Integrative Care plan for the Elderly in Ailshan-Mountain Three Tsou Tribes：Comparison on the Elderly, Families and Health Professionals

• Main Authors: Fen-Jyin Lin, 林芬瑾
• Other Authors: Fu-Jin Shih
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/42706212253937875957

碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 101 === Background The rapid growth of the aging population is an indisputable fact in Taiwan. In 1993, Taiwan officially became an “aging society” according to WHO. According to the statistics by the Ministry of the Interior Republic of China in the Taiwan (2013), currently the population over 65 years old have reached 11.22%, and such a population is expected to reach 14% by 2017, which will qualify Taiwan as an aged nation, and reach 20% by 2025, making Taiwan a super aged nation. This trend will lead to an increase of chronic diseases and all sorts of disabilities as the elderly age more (Council for Economic Planning and Development ,C.E.P.D ., 2012). The definition for the aboriginal elderly varies in accordance with individual conditions, and will take factors such as inhabited region into consideration. The age of 55 is the crucial point for a person who is deemed old (Council of Labor Affairs, 2008; Aborigine Elderly Pension Temporary Provisions, 2003). Based on the statistics by February 2013, the total number of the aboriginal elderly is 80,883, roughly 15.3% of the total aboriginal population (Council of Indigenous Peoples, C.I.P., 2013). At the same period, the population of the Tsou tribes comprises 7,012 persons, which is ranked ninth in indigenous tribes, and classified as minority. Alishan Township is the main region where the Tsou tribes inhabit, totaling 5,693 persons. Among them, 1,420 persons are over 55 years old, accounting for 24.9% of the population. It is evinced that aging population is the major concern the government should address in the future, no matter what the ethnic background is. Moreover, aboriginal people living in high mountainous areas face much complexity and inconvenience in medical resource delivery. Even though Taiwan’s medical treatment is widespread, the health care situation in mountainous areas has always been an issue, as health personnel are unwilling to go there, resulting in insufficient treatment resources. Purposes 1.To understand the cognitions, opinions, advices and expectations on current hygiene and social welfare systems from Tsou’s elderly who partake in the “Integrative Care Plan for the Elderly in Alishan Three Tsou Tribes”. 2.To understand the cognitions, opinions, advices and expectations on current hygiene and social welfare systems from the relatives of Tsou’s elderly families who partake in the “Integrative Care Plan for the Elderly in Alishan Three Tsou Tribes”. 3.To understand the cognitions, opinions, advices and expectations on current hygiene and social welfare systems from the health professionals who are involved with the “Integrative Care Plan for the Elderly in Alishan Three Tsou Tribes”. 4.To compare the cognitions, opinions, advices and expectations on current hygiene and social welfare systems from Tsou’s elderly and families and health professionals. 5.To develop medical model when getting sick for the Elderly in Alishan Three Tsou Tribes. Methods Using between-method triangulation and selects subjects (elderly, elderly families, and health professionals) from the three Tsou tribes (Sanmei, Hsinmei, and Chiashan) in Alishan. Health professionals consist of physicians, registered nurses, certified social workers, physiotherapists and home care workers. The study is conducted with purposive sampling. Quantitative research tools include 1. Visual analogue scale (VAS), by which to evaluate the level of satisfaction on self-perceived health care; 2. A checklist provided by all care institutions. The abovementioned quantitative data serves to clarify and compare the following conditions: 1. The analysis of the satisfaction of Tsou’s elderly and elderly families and health professionals on current medical and health system; 2. Demography and the analysis of satisfaction on medical and health condition; 3. The relevant analysis of the perception of the elderly and elderly families and health professionals on the health care provided by all agencies and satisfaction on health care system. We employ SPSS to conduct data analysis. Meanwhile this paper utilizes semi-structural interviewing for qualitative research. Through in-depth interviews with subjects, information is collected and a deeper understanding has achieved in the following two areas: 1. The opinions and suggestions of Tsou’s elderly and elderly families and health professionals on current hygiene and social welfare systems; 2. The expectations of the elderly and elderly families and health professionals on the “Integrative Care Plan for the Elderly in Alishan Three Tsou Tribes”. With qualitative content analysis, we conduct compilation and analysis. Results The involved interviewed subjects comprise three groups, namely: the elderly, the elderly families and health professionals, totaling 47 persons. There are 11 elderly persons (6 males and 5 females), with an average age of 76.64±9.48 ; the average year of residence is 70.55±20.18. There are 11 elderly families (9 females and two males), with an average age of 54±15.31; their average year of residence is 42.18±26.37. Among the 25 health professionals, there are 8 certified social workers, 7 nursing staffers (including 1 retired nurse), 5 home care workers, 4 doctors (including 2 physicians of Family Medicine, 1 community physician and 1 tribe’s doctor) and 1 physiotherapist. The average years of service at the three tribes are 8.24±8.01. The research results indicate that the satisfaction of the elderly and elderly families and medical staffs over the care system is mostly over the score of 80, without apparent diversity among the surveyed groups. This indicates the level of satisfaction positively correlates to the sufficiency of medical resources. The level of satisfaction does not show significant differences among differing backgrounds. Also, the increase of satisfaction is not influenced by any factors relating to experiences or backgrounds, including gender, age, marriage status, education or ethnic groups. In regard with the perception over the current health care system instituted in tribes, the health professionals ranked highest, followed by the elderly families, then the elderly. The more services an agency provide the more confusion the Tsou’s people feel. Hence, for a better understanding of the health services for Tsou’s people, it is best to keep the services simple. The most common care services (and best known to local people) are routine business, including outpatient services, inoculation and home care services. This phenomenon suggests the more commonly used, the better the promotion effect and understanding by local people. There is a positive correlation between the three groups’ perception and satisfaction for the agencies’ care services. As for the opinions of the three groups, most surveyed people regard the most serious issues with current care systems include a lack of local medical staff, the behavioral problems on health of Tsou’s people, and that the assessment tools are not appropriate for local conditions. The elderly emphasize the more commonly used care services, their family members emphasize the convenience and interest of the whole family, whereas the health professionals stress professional services. The surveyed subjects deem the operational performance and health care resources of current medical institutions as most satisfactory. They provide suggestions including cultivating and training local talents, improving the tribe’s medical conditions and providing help on the local-needed basis and constructing transportation networks. Tsou’s elderly people share their views on personal needs, their relatives offer suggestions from the perspective of care provider and service user, whilst the health professionals give advice from the care provider standpoint. The reasons that sway the choice made by the elderly and their family members include that no one accompanies them to the hospital, transportation problems (such as inaccessible by bus), unfamiliar surroundings (of a hospital), being afraid to communicate with medical staff or unable to understand the terms used in medical settings, and fear toward the information facilities. In regard with the expectations of the above three groups on integrative care, the elderly and their family members did not express concrete ideas or explicit demands for how to improve the present medical care resources. The medical staff expects to create a more effective transfer system by integrating inner / outer staff and projects, building a better retention of fulltime medical teams, creating a communication platform for cross-divisional teams and incorporating into the local culture. It is expected that the “Integrative Care Plan for the Elderly in Alishan Three Tsou Tribes” can take local population and project integration into account and cross beyond a care system that consists of acute disease, sub-acute disease, recovery period and long-term period. We hope that by further incorporating institutional and local resources, a cross-disciplinary, professional health team can be built to best provide the tribes’ people with health care networks. Conclusions This study explores the elderly, elderly families and health staff’s ideas and suggestions for the present health care services. This paper is intended to serve as reference for future revisions on current health care resources as well as trial operations in remote areas. This study further compares the opinions and advice of Tsou’s elderly and elderly families and health professionals on current health care services, and discovers that Tsou’s elderly share their views on personal needs, elderly families offer suggestions from the perspective of the care provider and service user, whilst the health professionals give advice from the care provider standpoint. The medical staff does not show significant difference in perceiving the insufficiency of the present health care system. Although research results indicate Tsou’s elderly people, their family members and health professionals have expressed some disappointment over health care, the satisfaction level of the health care system reached 80%. This implies that even though there is still room for improvement, the joint efforts by public sectors and private institutions have been generally recognized by the locals. In summation, this paper contributes to formulate an integrative structure and gives explanations for it, while offering concrete suggestions that address the predicament of medical channels, medical professionals, community and medical institutions. Hereby we suggest future research can explore the areas as follows: (1) to formulate more explicit improvement programs; (2) to evaluate the effect and satisfaction level of the trial plan; (3) to evaluate the applicability of promoting the plan in other remote areas.