居家共享活動衛教方案於失智症照顧者之介入效益探討

Abstract

背景：大多數的失智者住於社區中由非正式照顧者照顧，如何支持失智者及其照顧者面對長期與疾病症狀與照顧負荷的挑戰，維持最佳化的生活品質，是健康照顧照護團隊努力的方向。需求調查文獻指出：失智者需要而未被滿足之處為：參與有意義活動及親友的陪伴，而照顧者最期待患者能維持活動與功能，及營造共享關係，然過去照顧者介入多為針對照顧技巧、減少照顧負面影響為主，少有著重雙方關係維持及正向照顧經驗之介入研究。因此本研究目的為：以訓練照顧者執行居家共享活動、提升共享關係為主之介入方案—居家共享活動衛教方案，探討其對於照顧者與失智者之介入效益。方法：研究採準實驗設計，對象為與家人同住之失智者與照顧者。依據單位隨機分為實驗組，接受為期8週之居家共享活動衛教方案，前4週每週1次，每次120分鐘，共4堂課程，提供認知及感官活動道具包，並教導照顧者如何運用活動與失智者互動，並增加共享及正向的照顧經驗，另在第6、8週加上兩次的電話追蹤；控制組為等待組，在研究結束後給予同等的方案介入。兩組皆會在介入前(前測)、介入結束(後測)進行評估，主要成效指標包含照顧者之正向照顧經驗、共享關係、自我效能及失智者之活動參與度；次要成效指標包括照顧者之生活品質、照顧者負荷、憂鬱症狀，及失智者之行為精神症狀。結果：納入研究並完整分析的共有24對受試者(實驗組14對、控制組10對)。研究結果發現相較於控制組，實驗組照顧者的正向照顧經驗(p=.016; Cohen’s d=.99)及憂鬱症狀(p=.043; Cohen’s d=.87)有顯著的改善，照顧者的生活品質-生理功能(p=.084; Cohen’s d=.84)、失智者的活動參與度(p=.084; Cohen’s d=.92)也有增加的趨勢，在共享關係則可能有保護的作用。而不同家庭照顧模式在本方案獲得的效益也不同，介入方案對於全日家庭照顧的失智者的效益較明顯，而對於半日家庭照顧模式的照顧者則在此方案受益較多。結論：居家共享活動衛教方案教導失智症照顧者如何運用共享活動與失智者互動，傳達正向照顧經驗及共享概念，對於照顧者的正向照顧經驗和憂鬱症狀有正向的效益，且可增加失智者的活動參與度。但其效益可能會因居家照顧模式不同而有所差異，未來須增加樣本數進一步驗證之。

Background: Previous research has shown that the most unmet needs of persons with dementia (PwD) are participating in meaningful activities and having families or friends as company. However, most programs for caregivers focus on improving caregiving skills and decreasing the negative aspects of caregiving. Little is known about the effect of positive-aspect-of-caregiving-focused intervention on caregivers and PwD. Therefore, we develop a home-based shared activities education program (HSAEP), which emphasizes on improving the quality of relationship between PwD and caregivers and the activity engagement of PwD. This study aims to investigate the effect of HSAEP on the caregivers and PwD. Methods: A quasi-experimental design was employed. Twenty-four dyads of PwD and caregivers were recruited in the research. The experimental group (n=14) participated in 8-weeks HSAE program, including 1 session/ week, 2 hours/ session for 4 weeks and 2 telephone follow-up. Due to ethical concerning, the waiting-list group (n=10) would join the program after the research finished. The outcomes were measured at pre- and post-trial. The primary outcomes included caregivers’ positive aspects of caregiving (PAC), quality of shared relationship, self-efficacy of caregiving, and the activity engagement of PwD. The secondary outcomes included caregivers’ quality of life (QOL), caregiving burden, depression, and BPSD and agitative symptoms of PwD. Results: In comparison with waiting-list group, the caregivers of experimental group reported more improvement in PAC (p=.016; Cohen’s d=.99), depression symptoms (p=.043; Cohen’s d=.87), physical function of QOL (p=.084; Cohen’s d=.84), and PwD’s activity engagement (p=.084; Cohen’s d=.92). Besides, HSAEP may have protective effect on shared relationship. The results showed that the effect of HSAEP on different family caregiving mode varied. The effect on PwD of whole-day-family-caregiving was more apparent, while the caregivers of half-day-family-caregiving benefited more from HSAEP. Conclusion: HSAEP, conveying the concept of PAC and shared relationship, and educating caregivers how to utilize shared activities to interact with PwD, has positive effects on increasing the caregivers’ PAC, decreasing the depression symptoms and facilitating PwD’s activity engagement. A large sample size will be needed to further validate the generalization of current results.