研究背景:疏忽照顧是老人虐待常見的形式之一，死亡率是一般老年人的2到3倍，也是造成身心障礙的危險因素，且有較高的反覆住院率，有必要及早進行篩檢與介入。然而因衰弱老人的社會隔離特性，難以在居家或社區實際進行篩檢，因此醫療機構可能是衰弱老人唯一的對外聯結。目前在醫療機構，疏忽照顧議題未被注意，且無可用的篩檢工具，又其徵候易被其他病況混淆掩蓋，常被當做一般疾病表現而未被發掘。因此本研究目的:(1)建構適用於醫療機構之居家疏忽照顧篩檢指標，(2)透過篩檢指標的使用，了解疏忽照顧在住院之社區老年人的比例，(3)了解疏忽照顧之徵候表現及相關因子。
研究方法：參考國內外文獻及國內臨床專家意見，考量醫療機構屬性，擬定適合醫療機構人員評估的疏忽照顧篩檢工具的指標，內容效度係採專家效度方法。計分方式以3分法呈現，0分為無該項指標之表現，再依各指標嚴重程度依序為1、2分，最後計算所有指標之總分。於2016年9月至2017年4月以南部某醫學中心為研究場域，研究對象為年滿65歲以上之老年科及一般內科住院病人、凱茲量表(Katz index) 1項以上依賴或診斷為失智症CDR 1分以上、有主要照顧者(每週照顧時數大於或等於20小時)及同意參與本研究者，同時收集個案及主要照顧者的相關資料，並以專家會議討論結果作為本研究之黃金標準。以SPSS for Windows 17.0版統計套裝軟體進行描述性統計、卡方檢定、t檢定、二元複邏輯斯迴歸資料分析，及利用ROC曲線評估工具鑑別力，並根據Youden’s index找出篩檢工具最佳切點。
研究結果：篩檢工具包括營養不良、脫水、壓瘡、肢體關節攣縮或肌肉萎縮、尿液浸潤引起之相關問題、個人清潔衛生不良、跌倒、反覆出入醫院，共8項指標。共收案150份有效樣本進行分析與討論。結果發現有可能與非常可能疏忽照顧占24%，其中86% 為非刻意疏忽照顧，主要徵候表現為壓瘡(63.9%)、營養不良(55.6%)、脫水(55.5%)。經ROC曲線分析得知AUC=0.94，敏感度83%、特異性86.8%，篩檢分數總分≧3分可作為判斷老年人是否遭受疏忽照顧之最佳切點。經二元複邏輯斯迴歸分析發現Katz總分分數越高(OR：4.13, 95% CI：2.08-8.2)及主要照顧者有兼職工作(OR：22.24 , 95% CI：3.32-149.09)，是疏忽照顧的相關因子。另老年人有重大傷病卡反而容易受到疏忽照顧(OR：0.15 , 95% CI：0.04-0.57)。
研究結論：研究結果發現有二成以上失能老人在社區中可能受到疏忽照顧，且超過半數受到疏忽照顧的老年人有壓瘡、營養不良及脫水等徵候表現，而這些徵候表現皆可在醫療機構評估時發現，顯見醫療機構對疏忽照顧篩檢的可近性與重要性。經分析超過八成為非刻意疏忽照顧，將近半數原因為不了解照護方法，因此若能於住院期間進行疏忽照顧篩檢，及早發覺照護上之不足，適時介入提供衛教指導，或連結適當資源輔助居家照顧，可避免老年人因遭受疏忽照顧而有生命安全之危害。另將來可做前瞻性研究，並嘗試讓第一線照護人員使用此量表，以了解其問題並改進，藉由賡續研究提升大眾對此議題之關注。

Neglect is one of the common forms of elder abuse. Compared to those without neglect, the mortality rate among the elderly with neglect is two to three times higher, it is necessary to conduct earlier screening and interventions. Because of the characteristics of social isolation among the frail elderly, it is difficult to conduct screening at home or in the community. Therefore, medical facilities might be the only connection to the world for the elderly. This study aims: (1) to develop a screening tool of neglect applicable in medical facilities; (2) to understand the percentage of neglect among the hospitalized community-dwelling elderly assessed by the screening tool; and (3) to investigate the signs and related factors of neglect.
Based on literature reviews, opinions from clinical experts of medical facilities, parameters of a screening tool of elder neglect were developed for the use of medical staffs. A surveillance of neglect using the screening tool was conducted at general medicine and geriatric wards of a medical center in the southern Taiwan. Decision of neglect was based on discussion of the study cases in expert meetings as the gold standard for this study.
Receiver operating characteristic curve analysis shows that AUC is 0.94, with sensitivity 83% and precision 86.8%. A total of 150 statistically valid samples were collected for analyses and discussions. According to the discussion of expert meetings as the gold standard, the possible and highly possible neglect accounted for 24% of the elderly, and 86% of whom were unintentional neglect. The optimal cut-off point for the elderly neglect is ≧3 scores of the screening. The common signs of neglect were pressure sore, malnutrition and dehydration.
If necessary, the medical facilities can provide resources to assist caregivers and prevent the elderly from having their life safety endangered due to neglect. In the future, prospective studies can be conducted for the medical staffs to use the neglect screening tool in patient care and to improve it. The follow-up research will be helpful to raise the public's attention to the issue of neglect.

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