探討失智症患者使用日間照顧中心與瑞智互助家庭模式下之家庭照顧者多元評估

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୯ҥᆵ᡼εᏢϦӅፁғᏢଣ଼நࡹ฼ᆶᆅ౛ࣴز܌

ᅺγፕЎ

Institute of Health Policy and Management College of Public Health

National Taiwan University Master Thesis

௖૸Ѩඵੱ஻ޣ٬ҔВ໔ྣ៝ύЈᆶྷඵϕշৎ৥ኳԄΠ ϐৎ৥ྣ៝ޣӭϡຑ՗

Comprehensive Assessment of Family Caregivers with Dementia in Adult Day Care and Wisdom of Family

஭✎༇

Yu Chin, Chang

ࡰᏤ௲௤Ǻഋ໡ऍ റγ

BewjtpsǺZb.Nfj!Difo-!Qi/E/!

ύ๮҇୯104ԃ12Д

December, 2015

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ठ ठᖴ

ࡐ໒ЈಖܭֹԋᅺγፕЎǴஒाᗌӛΓғޑΠ΋໘ࢤǶᗨฅ೭ࢤၸำǴӭ޸

Α΋٤ਔ໔Ǵനࡕಖܭ໩ճޑֹԋΑǶ

२ӃǴाགᖴךޑࡰᏤԴৣ-ഋ໡ऍԴৣǴߚதᖴᖴԴৣޑ௲ᏤǴό໻๏ϒך Ꮲೌ΢ޑࡌ᝼ǴΨ௲Ꮴך଺ࣴزޑᄊࡋǴ୻ᎦךᐱҥࡘԵૈΚǴӧࣴزޑၸำύǴ

٬ךڙ੻ؼӭǶΨߚதགᖴѨඵੱڐ཮ޑ෯᜽ҏઝਜߏǴаϷࢬႣ܌ޑำ᝶๭Դ

ৣǴࡐᄪ۩ёаᗎፎգॺᏼҺךޑα၂ہ঩Ǵ๏ϒךፕЎࡐӭᝊ຦ޑཀـǴ٬ך ޑፕЎ׳уޑֹ๓Ƕ

ӆٰाགᖴǴךॺࣴز࠻ޑӳუՔॺǴᖴᖴ᐀༾ᏢۊǵޱࣦᏢۊϷ៪଻ᏢߏǴ Ꮲߏۆॺ೿όսᆶךϩ٦࿶ᡍǴΨૈ୼፾ਔޑ๏ϒךࡌ᝼ǶᗋԖӕᏢࠧ᱒ǵॕຬǴ གᖴգॺӧࣴزޑၸำύǴᆶך΋ଆᏢಞǵϕ࣬ן࡭ᆶႴᓰǶΨࡐགᖴࠔϡᏢ׌ǵ

⍌ޱᏢۂǴӧ૸ፕޑਔংΨૈ୼๏ϒؼӳޑࡌ᝼Ǵ࣬ϕᏢಞǶ

ԶӧךԏਢޑၸำύǴགᖴᅰЈڐշךԏਢޑВ໔ྣ៝ύЈϷྷඵϕշৎ৥Ǵ ᗋԖӚൂՏޑᖄ๎ืαǴߚதᖴᖴ໨රఘ࿎Ꮴǵᎄ໡ӵ࿎Ꮴǵ׵ఘमЬҺǵᐽཀ

൛ޗπৣǵ৪ᇞ౺ޗπৣǵڬޗπৣǵഋ୯۸஑঩ǴऩࢂؒԖգॺǴךόёૈٗ

ሶ໩ճޑֹԋԏਢǴགᖴգॺӧၸำύǴ๏ϒךࡐεޑᔅԆϷڐշǶ

നࡕǴाགᖴךޑৎΓǴգॺࢂךനமεޑࡕ࣯Ǵᡣךӧװ᠐ᅺγය໔ϣǴ คࡕ៝ϐኁǴ஑ЈᏢಞǶ

Ў҃Ǵךाठ΢ךനుޑགᖴǴߚதགᖴ೭΋ၡ΢ᔅշךޑգॺǶ

஭✎༇ ᙣठ

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ύ

ύЎᄔा

ࣴزङඳǺӄౚѨඵੱΓኧ೴ԃᚹϲǴѨඵੱ஻ޣҗৎ৥ྣ៝ޣ܌ගٮྣៈԖ ቚуޑᖿ༈Ǵৎ৥ྣ៝ޣӢྣ៝Զౢғޑቹៜሡ೏ΑှǴӢ཮ቹៜډྣ៝ޣϷ Ѩඵੱ஻ޣي౛ϷЈ౛Ǵ຾Զቹៜྣៈ่݀Ƕᒧ᏷٬ҔόӕޑߏයྣៈኳԄǴ

཮ჹৎ৥ྣ៝ޣౢғόӕޑ҅ॄӛቹៜǶҗԜ௢ෳǴѨඵੱ஻ޣϷৎ৥ྣ៝ޣ ᒧ᏷٬ҔВ໔ྣ៝ύЈኳԄϷྷඵϕշৎ৥ኳԄǴ཮ჹৎ৥ྣ៝ޣౢғόӕޑ

҅ॄӛቹៜǴҞ߻୯ϣࣴزεӭଞჹൂ΋҅ӛ܈ࢂॄӛቹៜ຾ՉࣴزǴՠ҂௖

૸ৎ৥ྣ៝ޣჹ٬ҔόӕኳԄޑ҅ॄӛྣ៝ቹៜǶ

ࣴزҞޑǺ௖૸Ѩඵੱ஻ޣ٬ҔВ໔ྣ៝ύЈኳԄϷྷඵϕշৎ৥ኳԄǴჹৎ

৥ྣ៝ޣӭϡຑ՗ϐቹៜǶ

ࣴزБݤǺҁࣴزӧϖৎВ໔ྣ៝ύЈϷྷඵϕշৎ৥຾ՉୢڔፓࢗǶࣴزჹ ຝࣁ࿶ᙴৣዴບࣁѨඵੱ஻ޣЪς࿶٬Ҕ୍ܺኳԄၲΟঁДѨඵੱ஻ޣϐЬा

ྣ៝ޣǴЪࣁЬाගٮѨඵੱ஻ޣྣ୍៝ܺϐৎ৥ྣ៝ޣǶࣴزаፄ଑ᘜ (Multiple Regression)௓ڋৎ৥ྣ៝ޣϷ஻ޣΓαᏢ੝፦Ǵ௖૸٬ҔВ໔ྣ៝ܺ

୍ኳԄϷྷඵϕշৎ৥ኳԄΠǴৎ৥ྣ៝ޣϐ҅ॄӛቹៜǶ

ࣴز่݀ǺҁࣴزӅયΕ93ΓǶྣ៝ޣӭϡຑ՗ໆ߄ٿಔ୍ܺኳԄคᡉ๱ৡ ౦ǴځΟঁᄬय़Ȩྣ៝ޣᓸΚࡰኧȩǵȨྣ៝ޑᅈىགȩǵȨྣ៝ޑዕግૈ

Κȩჹٿಔ୍ܺኳԄࣣคᡉ๱ৡ౦Ƕྣ៝ޣ൩཰ރݩࢂցׯᡂჹӭϡຑ՗Ϸྣ

៝ޣᓸΚࡰኧࣁ҅࣬ᜢǴᆶྣ៝ޑᅈىགࣁॄ࣬ᜢǹ؂Вྣ៝ѳ֡ਔ໔ჹӭϡ ຑ՗ࣁ҅࣬ᜢǹྣ៝ޣԃសჹྣ៝ޑዕግૈΚࣁॄ࣬ᜢǶ!

ࣴز૸ፕǺٿޣ୍ܺኳԄӧྣ៝ޣᓸΚࡰኧǵྣ៝ޑᅈىགϷྣ៝ޑዕግૈΚ คᡉ๱ৡ౦Ǵж߄ٿᅿ୍ܺჹৎ৥ྣ៝ޣځჴ೿ԖࡐӳޑЍ࡭Ƕࡌ᝼҂ٰว৖

ӭϡߏྣৎ৥Ѝ࡭ྣ୍៝ܺਔǴΨёගٮྷඵৎ৥๏ϐѨඵߏ፸ޑৎ৥଺ୖ

ԵǶࣴز่݀ࡌ᝼ჹܭৎ৥ྣ៝ޣǴӧ҂ٰᔈ๏ϒྣ៝ޣޗ཮Ѝ࡭Ϸྣ៝מѯ ޑ૽ግǴٰफ़եྣ៝ޑᓸΚǴቚуྣ៝ޑᅈىགϷዕግૈΚǶ!

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ᜢᗖӷǺВ໔ྣ៝ύЈǵྷඵϕշৎ৥ǵৎ৥ྣ៝ޣǵྣ៝ޣӭϡຑ՗

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Abstract

BackgroundǺAs global aging, more dementia patient are cared by family caregivers., family caregivingmay have great impact onboth physical and mental health of the caregiver and the dementia older adults they are caring for. Evaluating family cargivers' experiences, which may included both positive and negative experiences, are important for future program and policy development. People with dementia and their family caregivers may use adult day care model or wisdom of family model in Taiwan.

ObjectiveǺThe purpose of this study was to explore and compare comprehensive assessment of family caregiver with dementia using adult day care and wisdom of family.

MethodǺThis study administer a comprehensive questionnaire in five adult day care centers and one wisdom of family. The comprehensive Questionnaire incldued three subscale. There were caregiving satisfaction, caregiving mastery and modified caregiver strain index. Participants of this study is the caregiver who attended the dementia patient, patient used the service already three months and is the mainly caregiver. The study used multiple regression to analyze and compare the differences in comprehensive assessment between families using adult day care and wisdom of family. Dementia cases and their family caregivers' characteristics were controlled.

ResultǺ93 family caregiver were surveyed. There were no significant differences in comprehensive assessment scores between caregiver using adult day care and wisdom of family. For subscales, caregiver strain index, caregiving mastery and caregiving satisfaction, there were no significant differences found between family caregivers using adult day care and wisdom of family. As for the total score of comprehensive assessment scores, employment status change of caregiver was positively associated with caregiver comprehensive assessment scale and caregiver strain index, and negatively associated with caregiving satisfaction. The average care time of a day is

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positively associated with caregiver comprehensive assessment scale. Caregiver age was negatively associated with caregiving mastery.

DisscussionǺThere were no significant differences in the scores for conprehensive assessment, caregiver strain index, caregiving satisfaction and caregiving mastery between family careivvers using adult day care and wisdom of family. This indicated both services are equally supported family caregivers with demented older adutls.

Findings suggested both services can be recommended to family careivgvers with different service preference. In the future, we suggest service agency to give caregivers’

social support and skills of care to declined caregiving stress and increase caregiving satisfaction and mastery.

KeywordsǺ adult day care, wisdom of family, family caregiver, comprehensive assessment of caregiver

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Ҟ Ҟᒵ

ठᖴ...i

ύЎᄔा...ii

Abstract...iv

Ҟᒵ...vi

߄Ҟᒵ... viii

კҞᒵ...x

ಃ΋ക! ᆣፕ...1

ಃ΋࿯! ࣴزङඳ... 1

ಃΒ࿯! ࣴز୏ᐒ... 5

ಃΟ࿯! ࣴزҞޑ... 5

ಃΒക! Ў᝘ӣ៝...6

ಃ΋࿯! Ѩඵੱ... 6

ಃΒ࿯! Ѩඵੱৎ৥ྣ៝ޣӭϡຑ՗ᆶቹៜ... 16

ಃΟ࿯! Ѡ᡼Ѩඵੱྣ୍៝ܺ... 24

ಃѤ࿯! ຑ՗πڀӣ៝... 31

ಃΟക! ࣴزБݤᆶ೛ी...34

ಃ΋࿯! ࣴزࢎᄬ... 34

ಃΒ࿯! ࣴزჹຝ... 35

ಃΟ࿯! ࣴزၸำ... 35

ಃѤ࿯! ࣴزπڀ... 36

ಃϖ࿯! ୢڔਏࡋᆶߞࡋෳ၂... 44

ಃϤ࿯! ಍ीБݤ... 46

ಃѤക! ࣴز่݀...48

ಃ΋࿯! ୢڔӣԏ... 48

ಃΒ࿯! ୢڔߞਏࡋϩ݋... 49

ಃΟ࿯! ኬҁ੝ቻᆶӚᡂ໨ϩѲ௃׎... 58

ಃѤ࿯! ௖૸В໔ྣ៝ᆶྷඵϕշৎ৥ჹྣ៝ޣӭϡຑ՗ޑเᚒϩ݋... 69

ಃϖ࿯! ӭϡຑ՗ໆ߄ϐྣ៝ޣϷ೏ྣ៝ޣ୷ҁ੝፦Кၨ... 77

ಃϤ࿯! В໔ྣ៝Ϸྷඵϕշৎ৥୍ܺϐӭϡຑ՗ӭᡂ໨ϩ݋... 84

ಃΎ࿯! ྣ៝ޣᆶ೏ྣ៝ޣϐ੝፦ჹᒧ᏷٬ҔВ໔ྣ៝Ϸྷඵϕշৎ৥ܺ ୍ӭᡂ໨ϩ݋... 89

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ಃΖ࿯! ྣ៝ޣᆶ೏ྣ៝ޣޑ୷ҁ੝፦ϐӭϡຑ՗ӭᡂ໨ϩ݋... 90

ಃ ಃϖക! ૸ፕ...95

ಃ΋࿯! ࣴزၗ਑ࠔ፦... 96

ಃΒ࿯! В໔ྣ៝ᆶྷඵϕշৎ৥ჹӭϡຑ՗ໆ߄ϐ૸ፕ... 99

ಃΟ࿯! ྣ៝ޣϷ೏ྣ៝ޣ੝፦ჹ୍ܺᒧ᏷ϐ૸ፕ... 103

ಃѤ࿯! ྣ៝ޣϷ೏ྣ៝ޣ੝፦ჹӭϡຑ՗ϐ૸ፕ... 104

ಃϖ࿯! ࣴزज़ڋ... 107

ಃϤക! ่ፕᆶࡌ᝼...108

ಃ΋࿯! ่ፕ... 108

ಃΒ࿯! ࡌ᝼... 109

ୖԵЎ᝘... 111

ߕᒵ...120

ߕᒵ΋! ࣴزউ౛ቩࢗਡё᛾ܴ... 120

ߕᒵΒ! ࣴزୢڔ... 122

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߄ ߄Ҟᒵ

߄1-1-1! 2010 ԃӄౚ 60 ྃа΢ѨඵੱΓα౰Չ౗ ... 2

߄1-1-2! Ѡ᡼ 2013 ԃۭ 65 ྃа΢Ѩඵੱ౰Չ౗(؂ 5 ྃࣁൂՏ) ... 3

߄2-1-1! ѨඵੱΜε᝾ૻ ... 11

߄2-1-2! Ѡ᡼Ѩඵੱ౰Չ౗௢՗(2014 ԃԿ 2061 ԃ) ... 13

߄2-1-3! Ѡ᡼ߓ૟ੇᓨੱ஻ޣੱރᆶՉࣁϐ౰Չ౗ ... 14

߄2-3-1! Ѡ᡼ 2013 ԃۭВ໔ྣ៝ύЈৎኧ ... 26

߄3-4-1! Ծᡂ໨ᏹբࠠۓက ... 38

߄3-4-2! ৎ৥ྣ៝ޣӭϡຑ՗ໆ߄ୢڔᄬय़Ϸᚒ໨ϣ৒ ... 38

߄3-4-3! ৎ৥ྣ៝ޣӭϡຑ՗ໆ߄ᏹբࠠۓက ... 39

߄3-4-4! ྣ៝ޣ୷ҁၗ਑ᏹբࠠۓက ... 40

߄3-4-5! ೏ྣ៝ޣ୷ҁၗ਑ᏹբࠠۓက ... 42

߄4-2-1! ӭϡຑ՗ໆ߄ϐ KMO ᆶ Bartlett ᔠۓ... 53

߄4-2-2! ӭϡຑ՗ໆ߄ϐ௖઩܄Ӣનϩ݋ ... 54

߄4-2-3! ኳࠠଛ፾߄ ... 55

߄4-2-4! ӭϡຑ՗ໆ߄ϐᡍ᛾܄Ӣનϩ݋-ኳԄ΋ ... 56

߄4-2-5! ӭϡຑ՗ໆ߄Ӛᄬय़໔ϐ୔ᒣਏࡋ-ኳԄ΋ ... 57

߄4-2-6! ӭϡຑ՗ໆ߄Ӛᄬय़໔ϐ୔ᒣਏࡋ-ኳԄΒ ... 57

߄4-2-7! ӭϡຑ՗ໆ߄ӚኳԄߞࡋ ... 57

߄4-3-1! ྣ៝ޣ୷ҁၗ਑ϐඔॊ܄ϩ݋ ... 61

߄4-3-2! ೏ྣ៝ޣ୷ҁၗ਑ϐඔॊ܄ϩ݋ ... 66

߄4-4-1! ӭϡຑ՗ໆ߄ϐඔॊ܄ϩ݋ ... 72

߄4-4-2! ӭϡຑ՗ໆ߄ϐᐱҥኬҁ t ᔠۓ ... 74

߄4-4-3! ӭϡຑ՗ໆ߄ϐᄬय़ளϩ௃׎ ... 76

߄4-4-4! ӭϡຑ՗ໆ߄ϐᄬय़ନаᚒኧϐளϩ௃׎ ... 76

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߄4-5-1! ӭϡຑ՗ໆ߄ϐྣ៝ޣᜪձᡂ໨୷ҁ੝፦Кၨ ... 78

߄4-5-2! ӭϡຑ՗ໆ߄ϐ೏ྣ៝ޣᜪձᡂ໨୷ҁ੝፦Кၨ ... 81

߄4-5-3! ӭϡຑ՗ໆ߄ϐྣ៝ޣϷ೏ྣ៝ޣೱុᡂ໨୷ҁ੝፦Кၨ ... 83

߄4-6-1! ٬ҔВ໔ྣ៝܈ྷඵϕշৎ৥ჹӭϡຑ՗ໆ߄ᕴϩޑቹៜ ... 85

߄4-6-2! ٬ҔВ໔ྣ៝܈ྷඵϕշৎ৥ჹྣ៝ޣᓸΚࡰኧᕴϩޑቹៜ ... 86

߄4-6-3! ٬ҔВ໔ྣ៝܈ྷඵϕշৎ৥ჹྣ៝ޑᅈىགᕴϩϐቹៜ ... 87

߄4-6-4! ٬ҔВ໔ྣ៝܈ྷඵϕշৎ৥ჹྣ៝ޑዕግૈΚᕴϩϐቹៜ ... 88

߄4-7-1! ྣ៝ޣᆶ೏ྣ៝ޣ੝፦ჹܭ٬ҔВ໔ྣ៝Ϸྷඵϕշৎ৥୍ܺϐቹៜ ... 89

߄4-8-1! ྣ៝ޣᆶ೏ྣ៝ޣޑ୷ҁ੝፦ჹӭϡຑ՗ໆ߄ᕴϩޑቹៜ ... 91

߄4-8-2! ྣ៝ޣᆶ೏ྣ៝ޣޑ୷ҁ੝፦ჹྣ៝ޣᓸΚࡰኧᕴϩޑቹៜ ... 92

߄4-8-3! ྣ៝ޣᆶ೏ྣ៝ޣޑ୷ҁ੝፦ჹྣ៝ޑᅈىགᕴϩϐቹៜ ... 93

߄4-8-4! ྣ៝ޣᆶ೏ྣ៝ޣޑ୷ҁ੝፦ჹྣ៝ޑዕግૈΚᕴϩϐቹៜ ... 94

߄5-2-1! ٬Ҕ࣬ӕ୍ܺΠǴྣ៝ޣϷ೏ྣ៝ޣ੝፦ჹྣ่៝݀ቹៜ ... 102

߄5-2-2! ྣ៝ޣϷ೏ྣ៝ޣ੝፦ჹྣ่៝݀ቹៜ ... 102

߄5-4-1! ಔϣྣ៝ޣ܄ձჹӭϡຑ՗ޑቹៜ ... 104

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კ კҞᒵ

კ2-2-1! ߓ૟ੇᓨྣ៝ޣᓸΚኳԄ ... 17 კ3-1-1! ࣴزࢎᄬ ... 34 კ4-2-1! ଥڵკ ... 53

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ಃ΋ക! ᆣፕ

ಃ΋࿯! ࣴزङඳ

ӧ2012ԃࡰрӄౚѨඵੱൔ֋(World Alzheimer Report, 2012)ࡰрǴӧ2010ԃ

՗ीǴӄౚஒԖεऊ3,600࿤Γ೏ບᘐࣁѨඵੱ஻ޣǴѨඵੱΓαஒזೲቚуǴႣ

ीӧ2030ԃஒၲډ6,600࿤ΓǴ2050ԃஒၲډ11,500࿤ΓǴԶΟϩϐΒޑΓαஒՏ ܭύեԏΕޑ୯ৎǶӧ2010ԃ൩Ԗ58%ޑѨඵੱΓαࢂวғӧύեԏΕޑ୯ৎǴ Ⴃ՗ӧ2030ԃஒၲ63%Ǵ2050ԃၲډ71%(Prince et al., 2013)ǶШࣚፁғಔᙃ(World Health Organization,WHO)ӧ2012ϦթޑѨඵੱൔ֋ύǴࡰрӧ2010ԃԖ770࿤Ӝ ཥບᘐࣁѨඵੱޑঁਢǴ࣬྽ܭ؂4ࣾ൩р౜΋ՏѨඵੱ஻ޣǶӄౚѨඵੱΓα

೴ԃቚуǴ߄1-1-1ࣁ2010ԃӄౚ60ྃа΢ΓαѨඵੱ౰Չ౗ǴӄౚѨඵੱѳ֡౰

Չ౗ࣁ4.7%Ǵځύऍࢪଯၲ6.5%ǴՠࢂӧѨඵੱԴԃΓαኧ߾а٥ࢪۚ߷ǴԶځ ύаܿ٥Ϸࠄ٥ޑѨඵੱ౰Չ౗നଯǶ

ߓ૟ੇᓨੱ(Alzheimer’s disease, AD)ӧ21Шइჹܭ଼நǵޗ཮аϷ࿶ᔮࢂ΋

ঁࡐεޑࡷᏯǶ2010ԃऍ୯ஒ߈Ԗ1500࿤ޑߚ҅Ԅྣ៝ޣǴගٮߓ૟ੇᓨੱ஻ޣ ऊ170ሹঁλਔޑྣ៝ਔኧǴ܌ଅ᝘ޑሽॶຬၸ2020ሹऍϡǶऍ୯Ԗ520࿤Γ೏ບ ᘐࣁߓ૟ੇᓨੱ(Alzheimer’s disease, AD)ǴځύऊԖ20࿤Γλܭ65ྃǴӧᓻٽዊ ޑቹៜΠǴӧ҂ٰΜԃǴႣीஒ཮ӆቚу100࿤ޑߓ૟ੇᓨੱ஻ޣǶ(W Thies &

Bleiler, 2011; William Thies & Bleiler, 2013)Ƕ2010ԃ಍ीǴӄౚԖ6,040ሹ޸ӧѨ ඵੱ΢य़Ǵ70%޸ӧՋኻϷчऍӦ୔ǶځύଯԏΕ୯ৎǴӧᙴᕍ܌޸຤ޑԋҁᇻ եܭӧߚ҅Ԅྣ៝Ϸޗ཮ᜢᚶޑޔௗԋҁǶԶӧեԏΕ୯ৎύǴځޗ཮ᜢᚶԋҁ

ࢂཱུϿޑ(Wimo, Jönsson, Bond, Prince, & Winblad, 2013)Ƕ

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߄ 1-1-1! 2010 ԃӄౚ 60 ྃа΢ѨඵੱΓα౰Չ౗

୔ୱ 60ྃа΢Γα (ԭ࿤Γ, 2010)

ಉ՗౰Չ౗

(%, 2010)

ѨඵੱΓα (ԭ࿤Γ, 2010)

٥ࢪ 406.55 3.9 15.94

ᐞεճ٥ 4.82 6.4 0.31

٥ϼ 46.63 6.1 2.83

εࢩࢪ 0.49 4.0 0.02

ύ٥ 7.16 4.6 0.33

ܿ٥ 171.61 3.2 5.49

ࠄ٥ 124.61 3.6 4.48

ܿࠄ٥ 51.22 4.8 2.48

ኻࢪ 160.18 6.2 9.95

ऍԀ 120.74 6.5 7.82

ߚࢪ 71.07 2.6 1.86

ӄౚ 758.54 4.7 35.56

ၗ਑ٰྍǺPrince et al, 2013

Ѡ᡼ԴԃΓαזೲԋߏǴӧ1993ԃ65ྃа΢ԴԃΓαэᕴΓαኧၲډ7%а

΢ǴਥᏵᖄӝ୯ШࣚፁғಔᙃۓကǴ65ྃа΢ԴԃΓαэᕴΓαኧၲډ7%Ǵᆀࣁ ଯសϯޗ཮(Aging society)ǹၲ14%ࣁଯសޗ཮(Aged society)ǹၲ20%а΢ࣁຬଯ សޗ཮(Hyper-aged society)Ƕ2014ԃ6ДۭѠ᡼ԴԃΓας࿶ၲډ11.75%Ǵ୯ৎว

৖ہ঩཮ޑѠ᡼Γα௢ी2014ԃԿ2061ԃൔ֋ࡰрǴ௢՗ԴԃΓαӧ2018ԃஒᗌ Εଯសޗ཮Ǵ2025ԃ຾Εຬଯសޗ཮Ǵ2061ԃஒၲډ41%ǴןԴКၲ1.1Ǵ߄Ң1.1

ঁԃᇸΓሡןᎦ΋ঁԴΓǶЪ65-74ྃԃᇸԴΓǴஒҗ2014ԃ55.7%ǴΠफ़Կ2061 ԃ38.8%Ǵ85ྃа΢ຬଯសԴΓǴ߾җ2014ԃ11.5%Ǵ΢ϲԿ2061ԃ25.6%Ǵ࣬྽

ܭ؂4ঁԴԃΓ྽ύ൩Ԗ΋Տ85ྃа΢ຬଯសԴΓǶ

Ѡ᡼Ѩඵੱ౰Չ౗ਥᏵ2004ԃՉࡹଣፁғ࿿ہૼѠ᡼Ѩඵੱڐ཮ޑȨѠ᡼Ѩ ඵੱᐒᄬྣ៝ሡ؃ϐፓࢗ-ߏයྣៈᐒᄬѨඵੱ஻ޣϐ౰Չ౗ፓࢗȩǴൔ֋௢՗

2016ԃޗ୔65ྃа΢ѨඵΓαऊ18࿤ΓǴ՞ᕴΓαКٯࣁ0.7%Ǵӧ2060ԃޗ୔65

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ྃа΢ѨඵΓαஒၲ73࿤ΓǴ՞ᕴΓαКٯ4.2%Ǵ҂ٰޑѨඵΓαஒε൯ቚуǶ

߈ԃፁғᅽճ೽ӧ2013ԃہૼѠ᡼ࢂඵੱڐ཮ჹѠ᡼ѨඵੱΓαࢬՉੰᏢ ӆ଺ፓࢗǶ٩ϣࡹ೽ϦѲၗ਑Ǵ2013ԃۭӄѠ65ྃа΢ԴΓΓαၲ2,690,000ΓǴ ځύԖᇸࡋᇡޕምᛖޣၲ50࿤ΓǴऊ՞65ྃа΢ԴԃΓα18.7%ǴԶዴບࣁѨඵ

ੱޣၲ21࿤7ίӭΓǴऊ՞65ྃа΢ԴԃΓα8.1%Ƕፓ่ࢗ݀ӵ߄1-1-2Ǵ65ྃ-69

ྃ౰Չ౗ࣁ3.40%Ǵ70ྃ-74ྃ౰Չ౗ࣁ3.46%Ǵ75ྃ-79ྃ౰Չ౗ࣁ7.19%Ǵ80ྃ- 84ྃ౰Չ౗ࣁ13.03%Ǵ85ྃ-89ྃ౰Չ౗ࣁ21.92%Ǵ90ྃа΢౰Չ౗ࣁ36.88%Ƕ

߄ 1-1-2! Ѡ᡼ 2013 ԃۭ 65 ྃа΢Ѩඵੱ౰Չ౗(؂ 5 ྃࣁൂՏ)

ԃស(ྃ) 65-69 70-74 75-79 80-84 85-89 90ྃа΢

౰Չ౗(%) 3.40% 3.46% 7.19% 13.03% 21.92% 36.88%

ၗ਑ٰྍǺѠ᡼Ѩඵੱڐ཮(2013)

ਥᏵШࣚፁғಔᙃۓကѨඵੱࢂ΋ᅿတ೽ੱংဂǴ཮ჹ஻ޣޑ૶ᏫǵࡘԵǵ Бӛགǵ౛ှΚǵीᆉǵᏢಞૈΚǵᇟقکղᘐΚ೷ԋቹៜǶѨඵੱ஻ޣޑՉࣁ ό໻ჹ஻ޣғࢲࠔ፦೷ԋቹៜǴΨ཮ჹྣ៝ޣౢғॄ಻Ǵ೷ԋғ౛ǵЈ౛ޑቹៜ (Fauth, Zarit, Femia, Hofer, & Stephens, 2006; Herrmann et al., 2006; K. Eagar et al., 2006)Ƕғ౛ॄ಻Ԗᅵ઀ምᛖǵيᡏ଼நǵЈՈᆅ੯ੰϷཥഋжᖴୢᚒ(Mills et al., 2009; Martin Pinquart & Sörensen, 2005, 2006)ǹЈ౛ॄ಻Ԗኁᢠǵขቾǵྣ៝ॄ಻

฻(Mohamed, Rosenheck, Lyketsos, & Schneider, 2010; Zarit, Anthony, & Boutselis, 1987)Ƕ೭٤೿ёૈ೷ԋৎ৥ྣ៝ޣيᡏ଼நр౜᝾ૻǴࣗԿ໒ۈ٬Ҕᙴᕍၗྍ

(Beinart, Weinman, Wade, & Brady, 2012)ǶԖ׳ӳޑྣ៝ৎ৥ྣ៝ޣࢂШࣚӚ୯ޑ ख़ाޑߏྣࡹ฼(Keefe, Guberman, Fancey, Barylak, & Nahmiash, 2008; Seddon &

Robinson, 2001)ǶѠ᡼2015ԃΨຫٰຫख़ຎৎ৥ྣ៝ޣޑ᝼ᚒ(ߋ௴ዎ, ೚ల௵, &

ֆలӵ, 2003)ǶԶຑ՗Ѝ࡭ৎ৥ྣ៝ޣޑ٬Ҕ୍ܺޑ࿶ᡍҭࢂҞ߻Ѡ᡼ख़ाޑࡷ

ᏯǶځύВ໔ྣ៝ឦܭޗ୔Ԅޑഹ৲୍ܺǴჹܭྣ៝ޣ๏ϒኩਔྣ៝ޑڐշǴ٬

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ྣ៝ޣૈ୼Ԗቸ܄ၮҔޑਔ໔Ǵ٬ځёаᆢ࡭౜໘ࢤ൩཰ރᄊ(ֈᝊᓉ, ׵٫Ꮒ,

& ᇳ᐀ޱ, 2014)Ǵྷඵϕշৎ৥ኳԄࣁ΋ᅿᜪ՟ޗ୔Ԅޑഹ৲୍ܺǴྣ៝ޣϷ೏

ྣ៝ޣ೸ၸᆶځд࣬ӕ࿶ᡍޑ΋ဂΓௗ᝻ΠǴᕇள௃གޑЍ࡭Ϸྣ៝מѯޑҬࢬ (෯᜽ҏ, ֆ؊ᒹ, ׵཮ࣔ, & ࢫЈѳ, 2013)Ƕ

୍ܺჹৎ৥ྣ៝ޣޑԋਏຑ՗ᔈࢂӄय़܄Ǵҗܭόӕޑߏྣ୍ܺჹৎ৥ྣ៝

ޣ ࢂ Ԗ ό ӕ ޑ ቹ ៜ (Chen, Hedrick, & Young, 2010; Diehl-Schmid et al., 2013;

Jennings et al., 2015; Mossello et al., 2008; ഋ޹൛ & ߋ௴ዎ, 2015; ໳௵ስ, ৪٥

ྻ, ླྀ୻࣑, & ယࣂம, 2004)Ƕৎ৥ྣ៝ޣӢྣ៝πբǴ཮ౢғޑྣ៝࿶ᡍԖ҅

ॄӛ࿶ᡍǴՠࢂԖѠ᡼Ҟ߻ၨӭޑຑ՗ࣁॄӛ࿶ᡍ(ߋ௴ዎ, ೚ల௵, & ֆᛏᅈ, 2002; ೾ᑉᐇ, ቅЎؼ, & ᅩྷᑫ, 2014; ഋࢅӜ, 2013; මഓስ, 2014)Ǵଞჹӭय़ ӛຑ՗ޑࣴز׳ࢂલЮ(Ц᜽ഓ, 2005; ໳ד۸, 2013)Ƕ

ᆕӝ΢ॊǴҁࣴزགྷΑှӧόӕޑྣ៝ኳԄΠǴྣ៝ޣޑ҅ӛ࿶ᡍϷॄӛ࿶

ᡍ໔Ǵჹৎ৥ྣ៝ޣځྣ่៝݀ޑቹៜǴࡺҁࣴزஒଞჹѨඵੱৎ৥ྣ៝ޣǴ຾

Չྣ៝ޣӭϡຑ՗Ƕ

(16)

ಃΒ࿯! ࣴز୏ᐒ

ӧВ໔ྣ៝ᆶྷඵϕշৎ৥ٿᅿ࣬՟ޑ୍ܺኳԄΠǴྣ៝ޣॄ಻ࢂց཮Ӣࣁ

٬Ҕόӕ୍ܺኳԄԖ܌όӕǶҗܭྷඵϕշৎ৥ኳԄۘ҂х֖ӧߏයྣៈ୍ܺύǴ

௖૸В໔ྣ៝Ϸྷඵϕշৎ৥ኳԄჹѨඵੱ஻ޣৎឦޑྣ៝҅ॄӛቹៜǴ׆ఈᙖ җࣴز௖૸ჹЬाྣ៝ޣޑቹៜǴ଺҂ٰ௢ቶᆶࡹ฼ڋुޑୖԵǴ٬ߏයྣៈܺ

୍ჹѨඵੱ஻ޣޑྣៈӧޗ୔ૈ୼Ԗ׳ӭϡޑᒧ᏷Ƕ

ಃΟ࿯! ࣴزҞޑ

ၸѐଞჹৎ৥ྣ៝ޣ܌଺ޑຑ՗Ǵεӭѝଞჹൂ΋य़ӛǴջॄӛޑቹៜ຾Չ

௖૸Ǵ҅ӛϷॄӛޑቹៜࣣ཮ჹৎ৥ྣ៝ޣک೏ྣ៝ޣౢғόӕޑቹៜǶࡺҁࣴ

زޑҞޑགྷ௖૸٬ҔВ໔ྣ୍៝ܺኳԄϷྷඵϕշৎ৥୍ܺόӕኳԄΠǴѨඵੱ

ৎ৥ྣ៝ޣޑӭϡຑ՗ቹៜࢂցόӕǶ

ҁࣴزҞ኱ԖаΠΟᗺǺ

1. ௖૸٬ҔВ໔ྣ៝ᆶྷඵϕշৎ৥ᆶྣ៝ޣӭϡຑ՗ޑᜢ߯Ƕ

2. ௖૸ྣ៝ޣϷ೏ྣ៝ޣόӕޑΓαᏢ੝܄ᆶ٬ҔόӕҔ୍ܺኳԄޑᜢ߯Ƕ 3. ௖૸ྣ៝ޣϷ೏ྣ៝ޣόӕޑΓαᏢ੝܄ᆶྣ៝ޣӭϡຑ՗ޑᜢ߯Ƕ

(17)

ಃΒക! Ў᝘ӣ៝

ҁകϩࣁѤঁλ࿯Ǵಃ΋࿯ѨඵੱǹಃΒ࿯Ѩඵੱྣ៝ޣӭϡຑ՗ᆶቹៜǹ

ಃΟ࿯Ѡ᡼Ѩඵੱྣ୍៝ܺǹಃѤ࿯ຑ՗πڀӣ៝Ƕ

ಃ΋࿯! Ѩඵੱ

Ѩඵੱࢂߚ҅தԴϯϐ౜ຝǴѨඵੱ஻ޣ཮Ԗᇡޕфૈ΢ޑምᛖǴᝄख़ำ ࡋ཮ቹៜډВதғࢲϷᙍ཰ϐфૈǶ҅தԴϯ౜ຝ΋૓ٰᇥԴԃΓޑ૶ᏫΚ཮

КԃᇸΓৡǴՠЬाৡ౦ࢂࡰȨ૶ᏫೲࡋȩϷȨ૶Ꮻ৒ໆȩǶᖐٯٰᇥǴ҅தԴ ϯޣёૈ཮ँฅב૶Ծρ҅ाѐ଺ࢌ٤٣௃Ǵՠࢂϐࡕ཮གྷଆখωा଺ޑ٣

௃ǹԶѨඵੱ஻ޣό໻ב૶Ծρा଺ޑ٣ǴЪ཮ֹӄགྷόଆٰǶаΠଞჹѨඵ

ੱޑۓကᆶੱރբϟಏǺ

΋ǵѨඵੱۓက

ਥᏵШࣚፁғಔᙃۓကѨඵੱࢂ΋ᅿတ೽ੱংဂǴ཮ჹ஻ޣޑ૶ᏫǵࡘԵǵ Бӛགǵ౛ှΚǵीᆉǵᏢಞૈΚǵᇟقکղᘐΚ೷ԋቹៜǶཀ᛽όڙډቹៜǶ ՠࢂᇡޕфૈምᛖ೯த཮Քᒿ௃ᆣ௓ڋǵޗ཮ՉࣁϷ୏ᐒޑൾϯǴԶԖਔং߾ว ғᇡޕфૈምᛖ߻ޑׯᡂǶ

ΒǵѨඵੱᅿᜪ

Ѩඵੱޑᅿᜪ٩ྣੰӢёϩࣁѤεᜪǴϩձࢂଏϯ܄Ѩඵੱ(Degenerative Dementia)ǵՈᆅ܄Ѩඵੱ(Vascular Dementia)ǵషӝࠠѨඵੱ(Mixed Dementia)Ϸ ځ д Ӣ ન ܌ Ꮴ ठ ޑ Ѩ ඵ ੱ Ƕ ଏ ϯ ܄ Ѩ ඵ ੱ Ь ा த ـ ޑ ᜪ ࠠ Ԗ ߓ ૟ ੇ ᓨ ੱ (Alzheimer`s Disease)ǵᚐ㙠ယࠠѨඵੱ(Frontotemporal lobe degeneration)Ϸၡܰ

МᡏѨඵੱ(Dementia with Lewy Bodies)฻ᜪࠠǴځύаߓ૟ੇᓨੱനࣁதـ

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(American Psychiatric Association, 2013; ߋሎക & ෯᜽ҏ, 2006; ఉৎݒ, ำ᝶

๭, & ഋΓᇬ, 2014)ǶӚᜪѨඵੱඔॊӵΠǶ

ଏϯ܄ѨඵੱதـޑᜪࠠԖߓ૟ੇᓨੱ(Alzheimer’s Disease)ǵၡܰМᡏѨඵ

ੱ (Dementia with Lewy Bodies) Ϸ ᚐ 㙠 ယ ࠠ Ѩ ඵ ੱ (Frontotemporal lobe degeneration)(National Institutes of Health, 2013a, 2013b, 2014)ǴаΠϩձϟಏ೭Ο ᅿଏϯ܄ѨඵੱǶځ΋Ǵߓ૟ੇᓨੱЬा཮ౢғ૶ᏫΚϷᏢಞΚ೴ᅌ૰ଏǴЪӧ Γނǵਔ໔ǵӦᗺޑᒣᇡ΢р౜֚ᜤǶӧတ೽ޑੰቻЬाࣁߟҍੇଭ଑ǴаϷတ

೽ܴᡉޑ๺ᕭ௃׎Ǵੰ౛ᡂϯ߾хࡴ౦தԴԃඬ(amy loidplaques)Ϸઓ࿶ᠼᆢޟ

่(neurofibrillary tangles)ޑ௃׎ǶځΒǴၡܰМᡏѨඵੱԐය஻ޣёૈ཮ౢғي ᡏሼฯǵЋםکຳॹޑ௃׎ǶՔᒿౢғᇡޕфૈምᛖ(ٯӵǴᇟقǵຎ᝺ޜ໔ղᘐ

฻)ǴதวғӰགྷޑ௃׎ǴΨ཮ܴᡉޑЄ᝺౜ຝวғ(ٯӵǴౢғຎЄ᝺܈᠋Є᝺)Ƕ ၡܰМᡏѨඵੱࣁಃΒதـޑଏϯ܄ѨඵੱǶ஻ޣတ೽ಒझ֖Ԗα-Synucleinೈқ ޑᆫ໣ǴԶ׎ԋȨၡܰМᡏȩǴԶ஻ޣԝࡕޑတ೽ှওΨ཮ว౜ઓ࿶ݹඬǴՠࢂ

ੰ౛ᡂϯޑ೽ϩǴวғઓ࿶ᠼᆢޟ่ޑ௃׎߾ၨϿǶځΟǴᚐ㙠ယࠠѨඵੱ஻ޣ

཮ౢғΓ਱ᡂϯǴՉࣁᖐЗΨ཮วғׯᡂ(ٯӵǴ఩ᅃǵքᅉǵڰ୺܈ՉࣁѨѐ௓

ڋૈΚ฻)ǴᇟقૈΚҭ཮ౢғምᛖ(ٯӵǴނࠔӜᆀคݤᇥрǵפӷ֚ᜤ܈คݤ

౛ှӷက฻)Ƕတ೽ޑੰቻ཮Ԗֽ೽ޑҜ፦๺ᕭǴЬाаߟҍ೽ϩᚐယϷ㙠ယ߻

БࣁЬǴԖ٤཮Ԗtauೈқޟ่ޑ௃ݩǴ࣬ၨ΢ॊٿᅿᜪࠠޑѨඵੱǴတ೽લཞ٠ ߚӢࣁځдઓ࿶س಍ރݩ܌ౢғǶ

Ոᆅ܄Ѩඵੱࢂ೷ԋѨඵੱޑಃΒεচӢǴऊ՞ԴΓѨඵੱ஻ޣޑ15%Կ 20%(Duthie Jr & Glatt, 1988)Ǵӧύ୯ϷߚࢪӦ୔߾ଯၲ30%Ϸ26%(George-Carey et al., 2012; Zhang et al., 2012)ǶՈᆅ܄ѨඵੱࡰޑࢂӢՈᆅ੯ੰ(х֖Ǵӭख़܄တ ύ॥ǵӭว܄တఒ༞)܌೷ԋޑѨඵੱǶတύ॥཮೷ԋတ೽ՈనൻᕉόؼǴᏤठတ ಒझԝΫ೷ԋඵΚ෧ଏǴԐයதр౜୏բ጗ᄌǵϸᔈᒨ጗ǵ؁ᄊምᛖᆶᆒઓੱރǴ ԶՈᆅ܄Ѩඵੱޑ஻ޣǴ೯தᆶတύ॥ޑวғԖᜢǶՈᆅ܄ѨඵੱЬाԖٿᜪϩ

(19)

ձ ࣁ ύ ॥ ࡕ Ո ᆅ ܄ Ѩ ඵ ੱ (post-stroke vascular dementia) Ϸ λ Ո ᆅ ܄ Ѩ ඵ ੱ (dementia with small vessel diseases)Ƕதـޑቻރ཮ౢғ௃ᆣᡂϯǵኁᢠǵֿѨ࿣ǵ ຳॹǵտᚮ֚ᜤ฻௃ݩǶ

షӝࠠѨඵੱࣁଏϯ܄ѨඵੱϷՈᆅ܄ѨඵੱޑషӝᜪࠠǶόឦܭа΢Οε ᜪੰӢޑѨඵੱᜪࠠޣǴஒځϩᜪࣁځдӢન܌ᏤठޑѨඵੱǴёૈ཮Ӣགࢉǵ ੯ੰǵѦ໾฻ӢનٰᏤठѨඵੱǴٯӵǺ(1)Ѧ໾܄တ໾ǹ(2)ނ፦܈ᙴᛰޑ٬Ҕ(ٯ ӵǴଚᆒǵᙼۓᏊ฻)ǹ(3)ΓᜪխࣝલЮੰࢥགࢉ(HIV Infection)ǹ(4)දճܳੰ(Prion Disease)ǹ(5)ЃߎහМੱ(Parkinson’s Disease)ǹ(6)Վ΍Ⴅੰ(Huntington’s Disease)ǹ (7)ځдيᡏੰݩ(ٯӵǴӭว܄ฯϯੱ)ǹ(8)ߚ੝ۓੰӢ(ٯӵǴޗҬǵᙍ཰܈ځд ख़ाሦୱфૈ෧ཞ฻)Ƕ

ΟǵѨඵੱੰำϷᖏ׉ੱރ

όӕᜪࠠѨඵੱບᘐ኱ྗࢂਥᏵᇡޕጄᛑ(Cognitive Domains)ٰۓကǴᇡޕ ጄᛑх֖Ϥ ঁ೽ϩǴࣁፄᚇݙཀΚ(Complex attention)ǵ୺Չфૈ(Executive function)ǵ Ꮲ ಞ ک ૶ Ꮻ (Learning and memory) ǵ ᇟ ق (Language) ǵ ޕ ᝺ ୏ բ (Perceptual-motor)Ϸޗ཮ᇡޕ(Social cognition)(Ѡ᡼ᆒઓᙴᏢ཮, 2014)Ƕ

ፄᚇݙཀΚх֖࡭ុ܄ݙཀΚ(Sustained attention)ǵᚈӛݙཀΚ(Divided attention)ǵᒧ᏷܄ݙཀΚ(Selective attention)Ϸೀ౛ೲࡋ(Processing speed)Ǵ஻ޣ ӧӭख़ڈᐟޑᕉნύ(ٯӵǴႝຎǵፋ၉)஑ݙࡋफ़եǴЪ৒ܰӢᕉნύځд٣ނ ቹៜǶ࡭ុݙཀΚࣁߏਔ໔ޑᆢ࡭ݙཀΚǶᚈӛݙཀΚࣁӕਔ஑ݙٿ໨٣ނǶᒧ

᏷܄ݙཀΚࣁόڙډځдѦٰڈᐟ܈ࢂ٬ϩЈޑ٣ނቹៜޑݙཀΚǶೀ౛ೲࡋࣁ ஒ୺Չ΋໨٣ނ܌޸຤ޑਔ໔ໆϯǶ

୺Չфૈх֖ीฝ(Planning)ǵ،฼(Decision making)ǵπբ૶Ꮻ(Working memory)ǵӣ㎸/ᒱᇤঅ҅(Responding to feedback/Error correction)ǵঐᎯܭಞᄍ/׭

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ڋ(Overriding habits/inhibition)ϷЈ౛ቸ܄(Mental flexibility)Ǵ஻ޣคݤയҺፄᚇ ޑीჄǴ΋ԛѝૈ஑ݙܭ΋ҹ٣ނ΢Ƕीฝࡰޑࢂှញೱᕉკฝ܈ࢂނᡏ௨ӈޑ

ૈΚǴٯӵว౜଎৐рαޑૈΚǶ،฼ࡰޑࢂჹܭᝡݾᒧ໨ޑ،ۓၸำǴٯӵኳ ᔕ።റǶπբ૶ᏫࡰޑࢂอኩޑߥӸૻ৲Ъ௓ڋૻ৲ޑૈΚǴٯӵॹ๱௶ॊ΋ࢤ ኧӷǶӣ㎸/ᒱᇤঅ҅ࡰޑࢂёаவᒱᇤύᏢಞ܈ࢂவӣ㎸ύᕇ੻Ǵ຾΋؁௢ፕ рှ،ୢᚒޑૈΚǶঐᎯܭಞᄍ/׭ڋࡰޑࢂ׳ፄᚇϷ׳຤ࠂޑᒧ᏷҅ዴเਢޑ

ૈΚǴٯӵᇥрӷޑᚑՅԶߚӷޑཀࡘǶЈ౛ቸ܄ࡰޑࢂӧٿᅿཷۺǵπբ܈ࢂ

ϸᔈೕ߾ϐ໔ᙯඤޑૈΚǴٯӵኧӷޑуᕴډኧӷޑ௨ׇǶ

Ꮲಞک૶Ꮻх֖ҥջ૶Ꮻ(Immediate memory)ǵ߈ය૶Ꮻ(Recent memory)ǵ ߏΦ૶Ꮻ(Long term memory)Ǵ஻ޣ࿶தӧӕ΋ࢤჹ၉ύǴख़ፄޑ߄ၲӕ΋ҹ٣Ƕ ҥջ૶Ꮻࡰӆԛਟᇝ΋ࢤЎӷ܈ኧӷޑૈΚǶ߈ය૶Ꮻࡰჹܭཥޑၗૻጓዸޑૈ

ΚǴຑ՗ޑБԄх֖ԾҗӣᏫ(Free recall)ǵԖጕ઩ӣᏫ(Cued recall)Ϸᒤᇡ૶Ꮻ (Recognition memory)ǶߏΦ૶Ꮻࡰߏਔ໔ޑ૶ᏫǴຑ՗БԄԖᇟཀ૶Ꮻ(Semantic)ǵ Ծ໺Ԅ૶Ꮻ(Autobiographic)ϷϣᗦᏢಞ(Implicit memory)Ƕ

ᇟقх֖߄ၲ܄ᇟقϷௗڙ܄ᇟق(Receptive language)Ǵ஻ޣคݤӧ߄ၲ܄

ᇟقϷௗڙ܄ᇟق҅ዴ߄ၲǶ߄ၲ܄ᇟقх֖ڮӜ(Confrontational naming)ǵפӷ

ૈΚ(Word finding)ǵࢬᄣࡋ(Fluency)ǵЎݤϷᇟݤ(Grammer and Syntax)Ƕௗڙ܄

ᇟقࢂෳᡍ஻ޣޑ౛ှૈΚǶ

ޕ᝺୏բх֖ຎ᝺ޕ᝺(Visual perception)ǵຎ᝺ࡌᄬ(Visuocon-struction)ǵޕ

᝺୏բ(Perceptual-motor)ǵ٬Ҕ(Praxis)Ϸᒣ᛽(Gnosis)Ǵ஻ޣჹӃ߻ዕ஼ޑ٣ނ(ٯ ӵ໒ً)୺Չ΢Ԗ֚ᜤǴ܈ჹܭӀጕޑׯᡂቹៜޕ᝺གڙǶຎ᝺ޕ᝺ཀࡰό֖୏

բޑޕ᝺(ٯӵᖍޑᒣ᛽)Ƕຎ᝺ࡌᄬཀࡰЋ౳ڐፓٰࡌᄬ٣ނǴٯӵฝკǵಔး

ᑈЕ฻Ƕޕ᝺୏բཀࡰ᏾ӝޕ᝺ϷҞޑ܄ޑ୏բǴߚ٬Ҕຎ᝺ղᘐጕ઩Ǵٯӵஒ ଝηזೲܫΕԖϾޑЕ݈ϐύǶ٬ҔཀࡰஒᏢಞٰޑ୏բ߄౜рٰǴٯӵኳү୏

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բǵ࠮༈ޑૈΚǶᒣ᛽ཀࡰӆᒣᇡ܈ჸ᝺ޑޕ᝺᏾ӝૈΚǴٯӵᒣ᛽рΓᖍ܈ᚑ ՅǶ

ޗ཮ᇡޕх֖௃ᆣᒣᇡ(Recognition of emotion)ϷЈඵ౛ፕ(Theory of mind)Ǵ

஻ޣޑՉࣁ཮ܴᡉၴङޗ཮ૈ୼ௗڙޑጄൎǴჹܭӝ፾ޑऀ๱܈ፋ၉ϣ৒ಥᚆޗ

཮኱ྗǶ௃ᆣᒣᇡࡰҗᖍ೽߄௃ٰᒣ᛽܌߄ၲ௃ᆣǴ఼ᇂӭኬ܄ޑ҅य़Ϸॄय़௃

ᆣǶЈඵ౛ፕࡰࢂցૈ୼ԵቾдΓޑЈඵރᄊ(ٯӵǴࡘԵǵኅఈǵཀკ)Ƕ

ѨඵੱନΑ཮ჹ஻ޣ೷ԋᇡޕфૈ΢ޑཞ্ǴΨ཮Քᒿ๱ୢᚒՉࣁϷᆒઓੱ

ރޑౢғǴԶѨඵੱ஻ޣதـޑՉࣁϷᆒઓੱރ(Behavioral and Psychological Symptoms of Dementia, BPSD)Ԗኁᢠ(depression)ǵขቾ(anxiety)ǵӰགྷ(delusions)ǵ Є᝺(hallucinations)ǵ఩ᅃ(apathy)ϷՉࣁምᛖǶځύǴӰགྷΞёϩࣁ೏ୂӰགྷǵ

೏্ӰགྷϷג֪ӰགྷǹՉࣁምᛖх֖װᔐՉࣁǵᅵ઀ምᛖǵ଎ၡǵख़ፄ౜ຝǵᅐ ၯǵ໯१ׯᡂǵੰᄊԏ໣Ϸ໳ܶੱংဂ(Aalten et al., 2007; ໳҅ѳ, 2006)ǶԶѠ

᡼Ѩඵੱ஻ޣதـޑՉࣁϷᆒઓੱރԖኁᢠǵขቾǵӰགྷǵЄ᝺ǵᅵ઀ምᛖǵߟ

ౣՉࣁǵច୏ǵ఩ᅃ฻(J. Fuh, 2006)Ƕ

ѨඵੱำࡋёаϩࣁΟᜪǴࣁᇸǵύǵख़ࡋǴаΠϩձඔॊόӕයำѨඵੱ

ำࡋ܌ౢғޑՉࣁϷੱރ(National Institutes of Health, 2013a; ߋሎക & ෯᜽ҏ, 2006; ఉৎݒ et al., 2014)Ƕ

(΋) ᇸࡋѨඵੱ

ੱރ೯தόܴᡉǴ৒ܰ೏౧۹Զۯᇤ൩ᙴǶ஻ޣჹܭϐ߻Ԗᑫ፪ޑ٣ނǴᡂ ளόགᑫ፪Ǵ৒ܰב૶ܿՋܫ࿼ޑӦБǵᆶдΓޑऊ཮܈ᇥၸޑ٣௃Ƕрߐډа

߻όதѐޑӦБਔǴ৒ܰ଎ၡǴ٬ளᅌᅌ໒ۈό഻៿ѦрǶԶ߈යวғޑ٣௃৒

ܰב૶ǴᏢಞཥ٣ނౢғ֚ᜤ(National Institutes of Health, 2013a; ߋሎക & ෯

᜽ҏ, 2006; ఉৎݒ et al., 2014) Ƕ

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(Β) ύࡋѨඵੱ

૶ᏫΚଏϯຫٰຫܴᡉǴԾρрߐᖼނ܈མ४Ҭ೯πڀౢғ֚ᜤǴ཮ӧዕ஼

ޑӦБوѨǶӧৎѝૈ຾Չᙁൂޑৎ٣Ǵ೚ӭਔংሡाдΓޑᅱ࿎Ƕ௃ᆣଆҷεǴ

৒ܰғ਻ǵว๠਻Ǵ໒ۈр౜Є᝺ǶӧᇟقૈΚϷ᎙᠐ૈΚ΢Ψᅌᅌр౜ୢᚒǴ ᇥ၉ӷѡ෧ϿǴፋ၉ϣ৒όೱೣǴલЮᡄᒠ(National Institutes of Health, 2013a; ߋ ሎക & ෯᜽ҏ, 2006; ఉৎݒ et al., 2014) Ƕ

(Ο) ख़ࡋѨඵੱ

૶ᏫΚᝄख़ଏϯǴѨѐғࢲԾ౛ૈΚǴคݤᐱΚֹԋৎ٣܈ှ،ୢᚒǴيᡏ фૈΠफ़ǴֹӄคݤԾՉрߐǶਔதวғό፾྽ޑՉࣁǴႽࢂעܿՋܫ࿼ӧόჹ ޑӦБ(ٯӵǴᇿ௓ᏔܫӧӇጃ္)Ǵჹܭελߡคݤ௓ڋǴᏤठѨ࿣วғǶЪᅌ ᅌ཮ԖտᚮӢᜤǴᝄख़ਔѝૈ٩ᒘሷगᆅ(National Institutes of Health, 2013a; ߋ ሎക & ෯᜽ҏ, 2006; ఉৎݒ et al., 2014)ǶѨඵੱคݤ౫ᘰǴᗨฅёа೸ၸܺ

Ҕᛰނ෧጗ѨඵੱޑੰำϷफ़եӢ੯ੰ܌ౢғޑੱރǴՠࢂჹܭတ೽ޑཞ্ࢂค ݤݯᘰǶѨඵੱ஻ޣ΋૓ੰำऊࣁ8Կ10ԃǶ྽΋૓Γখ໒ۈр౜ᇡޕфૈԖୢ

ᚒਔǴ೯தࡐᜤว౜Ǵத཮ᇤаࣁѝࢂ҅தԴϯޑ౜ຝǴԶۯᇤݯᕍޑਔᐒǴऍ ୯Ѩඵੱڐ཮(Alzheimer's Association)ჹѨඵੱ߃ය๏ϒΑΜε᝾ૻ(߄2-1-1)Ǵ යఈѨඵੱૈ୼Ԑයว౜ԐයݯᕍǴωૈ୼ۯ጗Ѩඵੱޑ຾ำǶ

߄ 2-1-1! ѨඵੱΜε᝾ૻ

1. ૶ᏫΚ૰ଏǴ຾ԶቹៜډВதғࢲǶ 2. ഼Ѩीฝ܈ှ،ୢᚒޑૈΚǶ

3. চҁዕ஼ޑ٣ނคݤയҺǶ 4. ഼Ѩਔ໔ᆶӦᗺޑཷۺǶ

5. ຎ᝺Ϸޜ໔ᜢ߯ղᘐр౜֚ᜤǶ 6. قᇟ߄ၲр౜֚ᜤǶ

7. ނࠔᘍܫᒱ໶Ƕ

8. લЮղᘐૈΚ܈᝾᝺܄फ़եǶ 9. ঁ܄ׯᡂǶ

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10. ௃ᆣᆶՉࣁׯᡂǶ

ၗ਑ٰྍǺAlzheimer's Association, 2009

ѤǵѨඵੱᆶѨඵੱՉࣁϷᆒઓੱރϐ౰Չ౗

ӄౚԴԃΓαቚуǴѨඵੱΓαΨᒿϐቚуǴѨඵੱޑวғ౗ᒿ๱ԃសޑቚ уԶቚу(C.-s. Lee, Chang, Su, Chen, & Chen, 1997)Ƕ65ྃԴԃΓαǴ؂ቚу5ྃǴ ᑡ஻Ѩඵੱޑ॥ᓀ൩཮ቚуǶ٩ᖄӝ୯ШࣚፁғಔᙃۓကǴ65ྃа΢Γα՞ᕴΓ α7%Ǵᆀࣁଯសϯޗ཮(Aging society)Ǵၲډ14%ࣁଯសޗ཮(Aged society)Ǵၲډ 20%а΢ࣁຬଯសޗ཮(Hyper-aged society)ǴѠ᡼ӧ1993ԃԴԃΓαК౗ςၲ7%Ǵ

຾Εଯសϯޗ཮ǶਥᏵ୯ৎว৖ہ঩཮Ȩύ๮҇୯Γα௢ी(2014ԃԿ2061ԃ)ȩ ൔ֋ࡰрǴך୯2014ԃ6ДԴԃΓαςၲډ11.57Ǵ௢՗Ѡ᡼ԴԃΓαஒӧ2018ԃ

ၲډ14%Ǵ຾Εଯសޗ཮Ǵӧ2025ԃၲډ20%Ǵ຾Εຬଯសޗ཮Ƕ2014ԃԿ2061 ԃԴԃΓαэᕴΓαК౗Ǵஒҗ12%ቚуԿ41%ǶԶ2014ԃԿ2061ԃ80ྃа΢Γ αэԴԃΓαϐК౗Ǵஒҗ25.1%΢ϲԿ43.2%(୯ৎว৖ہ঩཮, 2014)Ƕ

ਥᏵШࣚፁғಔᙃ2012ԃޑȨѨඵੱǺϦӅፁғᓬӃ᝼ᚒȩൔ֋ύǴࡰрܿ

٥Ӧ୔60ྃа΢ԴԃΓαѨඵੱ౰Չ౗ࣁ4.98%(World Health Organization &

Alzheimer’s Disease International, 2012)ǶќѦǴԖࣴزࡰр2010ԃǴӄౚѨඵੱ

Γα౰Չ౗ࣁ4.7%ǴځύаऍࢪѨඵੱ౰Չ౗നଯࣁ6.5%ǴՠࢂѨඵੱԴԃΓα ኧ߾ࢂ٥ࢪۚ߷ǶԶ٥ࢪΞаܿ٥Ϸࠄ٥ޑѨඵੱ౰Չ౗നଯ(Prince et al., 2013)Ƕ

Ѡ᡼ԴԃΓα೴ԃᚹϲǴѨඵੱΓαΨஒᒿϐቚуǴѨඵੱ౰Չ౗Ψஒၟ๱

ᚹϲǶ2014ԃፁғᅽճ೽ہૼѠ᡼Ѩඵੱڐ཮ჹѠ᡼Γα܌଺ޑѨඵੱፓࢗύǴ 2014ԃ65ྃа΢ԴԃΓѨඵੱΓαኧऊࣁ22࿤ΓǴޗ୔65ྃа΢Ѩඵ՞ӄ୯ᕴΓ αКࣁ1.02%ǶѠ᡼Ѩඵੱڐ཮а࿶ࡌ཮2014ԃԿ2061ԃѠ᡼Γα௢ीኧൔ֋ϐ ե௢ीǴ௢՗2061ԃ65ྃа΢Ѩඵ՞ӄ୯ᕴΓαКஒၲ5.60%ǴԶ65ྃа΢Ѩඵ Γኧஒၲ92࿤Γ(߄2-1-2)Ƕ

(24)

߄ 2-1-2! Ѡ᡼Ѩඵੱ౰Չ౗௢՗(2014 ԃԿ 2061 ԃ)

ԃ 2014 2016 2026 2036 2046 2056 2061 ӄ୯ᕴΓα

ኧ 23,433 23,478 23,313 22,269 20,376 17,939 16,628 65ྃа΢Ѩ

ඵΓኧ 227.13 251.09 376.17 563.93 785.05 896.53 924.99 65ྃа΢Ѩ

ඵ՞ӄ୯ᕴ ΓαК

1.02% 1.12% 1.67% 2.58% 3.90% 5.04% 5.60%

(ൂՏǺщΓ)

ၗ਑ٰྍǺѠ᡼Ѩඵੱڐ཮(ᘏڗВයǺ2015ԃ11Д) Ѩඵੱ஻ޣନΑᇡޕጄᛑ(Cognitive Domains)཮ڙډቹៜаѦǴ۳۳཮р౜

ୢᚒՉࣁϷᆒઓੱރޑׯᡂǶόӕᜪࠠޑѨඵੱǴ཮р౜ޑୢᚒՉࣁϷᆒઓੱރ Ψ཮Ԗ܌όӕǶFuh(2006)ӣ៝Ѡ᡼1990ԃԿ2005ԃЎ᝘(߄2-1-3)Ǵว౜ߓ૟ੇᓨ

ੱ஻ޣౢғኁᢠੱރऊ՞22%Կ55%ǹԖขቾ௃׎ऊ՞35%Կ76%ǹԖӰགྷ௃׎

ऊ՞30%Կ63%ǹԖЄ᝺ੱރऊ՞21%Կ26%ǹԖᅵ઀ምᛖऊ՞Ԗ26%Կ61%ǹԖ ߟౣՉࣁ/ᐟ୏௃׎ޣऊ՞10%Կ57%ǹԖ఩ᅃ௃׎ޣऊ՞39%Կ47%(J. Fuh, 2006)Ƕ

ϖǵλ่

ШࣚӚ୯ᒿ๱ԴԃΓαޑቚуǴѨඵੱΓαΨᒿϐቚߏǶ྽Ѩඵੱ஻ޣᇡޕ фૈຫٰຫଏϯਔǴ຾Զቹៜډ஻ޣޑВதғࢲǴаϷ൩཰཮ౢғምᛖǶѨඵੱ

஻ޣӧ᏾ঁੰำය໔Ǵ཮ౢғ೚ӭୢᚒՉࣁϷᆒઓੱރǴԶόӕѨඵੱΨ཮ౢғ όӕޑੱރǴᒿ๱੯ੰੰำޑว৖Ǵஒ཮़ғࡐӭྣ៝΢ޑୢᚒǶ

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߄ 2-1-3! Ѡ᡼ߓ૟ੇᓨੱ஻ޣੱރᆶՉࣁϐ౰Չ౗

ੱރ բޣ ԃҽ ঁਢኧ(Γ) ٬Ҕπڀ ౰Չ౗(%)

ኁᢠ Liu et al. 1999 141 SCID ख़ᢠੱ5%ǹᇸᢠੱ

8%ǹځд҂ຏܴϐ ኁᢠ੯஻4%

ቅ჏ຽ ᆶ ቅذ݄ 1999 103 BEHAVE-AD 22%

J.-L. Fuh, Liu, Wang, Wang, & Liu

1999 76 RMBPC 50%

J.-L. Fuh, Liu, Mega, Wang, & Cummings

2001 95 NPI 38%

Chow et al. 2002 230 NPI 49%(ѠчӦ୔) 44%(ଯ໢Ӧ୔) JL Fuh, Wang, &

Cummings

2005 320 NPI 47%

ขቾ ቅ჏ຽ ᆶ ቅذ݄ 1999 103 BEHAVE-AD 35%

J.-L. Fuh et al. 1999 76 RMBPC 76%

J.-L. Fuh et al. 2001 95 NPI 54%

Chow et al. 2002 230 NPI 39%(ѠчӦ୔) 38%(ଯ໢Ӧ୔) JL Fuh et al. 2005 320 NPI 37%

Ӱགྷ J.-P. Hwang, Yang, Tsai, & Liu

1996 54 BEHAVE-AD 63%

ቅ჏ຽ ᆶ ቅذ݄ 1999 103 BEHAVE-AD 30%

J.-L. Fuh et al. 2001 95 NPI 47%

Chow et al. 2002 230 NPI 31%(ѠчӦ୔) 40%(ଯ໢Ӧ୔) JL Fuh et al. 2005 320 NPI 31%

Є᝺ J.-P. Hwang et al. 1996 54 BEHAVE-AD 26%

ቅ჏ຽ ᆶ ቅذ݄ 1999 103 BEHAVE-AD 26%

J.-L. Fuh et al. 2001 95 NPI 21%

Chow et al. 2002 230 NPI 25%(ѠчӦ୔) 19%(ଯ໢Ӧ୔) JL Fuh et al. 2005 320 NPI 24%

(ុΠ।)

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ᅵ઀ምᛖ J. P. Hwang, Yang, Tsai, & Liu

1997 75 BEHAVE-AD 61%

ቅ჏ຽ ᆶ ቅذ݄ 1999 103 BEHAVE-AD 26%

J.-L. Fuh et al. 2001 95 NPI 36%

Chow et al. 2002 230 NPI 36%(ѠчӦ୔) 35%(ଯ໢Ӧ୔) JL Fuh et al. 2005 320 NPI 42%

ߟౣՉࣁ /ᐟ୏

Tsai, Hwang, Yang, &

Liu

1996 47 BEHAVE-AD 57%(يᡏ΢) J. P. Hwang et al. 1997 75 BEHAVE-AD 55%(يᡏ΢) ቅ჏ຽ ᆶ ቅذ݄ 1999 103 BEHAVE-AD 21%(قᇟ΢) 10%(يᡏ΢) J.-L. Fuh et al. 1999 76 RMBPC 35%(قᇟ΢) J.-L. Fuh et al. 2001 95 NPI 46%

Chow et al. 2002 230 NPI 46%(ѠчӦ୔) 40%(ଯ໢Ӧ୔) JL Fuh et al. 2005 320 NPI 39%

఩ᅃ J.-L. Fuh et al. 2001 95 NPI 44%

Chow et al. 2002 230 NPI 47%(ѠчӦ୔) 39%(ଯ໢Ӧ୔) JL Fuh et al. 2005 320 NPI 42%

SCID: structure clinical interview for DSM-IIIR; NOS: not otherwise specific; BEHAVE-AD:

Behavioral Pathology in Alzheimer’s Disease rating Scale; NPI: Neuropsychiatric Inventory; RMBPC:

Revised Memory and Behavior Problem Checklist

ၗ਑ٰྍǺFuh, 2006

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ಃΒ࿯! Ѩඵੱৎ৥ྣ៝ޣӭϡຑ՗ᆶቹៜ

Pearlin฻Γӧ1990ԃගрᓸΚၸำኳԄ(Stress Process Model)ჹܭߓ૟ੇᓨ Ѩඵੱྣ៝ޣޑᓸΚࡌᄬр΋ঁᓸΚၸำᆛ๎(კ2-2-1)ǴౢғᓸΚޑၸำϩԋ6 εሦୱǺ(1)ྣ៝ޣޑङඳ੝Յ(ٯӵǴޗ࿶௃ݩǵྣ៝ޣ੝܄฻)ǹ(2)ᓸΚྍǴΞ ϩԋЬाᓸΚྍ(ٯӵǴᇡޕ௃׎ǵୢᚒՉࣁ฻)ǹ(3)ԛाᓸΚྍ(ٯӵǴৎ৥ፂँǵ πբᆶྣ៝΢ޑፂँ฻)ǹ(4)ᓸΚፓ࿯ӛ(ٯӵǴޗ཮Ѝ࡭฻)ǹ(5)Ј౛ϣ೽ᓸΚ (ٯӵǴԾ൧ǵفՅ೏߳ज़Ր)ǹ(6)่݀ᡂ໨(ٯӵǴኁᢠǵขቾǵܰࡗ฻௃׎)Ƕ

௖૸ԜϤεሦୱϐ໔܌ౢғޑᜢᖄ܄(Pearlin, Mullan, Semple, & Skaff, 1990)Ƕࡺ

ҁࣴزаᓸΚၸำኳԄ(Stress Process Model)ٰ௖૸ৎ৥ྣ៝ޣޑ҅ॄӛቹៜǶ

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17

კ2-2-1!ߓ૟ੇᓨྣ៝ޣᓸΚኳԄ

่݀ 1.ኁᢠ 2.ขቾ 3.ܰࡗ 4.ᇡޕڙཞ 5.଼நيᡏ 6.فՅܺவ

Ј౛ϣ೽ᓸΚ ᏾ᡏ 1.Ծ൧ 2.ᆒ೯ ௃ნ 1.ԾךޑѨѐ 2.فՅڙज़ 3.ωૈ 4.ᕇள

ԛભᓸΚྍ 1.ৎ৥ፂँ 2.πբᆶྣ៝ πբፂँ 3.࿶ᔮୢᚒ 4.ޗҬғࢲڙ ډᓸॐ

߃ભᓸΚྍ Ьᢀ 1.ᇡޕރᄊ 2.ୢᚒՉࣁ 3.Вதғ୯ф ૈϐ٩ᒘ௃ ׎ ࠼ᢀ 1.ၸࡋॄ಻ 2.࣬ᜢগღ

ङඳᆶ௃ნ 1.ޗ࿶ӦՏ 2.ྣ៝ᐕў 3.ৎ৥܈ޗ཮ ᆛ๎ޑಔԋ 4.ё٬Ҕޑी ฝ ፓ࿯ 1.ӢᔈኳԄ 2.ޗ཮Ѝ࡭

(29)

ၸѐЎ᝘ӧଞჹྣ៝ޣຑ՗Ǵஒځϩࣁྣ៝ޑ҅ӛቹៜຑ՗Ϸॄӛቹៜຑ՗

຾Չ௖૸Ƕྣ៝ޑॄӛ࿶ᡍӢનх֖Αғ౛ǵЈ౛ǵޗҬϷ଄୍Ƕྣ៝ޑ҅ӛ࿶

ᡍӢનх֖ഉՔǵዛᓰаϷ኷ܭௗڙྣៈπբ(Beinart et al., 2012)Ƕ҅ӛྣ៝࿶

ᡍᆶॄӛྣ៝࿶ᡍ཮ϕ࣬ቹៜǴ྽ྣ៝ޣԖၨଯޑ҅ӛྣ៝࿶ᡍਔǴځғ౛ǵЈ

౛ॄ಻཮ၨե(Chiao, Wu, & Hsiao, 2015)Ƕ

΋ǵѨඵੱॄӛྣ៝࿶ᡍޑቹៜ

ӧྣ៝ޣॄӛຑ՗ǴႽࢂғ౛ǵЈ౛ǵޗҬϷ଄୍฻Бय़ຫৡǴ߄ҢѨඵੱ

ྣ៝ޣޑғࢲࠔ፦ຫόӳ(Ankri, Andrieu, Beaufils, Grand, & Henrard, 2005; Mills et al., 2009; Mohamed et al., 2010; Vellone, Piras, Talucci, & Cohen, 2008)ǶЪѨඵ

ੱ஻ޣޑୢᚒՉࣁ཮ჹྣ៝ޣҁي೷ԋғ౛ϷЈ౛ޑቹៜǴ྽ྣ៝ޣౢғྣ៝ॄ

಻ਔǴ຾Զቹៜډ೏ྣ៝ޣғࢲࠔ፦(Fauth et al., 2006; Herrmann et al., 2006; K.

Eagar et al., 2006)Ƕॄӛྣ៝࿶ᡍӧޗҬӢનБय़ёૈჹྣ៝ޣౢғېᐱགک஍

ჰགǵޗҬᐒ཮ᆶু኷ࢲ୏ޑ෧Ͽǵ܈ࢂৎ৥ғࢲޑׯᡂ฻ǴӧЈ౛ӢનБय़ౢ

ғኁᢠǵขቾǵғ਻ǵϣސ܈คΚག฻௃׎Ǵӧғ౛ӢનౢғੲമǵੵภǵЈՈ ᆅ܈ཥഋжᖴ੯ੰǵᅵ઀όى฻௃׎ǴԶӧ଄୍ӢનБय़཮ԖѨ཰ǵౢғ࣬ᜢᇶ ڀԋҁǵ܈ځдᙴᕍճҔԋҁ(ٯӵǴՐଣ຤Ҕǵ࣮ៈ຤ҔǵӼᎦ຤Ҕ฻)(Donaldson, Tarrier, & Burns, 1997; Weiler, Chiriboga, & Black, 1994; Zarit et al., 1987)Ƕ

ྣ៝ޣӧޗҬϷЈ౛ౢғॄ಻ਔǴჹྣ៝ޣ཮ౢғኁᢠǵขቾϷېᐱག฻ቹ ៜǴ຾Զቹៜྣ៝ޣϷ೏ྣ៝ޣޑғࢲࠔ፦ǶႽࢂྣ៝ޣӢྣ៝πբޗҬࢲ୏෧ ϿǴ߾཮Ԗၨଯޑې஍གϷኁᢠ௃׎ޑౢғǶ܈ࢂჹ೏ྣ៝ޣޑୢᚒՉࣁϷᆒઓ

ੱރೀ౛ૈΚၨեޣǴ߾཮ԖၨଯޑኁᢠϷขቾޑ௃ᆣౢғǶMohamed et al.(2010) аߐບੰΓࣁࣴزჹຝǴϩձჹྣ៝ޣϷ೏ྣ៝ޣ຾Չୢڔຑ՗Ǵӧྣ៝ޣޑ೽

ϩଞჹځྣ៝ॄᏼǵྣ៝ኁᢠำࡋکྣ៝धཱำࡋ຾Չຑ՗Ǵӧ೏ྣ៝ޣ߾ଞჹ ᇡޕфૈǵВதࢲ୏ૈΚ(ADCS-ADL)ǵғࢲࠔ፦کྣ៝ำࡋ຾ՉෳໆǴ่݀ว

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౜೏ྣ៝ޣᆒઓރᄊᝄख़ำࡋǵՉࣁምᛖᝄख़ำࡋک೏ྣ៝ޣޑғࢲࠔ፦Бय़Ǵ ᆶྣ៝ޣޕ᝺Ϸྣ៝ॄᏼԖࡐεޑᜢೱǴԶ྽೏ྣ៝ޣԖᝄख़ޑᆒઓ੯ੰǵՉࣁ

ୢᚒਔǴ܈೏ྣ៝ޣғࢲࠔ፦Πफ़ਔǴ཮ቚуྣ៝ޣޑॄ಻Ϸኁᢠ௃׎Ƕ

ྣ៝ޣऩࢂલЮྣ៝ޕ᛽Ǵჹܭ೏ྣ៝ޣ୷ܭৎ৥ޑၰቺೢҺǴӧόޕၰ܈

ࢂคݤ൨؃ڐΠǴ຾Զவ᏾ޑޗ཮ᕉნଏрٰྣ៝೏ྣ៝ޣǴ೭཮ቚуྣ៝ޣޑ ႖ᚆǵېᐱϷኁᢠޑ௃ᆣ(Beeson, Horton-Deutsch, Farran, & Neundorfer, 2000;

Mahoney, Tarlow, & Jones, 2003)ǶMahoney et al.(2003)ଞჹޗ୔ޑߓ૟ੇᓨࠠѨ ඵੱྣ៝ޣ຾Չႝ၉Ѝ࡭س಍຾Չ18ຼޑϟΕࣴزǴϩձӧ6ঁДǵ12ঁДϷ18

ঁਔǴ຾Չྣ៝ޣޑ֚ᘋǵขቾϷኁᢠ௃׎຾ՉෳໆǴ่݀ว౜ྣ៝ޣऩࢂྣ៝

ޑඓ௓ૈΚၨեǴӧ֚ᘋǵขቾϷኁᢠޑ௃׎΢ౢғᡉ๱ޑቹៜǶၸѐྣ៝ࣴز εӭӧ٬Ҕ୍ܺ΋ࢤਔ໔ࡕ຾Չຑ՗Ǵ܌аҁࣴزޑ٬Ҕ୍ܺયΕచҹǴ೛ࣁ٬

Ҕ၀໨୍ܺၲΟঁДа΢ǶBeeson et al.(2000)аऍ୯ύՋ೽΋܌ᙴᏢεᏢޑߓ૟

ੇᓨ੯ੰࣴزύЈ܌ԏ໣ޑԛભၗ਑຾ՉࣴزǴࣴزх֖242Տߓ૟ੇᓨੱ஻ޣ

܈ځдѨඵੱ஻ޣޑΡϻǵۀη܈ζٽϐৎ৥ྣ៝ޣǴ٬ҔCES-D(Radloff, 1977)Ǵ

຾Չྣ៝ၸำ܌ౢғޑې஍གᆶኁᢠ௃׎଺ϩ݋Ǵࣴز่݀ว౜ߓ૟ੇᓨੱޑྣ

៝ޣऩԖᜢ߯೏গღ(ٯӵǴޗҬࢲ୏෧Ͽ)܈ࢂᆶ೏ྣ៝ޣ໔ޑᜢ߯όӳޑ׎ݩǴ Զྣ៝ޣ཮ౢғၨଯޑې஍གϷౢғޑኁᢠ௃׎Ƕ

ྣ៝ޣӧғ౛ॄ಻཮ቹៜډځيᡏ଼நǵᅵ઀ࠔ፦ϷЈՈᆅ੯ੰޑቚуǶࣴ

زЎ᝘ࡰрǴྣ៝ޣӧت܄ޑଛଽၨζ܄ଛଽǴ཮Ӣ஻ޣޑѨඵੱำࡋԶ٬ᅵ઀

ࠔ፦Πफ़ǹӧྣ៝ޣ੝፦΢Ǵऩࢂᅵ઀όӳǵଯᏉՈૈΚǴ೿཮ቚуՈᆅ੯ੰϷ ځд੯ੰޑ॥ᓀ(Mills et al., 2009)ǶќѦǴԖࣴزࡰрζ܄ޑৎ৥ྣ៝ޣКت܄

ޑৎ৥ྣ៝ޣǴԖၨեޑيᡏ଼நރݩǹқᅿΓၨځдϿኧᅿ௼ޑৎ৥ྣ៝ޣǴ Ԗၨଯޑيᡏ଼ந௃ݩ(Martin Pinquart & Sörensen, 2005, 2006)ǶMartin Pinquart

฻ΓǴࣴزࡰрྣ៝ޣԃសၨଯǵեޗ࿶ӦՏϷၨեޑߚ҅ԄЍ࡭Ǵྣ៝ޣ཮Ԗ يᡏ଼நၨৡǶ(Martin Pinquart & Sörensen, 2007)

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ΒǵѨඵੱ҅ӛྣ៝࿶ᡍቹៜ

҅ӛྣ่៝݀ёаϩࣁٿঁቫय़Ǵࣁྣ៝ቫय़(Caregiving aspect)Ϸᜢ߯ቫय़ (Relation aspect)ٰ૸ፕǴྣ៝ቫय़ࡰޑࢂྣ៝ޣӢࣁྣ៝πբӧЈᡫளډᅈى܈

҅ӛޑׯᡂǴٯӵȨྣ៝ᅈཀ(Caregiving satisfaction)ȩǵȨྣ៝ճ੻(Gain)ȩǵȨӣ ൔ(pay back)ȩǵȨྣ៝ཀကȩ฻ǹᜢ߯ቫय़߾ࢂࡰྣ៝ޣӢྣ៝ၸำύǴᆶ೏ྣ៝

ޣԖؼӳޑག௃ҬࢬϷᜢ߯ϕ୏ǴٯӵȨᒃஏࡋ(Mutuality)ȩǵȨϕඁ(Reciprocity)ȩ

฻(Ֆᛏޱ, 2000)Ƕ

ྣ៝ޣޑ҅ӛ࿶ᡍၨӳޣǴྣ៝ޑᅈཀࡋ཮ၨଯǶHarris(1998)аѨඵੱ஻ޣ ޑٽηࣁࣴزჹຝǴჹ30Տྣ៝ޣ຾Չ፦܄ೖፋǴٰ௖૸ྣ៝ޣޑྣ៝ᐕำǴࣴ

ز่݀ว౜Ԗ11Տޑྣ៝ޣගډྣ៝πբ܌ளډ҅ӛྣ่៝݀ǴԖȨԖᐒ཮ൔเ Р҆ȩǵȨԖҞ኱གϷঁΓԋߏȩаϷȨࢂηζᅿाޑفՅڂጄȩ(Harris, 1998)Ƕ Kramer(1993)ଞჹ72ՏѨඵੱ஻ޣޑζ܄ଛଽ຾ՉୢڔፓࢗǴࣴزόӕӢᔈ฼ౣ

ᆶ ҅ ॄ ӛ ྣ ៝ ่ ݀ ޑ ᜢ ߯ Ǵ ӧ ҅ ӛ ྣ ៝ ่ ݀ Б य़ ٬ Ҕ Ȩ ྣ ៝ ᅈ ཀ ࡋ ໆ ߄ (Caregiving satisfaction scale, CCS)ȩ຾Չຑ՗Ǵॄӛྣ่៝݀߾ෳໆኁᢠำࡋǴ

٬ҔCES-D(The center for epidemiologic studies depression scale)຾Չຑ՗Ǵࣴز่

݀ว౜ȨаୢᚒࣁᏤӛȩǵȨ҅ӛᜢ߯ȩࣁӢᔈБԄޑྣ៝ޣǴځྣ៝ޑᅈཀࡋၨ

ଯǴՠኁᢠำࡋคᡉ๱࣬ᜢǴ߄Ң҅ӛྣ៝࿶ᡍ཮ቹៜډྣ៝ޑᅈཀࡋ(Kramer, 1993)ǶLópez et al(2005)௖૸ྣ៝ޣޑྣ៝ቹៜӢηǴǴჹྣ៝ޣޑॄӛϷ҅ӛ ቹៜϩձ٬Ҕόӕޑໆ߄຾Չຑ՗ǴϩձࣁᓸΚྍ(ٯӵǴྣ៝ය໔ǵԖӭϿྣ៝

ޣΓኧ฻)ǵྣ៝ॄᏼຑ՗ǵྣ៝ޣၗྍ(ٯӵǴԾ൧ǵޗ཮Ѝ࡭Ϸᔈჹ฼ౣ)ǵྣ

៝ޣୢᚒ(ٯӵǴኁᢠǵขቾϷ଼ந௃׎ׯᡂ฻)Ǵӧྣ៝ॄᏼຑ՗٬Ҕྣ៝ॄᏼ ໆ߄(caregiver burden interview, CBI)(Zarit, Reever, & Bach-Peterson, 1980)Ǵྣ៝

ၗྍޑԾ൧೽ϩаԾ൧ໆ߄(Rosenberg, 1965)ෳໆǵޗ཮Ѝ࡭аᙁอޗ཮Ѝ࡭ໆ ߄(social support questionnaire short form-revised, SSQSR)(Sarason, Sarason, Shearin,

& Pierce, 1987)ෳໆǵᔈჹ฼ౣаᙁอᔈჹໆ߄(brief COPE)(Carver, 1997)ෳໆǴ

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่݀аྣ៝ޣᅈཀࡋໆ߄(Caregiving Satisfaction Scale, CSS)(Lawton, Kleban, Moss, Rovine, & Glicksman, 1989)຾Չຑ՗Ǵനࡕว౜ྣ៝ޣᆶ೏ྣޣӃ߻Ԗؼ ӳޑᜢ߯ޣǴྣ៝ޑᅈىགၨଯǴ҅ӛ௃ᆣନΑڙډྣ៝ޣᆶ೏ྣ៝ޣӃ߻ᜢ߯

ޑቹៜѦǴԖӳޑ࠹ࢻᆅၰǵӕ΋ྣ៝ޣǵߥԖؼӳޑҶ໕ਔ໔ǴаϷόሡѦр ӅբǴࣣ཮ቹៜྣ៝ޣޑ҅ӛྣ៝࿶ᡍǶόၸࣴزΨќѦว౜ྣ៝ޣޑᅈཀࡋᆶ ᓸΚྍคᜢǴջԖၨଯ࠼ᢀޑॄᏼޣǴᆶځྣ៝ޑᅈཀࡋคᜢǶ

ྣ៝ޣ҅ӛ࿶ᡍၨӳޣǴځྣ៝ޣᆶ೏ྣ៝໔ޑᜢ߯ၨᆙஏǴЪৎឦ໔ޑᜢ

߯Ψ཮ၨᒃ߈ǶFarran et al(1991)а94ՏѨඵੱྣ៝ޣࣁࣴزჹຝǴ຾Չъ่ᄬБ Ԅ຾ՉࣴزǴԖ90%ޑྣ៝ޣख़ຎྣ៝ޑ҅ӛ࿶ᡍǴႽࢂӧྣ៝ቫय़х֖ྣ៝ޣ ߞЈޑගϲǵჹ೏ྣ៝ޣԖӳޑϸᔈ฻Ǵӧᜢ߯ቫय़х֖ྣ៝ޣᆶ೏ྣ៝໔҅ӛ ᜢ߯ගϲǵࣔெৎΓᜢ߯ǹԶྣ៝ޣᜢ߯ࣁଛଽ࣬ၨܭߚଛଽޣ཮࡭ၨଯޑ҅ӛ ᄊࡋ(Farran, Keane-Hagerty, Salloway, Kupferer, & Wilken, 1991)ǶNeufeld et al(1998) ଞჹ22Տت܄ྣ៝ޣ຾Չ፦܄ࣴزǴ௖૸ྣ៝ޣϷᇡޕфૈምᛖԴΓϷдΓ໔ޑ ϕඁᜢ߯Ǵϕඁᜢ߯ࡰޑࢂྣ៝ޣख़ຎྣ៝ޑفՅǵྣ៝πբёբࣁηζޑڂጄ

฻Ǵࣴزว౜ྣ៝ޣᆶ೏ྣ៝ޣ໔Ԗϕඁᜢ߯Ǵ߾҅ӛྣ៝࿶ᡍၨӳ(Neufeld &

Harrison, 1998)ǶBeach(1997)ჹ20Տ14Կ18ྃޑѨඵੱԃᇸྣ៝ޣ຾Չъ่ᄬࣴ

زǴ௖૸ྣ៝ᅈཀࡋᆶྣ៝ය໔ޑ҅ӛྣ៝ቹៜǴࣴز่݀ว౜73%ޑྣ៝ޣǴ ځྣ៝πբჹৎ৥໔ϕ୏ᜢ߯Ԗ҅ӛቹៜǴٯӵᆶৎΓ໔ᜢ߯ᡂᒃ߈ǴΨቚуځ ӕ౛ЈǴ߄ҢԖၨӳޑ҅ӛ࿶ᡍǴځྣ៝ޣϷ೏ྣ៝ޣޑᜢ߯ၨᆙஏǶ

ࣴزᡉҢԖၨଯޑ҅ӛྣ៝ϩኧޣǴྣ៝ޣޑኁᢠ௃׎ၨեǶRoff et al(2004) வऍ୯୯ৎፁғࣴزଣޑቚமߓ૟ੇᓨੱ଼நྣ៝ၗྍResources for Enhancing Alzheimer’s Care Health, REACH)ύ຾ՉࣴزǴКၨߚࢪဴϷқΓޑྣ៝ޣӧྣ

៝ޑ҅ӛ೽ϩ(positive aspects of caregiving, PAC)ৡ౦ǴϩձܜኬΑ275Տߚࢪဴ

ྣ៝ޣǴϷ343ՏޑқΓྣ៝ޣǴࣴز่݀ว౜Ԗၨଯޑ҅ӛྣ៝ϩኧޣǴځኁ ᢠ௃׎ၨեǶFarran et al(1997)а215ՏѨඵੱ஻ޣޑଛଽྣ៝ޣࣁࣴزჹຝǴ຾

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Չྣ៝ཀကჹྣ៝ኁᢠϷفՅᆙ஭ޑቹៜ຾ՉୢڔፓࢗǴࣴزว౜؂Ϻྣ៝ࢲ୏

ჹྣ៝ޣཀကຫଯޣǴྣ៝ޑኁᢠำࡋϷفՅᆙ஭ำࡋ߾ຫե(Farran, 1997)Ƕྣ

៝ޣޑ҅ӛྣ៝࿶ᡍၨӳǴᆶኁᢠ௃׎ϷᓸΚॄ಻և౜ॄ࣬ᜢǶ(Beach, Schulz, Yee, & Jackson, 2000; Cohen, Colantonio, & Vernich, 2002; López, López-Arrieta, &

Crespo, 2005; Roff et al., 2004)

ΟǵቹៜѨඵੱྣ៝ޣຑ՗ϐ࣬ᜢӢη

ό໻΢ॊޑӢન཮ቹៜډྣ៝ޣޑ҅ॄӛྣ៝࿶ᡍǴΨ཮ڙډྣ៝ޣϷ೏

ྣ៝ޣޑ୷ҁ੝፦ޑቹៜǴӧྣ៝ޣБय़཮ڙډԃសǵ܄ձǵྣ៝ਔ໔ޑߏ อǵπբॄ಻ǵ௲ػำࡋǵԏΕǵ൩཰௃׎ǵ଼ந௃׎ǵޗ཮Ѝ࡭ǵᆶྣ៝ޣ ᜢ߯฻Ӣનቹៜǹӧ೏ྣ៝ޣБय़ёૈ཮ڙډ஻ੰਔ໔ߏอǵ੯ੰᝄख़ำࡋǵ

ୢᚒՉࣁޑᝄख़ࡋǵيᡏфૈǵᇡޕڙཞ௃׎ǵғࢲࠔ፦ǵ௲ػำࡋ฻Ӣࣁቹ ៜ(Beinart et al., 2012; Farran et al., 1991; Kramer, 1997; Riedel, Fredman, &

Langenberg, 1998)Ƕ

ቹៜ҅ӛྣ่៝݀ޑྣ៝ޣ੝፦ǴԖԃសǵ܄ձǵ௲ػำࡋǵ଼ந௃ݩǵޗ

཮Ѝ࡭ǵৎ৥ԏΕ฻Ԗᜢ(Kramer, 1997; Riedel et al., 1998; ໳ඁ࣓, ቅᒸᑻ, & ৪ ٥ྻ, 2006)Ƕ೏ྣ៝ޣόӕޑ੝፦཮ቹៜډ҅ӛྣ่៝݀ǴႽࢂ೏ྣ៝ޣԾךྣ

៝ޑૈΚǵ૶ᏫǵୢᚒՉࣁ੯ੰޑ੝܄Ԗᜢ(Farran et al., 1991; ቅഓে, 1992)Ƕቹ ៜྣ៝ޣ҅ӛྣ៝࿶ᡍޑ҅࣬ᜢӢનԖྣ៝ޣᆶ೏ྣ៝ޣϐ߻ᜢ߯ޑᅈىགǵ೏

ྣ៝ޣᇡޕڙཞ௃׎ǵྣ៝ޣޗ཮Ѝ࡭ޑᅈىགǵྣ៝ޣيᡏ଼நำࡋၨӳϷୢ

ᚒှ،฼ౣޑ٬Ҕ(Tarlow et al., 2004)Ƕӧྣ៝ၸำύౢғޑ҅ӛྣ៝࿶ᡍቹៜ ӢનǴӵྣ៝ޣԃសຫεǴ߾ྣ៝ޑ҅ӛ࿶ᡍຫৡǹѨඵੱ஻ޣޑ੯ੰᝄख़ำࡋǴ ᝄख़ำࡋຫଯޣǴ҅ӛྣ៝࿶ᡍຫեǹྣ៝҅ӛ࿶ᡍΨ཮ڙډྣ៝ޣޑৎ৥࿶ᔮ ԏΕϷғࢲރݩޑቹៜ(ᔎߎम & ঞذݯ, 2006)Ƕྣ៝ޣঁΓޑྣ៝੝፦཮ቹៜ ډ҅ӛޑྣ៝࿶ᡍǴႽࢂԃសǵ଼நރݩǵࢂցԖҶ໕ਔ໔ǵᆶੰ஻໔ޑᜢ߯٬

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ցؼӳϷၨϿޑ௃ᆣ࠹ࢻǴԶ೭٤ቹៜڗ،ܭྣ៝ޣঁΓჹܭޗ཮Ѝ࡭ޑᒧ᏷Ϸ ᅈཀำࡋǶྣ៝ޣޑ҅ӛྣ៝࿶ᡍၨӳǴᆶኁᢠ௃׎ϷᓸΚॄ಻և౜ॄ࣬ᜢǴᆶ ғࢲࠔ፦ϷԾ᝺ၨӳيᡏ଼நރݩԖ҅࣬ᜢ(Beach et al., 2000; Cohen et al., 2002;

López et al., 2005; Roff et al., 2004)Ƕ

ቹៜॄӛྣ៝࿶ᡍޑྣ៝ޣ੝፦ǴԖԃសǵ܄ձǵ௲ػำࡋǵ଼ந௃ݩǵޗ

཮Ѝ࡭฻(Martin Pinquart & Sörensen, 2007)Ƕቹៜॄӛྣ៝࿶ᡍޑ೏ྣ៝ޣ੝፦Ǵ Ԗ஻ੰਔ໔ߏอǵ੯ੰᝄख़ำࡋǵୢᚒՉࣁޑᝄख़ࡋǵيᡏфૈǵ௲ػำࡋǵᇡ ޕфૈ฻(Germain et al., 2008; Mohamed et al., 2010; Martin Pinquart & Sörensen, 2007; Schölzel-Dorenbos, Draskovic, Vernooij-Dassen, & Rikkert, 2009)ǶPinquart฻

Γ(2007)ࣴزࡰрྣ៝ޣԃइၨεǵեޗ࿶ӦՏǵόӳޑৎ৥ᜢ߯ǵեޗ཮Ѝ࡭

ޣǴ཮Ԗၨଯޑྣ៝ॄ಻ǶԖࣴزࡰрǴζ܄ৎ৥ྣ៝ޣǴ৒ܰౢғЈ౛ॄ಻Ǵ Ԗၨଯޑې஍གϷኁᢠޑ௃׎ǹԶت܄ޑৎ৥ྣ៝ޣǴၨ৒ܰౢғғ౛ॄ಻Ǵٯ ӵЈՈᆅ੯ੰޑౢғ(Beeson et al., 2000; M Pinquart & Sorensen, 2004; Schölzel- Dorenbos et al., 2009)ǶၸѐЎ᝘ࡰрǴߓ૟ੇᓨࠠѨඵੱ஻ޣޑྣ៝ޣǴځྣ៝

ॄ಻ᆶྣ៝஻ޣਔ໔ߏอǵ஻ޣ௲ػำࡋϷ஻ޣޑኁᢠำࡋԖଯࡋ࣬ᜢ(García- Alberca, Lara, & Berthier, 2011; Mohamed et al., 2010; Martin Pinquart & Sörensen, 2007)Ƕύࡋߓ૟ੇᓨࠠѨඵੱ஻ޣޑୢᚒՉࣁ(ٯӵǴၯوϷقᇟװᔐ)Ǵ཮ჹྣ

៝ޣౢғྣ៝ॄ಻(Gaugler et al., 2010; Gaugler et al., 2011; Mahoney et al., 2003)Ƕ

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ಃΟ࿯! Ѡ᡼Ѩඵੱྣ୍៝ܺ

Ѡ᡼ߏයྣៈၗྍᅿᜪᕷӭǴ٩୍ܺᜪࠠЬाϩࣁΟεᜪྣៈኳԄǴϩձࣁ

ۚৎԄྣៈǵޗ୔ԄྣៈϷᐒᄬԄྣៈǴۚৎԄྣៈх֖ۚৎ୍ܺ(ٯӵǴଌᓓǵ ᆙ࡚ڥћ୍ܺǵҬ೯ௗଌǵഉՔ୍ܺǵঁΓ୍ܺྣ៝ǵৎ٣୍ܺ)Ϸۚৎៈ౛ǹޗ

୔Ԅ୍ܺх֖ഹ৲୍ܺǵВ໔ྣ៝Ϸڹ໔Ԏ៝ǹԶᐒᄬԄ୍ܺ߾х֖Ꭶៈᐒᄬǵ ӼᎦᐒᄬǵៈ౛ϐৎ(Ξϩ΋૓܄ៈ౛ϐৎϷфૈ܄ៈ౛ϐৎ)Ϸᄪ҇ϐৎǶ

Ѡ᡼ӧྣ៝Ѩඵੱ஻ޣᆶځৎ৥ྣ៝ޣي΢܌ว৖рޑߏයྣៈ୍ܺ࣬྽

ӭϡǴ٩୍ܺᜪࠠ୔ϩࣁۚৎԄǵޗ୔ԄϷᐒᄬԄ୍ܺǶۚৎԄх֖ۚৎ୍ܺǵ

ۚৎៈ౛ǵۚৎൺ଼ϷۚৎᔼᎦ୍ܺǴۚৎ୍ܺࢂ࿶җྣ୍៝ܺ঩ගٮৎ٣୍ܺǵ يᡏྣ៝ǵഉՔᆶڐշ൩ᙴ฻ǹۚৎៈ౛߾җ஑཰ៈ౛Γ঩ډ۬ගٮ஑཰ޑៈ౛

πբ܈ᙴғ܌ࡰҢޑᙴᕍ௛ࡼǹۚৎൺ଼ϷۚৎᔼᎦ୍ܺ߾ࢂҗ஑཰ޑൺ଼ৣᆶ ᔼᎦৣගٮނ౛ݯᕍǵᙍૈݯᕍϷᔼᎦࡌ᝼Ƕ(Ϊᅋ, ֆలᛏ, & ླྀਦስ, 2003)

ޗ୔Ԅх֖В໔ྣ៝ύЈϷྷඵᏢ୸ǴВ໔ྣ៝ύЈЬाගٮৎឦӧқϺଌ ߏ፸ډύЈԎ៝ǴύЈ཮Ӽ௨ፐำϷҶ໕ࢲ୏Ǵఁ΢ᡣߏ፸ӣډৎύᆶৎΓ࣬ᆫǹ

ྷඵᏢ୸ЬाගٮᇸࡋѨඵੱ஻ޣ຾Չག۔ڈᐟޑፐำǴٯӵ᛬ೌ੤ǵॣ኷੤ǵ ၮ୏੤ǵᚶᙑ੤฻Ƕ(Ϊᅋ et al., 2003; ෯᜽ҏ et al., 2013)

ᐒᄬԄх֖ӼᎦǵᎦៈϷៈ౛ϐৎǴ྽ৎឦคΚॄᏼྣ៝Ѩඵੱ஻ޣޑᓸΚ ਔǴૈ୼ගٮৎឦԎ៝Ѩඵੱ஻ޣܭᐒᄬύǴ൨؃஑཰Γ঩ӄВޑྣ៝ǶѠ᡼Ѩ ඵੱߏයྣ៝ҭว৖р಄ӝѨඵੱ஻ޣޑྣ୍៝ܺኳԄǴٯӵიᡏৎࡂǵ੝ਸྣ

៝ൂϡϷྷඵϕշৎ৥฻୍ܺኳԄǴว৖р׳ӭϡޑѨඵੱྣ៝ኳԄǴ٬ځૈ୼

׳಄ӝѨඵੱ஻ޣޑሡ؃ǴᡣѨඵੱ஻ޣளډ׳ӳޑྣ៝(Ϊᅋ et al., 2003; ෯᜽

ҏ et al., 2013)Ƕ

ߏයྣ៝Ѩඵੱ஻ޣޑৎ৥ྣ៝ޣǴӧيЈБय़೷ԋཱུεޑፂᔐǴ۳۳ԋࣁ

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ᗦ׎ޑ஻ޣǴྣ៝Ѩඵੱ஻ޣߚதό৒ܰǴाय़ჹځୢᚒՉࣁϷᆒઓੱރǴਔத ъڹाᏼЈѨඵੱ஻ޣ཮ό཮ᐱԾрߐǴ܈ࢂଆٰၯوǴߏයΠٰคݤளډкϩ ޑҶ৲Ƕ྽ৎឦྣ៝΢ၶډ౟ᓍǴགډੲᏩਔǴЪВதғࢲύΨԖ೚ӭ٣ሡाമ ЈǴЪคݤӆ޸׳ӭЈΚഉՔѨඵੱ஻ޣਔǴВ໔ྣ៝ύЈࢂ΋ঁӳޑᒧ᏷Ǵқ ϺஒѨඵੱ஻ޣଌډВ໔ྣ៝ύЈǴ஻ޣёаӧύЈளډӳޑྣ៝Ǵఁ΢Ξёа ӣৎᆶৎΓ࣬ೀǴԶόࢂޔௗ൩ஒ஻ޣଌډᐒᄬԄޑ୍ܺǴёаᅈى໺಍ύ୯Γ ޑֵၰǴٰफ़եྣ៝ޣޑ࿾ൾགǶѨඵੱ஻ޣόૈ୼ӢࣁғੰԶᇻᚆΓဂǴ׳ሡ

ाѦࣚޑڈᐟǴѦࣚޑڈᐟёа෧጗Ѩඵੱ஻ޣੰำว৖ޑೲࡋǴ೸ၸᆶΓޑௗ

᝻Ǵ๏ϒག۔ޑڈᐟǶ

Ѩඵੱ஻ޣޑྣ៝΢Ǵ፾ਔ๏ϒྣ៝ޣഹ৲ޑޜ໔ࢂѸाޑǶӧВ໔ྣ៝ύ ЈϷྷඵϕշৎ৥ٿᅿ୍ܺኳԄǴ೿ૈ๏ϒྣ៝ޣ፾ਔޑഹ৲ǴаΠϟಏٿᅿܺ

୍ኳԄޑၮբБԄǺ

΋ǵВ໔ྣ៝ύЈኳԄ

1997ԃԴΓᅽճݤಃ΋ԛঅݤύǴஒԴΓВ໔ྣ୍៝ܺયΕځύǴ1998ԃঅ

҅ԴΓᅽճᐒᄬ೛ҥ኱ྗǴቚуВ໔ྣ៝೛ࡼ࣬ᜢޑೕۓǶӧ2007ԃԴΓᅽճݤ

ಃΒԛঅݤύǴঅ҅࣬ᜢచЎǴಃ19చύࡰрሡᇶᏤԴΓᅽճᐒᄬගٮВ໔ྣ៝

୍ܺǶВ໔ྣ୍៝ܺ܌ගٮޑ୍ܺǴਥᏵȨԴΓᅽճ୍ܺගٮޣၗ਱ाҹϷ୍ܺ

ྗ߾ȩ୍ܺϣ৒ӵΠǺ (1) ғࢲྣ៝Ƕ (2) ғࢲԾҥ૽ግǶ (3) ଼நߦ຾Ƕ (4) ЎநҶ໕ࢲ୏Ƕ

(5) ගٮ܈ೱ่Ҭ೯୍ܺǶ (6) ৎឦ௲ػϷᒌ၌୍ܺǶ (7) ៈ౛୍ܺǶ

(8) ൺ଼୍ܺǶ (9) ഢᓓ୍ܺǶ

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Ᏽϣࡹ೽Ȩ௢ቶޗ཮ᅽճံշ࿶຤ҙፎံշ໨ҞϷ୷ྗȩǴவ҇୯88Կ100ԃ ࡋǴࡹ۬೿ஒВ໔ྣ୍៝ܺયΕံշ໨ҞǴᙖҗံշٰว৖В໔ྣ୍៝ܺǶӧ2011 ԃፁғᅽճ೽຾΋؁௢ՉȨВ໔ྣ៝ڡԭΒीฝȩǴӧ2013ԃၲډӄѠВ໔ྣ៝

120ৎޑҞ኱ǴځύѨඵੱВ໔ྣ៝ύЈ಍ी΢ӅԖ21ৎ(߄2-3-1)Ƕ ߄ 2-3-1! Ѡ᡼ 2013 ԃۭВ໔ྣ៝ύЈৎኧ

ԃ

ԃࡋ 2008 2009 2010 2011 2013 2014

໨Ҟ ൂ

Տ ኧ

ൂ Տ ኧ

ൂ Տ ኧ

ൂ Տ ኧ

ൂ Տ ኧ

ൂ Տ ኧ

΋૓В໔ྣ៝ύЈ 26 31 54 58 99 103

ѨඵੱВ໔ྣ៝ύЈ 5 8 12 15 21 20

ӝी 31 39 66 73 120 123

ၗ਑ٰྍǺፁғᅽճ೽ޗ཮Ϸৎ৥࿿(2014)

ࣴزࡰр٬ҔВ໔ྣ៝ёаफ़եྣ៝ޣޑॄय़௃ᆣǵЈ౛଼நϷኁᢠ฻ୢᚒ (Cox, 1997; Gilleard, Gilleard, & Whittick, 1984; Jarrott, Zarit, Stephens, Townsend,

& Greene, 2000)ǴΨԖࣴزࡰр٬ҔВ໔ྣ៝ό໻ёа෧Ͽྣ៝ޑਔኧǴΨૈफ़ եྣ៝ޣӧ௃ᆣϷЈ౛΢ޑୢᚒ(Zarit, Stephens, Townsend, & Greene, 1998)ǹՠ Ԗ٤ࣴز೛ी఼ᇂၨӭόӕ୍ܺኳԄޑࣴز่݀ᡉҢǴВ໔ྣ៝ޑ٬Ҕჹܭॄय़

௃ᆣϷЈ౛଼நޑؒԖᡉ๱ቹៜ(Lawton, Brody, & Saperstein, 1989; Montgomery RJV, 1989)Ƕ

ӧࢌ٤ࣴزว౜В໔ྣ៝ύЈǴૈ୼फ़եྣ៝ޣޑॄᏼǶMossello et al(2008) ჹ٬ҔВ໔ྣ៝ύЈޑѨඵੱ஻ޣϷځྣ៝ޣ຾Չቹៜຑ՗Ǵஒ٬ҔВ໔ྣ៝ύ ЈޑѨඵੱ஻ޣᆶۚৎྣ៝ޑѨඵੱ஻аԃសϷᇡޕфૈ຾ՉଛჹǴځЬाྣ៝

ޣΨ٩ԜБԄ຾ՉଛჹǴଛჹֹԋࡕǴٿঁДࡕӆ຾Չઓ࿶ᆒઓੰቻໆ߄ ȐNeuropsychiatric Inventory, NPIȑϷྣ៝ޣॄᏼໆ߄(Caregiver Burden Interview, CBI)຾ՉෳໆǴࣴز่݀ว౜ઓ࿶ᆒઓੰቻໆ߄ளϩӧВྣ៝ύЈԖᡉ๱ޑΠफ़Ǵ

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ӧྣ៝ޣॄᏼໆ߄೽ϩӧۚৎྣ៝คᡉ๱ቹៜǴԶӧВ໔ྣ៝ЈύԖᡉ๱ޑቹៜ (Mossello et al., 2008)Ƕ߄ҢٿঁДޑВ໔ྣ៝٬ҔǴૈ୼෧ᇸྣ៝ޣޑॄᏼϷफ़ եѨඵੱ஻ޣޑᆒઓੱރǶВ໔ྣ៝ύЈޑ٬ҔӧЈ౛ቫय़ჹܭྣ៝ޣԖ҅ӛቹ ៜǴૈ٬ྣ៝ޣ෧ᇸྣ៝ޑॄ಻ǶZarit et al(1998)௦Ҕྗჴᡍ೛ीǴჴᡍಔࣁ٬

ҔВ໔ྣ៝ޑ୍ܺǴჹྣಔ߾ࢂؒԖ٬ҔВ໔ྣ୍៝ܺ܈٬ҔϿ೽ϩޑഹ৲୍ܺǴ

຾Չ΋ԃޑຑ՗Ǵϩձӧ໒ۈǵ3ঁДջ12ঁД຾Չ6ঁᄬय़ෳໆǴϩձࣁفՅޑ

״ᑛǵॄ಻ǵᏼЈǵᓸΚǵኁᢠǵғ਻ᆶ҅ӛޑቹៜ຾Չຑ՗Ǵࣴز่݀ว౜ჴ ᡍಔᆶჹྣಔӧ3ঁДޑ٬ҔВ໔ྣ៝ࡕǴჴᡍಔӧኁᢠکғ਻аϷॄ಻کᓸΚ ޑϩኧԖᡉ๱ޑफ़եǴӧ΋ԃޑ٬ҔΠǴӧॄ಻ϷኁᢠԖᡉ๱ޑफ़ե(Zarit et al., 1998)Ƕ܌аǴВ໔ྣ៝ޑ٬Ҕૈ୼ගϲྣ៝ޣӧЈ౛଼நǴЪफ़եྣ៝ޣޑྣ៝

ᓸΚǶ

В໔ྣ៝ύЈගٮԴԃΓқϺԖӦБёаԎ៝ǴᡣৎΓёӼЈπբ܈ၸբԾ ρགྷ଺ޑ٣ǶВ໔ྣ៝ό໻ૈ୼ߦ຾ԴԃΓޑ଼நᆶғࢲࠔ፦Ǵ๏ϒྣ៝ޣഹ৲

ޑᐒ཮ǴΨૈ෧጗Ѩඵੱ஻ޣۯߏՐ຾ᐒᄬޑਔ໔(Hasselkus, 1997; Johnson &

Maguire, 1989; Neufeld & Strang, 1992; ໳௵ስ et al., 2004)Ƕ໳௵ስ(2004)ଞჹ9 ՏѨඵੱ஻ޣϷځৎ৥ྣ៝ޣǴ຾Չ፦܄ࣴزǴ่݀ࡰрǴВ໔ྣ៝ૈ୼ගٮྣ

៝ޣЈ౛ቫय़ޑЍ࡭Ǵྣ៝ޣ᝺ளЈ౛ॄ಻ёӢ٬ҔВ໔ྣៈ෧ᇸᓸΚǴᕇளഹ

৲ޑᐒ཮Ǵՠࢂӧ࿶ᔮቫय़ॄ಻ࢂቚуޑ௃ݩǶќѦǴӧ௃ᆣᆶ௃གЍ࡭ቫय़Ǵ

ྣ៝ޣ᝺ளᆶѨඵੱ஻ޣ໔ᜢ߯ᕇளׯ๓Ǵჹܭ஻ޣΨૈ୼࡭ុ߄ၲᜢᚶϷᜢངǴ ᅈىύ୯໺಍ֵၰޑሡ؃ǴЪᔅշᆢ࡭ৎ৥ޑֹ᏾܄Ƕ

В໔ྣ៝ჹܭѨඵੱ஻ޣёаගٮғ౛ᅱෳǵቚуѨඵੱ஻ޣޑޗ཮ௗ᝻ǵ ቚ຾Ѩඵੱ஻ޣޑז኷Ϸᅈىགǵᆢ࡭ᇡޕфૈϷۯ጗ᇡޕфૈଏϯǵׯ๓Ѩඵ

ੱ஻ޣቹៜ௃׎Ϸफ़եኁᢠکݪ഼གǶჹܭྣ៝ޣ߾ࢂૈ୼ኩਔᔅԆྣ៝೏ྣ៝

ޣǴ๏ϒྣ៝ޣਔ໔ၮҔޑቸ܄ǹ෧ᇸྣ៝ޣޑྣ៝ॄ಻ǹૈ୼٬ྣ៝ޣᅰֵၰǹ ᡣྣ៝ޣёаπբǴόҔӢྣ៝πբԶᜏᙍ܈ׯᡂπբࠠᄊǹྣ៝ޣᕇளӳޑғ

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ࢲࠔ፦(ֈᝊᓉ et al., 2014)Ƕ

Βǵྷඵϕշৎ৥ኳԄ

ӕኬឦܭޗ୔Ѩඵੱߏޣྣៈ୍ܺྣៈޑ΋ᅿ୍ܺޑྷඵϕշৎ৥ӧޗ୔

ගٮৎឦϷѨඵੱ஻ޣޑࢲ୏ޜ໔Ǵࢂ΋ᅿ่ӝߚᛰނݯᕍǵৎឦიᡏǵྣ៝מ ѯ૽ግϷΓω୻Ꭶޑྣ៝ኳԄǶᡣৎឦૈ୼ӧқϺ஥๱Ѩඵੱ஻ޣୖᆶޗҬࢲ୏Ǵ ᙖҗৎឦ໔ϕ࣬ᔅշᆶྣ៝מѯҬࢬΠǴගϲৎឦᆶѨඵੱ஻ޣޑғࢲࠔ፦Ǵۯ

጗຾ΕВ໔ྣ៝Ϸᐒᄬޑਔ໔ǶЪӧୖᆶޑၸำύǴό໻ৎឦ໔ёа࣬ϕྣ៝Ǵ Ѩඵߏ፸ϐ໔Ψૈᙖҗიᡏࢲ୏ޑୖᆶǴౢғ࣬ϕྣ៝ޑਏ݀Ǵ׳ᜤளޑࢂǴё аᙖҗྣ៝όӕޑߏ፸Ǵ٬ளচҁᆙ஭ޑྣ៝ᜢ߯ᕇள጗ှ(Цቚ߿ & ጰ᐀ݒ, 2014; ෯᜽ҏ et al., 2013)Ƕ

2005ԃѠ᡼Ѩඵੱڐ཮໒ۈȨྷඵᏢ୸ȩޑ୍ܺǴৎឦჹܭԜ୍ܺۯ጗Ѩඵ

ੱ஻ޣଏϯޑ຾ำ๏ϒ࣬྽εޑޭۓǴՠࢂԜ୍ܺኳԄа10ຼࣁ΋ఊԛǴ؂Տ஻

ޣ؂ຼѝૈୖᆶ΋୸ፐำǴৎឦॺ׆ఈૈ୼ୖᆶ׳ӭޑፐำǴӧৎឦϷѨඵੱ஻

ޣޑሡ؃ΠǴ໒ܫচҁᏢ୸ޑޜ໔Ǵ๏ৎឦԾՉ஥ߏ፸ᆶځдৎ৥ϕ୏Ǵ຾Չޗ Ҭࢲ୏ǶҗܭৎឦϷѨඵੱ஻ޣሡा൑܌Ǵ٬дॺёаᆶдΓ຾ՉޗҬࢲ୏Ǵ2011 ԃȨྷඵϕշৎ৥ȩ҅ԄԋҥǴ೭ঁ൑܌ό໻๏ϒѨඵੱ஻ޣѦӧڈᐟǴΨ๏ϒ ৎឦྣ៝΢ޑЍ࡭Ǵ׎ԋ΋ঁϕշޑᆛ๎Ƕৎឦ໔ޑЍ࡭Ǵૈ୼෧ᇸྣ៝΢ޑᓸ ΚǴΨёаϩ٦۶Ԝޑྣ៝࿶ᡍǴϕ࣬ᏢಞϷԋߏǶ

ৎឦЍ࡭იᡏჹܭྣ៝ޣࢂԖᔅշޑǶChien et al(2011)ޑࣴزύว౜Ǵவό ӕޑၗ਑৤ύǴԏ໣Α1998ԃԿ2009ԃ໔ǴৎឦЍ࡭იᡏޑ࣬ᜢࣴز຾Չࡕ೛ϩ

݋(Meta-analysis)Ǵࣴز่݀ว౜ྣ៝ޣЍ࡭იᡏᆶྣ៝ޣޑЈ౛଼ந௃ݩǵኁᢠ

௃׎ǵॄ಻аϷޗҬ่݀Ԗᡉ๱ޑᜢ߯(Chien et al., 2011)Ƕ׵ীী(2004)аъ໒ ܫԄୖᆶࣴزჹѨඵੱ஻ޣޑྣ៝ޣ຾ՉࣴزǴ٠௖૸ৎឦЍ࡭იᡏჹྣ៝ޣޑ ԋਏǴࣴز่݀ว౜ྣ៝ޣයࡑவৎឦЍ࡭იᡏύᕇளྣ៝΢ޑࡌ᝼ǵྣ៝מѯ

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ک҂ٰྣ៝ޑБӛǴЪԜࣴزϕ୏ޑࠠᄊεӭࣁࡌ᝼܄ࣁЬ(׵ীী, 2004)Ƕ

෯᜽ҏ(2000)ଞჹѨඵੱৎឦიᡏԋਏ຾Չ௖૸Ǵ຾Չ10ԛޑৎឦЍ࡭იᡏǴ

ၗ਑ϩ݋೽ϩ٬ҔYalomޑიᡏݯᕍӢનࢎᄬٰߞՉϩ݋ǴYalomޑიᡏݯᕍԖ ਏݯᕍӢનԖ11ᅿǴϩձࣁȨ׆ఈޑឲݙ(instillation)ȩǵȨදϷ܄ȐUniversalityȑȩǵ Ȩޕ᛽ૻ৲໺௤(imparting information)ȩǵȨճд܄ȐAltruismȑȩǵȨԐයৎ৥࿶ᡍ ޑᕖ҅ख़᏾(corrective reenactment of primary family group)ȩǵȨว৖ޗҬמѯ (development of social interaction techniques)ȩǵȨኳүՉࣁ(imitative behavious)ȩǵ ȨΓሞᏢಞ(interpersonal learning)ȩǵȨӸӧӢન(existential factors)ȩǵȨ௃ᆣ࠹ࢻ (catharsis)ȩǵȨიᡏᏉᆫΚ(group cohesiveness)ȩǴࣴز่݀ว౜ৎឦЍ࡭იᡏܴᡉ ޑݯᕍӢηԖ׆ఈޑឲݙǵදၹ܄ǵޕ᛽ૻ৲໺௤ǵճд܄ǵว৖ޗҬמѯǵ௃

ᆣ࠹ࢻϷიᡏᏉᆫΚǴ߄Ң໒ܫԄޑৎឦЍ࡭იᡏჹܭྣ៝ޣࢂԖᔅշޑ(෯᜽

ҏ, ယࣂம, ഋؼী, & ᖴᅸ৒, 2000)Ƕ

а΢ࣴز೿߄ҢৎឦЍ࡭იᡏૈ୼ቚуྣ៝ޣྣ៝Ѩඵੱ஻ޑࠔ፦Ƕྷඵϕ շৎ৥ޑ୍ܺኳԄёаᙖҗৎឦ໔ޑϕշӝբᜢ߯ǴٰၲډৎឦЍ࡭ޑਏ݀Ǵᙖ җ۶Ԝϐ໔ޑ࿶ᡍϩ٦Ǵٰගଯྣៈࠔ፦Ƕᙁզػ(2010)ࣴزࡰрǴЍ࡭იᡏޑ ϟΕჹྣ៝ޣޑЈ౛଼நǵኁᢠǵॄ಻ࣣԖᡉ๱࣬ᜢǴԶԖӭ஑཰ङඳޑሦᏤޣ

཮ԖၨଯޑЍ࡭იᡏׯ๓ਏ݀(ᙁզػ, 2010)Ƕ

ΟǵВ໔ྣ៝ύЈᆶྷඵϕշৎ৥ϐКၨ

В໔ྣ៝ύЈᆶྷඵϕշৎ৥ٿᅿ୍ܺኳԄനεޑόӕೀǴԖаΠ൳ᗺǶ(1)

٬Ҕ୍ܺޑਔ໔ǺВ໔ྣ៝ύЈ೯த؂В٬Ҕ8λਔǴࡐϿԖଌѨඵੱ஻ޣ؂Ϻ 4ঁλਔԿύЈǴԶྷඵϕշৎ৥٬Ҕ୍ܺਔ໔࣬ჹቸ܄Ǵёаᒧ᏷΋ຼ٬ҔϺ ኧǴЪёаᒧ᏷؂В٬ҔਔࢤǴёа๏ϒѨඵੱ஻ޣቸ܄Ӽ௨ځд࣬ᜢࢲ୏ǹ(2) ࢲ୏Ӽ௨ޑቸ܄ǺВ໔ྣ៝ύЈ؂ڬ཮Ӽ௨ڰۓፐำǴѨඵੱ஻ޣ؂ВډၲВ໔

ྣ៝ύЈሡ຾ՉύЈ܌Ӽ௨ࢲ୏ǴԶྷඵϕշৎ৥ό཮Ӽ௨ፐำ๏஻ޣǴᡣѨඵ

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ੱ஻ޣԾҗᒧ᏷྽Вགྷाவ٣ޑࢲ୏ǹ(3)ᆶޗ཮ௗ᝻ᐒ཮ǺВ໔ྣ៝ύЈ஻ޣ܌

ௗ᝻ډޑΓǴаځд஻ޣϷπբΓ঩ۚӭǴՠࢂӧྷඵϕշৎ৥ёаௗ᝻ډځд

஻ޣϷৎឦǴௗ᝻׳ӭό΋ኬޑڈᐟǹ(4)ৎឦୖᆶำࡋǺВ໔ྣ៝ύЈྣ៝ޣό ሡाഉՔ஻ޣǴԶྷඵϕշৎ৥ྣ៝ޣሡाഉӕ஻ޣǴаӢᔈँว௃ݩǹ(5)ྣ៝

ࠔ፦ගϲǺྷඵϕշৎ৥ᙖҗόӕৎ৥໔Ǵྣ៝࿶ᡍޑϩ٦Ǵගϲྣ៝ૈΚǴ٬

Ѩඵੱ஻ޣૈ୼ளډྣ៝ࠔ፦΢ޑගϲǹ(6)ྣ៝ޣਔ໔΢ޑቸ܄ǺВ໔ྣ៝ύЈ җܭྣ៝ޣόሡഉՔ஻ޣǴВதғࢲԖ׳ӭޑਔ໔ёаӼ௨Ծρޑࢲ୏ǹ(7)஑཰

Γ঩ǺВ໔ྣ៝ύЈሡाӭՏ஑཰Γ঩Ǵྷඵϕշৎ৥ࡰሡा΋Տᆅ౛Γ঩Ǵε ൯फ़եΓΚޑ٬ҔǶ

Ѥǵλ่

ᗨฅВ໔ྣ៝ύЈᆶྷඵϕշৎ৥ӕኬឦܭ๏Ѩඵੱߏޣޑޗ୔ԄྣៈǴᗨ ฅ೭ٿᅿኳԄჹৎឦޑЍ࡭ᆶৎឦޑୖᆶځჴࢂό࣬ӕޑǴՠࢂჹ೭ٿᅿ୍ܺჹ ৎ৥ྣ៝ޣޑቹៜǴҞ߻Ѡ᡼ၨલЮ࣬ᜢޑຑ՗Ƕࡺᔈவӭϡفࡋٰٰຑ՗೭ٿ ᅿόӕ୍ܺኳԄჹܭྣ៝ޣϷ೏ྣ៝ޣޑቹៜǶ

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ಃѤ࿯! ຑ՗πڀӣ៝

୯ϣѦࣴزჹܭѨඵੱྣ៝ޣޑຑ՗ၨத٬ҔǴྣ៝ޣຑ՗ໆ߄(CAS)ǵZarit

ॄᏼໆ߄(ZBI)ǵྣ៝ޣᓸΚໆ߄(CSI)Ϸ҅ӛྣ៝࿶ᡍໆ߄(PAC)฻ໆ߄Ǵҁࣴز ਥᏵࣴزҞޑϷЎ᝘ӣ៝ࡕǴᒧ᏷ྣ៝ޣຑ՗ໆ߄(CAS)Ϸྣ៝ޣᓸΚໆ߄(CSI)

຾ՉୢڔፓࢗǴаΠஒ၁ಒϟಏԜٿᅿໆ߄Ƕ

΋ǵྣ៝ޣຑ՗ໆ߄(Caregiver Appraisal Scale,! CAS)

Lawton(1989)܌ว৖ޑྣ៝ޣຑ՗ໆ߄(Caregiver Appraisal Scale, CAS)Ǵୢ

ڔว৖ࣁΑෳໆྣ៝ޣޑ٬Ҕ࣬ᜢߏයྣ୍៝ܺ຾Չຑ՗Ǵୢڔᚒ໨Ӆ47ᚒǴϩ ኧጄൎ47~235Ǵх֖Αϖঁय़ӛǴϩձࣁЬᢀྣ៝ॄᏼ(Subjective caregiving burden)Ǵྣ៝ޑቹៜ(Impact of caregiving)Ǵྣ៝ޑዕግૈΚ(Caregiving Mastery)Ǵ

ྣ៝ޑᅈىག(Caregiving satisfaction)Ǵख़ཥຑ՗ޑᇡޕ(Cognitive reappraisal)Ǵ؂

ঁय़ӛᚒኧӚࣁ13ᚒǵ9ᚒǵ12ᚒǵ9ᚒϷ4ᚒǴ௦ҔϖᗺЁࡋीϩǴϩኧຫଯ߄ ҢำࡋຫଯǶЬᢀྣ៝ॄᏼޑୢᚒх֖ǴȨӢࣁྣ៝஻ޣǴԶ೷ԋғࢲѨѐඓඝ?ȩǵ Ȩ᝺ளόૈӆྣ៝೏ྣ៝ޣࡐΦΑ?ȩǵȨ྽գྣ៝஻ޣਔǴ཮གډғ਻?ȩǶྣ៝

ޑቹៜᚒ໨ԖǴȨாޑޗҬғࢲӢࣁྣ៝஻ޣԶౢғ֚ᘋ?ȩǵȨாޑਔ໔ϩଛӢࣁ

ྣ៝஻ޣԶ٬ளாؒԖى୼ޑਔ໔๏Ծρ?ȩǵȨாӢࣁྣ៝஻ޣԶؒԖঁΓޑᗦ د?ȩྣ៝ޑዕግૈΚᚒ໨ԖǴȨόዴۓ၀ࣁ஻ޣ଺ࣗሶ٣?ȩǵȨாᔈ၀ाӆࣁ஻

ޣ଺ޑ׳ӭ?ȩǵȨךૈ୼మཱޕၰ஻ޣޑሡ؃?ȩǶྣ៝ޑᅈىགᚒ໨ԖǴȨா኷ܭ ᆶ஻ޣӧ΋ଆ?ȩǵȨྣ៝஻ޣǴᡣா᝺ளᆶ஻ޣ׳ᒃ߈?ȩǵȨӆᆶ஻ޣޑᜢ߯΢Ǵ

ா଺ΑࡐӭѸ໪଺ޑ٣ǴԶόࢂாགྷा଺ޑ٣?ȩǶख़ཥຑ՗ޑᇡޕᚒ໨ԖǴȨா

ྣ៝஻ޣځύ΋ঁख़ाচӢࢂӢࣁৎ৥ޑ໺಍?ȩǵȨӢࣁྣ៝஻ޣԶ٬ளգ஌ૼ

ے௲ߞһ?ȩǵȨாᇡࣁྣ៝஻ޣࢂჹܭ஻ޣޑ΋ᅿൔเ?ȩǶϣ೽΋ठ܄ߞࡋࣁ (Cronbach's alpha)ࣁ0.90(Lawton, Brody, et al., 1989; Lawton, Kleban, et al., 1989;

Lawton, Moss, Hoffman, & Perkinson, 2000)Ƕ

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Βǵঅुހྣ៝ޣᓸΚໆ߄(Modified Caregiver Strain Index,! MCSI)

ྣ៝ޣᓸΚໆ߄(Caregiver Strain Index, CSI)ࣁRobinson(1983)܌ว৖ޑໆ߄Ǵ Robinsonখ໒ۈࣴزჹຝࣁӢᢇᜢ࿯ЋೌԶՐଣ܈ӢЈ᠌ੰԶՐଣޑੰΓϐྣ

៝ޣǴྣ៝ޣԃសϟܭ22~83ྃǴёࣁ஻ޣޑଛଽǵৎΓǵᎃۚ܈ܻ϶Ƕྣ៝ޣ ᓸΚໆ߄(CSI)ᚒ໨Ӆ13ᚒǴीϩБԄ௦ҔΒϩݤǴȨ1ȩ߄ҢࢂǴȨ0ȩ߄ࢂցǴᕴ ϩࣁ0~13ϩǴϩኧຫଯ߄ҢᓸΚຫεǶԜໆ߄ޑϣ೽΋ठ܄ߞࡋ(Cronbach's alpha) ࣁ0.86Ǵࡌᄬਏࡋޑ೽ϩёவΟ೽ϩڗளǴϩձࣁੰΓޑྣ៝੝፦ǵྣ៝ޣᆶ೏

ྣ៝ޣ໔ޑЬᢀགڙϷྣ៝ޣޑ௃ᆣ଼ந௃׎Ƕࣴز่݀ྣ៝ޣᓸΚໆ߄(CSI) ёаଞჹߚ҅Ԅྣ៝ޣޑྣ៝ᓸΚԖਏޑ຾Չෳໆ(B. C. Robinson, 1983)Ƕ

অुހྣ៝ޣᓸΚໆ߄(Modified Caregiver Strain Index, MCSI)ܭ2003ԃҗ Thornton܌ගрǴӢࣁྣ៝ߏයྣ៝ᄌ܄੯ੰޑԴΓԃεӭҗߚ҅Ԅޑྣ៝ޣྣ

៝Ǵྣ៝ޣӧޗ཮ᜢ߯΢۳۳཮ౢғኁᢠǵੲമǵൿ໾Ϸׯੰޑ௃׎Ǵ٬ளྣ៝

ޣޑيᡏ଼நр౜ୢᚒϷ೷ԋമಕǶਠ҅ࡕޑྣ៝ޣᓸΚໆ߄(MCSI)ᚒ໨ࣁ13 ᚒǴीϩБԄ௦ҔΟᗺЁࡋǴȨ2ȩ߄ҢததӵԜǴȨ1ȩ߄ҢԖਔӵԜǴȨ0ȩ߄ࢂ

ؒԖǶᕴϩࣁ0~26ϩǴϩኧຫଯ߄ҢᓸΚຫεǶୢڔᚒ໨ԖǴȨךޑᅵ઀ڙډυ ᘋ(ٯӵǴڹ໔ሡྣ៝஻ޣ΢Π׉܈ၯو௃ݩ)ȩǵȨӢྣ៝܌೷ԋޑيᡏᓸΚ(ٯӵǴ

஻ޣ౽୏֤Տਔࡐ઻Κ܈ሡ޸ࡐε஑ݙΚྣ៝஻ޣ)ȩǵȨӢࣁྣ៝Զགډڙज़(ٯ ӵǴӢࣁྣ៝஻ޣज़ڋΑԾҗਔ໔܈คݤᒿཀѦр)ȩǶ

অुހޑໆ߄ϣ೽΋ठ܄ߞࡋ(Cronbach's alpha)ࣁ0.90Ǵӆෳߞࡋࣁ(test–

retest reliability)ࣁ0.88ǴԜπڀჹܭߏයྣ៝ሦୱྣ៝ޣޑᓸΚё຾Չᛙۓޑໆ

ෳ(Thornton & Travis, 2003)Ƕ

MCSIໆ߄ଞჹCSIໆ߄຾Չ໨Ҟޑፓ᏾Ǵ٬CSIໆ߄ૈ୼ჹߏයྣ៝ޑྣ៝

ޣ຾Չຑ՗Ƕ೷ԋྣ៝ޣॄ಻ޑচӢԖࡐӭӢનǴႽࢂৎ৥فՅޑፂँǵ଄୍ॄ

ᏼǵྣ៝فՅޑፂँǵྣ៝ޣޑޗ཮Ѝ࡭ǵѨඵੱ஻ޣޑᇡޕфૈำࡋکୢᚒՉ

(44)

ࣁ฻Ǵࣣ཮ቹៜྣ៝ޣޑ᏾ᡏॄ಻ຑ՗Ǵ܌аྣ៝ޣޑॄ಻ຑ՗ᔈ຾Չ׳ӄय़ޑ ԵໆǶ

Οǵλ่

౜Ϟྣ៝ޣ܌٬Ҕޑຑ՗ໆ߄εӭࣁॄӛޑຑ՗ǴЪલЮӄय़܄ޑຑ՗ໆ߄Ǵ คݤӕਔჹྣ៝ޣ຾Չ҅ӛϷॄӛޑຑ՗ǴҁࣴزஒԾՉว৖ཥޑໆ߄Ǵ٬Ҕਠ

҅ࡕޑྣ៝ޣᓸΚໆ߄(MCSI)Ϸᘏڗ೽ϩྣ៝ޣຑ՗ໆ߄(CAS)ϐᚒ໨Ǵว৖ࣁ ཥޑӭϡྣ៝ޣຑ՗ໆ߄Ǵයఈૈ୼аᆒᙁޑᚒ໨Ǵჹྣ៝ޣ຾ՉԖਏޑຑ՗Ƕ

(45)

ಃΟക! ࣴزБݤᆶ೛ी

ಃ΋࿯! ࣴزࢎᄬ

ҁࣴزࣁᐉᘐ܄ࣴزǴ௦ҔҥཀڗኬǴаѨඵੱ஻ޣޑЬाྣ៝ޣࣁԏਢჹ ຝǴஒ٬Ҕ่ᄬԄୢڔǴ຾ՉୢڔፓࢗǶ

ҁࣴزགྷΑှӧВ໔ྣ៝ύЈϷྷඵϕշৎ৥ٿᅿόӕޑྣៈኳԄΠǴόӕ ޑྣ៝੝፦ࢂցΨ཮ቹៜྣ៝ޣޑॄ಻Ǵ٠ӧ௓ڋΓαᏢ੝፦ࡕǴ຾΋؁௖૸ྣ

៝ޣޑྣ៝ॄ಻ࢂց཮Ԗ܌όӕǶ

კ 3-1-1! ࣴزࢎᄬ Ծᡂ໨!!

ྣ୍៝ܺኳԄ!

В໔ྣ៝ύЈ!

ྷඵϕշৎ৥!

٩ᡂ໨!

ྣ៝ޣӭϡຑ՗!

௓ڋᡂ໨!! ΓαᏢ੝܄!

ྣ៝ޣ୷ҁ੝܄!

೏ྣ៝ޣ୷ҁ੝܄!

(46)

ಃΒ࿯! ࣴزჹຝ

ҁࣴز௦ҥཀڗኬǴଞჹᆵчѱϖ໔В໔ྣ៝ύЈѨඵੱ஻ޣޑЬाྣ៝

ޣǴаϷྷඵϕշৎ৥ޑѨඵੱ஻ޣޑЬाྣ៝ޣǴࣴزયΕచҹǺ(1)20ྃа

΢ǹ(2)࿶ᙴৣዴບࣁѨඵੱϐ஻ޣޑЬाྣ៝ޣǹ(3)قᇟૈ୼ྎ೯ޣǹ(4)ӧৎ ύ޸຤നӭਔ໔ޔௗ܈ᅱ࿎ྣ៝πբޑৎឦ(ߋ௴ዎ et al., 2002)ǶऩࢂЬाǵ ԛाྣ៝ޣคݤղۓਔǴٿޣࣣวܫୢڔ(෯᜽ҏ, 1991)Ƕ௨ନచҹǺ(1)Ѩඵੱ

஻ޣ٬Ҕ၀໨୍ܺਔ໔҂ᅈ3ঁДǹ(2)Ѩඵੱ஻ޣ؂ຼ٬ҔϺኧեܭ3Ϻǹ(3)௨ ନѦᝤྣ៝ޣǶӧቻ؃Ьाྣ៝ޣӕཀࡕǴჹЬाྣ៝ޣ຾ՉୢڔፓࢗǴЬा

аԾ༤ޑБԄ༤เୢڔǴऩࢂԖሡाਔΨૈ୼аೖፋޑБԄ຾ՉǶ

ಃΟ࿯! ࣴزၸำ

ҁࣴزၗ਑ԏ໣ਔ໔ࣁ2015ԃ3Д9ВԿ2015ԃ6Д30ВǴӅी17ຼǴႣीԏ ਢᕴኧࣁ100ҽǶࣴزኬҁԏ໣ࢬำԿВ໔ྣ៝ύЈϷྷඵϕշৎ৥຾ՉԏਢǴ ஒځϩࣁٿಔǴ΋ಔࣁ٬Ҕྷඵϕշৎ৥ޑЬाྣ៝ޣǴќ΋ಔࣁ٬ҔВ໔ྣ

៝ޑЬाྣ៝ޣǶВ໔ྣ៝ԏਢБԄǴҗܭ٬ҔԜ୍ܺኳԄϐ೏ྣ៝ޣǴεӭ ࣁᐒᄬҬ೯ௗଌ۳߇Ր܌Ǵऩा຾Չय़ჹय़ԏਢԖ୺Չ΢֚ᜤǴ܌аہૼВ໔

ྣ៝ύЈޑՉࡹൂՏ຾ՉวܫୢڔǴୢڔวܫ߻ǴࣴزΓ঩཮ᒃԾ߻۳В໔ྣ

៝ύЈǴჹॄೢжวୢڔϐΓ঩၁ಒᇥܴࣴزޣيϩǵࣴزҞޑǵࣴزჹຝϷ

ୢڔϣ৒ǴЪჹВ໔ྣ៝ύЈϐගୢ຾ՉှᇥǶ฻ࡑୢڔӣԏࡕǴᔠࢗୢڔ༤ เֹ᏾ࡋǴऩࢂԖᅅเޑ௃ݩǴ߾ᆶВ໔ྣ៝ύЈڐ୘Ǵࢂցёааႝ၉ೖፋ ޑБԄஒග໨ံሸǴԶऩࣁคਏୢڔǴ߾཮຾ՉΒԛวܫୢڔǴٰቚуୢڔӣ ԏ౗Ƕྷඵϕշৎ৥ޑԏਢБԄҭӕܭВ໔ྣ៝Ƕ܌ԏ໣ޑၗ਑໻ٮीฝЬ࡭

ΓϷࣴزΓ঩٬ҔǴό཮ஒঁΓၗ਑ࢻᅅ๏ൂՏǴߥៈԏਢჹຝޑ٬Ҕ៾੻Ǵ നࡕѝ཮ஒࣴز่݀ᆶൂՏϩ٦Ǵࣴز่݀ගٮ๏ൂՏǴࣁВࡕׯ๓୍ܺϐࡌ

᝼Ƕӧቻ؃ڙ၂ޣӕཀǴᛝ࿿ڙ၂ޣӕཀਜࡕǴω໒ۈ຾ՉୢڔޑፓࢗǶӧ༤

(47)

เୢڔ߻ǴӃၟڙ၂ޣ၁ಒᇥܴୢڔϣ৒ǴЬाҬҗڙ၂ޣԾՉ༤เୢڔǴѸ

ाਔࣴزޣаೖፋޑБԄжࣁ༤เǶ؂ҽୢڔऊ༤เ10Կ20ϩដǶֹԋޣ཮ග ٮλᘶࠔаҢགᖴǶ

ಃѤ࿯! ࣴزπڀ

ҁࣴز௦Ҕ่ᄬԄୢڔǴୢڔϩࣁٿঁ೽ϩǴࣁ୷ҁၗ਑߄ǵৎ৥ྣ៝ޣӭ ϡຑ՗Ƕ၁ಒϣ৒ϩॊӵΠǶ

΋ǵ୷ҁၗ਑߄

୷ҁၗ਑߄ᡂ໨٩ᏵЎ᝘ӣ៝Ϸࣴزᑫ፪ᒧۓǴϩԋٿε೽ϩǴಃ΋೽ϩࣁ Ьाྣ៝ޣ୷ҁၗ਑Ǵх֖܄ձǵԃសǵᆶ೏ྣ៝ޣᜢ߯ǵࢂցᆶ೏ྣ៝ޣӕՐǵ ஆ࠷௃ݩǵ௲ػำࡋǵᙍ཰ǵ൩཰ރݩǵྣ៝߻ࡕ൩཰ރݩࢂցׯᡂǵྣ៝ੰ஻

ය໔ǵ؂Вྣ៝ਔኧǵࢂցԖ࣮ៈڐշྣ៝ੰ஻Ϸৎ৥ԃԏΕǶЬाྣ៝ޣ୷ҁ

ၗ਑ᡂ໨ᏹբࠠۓကǴӵ߄ 3-4-4ǶಃΒ೽ϩࣁ೏ྣ៝ޣ୷ҁၗ਑Ǵᡂ໨х֖٬

Ҕ୍ܺᜪࠠǵ܄ձǵԃសǵۚՐ௃ݩǵஆ࠷௃ݩǵ௲ػำࡋǵ౜ӧࢂց൩཰ǵ౜

ӧࢂցሦДଏॲǵ஻ੰ߻ᙍ཰ǵวੰԃសǵ஻ੰය໔ǵѨඵੱำࡋϷЬाྣ៝ޣ

܈೏ྣ៝ޣԖ٬Ҕډޑߏයྣៈ࣬ᜢ୍ܺǶ೏ྣ៝ޣ୷ҁၗ਑ᡂ໨ᏹբࠠۓကǴ ӵ߄ 3-4-5ǶҁࣴزԾᡂ໨ࣁ٬Ҕޑ୍ܺᜪࠠǴځᏹբࠠۓကӵ߄ 3-4-1Ƕ

Βǵৎ৥ྣ៝ޣྣ៝ॄ಻ຑ՗

ҁࣴزޑୢڔӧৎ৥ྣ៝ޣྣ៝ӭϡຑ՗ϩࣁΟঁηໆ߄Ǵϩձࣁྣ៝ޣᓸ Κࡰኧໆࡋ߄ǵྣ៝ޑᅈىགϷྣ៝ޑዕግૈΚǶୢڔᚒ໨ӵ߄ 3-4-2Ƕྣ៝ޣ ᓸΚࡰኧໆࡋ߄Бय़௦Ҕ Thornton(Thornton & Travis, 2003)܌ว৖ޑ Modified Caregiver Strain Index(MCSI)ǴमЎހୢڔᚒ໨ӅԖ 13 ᚒǴीϩБԄ௦ҔΟᗺЁ ࡋǴȨ2ȩ߄ҢததӵԜǴȨ1ȩ߄ҢԖਔӵԜǴȨ0ȩ߄ࢂؒԖǶᕴϩࣁ 0~26 ϩǴ ϩኧຫଯ߄ҢᓸΚຫεǶҁࣴزୢڔǴΨஒԜϩࣁΟঁЁࡋǴȨ1ȩ߄ҢֹӄคǴ

(48)

Ȩ2ȩ߄ҢԖਔǴȨ3ȩ߄Ң࿶தǴԜ೽ϩᕴϩࣁ 13~39 ϩǴϩኧຫଯ߄Ңॄӛቹ ៜຫεǶ

ӧྣ៝ᅈىགϷྣ៝ޑዕግૈΚБय़٬Ҕ Lawton(Lawton, Kleban, et al., 1989)ว৖ޑྣ៝ޣຑ՗ໆ߄(Caregiver Appraisal Scale,CAS)ύٿঁ҅ӛຑ՗ޑη ໆ߄Ǵϩձࣁྣ៝ޑᅈىགϷྣ៝ޑዕግૈΚǴᚒ໨٩ࣴزҞޑϷୢڔߏࡋޑԵ ໆΠǴׯࣁ 5 ᚒϷ 4 ᚒǴीϩБԄҗচҁ٬ҔϖᗺЁࡋीϩǴȨ1ȩ߄Ңߚதόӕ ཀǴȨ2ȩ߄ҢόӕཀǴȨ3ȩ߄Ңද೯ǴȨ4ȩ߄ҢӕཀǴȨ5ȩ߄ҢߚதӕཀǴࣁΑ ᆶྣ៝ޣᓸΚࡰኧ಍΋Ǵׯ௦Ҕ 3 ᗺЁࡋǶԶচҁޑीϩБԄǴᆶॄӛྣ៝ቹៜ

܌ຑໆЁࡋόӕǴЪ௦ҔӕόӕཀࣁຑໆБԄǴҗܭӕόӕཀޑຑϩБԄၨคݤ Кၨр฻ભǴ܌аׯ௦Ҕᓎ౗ޑБԄ຾ՉຑໆǶԜ೽ϩᕴϩࣁ 9~27 ϩǶ

Զৎ৥ྣ៝ޣӭϡຑ՗ໆ߄ࢂஒ 3 ঁηໆ߄уᕴǶࣁΑ٬Ӛ໨ᚒҞև౜࣬ӕ БӛǴ܌аӧᕴϩीᆉਔǴஒྣ៝ޑᅈىགϷྣ៝ޑዕግૈΚηໆ߄ׯҔϸӛी

ϩǴȨ3ȩ߄ҢֹӄคǴȨ2ȩ߄ҢԖਔǴȨ1ȩ߄Ң࿶தǴӧྣ៝ޑᅈىགϷྣ៝

ޑዕግૈΚ೭ٿ೽ϩޑϩኧຫଯ߄Ңྣ៝ޑᅈىགϷዕግૈΚຫόӳǶ᏾ᡏໆ߄ ᕴϩጄൎࣁ 22~66 ϩǶϩኧຫଯ߄Ңྣ៝ޣॄ಻ຫεǶ

ҁୢڔਏࡋ೽ϩ຾Չࡌᄬਏࡋϩ݋Ǵ٬Ҕᡍ᛾܄Ӣનϩ݋(confirmatory factor analysis, CFA)଺ᔠᡍǶߞࡋ߾཮Ӄ຾ՉႣෳǴᔠۓୢڔޑϣ೽΋ठߞ(Cronbach alpha)ॶǶᡂ໨ᏹբࠠۓကǴӵ߄ 3-4-3Ƕ

數據

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參考文獻

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