' @ 6 ' it~;$.~1i~tiJ.:~ k. A~tli.. AlIHli ') 61%. , •• iJ.:~~·~~%'A~Lt. ,~.~4@·~ •• At~'L.~.t. \~~'~ A~~.~n ·.I~. Shryock, Henry S. and Jacob S. Siegel, et aL 1976. The Methods and materials 0/ Demography. Condensed Edition. New York: Academic Press, Inc.. ••. ~~~~.'4. ••. ••• ML~oo*~~.~. •• ·.~.M~oo,*~~.~~~~t.·~~. 14%0 6st~oo~~.· ~~ki.i~~"~J#t*~v).:iiIi:t~. @~~~~ 1.&.~.&.Mo~ •• A~~~Aa81· • • a~R'A~. .·~~~ti·8~~ •• Ct~~.QA')it~.~rd1~.t~4· 1) itlfl r; ~'Jitt~. ~'~If J '1t I f:J!•• a~R , •• t!itffl fj '~'.tfiS~L~~~t--J;~ • ~~~t~~«fn~.~.~~~.tfi~.o~~it~. ".ftil~~~4f*.i..fUtt..f.. ... lI.!iitii;k~;f:l:i"~.~~~. •• A. 0. 0. ·*.~~a~~*~.;f:l:i"~.~~~~r.~*~.;f:l:~.A.~~.~~~:~~. A#Il.~t ,;f.$IIitJ ~f~tHl ... "I.f,*~1iBLtt-it*~:tJl... 0. 0.

(2) 48. 1M~-Il\. «~ft~A~a •• ~.*~. •••••. ilA1t)~ id":f:li""_. ~~A. Community Care Needs of the Disabled. Elderly and the Establishment of. Service Network. EE1n.~f-l.iX!¥Jji;jJ7. 49. ~~ ijl., .p. *'. , ~A!¥J.frJ~fg~~ , J!{t~$:PJtIg3&frJ!¥J~. ~,~~~m~®~WttfrJo~~AU~~~~~.~ffmT*'illfu~~ 9"ttf§lJ!¥J~A. '. aPf.iX~ftB 'lji;1::mmlbJ:'ilW~~ilftJ!AlhhWJ!¥JA. 0. ~lltL. 9t- ' ~A'i1iL~"'lttEm!¥Jttf§llfutt-~A*r~r.u ;flUfliH~ , ~A~:Pi',~3§.=fI!¥J'lt11m ~'tt'l1m91- ' ~AJtt'Jflfru$~m!¥JPJij~'l1furN~ (~~ , MJ l'/i1llJ ' 1984) ft~W3~~~~~~ , ~AIHii1:llE~~~ffllEfu'ilW~~W3!¥J~ Iii· ;fN.1J.f::EW:I:S) (1995) ~Lf2iH' t1.:tt!HI1i~A.*liE~1j?¥ft1.9~4.3% 0. 0. 0. Mei-O Hsieh. L""~· EE1n~m!¥Jl!ltl¥f;lJ[JJ:~~ij'~5filIl!¥JEl~~ft ,ltf~~A~iilj1i].~~ 1::mElJ!l!!¥Jij~::IJ. Abstract This paper presents some research results of survey of health care need and welfare service need among the disabled elderly in Taipei. The establishment of community care network is also suggested. On the one hand, the establishment of community care network allows the disabled elderly to live independently without immature institutionalization. On the other hand, it relieves care burden of families and allows the partnership of the public sector and the private sector. The research result shows that the disabled elderly are widely distributed. However, those who are 75 and older designate the most among all subjects, representing 61.8%. Aging, and the following chronic diseases, is one of the most important factor contributing disability among the elderly. There is 63% of the disabled elderly who have at least three kinds of chronic diseases, representing 2/3 of the subjects. Although the disabled elderly may receive social support mentally, materially, and informationally, they receive least support of information and experience. The information support may be provided by related social welfare agencies. Therefore, before providing necessary services, the information network of welfare services must first be constructed. This is also the easiest part of all provision. The result also shows that demographic characteristics, health status and health service utilization, and social interactions relate to community care needs. In order to make the relationship more explicitly, multiple regression is employed. Finally, a case management model and a blueprint of community care network are presented.. ' *1lffi5§tt1~tm~ij~~A¥:I~=~~1iBA(l5.~ , ~ ' 1994) , tt?¥r.u~1O.8% ' tt~1lIJ65~J..:,U-.~ij~~A!¥Jfi5nI2.5% ~,~ (phillipson & Walker, 1986) , ,gtt~IlIJ~A1::mifj;:~:5rJlffl.l~~!¥J4.6%r.uteltf~ (ttt:r&1lf.Rijljii(B'Iji;1::mJ;iJtI~~ij~ElJ!l!1lf ' f!PADL!¥J1f!Sfi5 ' :Mz*li:!j~fmWJ11 Bm1::mJ;iJij~(IADL )!¥J1f!Sfi5) ~1I. 0. ft~~·3§.~~-~B'Iji;1::m~n'ilW.lhhWJ!¥J~A~H~~~. 8.1O/o(Wiener et aL, 1990) .;g=li:!jlf B m1:: m~ij~w.WJ'11 B'Iji; 4: mJ;iJfj~~m~ liI!¥Jf!U~20% !¥J~ijg~A EE1n~ij~~A~:Pfl ~1lJ}]~~..t.!¥J~if ' ~'ilW J!.1liJ:LijEl~ , ~lltft.~~UI!¥J7t~fummte~l!ltl 0. 0. t).a~tm®~ ';fN.tft1~tmil?x:f&. (1996). 1I~4:.~:!J~8etll.ll. JtJE. ~tm.~~.PJTfF!¥J~~m7f:: §W1JE~tm.~z~Jt~~~~APJTtIH~!¥J~ I*wJ&.R~4033*' ;g=v)'~.~fIl$F~!¥JijEl~m:#tl;{:Unt?¥H.' fJJ~-' .~=f~::g~ij~~A~J5ftJfrr~'&~fI ~~. 0. .,f:. ® it ' 1~H!l~~.!¥J£JffJJr'i'fH~ $'5.t~ijg~A'6J1H~.l:'I1U~~.!¥Jl1llf~fuf§&,ffji (~1::W ' 1994) 0. 0. ~A~fIl ' ft-'f5Jmff~~~fifBJ!I!!¥J~~ftMtfr±llt~. , ~~l~~r:R*~:tt!!~!¥J ~®ili±.~~!¥J;lJ[J~ , 5Ii1Il~~*5.!¥J;f~{J"t (~::IJ ' 1990) ,V).,& ~1li~A!¥J.:t~A::IJ--m:tz:: ' ;1t9l-tegt;~!¥Jtt19l1m:!n (::EIi~ , 1995) ~~ *~ft~fIl~tIg~A(disabled elderly)!¥Jij~::IJ*I/IM~f~ · m'lji;~{J'~~® 0. *'. ::IJ~'@ Jt1n~ij~~A!¥J*~*~' ~;1t':tji;.~~.nrtI~~-~~:fl(m~ (Il1JWIG,J!I!) !¥J~~F ' ,gJt~A® j§j , aP~~~~!¥J~~ ~~liH~*5* 0. 0. ft~, ~1lIJ~A~tfiU~B7tLJ\+1i !¥Jtt?¥~W!efM~T:tz::~,:t C1jil?x:~ ±'H~. , 1994 ; ~~!!lX ' 1992). '*$7t~A ~~ifi;1t~Ilifj;:btt10{fiJffB;ffl-'§i'H:t.

(3) 50 lilt J:ll\. ~~.~A~. .... ~S~~. ••• M.~~~. gI,J ~JtiG :k '" ~±.. ,%: f£t~~~ffi'~?fi' Bra'~~' ~Utl:l~~W3i:$~~ -a:r?t5Jtlt't~mfi1j ,. ft§ c?fi'A~I¥JJfd:lill!fD*&¥ cp E§llt ' ~I5V:Jj~mtWwil~HifUl¥Jm*fr±lill! \l.ij,lt(home-based community care) ~mWJ~A ' ~5JIj~92.:~g~AI¥JHliU':ljJ rEJo. 0. 0. l3n5l'~;~~~~~(~~!t,1994) U"IfF4lJi~fI ' Jfd:l¥J!~,It~IHI1ji&Jfft't1~$ 0. ,. ~:~iii~. .. ~fi!.:i;~A. I! .. 0. I: ;. r". ~.~jt. 0. 0. ~ilIiI¥JWII~ m{,f{:m*~,ltn~l9!i~'iI-'l7'GIEI¥JMtifWmIDIJJ *~3i:1Jj:Jm Q. 0. f:£:t£*flll $-'lfrilil\l.ij,ltI¥J92.:tig~Amfj~. 0. ( -) :1r 1lf1 lilF''l ~ fi~ ::t A lt9 ,OJf it J~ iJL fii&~±~tJj! ( 1994) Mt~t92.:~g~A~,It:fi:rtl¥Jtt-Wtl : fI.:rt3i."!t(V , :Jj.fI•. 3i."lt• •)l¥Jtt-WUtE ]I"861f:1¥J3.96%:ttH~ I 9891f:1¥J1 1.75% ' ~ m*~,It~ljtE96.04%~~19891f:1¥J88.25% ' 19931f:@] 1.37% ' ;ltcpm*\l.ij,ltxm:?tm*A\l.ij,lt, miZ\l.ij,ltfDf1.~,It °,giG r#tt~1fu~I¥J92.:tig~Af'±:{E*fI ' ~mm*\l.ij,ltH~~. Elderly). 71~ '~'ltV!ttt1Wi. ~A~¥U1IHfl¥J:1:$~,It millM&lJi~1J;1.~~Mt¥l¥JjiVltJ '$Jtt{1j'il-'l*~. .::.. ' lEI ~"~Jt 1t 69 ~ ~t. o. 0. '. ' t't:n~$8b:i1f ' 1l;f;7r~:P*AI¥J\l.ij,lt~tI:9f. ' J1:-a:rtJ*iE~*~1E. 0. 0. 92.:ijg~AI¥JJEtl~m Bm~$JiJ~g~92.:~~WI¥J~A ;!;t±-'lI¥J!*E§~ :9f.~~1t. ~:.:t~g. '.-'l.mtl¥J.~A1J 'f~M&lJi~Ij~fi1il-~~~I~*$nal9!i~littIlJtJ~92.:~g. ;ffllWl-t laJ M~ ~Abt-A(Disabled. , j:Jt'tf~92.:tm~. 0. , ~-lnm '-lli~f~*Aft\l.ij,ltJ:tJL1iI¥J~. ,~;!;t~g~¥tli&H1W~rJlfl. (-). ~lltUliI~,It~-,*)1iJ3Z:iittI¥JHa~. 0. .zWr±lill!~,ltjli1jo. ~. 0. wim: \l.ij,lt~ III)J{¥z ' XIlJ tJ liI ?tm~F m*il'r:iliI ~,It(community-based . out-of home services)(MilIer, 1991) ,fDm*l¥Jid: liI~,It(home-based community care) , f~~mHll}~m*~,It m*~,ltX-a:rtJlill!?t~m*v:Jj , m*itl{J!!! ' ~*~mtj..y,,&*$n~~ (If~m ' 1993) m*v:Jjwm*~J!!!IlJM~m#l ItfiOOl¥JtbbWJ ; !l!i*~itl{,&*$ijal9!i~lJpJMmJfd:":fiOOl¥JmWJ WI -lJin~l9!i. 0. -. ' 1993). (.:::.) J6~I!U1i(home care). 0. 1\,. (ii!H~m. 0. 0. ~. .~. , sl:.([flJffl~rdHiSr' , *&¥ ' miZ ' 1;;JJiA~zjlijN,$5l5mjli1jl¥J**J5. A~~k&I¥JVitl{WJfd:"iilflJ~,It t(jf!l§~ • wim:\l.ij,ltIlJtJ~liftE~,It~~1¥J. §WII¥J~3i:' ff®jtfl~A~±~~,It~z~mt~)j(~m*~,It$)j(~. 1TlWftIDIJJ:1i (1IjfHffi:\~ , ~H~ , ~~~ , 1991 ; ~M~ , MflJ:iM1 ' 1990 ;.:f~ 1;;!! ' *~~ m~!IJ ' 1989) ff!1:~JYf~jtfl~M~itl{t~\tf.l¥Jn~ 19!i~filWftIDIJJ:1i(ll7C3S.tta ' 1988 ; ~jd~tta ' 1990 ; *51'1't:l ' 1990 ; ~i:!ftE, ~E51a)j , 1991 ; ~~!! '*film, 51H~BB' ~t51a)j , 1992; #1:13. ' *film '#I:~l.X 'Jia)j~ , ~~!! ' 1991 ; f*.5:2~ '~9IJ 'm3S.:£X 'Ji~~ , 1992 ; f*Q~ , 1989 ; 1Z3S.~ , 7R3S.J§ , ~fflfi¥J ' 1990 ; Jiix~ , 1992) ~~tPJl1jte§WIfl92.:ijg~AiliR:z~I£'~7M (8WJIW ' ~~Jl . 1994 ; f$j~ , 1994) ¥U@92.:~g~A~-M~MfII¥JA ? ;!;t~mtlfj\?5UlOfilJ? ;!;twilill!~ ,It$)j(tzOfilJ ? tzOfilJ~fifrim:\l.ij,lt ? ~ill&l~~MI¥J *~~I¥J Ell¥Jft~1f ' ~ MiJ~tmJfd:m:CP92.:~g~AI¥JVitl{\l.ij,ltWfrlilfJj~~~I¥J$)j( , iiffijiljH~92.:~g~A ~mJfd:m:~,ltI¥JM!'IlIWf$~ • -1riID.illlEl;92.:~g~ Ang1ij:lLffijff#MI¥J~$. ,*fm-- ,. t-"'ell 51. imm~U::l:~Al¥Jm~gtl1j~ffM&fj. : ;It-~. 0. of Daily Living,ADL) ; ~-fj~~WJtiBm~ $$i!Jzm~g(Instrumental Activity of Daily Living,IADL) WI~{gml¥JJ"Ji § ff : ~1!;: , 1*m ' ~tR ' tzoOOi ' 1lLf$. , */J\'f~Et~U 1!t~{gttll¥JlJi§ff : ~~1!;: , n~~ , J!!!M ' lWJ4o/J ' nm~ , fIfl~~*$ , i)ttRfD~m.XimI~ (Guralnik & Simonsick, 1993 : Kane & Kane, 1987) B',lj:5~$$i!Jzm~g(Activity. ~~!t ( 1994 )fl*iJ~tttt!:m:frilil~AI¥JIDIJJ:1i: 92.:tiE~Att-WUitI0.9%. 0. 2¥l\\Iiimffijftl ~ -WUtz03z::'li65-69~1¥J B m- ~$$IfJJiJ~g92.:fig$f1i. 0. 0. to%, J3t1~1.8%' {g75-79~*Jl~IJ7T~ ,?t5JIJ~IO.2%fD7.4% 80~tJl:~1j 0. • •20%fDI5.6%, wim:92.:fig~A*~,ltI¥J'IWID· ft~tiff3i:CP-lli-a:r-m~J! ~.JJ!1¥J173flL92.:~E~XCP , ff7 Az.A~,It , 3AB1'±~3i."ltcp{J' , 4A~ffl 11I:t£~.'tt ' IAs:nmJlfi\l.ij,lt , ;!;t~155A:I:~HB*AmiZ\l.ij,lt , ~FIE:rt\l.ij,lt. 0. 0. ( .::::..) rl.e ,~UJ{(communi~ care) Jfd:lill!~,It{t(~rq]I¥J~~~J:~~j~ffijft~}f:Lt~ff~rq] ;gfflHmmffV~n~~ 0. I¥JWd:liI\l.ij~Wjfd: .. n~~tbbWJI¥JJfd:lill!~,It. 0. ftV~4lJit£JXCP. , Ulil~~I¥JWJE. '. ..

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(15) 14 0fI. *iR.. K~~~A~.~~~.~~. ~4-16. __. .~~Z~~. ~~~*~~tt-ft~~:5t:fJT (stepwise selection). Predictors. b f~. s.d.. ~~*. 'ffi'fl. -1.9675. ~m1fJJWJ~* -3.9734**. 1.2363. IADL~:5t. 0.1241. 0.0787. .¥!.J~t.§,WJ. 2.4267***. 0.5393. 'ffi'fl. 1.9622. 2.7035**. 0.9984. ADL~:5t. W~A;f§~rg1*. 0.3619***. 0.0659. ADL~:5t. 0.1241*. 0.0575. .¥!.J~1fJJWJ. 4.0029***. 0.9128. test of the model. P<O.OOOI. ~~:;'lZfl. 1.4018*. 0.5737. Adjusted R2. 0.3556. *~~~*. !ljt~A:f§~rg{*. 3.5'195*. 1.6975. ZP:¥-g1&A. 0.0443. 0.0238. test of the model. P<O.OOOI. Adjusted R2. 0.4070. @~~J]!~*. 2.3855*** -0.8773**. 0.2838. 1.3965**. 0.5349. ZP:¥-gJ&A. -0.0106*. 0.0050. IADL~:5t. -0.0353. 0.0188. 'ffi'fl. 0.0750. 0.2454. ~~:;'lZfl. 0.4613***. 0.1199. test of the model. P<O.OOOI. ~ttAfl. 0.1669***. 0.0486. Adjusted R2. 0.1784. m1;!U~til. 0.5415*. 0.2627. ttlJU -¥Vffj':;'lZfl. 0.4035*. 0.2026. r.ill1lffif5l~*. 0.3009*. 0.1540. test of the model. P<O.OOOI. Adjusted R2. 0.2526. l5*if~~*. 'ffi'fl. -2.2865. ADL~:5t. 0.0349. IADL~:5t. 0.1035*. 0.0471. ~~~J&. 0.5068*. 0.2046. .¥!.J~t'§'WJ. 0.5367***. 0.4149. 0.0208**. 0.0083. ZP:¥-g1&A *IA5[~. -1.l849*. test of the model. P<O.OOOI. Adjusted R2. 0.5573. 'ffi'f5( 1iI@W:e":i. 0.0106. 0.0312. 0.1781. 0.1201. ZP:¥-gJ&A. 0.0023*. 0.001l. test of the model. P<0.0393. Adjusted R2. 0.0393. 0.6596. 0.1551***. 0.4849. 0.3562. R;f5( UfHim1J 1iI@W:e":i. ".

(16) fV. 'fMo--''"t1t;,.~'''''''I'-r.::.I'·''por". q:~~.Jtf\. 7. U:J tfQ ....J"~V#·.J..1'../~.l',JTJ "'f"1 ..v-.....~,.:L... 1~Hif~*;;(.fIilmM7HJT (-=:'flfl~;;('tt~). Predictors ~fIlH~.. ;litm. Modell S.D. 1*m 2.09085.6139. Model 2 S.D. f*m. Model 3 S.D. 1*~. -0.8257. -3.7348. 0.3611 0.0108 -0.0299 -1.3205 I.F39 0.0429 0.0545. 0.5907 0.0195 0.1148 -0.7851 2.1698 0.0402 0.0443. 1.2138 0.0869 0.2662 0.2997. 1.2680 -0.0301 0.3235 0.1225. p<0.0386 0.0472. p<O.OOOI 0.3200. 2.6578 -1.4258 0.7989 4.6356 1.2436 -1.9368 P<O.OOOI 0.3679. 0.7519. 0.5543. -0.0525. 0.1561 -0.0103 0.5383 0.3665 0.0965 0.0041 0.1803. 0.1904 0.0125 0.4458 0.3066 0.2232 0.0044 0.1655. 0.2933 -0.0076 0.6688 0.5479 0.2678 -0.0006 0.1652. 0.3134 0.1838 0.0471 0.0283. 0.4466 0.2982 0.0302 -0.0383. p<O.OOOI 0.2106. 0.2487 0.3533 -0.2726 0.1111 0.5864 0.1193 p<0.0007 0.2143. jfr:t1tAD~jt. tt7Jtl. if.~. e~mgl. .~1Mmg2. 1Jijf5 i&,A Imf£AD. 0.l686 0.1030 -0.3045 -1.7712 -1.5027 0.0511 0.3083. !lftfmaJti\bL f&;~*fi{. "'¥1Ji*fi{. ADLN!!\7t IADL~7t. ~~lHlf*~Ud:frB:!I!I.1 W~Affi~lJM1*. m±frB:!I!I.1 flAftl{~. ifAm:L~ ifAt'H!H~~ flA1i:~. test of the model adjusted R2 ~~~:J:§!.ff&3J<. ;litfi{ ffd:frAD~jt tE7J~ if.~. e~~mgl .~{Mmg2. 1Jijf5 i&,A 1m,:EAD. !lftfmaJti\rJt f&;~*~ "'¥flfij*fi{. ADL~7t. IADLN!!\7t ~f@.Im{*Wffd:frJI!I!I.1. W*A;fEl~IHl,* ffd:frJI!I!I.1 flAftl{~. fl~. ifAm,:lU~~. ifA1i:fi¥ test of the model adjusted R2. p<0.0002 0.1214. 1-2.3536. -0.7856 ffd:frAD~jt. '117JU. if.~. e~~mgl .~fMmg2. 11)6 Wl,A 1m f:EA 0. -0.0880 0.0411 -0.4528 -0.4734 -0.7140 0.0205 0.1849. -0.2721 0.4943 0.0166 0.0460. !lttfmJ1Jt)jj\~Jt. 0.3838 0.0153 0.1552 0.1319. ~~;.xfM{. ",¥1Ji*~. ADL~7t IADL~.7t. *~IJM1*Wffd:frJI!I!I.1. ~-1.5264. I. 0.2520 0.0208 0.0579. 0.5184 -0.2121 0.1576 0.0971. I 0.4263. W%A;fEI~IJM1* m±frJI!I!I.1 flAmlti. flAmf~. flAm{;~*~~ flA1i:~ of the model R2. p<0.0164 0.0608. L~ ,\RRR. 1.4121 jjitfrAD~1t. tt7JU. if.~. e~mgl. JlI~fMmg2. 1Jijf5 i&,A Imf:EAD. !lftfmJ1Jt)jj\~Jt ~~~~. "'¥fJ\ij;Xm ADL~,7t IADL~7t. ~~mH*Wffd:fr:a!l!l.1 W~A;fEl~lHll* ffd:frJI!I!I.1 flAm~. flAmf~ fl Amf;tt*~.~ flA1i:fi¥ of the model R2. b.6258. 0.5480. 0.0201. 0.2849. -0.4990. 0.4182. 0.0152. 0.0175. 0.2137 0.0662 0.l989 -0.8164 -1.1427 0.0180 0.1302 ,. 0.1878 0.1038 0.0785 0.2410. ·0.1507 0.1197 0.1489 0.1350. I 1.6540.

(17) lil~l!f~~ ~~ ~±itAO~D. 11lJU. if:1Iil. B~mgl ~~1Mmg2. 11115 .r&A. l8JitAO. 3,5679. 3,8362. 2.3650. 0,0309 ·0,0137 ·0.5767 -0.4592 -0,1463 ·0,0046 ·0,1184. ·0,1109 ·0,0099 ·0.4847 -0.4319 -0,1431 ·0,0062 ·0,1l66. ·0,0036 -0,0048 0.5725 0,6675 1.0337 -0,0126 ·0,0729. 0,1302 -0." 194 0.0038 ·0.0342. 0,0502 -0.1l46 0.0040 -0.0423. :!itIHttSt~R ADL~5t IADL~5t. ~1l1ll11*WWd:it1DI;I] W~AffimtMl1*. ffd:itlfJ1iJ frAMti. fr~~. test of the model adjusted R2 jf.ai@i''''::''''ITQ;'1'. p<0.0417 0,0459. ns 0.0480. -0.0233 ·0.7853 ·0.1580 -0.0801 0.3165 0.3195 p<0.0235 0.1223. 0.0811. 0.1584. -0.0393 0.0007 ·0.0790 ·0.0461 0.0095 0.0023 -0.0098. -0.0358 -0.0008 -0.1324 ·0.0873 ·0,0131 0.0025 -0.0085. 0.0144 0.0001 -0.0158 0,0524 0,0926 0.0020 -0.0088. 0.0153 -0.0126 0.0067 -0.0097. 0.0385 0.0157 0.0029 -0.0082. ffd:itAO~D. 1:1lJU. if:1Iil. e~frmgl ~~fMmg2. jiJ15 .r&A. l8JitAO. :!it~JI'~R ~~;.x~. -¥fl~*1fl. ADL~5t IADL~5t. ~lllUl1*Wffd:tt lfJ1iJ ~~AtElJfimH*. ffd:tt lfiJ)] 1'lAMti. fr~~ frA1JH~~~ frA5i~. test of the model adjusted R2. .P<.OOI. tt:zfs:liHJf:tp , :Kfig~.A.1f.~7tf(j1~F1t~ , ::fi@l75~tJJ::K1m89~.A.fti7 61.8% miJ~1f.~~ft ' llSlmpm*89:S-fl'tt'11~~ , ~~.A.:Kfig89m.~JJj(~ L - §3fi-Jlfmtp J!\(33.2%)®1ffm!lJ1~~~(24.5%)~~*tffii?5¥5!:~.A.:Kfig a9::t~JJj(~ *$7t:Ktm~.A.fI~.A.~f:r ' ZjS¥-§J~f:r.A.1l!:~3.29.A. ftcfM~ ::t~89~Jm~ , :Kfig~.A.89~IJ:M?:5Lf!r~Jl~* ' jt.tp1iii@,=tffiitJJ: 1ttt~~89 ' ~lli-=-7t~= ttZP:¥-§JJ:i~ , :Kfig~.A.fI3.3tffii89'It'l1m g:KtigM?:5Lp.x~~M' ::fOJ~fli89m~1& ' :Kfig~.A.itd6\@UEJE89~}iHElg t19gliHlUfi' *~~lli-*89:Kfig~.A.tti@l~-1f.pgtU~1±1I1G 'jt.tptJ- , 0. 0. 0. 0. 0. 0. . =;;xliS~' I1589:Kfjg~.A.tti@l~-1f.pg'tf*~)'@:.:f.Vltj' r~llt~JE~fI2/3iJ9i ~~-1f.pg'tf~llt~fuftiI/5 a:IlIt~:Kfig~.A.tt®-lN:~.A. ' 89~fljJ~~ 0. 0. ~89.mJi~o. 3.22%89:Kffg~.A. fIlOtffii B1t~$$,JJI/Jfig%:3:!~fljJ~fffi7tmWJ tt~ WJtt B 1t~m$lJJl/Jfig(IADL)fljJ~1ZbW]'I1iffj~ , B'lJfI43.2%89~.A.tt8tffii IADLJ:fljJ~fffi7t~:3:!fi~mWJ mt~:Kfig~.A.~.fljJ~tt B1¥; ~$$IIJl/Jfig J:.:y.tJ1ZbWJ ' ::;t~~IJi±""1189B1¥;~$$1JJ 0. 0.2977. 'Iltlfl. '". -,MjQ:. 0. ~~*~ -¥~*Ifl. frA1JHtUfl!~ frA:£~. 1li " ~tl~~~~. ns. ns. 0.0068. 0.0010. **:P<.OI. *:P<.05. -0.0675 0.0241 -0.0272 0.0454 0.0312 ·0.0210 ns 0.0454. 0. 0. :Kfig~.A. OJtJ f;:NJ<ElI!:l1i~ , ~W®JiW\mm:::'1.f[ill1~¥tlpJT.~89Wd:"'2 ~ , ttJiW\ ' *~~mm1Jim ' 1~¥tl2M'89tt{9lHEl1ltfI£ ' liiftil4%. 0. 89~~ , IEW~~±"'fl/l1~!J:f!IHf4OJ tJ..fii1E89 ' llSl !ItfI~;fElg ~ f3i:1JaiJ9iW\,f@Jm ~. 0. /:. :Kffg:t.A.89IJiHlh~Jm.* ' tJ~$J:89~JmmWJ~fljJ~ , ~;;xf?<~~liS ~~NmWJ ' *~~~1lmWJ ' liS~1li:@.m.WJj..~.&.mlllicW~~1ZbWJ 0. :Kfig~.A.891llIJ:M?:5L ' Um§lH<S~ffl®B1t4.$$IJJWfi~ ,~jjii~~Jm "*fIg{~ ~5:E~r'~~' ttjjii~~lifljJ*J:tt~fJ£' ffij~~89:K1i~~.A. ' 1i§~~M?:5L~~ ''''fI~~89iii±~~JmfljJ* :KfiE~.A.tE81¥;4.m$IJJJJJffg Jl.!fI1iWJ'l1 B~~m$lJJl/Jfig~¥tl89~~ijitl~f.l~*!K¥ ' ~.~liS~N:@' , liS~ ~.®~$1ZbWJ fI75tfIfJE:fflIE~• •m#t~§lH<S ' ttjjii~~Jm~.* ' liS ~~• •*®~JmmlllifljJ*..tfI~~ fI~fflIE~• •§lH<S89:Klfg~.A.' 0. 0. 0. 0.

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(21) ~~ftMA~ • • • ~.*~. 86 lit ~~. ~::Ei~. , ,*.:t:J§I ,. ~~). iil!~i¥J ,1990.. '17(2)' 171-180. ~iJ~. , 1996.4J':l68. il!H~~. , 1992.. ~§"~ , tiH~). ~.~.~. ('liJffi!)=lJJjl!ij~Jl!D19fti.O. 0. (0~. 0. Higgins, J.(1989). Derming community care: Reality and myths, Social. <tJ~tm~Am~~fJj~*~~Il~~ZtiH~}. 0. tJ~t. policy and administration, 23(1). PP3-16. Kane, R. A. & Kane, R. L. (1987). Long-term care: Principles, programs,. 0. <~Aft:M~[;j;fEIlMlliBg). 0. tJ~t. : f:Eltt. 0. 1990. <tJ~tm~t~liicp~1fAfjtfifBlIi~~ZllmJ1tt <0~~~) '17(2), 159-169. f*flffiUi ' 0. Guralnik,J.M.& Simonsick, E. M (1993). Physical disability in older Americans, Journal o/Gerontology. 48(Suppl): 3-10.. 0. mjJi:IOM,fct1ffqJ~M:tiH~ il!H~~ ,1993.. •••. 0. .::..,~Jt~1)-:. Able, E. K. (1986). Adult daughters and care for the elderly. Feminist. Studies, 12,479-497.. andpolicies. New York: Springer. McAuley, W.J.& Arling,G.(l984). Use of in-home care by very old people.. Jurnal 0/Health and SocialBehavior, 25:54-64,1984 MiIler,J.A.(1991). Community-based long-term care. Newbury Park. CA : Sage Publications. Molley,S.P.(1994). Defining case management, Home Health care Nurse, 12(3),51-54.. Anderson, N.N.,Patten,S.K.& Greenberg,1.N.(l980). A comparsion o/home. Montgomery, R. J. V. (1992). Gender differences in patterns of child-parent. care and nursing home care/or older persons In Minnesota.Vo.!. caregiving relationships, in Dwyer,J.W.& Coward, .T.(ed) Gender,. Summary, Minneapolis,U of Minnesota.. /amily, and elder care, Newburg, CA: Sage.. Barusch,A.& Spaid,W.(1989). Gender differences in caregiving: Why do wife report greater burden? The Gerontologist, 29, 667-676. Chapple,N.L.(l985) . Social support and the receipt of home care service.. The Gerontologist, 25 : 47-54. Chenoweth, 8.& Spencer, 8.( 1986). "Dementia: The experience of family givers", The Gerontologist, 26, 267-272. Dwyer, J. W& Coward,R. T.(Editors)( 1992). Gender,families and elder care.. Newbury Park, CA: Sage Publications. Coward, R. T.& Dwyer, J. W.(l990). The association of gender, sibling network composition, and patterns of parental care by adult children.. Research on Aging, 12 : 158-181. Crawley,W.D.(l994). Case management: managing the nurse case management.. Health Care Supervision, 12(4) 84-89. Goldscheiger,F.K.(l990). The aging of the gender revolution, Research on hiM. 12 : 531-545.. Phillipson, C. & Walker, A. (1986). Ageing and social policy: A critical. assessment. Aldershot, Hants, England: Gower. Stone,R.,Cafferata,G.L.& Sangl,J.(l987). Caregivers of the frail elderly; A National profile, The Gerontologist, 27, 616- 626. Walker, A. J.(1992). "Conceptual perspectives on gender and family caregiving." in 1. W. Dwyer, & R. T. Coward (eds). Gender,families, and. elder care. Newbury Park, CA: Sage Publications. Wallace, S. P.& Cambell, K.& Lew-Ting, C-Y.(1994). Structural barriers to the use of formal in-home services by Elderly Latino, Journal. 0/. Gerontology:Social Science, 49:5 Wallace, S. P.& Lew-Ting, CoY. (1992). Getting by at home community based long-term care of Latino elders, West Journal 157: 337-344.. 0/ Medicine,. Sep..

(22) H15 1it1 *- 1P,. ~~~~A.~ft~~.~. • • • • ~~Z~~. Wiener, 1. M., Hanley, R 1., Clark, R,& Van Nostrand, J. F, (1990), Measuring the activities of daily living: Comparisons across national survey, Journal ofGerontology:Social Sciences, 45, 229-237,. ':i~~~~~AEl r~'~~~{~ift.w~~-tl91~. :. ~~A1tJfl~&.~~~a9af,5ili-i-·. g f .... #. f~~.t-. ••• A~~a~ •••• M~.·~A~~ .ti.A~~4 ••:fM.f}'· A~t.t~I:~~.t.t. •• (respite care) .'M.~·.~.f.~M'.Aa~ •• ~.M~~·t*Ml S~~A.~ti.~·fiti.'+L~a~ •• ~.M~m.~AA ~~4 •• :f·~~M.g~:~~.A~m:f~~~4~.Aa~ ••••• ~~ •••:fMt.,.M•• :fC&M.~;~A~m a~ •••• ~ ••• AM#~~·~.~ •• ,ft~.~h·~~ '~~~ ••• M~a~M~.·~A ••• #~M~~~f·.a' ~~~A~.~.~M~*~~a~ •••• ~.M~~· __ : a ~ ••••. C& •••• · •• fft;$ • ~m:ftut ~~~MQM.4. ". *-.1.. :t fJf i*. rn z. jNt >t 4,dl 1I;f4- -t:/ill B/J 6i} bit !Jt'it.: r :HU; A..1f.if. i(,;fa .if. i(, ~,. ft ,¥< (It • .,*-: NSC 85-2412-H-004-002). lII{f.z.!Jt--~;l. El ~~"!Il;Jt~"zi*.rn~ff!lJ • .u:.aii; *.*,,ji.-t*, ,¥-. jll~;j:t.

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