失智症家庭受歧視與消除歧視之初探---日間照顧中心社工人員之觀點

Abstract

背景：失智症盛行率與年齡有著高度的相關性，伴隨著高齡人口逐年增長，成為近年來公共衛生的優先議題。然而失智症在社會大眾的認知裡往往是被標籤化的，在日常生活中存在著不少的歧視與不友善，成了失智症家庭獲得良好支持與生活品質之阻礙。本研究主要係探討日照社工觀察到失智症家庭受歧視的經驗與看法，以及消除歧視的方法。方法：本研究採質性研究，透過立意抽樣搭配滾雪球取樣，深度訪談大台北地區，台北市與新北市共六位日照社工，以主題分析法進行文本分析。結果：研究發現不論是失智者或家屬照顧者皆有面臨受歧視或隱微歧視的經歷，以及有預期歧視之狀況，即因擔心受到不公平對待而卻步，如：失智者與照顧者因擔心受到不公平對待，而避免至社交或公共場所等。社工人員在消除歧視方面：一、透過失智友善溝通技巧營造尊重與包容的環境；二、與社區建立關係，減少社會大眾對失智症的誤解與歧視；三、提出營造失智友善社區之建議。然而，落實失智友善溝通仍面臨挑戰，包含團體照顧會擠壓到友善溝通的機會以及現實資源有限與照顧負荷沉重間的兩難。結論：一、歧視並沒有消失，而是以更隱藏難以察覺的方式，影響著失智症家庭。二、建議透過「由上而下」輔以「由下而上」，建構失智友善環境，減少歧視發生。

Background: The prevalence of dementia is highly correlated with age. With the continual growth of the elderly population, dementia has emerged as a public health priority in recent years. However, dementia is often subject to labeling in public perception, leading to discrimination and unfriendly treatment in daily life, which is an obstacle for dementia families to get good support and maintain a good quality of life. This study focused on the experiences and perspectives of social workers regarding discrimination faced by dementia families, as well as their suggestions for anti-discrimination strategies.Methods: This study adopts a qualitative approach. We used purposive sampling in combination with snowball sampling to in depth interview six social workers from day-care centers in Taipei City and New Taipei City. The interview data were analyzed by thematic analysis.Results: This study found that both dementia patients and family caregivers had experienced discrimination and/or microaggressions. They would anticipate the discrimination and have some behaviors, such as avoiding attending social activities or going to public area, to prevent themselves from unfair treatment.In terms of anti-discrimination efforts, social workers adopted the following approaches:1. Creating an environment of respect and inclusion through dementia-friendly communication techniques.2. Building relationships between community members and residents to reduce public misunderstanding and discrimination.3. Proposing strategies for developing dementia-friendly communities.However, the implementation of dementia-friendly communication faced several challenges, including limited chance of friendly communication due to group caring, and balance between resource limitations and high caregiving burdens.Conclusion: First, discrimination against dementia families has not disappeared; rather, it has become more difficult to detect. Second, we recommended building a dementia-friendly environment through a “top-down approach”, complemented by a “bottom-up approach”, in order to minimize the occurrence of discrimination.