高齡長者隨生物老化衍生日常生活活動功能退化或失能，導致居家生活及行動障礙的壓力，也衍生老年人日常生活照顧及社會支持的必要性。因此，老年人日常生活協助需求足夠性議題和健康相關生活品質之關係多年來一直受關注和研究。本研究目的為瞭解居住於社區的高齡榮民日常生活協助未符合需求(unmet needs)的相關因素，進而探討生活協助未符合需求對其健康相關生活品質的影響。
研究對象為南部某地區型榮民醫院門急診就診之65歲以上，具有任一項ADLs/IADLs失能之榮民，抽樣方式為便利取樣，使用結構式問卷進行一對一面談與評估，評估量表有日常活動能力(ADLs)，工具性日常活動能力(IADLs)，憂鬱量表(GDS-15)，簡易心智量表(SPMSQ)，健康相關生活品質量表(EUROQOL, EQ-5D)。本研究共完成訪談調查有211人，全部為男性，平均年齡為86.64歲。
研究結果：本研究樣本為社區中高高齡失能的族群，平均年齡高達86.64歲，其任一項ADLs/IADLs失能之日常生活照顧未符合需求比率有113人(53.5%)，經邏輯斯最適迴歸模式分析發現退休階級、IADLs、巴氏量表41~60分、GDS憂鬱指數以及主要照顧者為太太和付費傭為具顯著性的影響因素，模式解釋量為0.457。退休階級每低一階，發生未符合需求的勝算比有1.562倍。憂鬱指數(GDS)在本研究未符合需求的迴歸式中具相當顯著地影響性，每增加一分的憂鬱指數，發生未符合需求的勝算比有1.274倍；在GDS變項加入後，對IADLs、巴氏量表各分組失能狀態具變動性影響，最後僅在巴氏量表41~60分組呈現一些顯著性差異；主要照顧者方面，無人照顧比起有太太或付費傭為主要照顧者，發生未滿合需求的機率則顯著提高，勝算比分別為5.64倍及14.49倍，而在年齡、婚姻、教育程度、罹病數、自評健康、社會網絡並無顯著差異。其次在整體健康相關生活品質方面，未符合需求在本研究樣本之健康相關生活品質結果的影響性並不顯著，而自評健康、ADLs、IADLs及憂鬱則為重要影響因子。
結論：本研究樣本中雖僅限於居住社區之高齡榮民，但其高高齡和生活上功能性障礙之失能特性，在過去研究中較為少見。研究結果發現退休階級、憂鬱狀態、日常生活活動能力與主要照顧者是未符合需求重要影響因子。自覺健康、日常生活活動能力、工具性日常生活活動能力、憂鬱狀態為影響健康相關生活品質HRQOL重要因子，未符合需求在本研究中則不顯著，值得進一步實證探討。
建議：足夠性的照顧是個案為中心健康照護的理想目標，在地老化政策下，應搭配以病人為中心的資源評估和處置，而降低未符合需求以及老年人未尋求協助的缺漏，防範居家生活不良事件的發生與醫療照護成本的支出。由於老年人的憂鬱可能代表某些健康和生活照顧上不足的訊息。因此，欲改善社區失能長者之未符合需求和失能健康相關生活品質，可以從自評健康、日常生活活動功能及憂鬱指數的評量著手。

This study objective was identified factors affecting the unmet needs of senior veterans living in communities for assistance during activities of daily living, investigating the effects that the unmet need for assistance exerts on health-related quality of life. The participants comprised senior veterans with disabilities who were 65 years old or older and were treated in the outpatient or emergency departments of a local veterans’ hospital in Southern Taiwan. Convenience sampling was conducted and a structured questionnaire was used to perform one-on-one interviews and assessments. The assessment scales employed included the Activities of Daily Living scale (ADLs), the Instrumental Activities of Daily Living scale (IADLs), the Geriatric Depression Scale (GDS-15), the Short Portable Mental State Questionnaire, and the EuroQol Index of Health-Related Quality of Life scale (EQ-5D). The results of the present study indicated that rank at retirement, depression level, ability to engage in activities of daily living, and primary caregivers were the most significant factors influencing unmet needs for assistance. In addition, self-rated health status, ability to engage in activities of daily living, ability to engage in instrumental activities of daily living, and depression level were vital factors influencing the health-related quality of life. However, the unmet need for assistance did not significantly affect the health -related quality of life. Considering the local policies regarding caregivers providing sufficient care is the ideal goal of patient-centered health care.

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