失智症患者使用日間照顧中心與瑞智互助家庭功能維持研究

Abstract

研究背景與目的：全球人口結構逐漸朝高齡化發展，老化現象伴隨慢性疾病與功能障礙的人口逐年增加，其中失智症好發於高齡長者，形成現今公共衛生重大議題之一。失智症患者受到腦部病變致使認知功能產生障礙，隨著疾病惡化造成嚴重的行為問題、甚至可能影響到患者本身的日常生活功能；目前尚未有任何療法能完全根治受損的腦部細胞，失智症患者透過社區式服務的介入給予非藥物性的治療以延緩疾病惡化、維持功能。日間照顧中心與瑞智互助家庭為2017年長期照護2.0政策中失智症照護主力推動之社區式服務模式，但目前已將瑞智互助家庭從政策中刪除，僅支持日間照顧中心服務。前者已有國內外文獻佐證可有效維持患者功能表現，但尚未有研究探討瑞智互助家庭是否能有相似成效。故本研究目的為探討失智症患者使用瑞智互助家庭與日間照顧中心在維持認知功能、身體功能、行為問題的成效。 研究方法：本研究為準實驗設計，以前後測問卷進行調查，採用立意取樣。研究對象為北部地區使用瑞智互助家庭及日間照顧中心50歲以上失智症患者。本研究使用簡易心智狀態問卷調查表(SPMSQ)、日常生活活動量表(ADL)、工具性日常生活活動量表(IADL)及簡短版神經精神量表(NPI-Q)分別量測並比較瑞智互助家庭及日間照顧中心失智症患者期三個月前後認知功能、身體功能與行為問題之改變與差異性。統計方法以成對樣本T檢定(Paired-Samples T-Test)進行組內功能量表前後測是否有進步或退步的情況；另外，以單因子共變異數分析(One-Way ANCOVA)控制功能量表前測與基本人口學特性，探討兩組組間後測是否有差異。 研究結果：本研究在三間瑞智互助家庭與四間日間照顧中心總共發放64份，有效問卷共53份，分別為瑞智互助家庭27份及日間照顧中心26份。首先在瑞智互助家庭或日間照顧中心組內前後測在三個月後無顯著差異，但除了IADL工具性日常生活活動量表外，兩組的平均分數改變量皆為進步狀態。瑞智互助家庭三個月後的IADL表現進步；但在日間照顧中心組則反向退步。在控制相關人口學變項與前測分數後，兩組組間在後測認知功能、身體功能及行為問題等方面則皆無顯著差異。 結論與建議：失智症患者使用瑞智互助家庭或日間照顧中心其兩組認知功能、身體功能及行為問題在服務使用三個月前後都沒有差別，代表兩種服務對失智症患者而言在短期效果皆能維持功能的成效，且功能表現大多呈現些微進步。因此，建議未來政策重新將瑞智互助家庭納入失智社區服務據點中，持續增加瑞智互助家庭的單位數量與保持服務品質，提供失智症家庭選擇不同類型需求的服務使用可近性。另外亦建議未來研究能延長觀察時間與增加評估次數，以此看出在時間演進上是否能持續維持功能表現。

Research Background and Study Purposes：As global population aging, older adults with chronic diseases and dysfunction increase dramatically. Dementia is now a major challenge for public health. People with dementia suffer from cognitive impairment due to brain damage. As the disease progress, it will affect their physical function as well as causing serious behavior problems. At present, there is no treatment for dementia disease. Most commonly, people with dementia are recommended with non-pharmacological therapies through community-based services and hope to delay disease progression and maintain both physical and mental function. Adult Day Care and Family of Wisdom are the common community-based service models which were promoted by the long-term care policies in 2017 for people with dementia in Taiwan, but currently only Adult day care service are supported. Adult Day Care has been shown to maintain function performance of people with dementia. However, there weren’t study on the effects of Family of Wisdom for people with dementia. The purpose of this study was to explore and compare the effects of Adult Day Care and Family of Wisdom on maintenance of cognitive functions, physical functions, and behavioral symptoms of people with dementia. Research Methods：The study design was a quasi-experimental design study with two groups of demented older adults using different community-based long-term care services. The subjects of this study were people with dementia aged fifty and over in northern Taiwan who have used Adult Day Care or Family of Wisdom. The study compared the changes of cognitive functions, physical functions, and behavioral symptoms of people with dementia in the two groups using Short Portable Mental State Questionnaire(SPMSQ), Activities of Daily Living(ADL), Instrumental Activities of Daily Living Scale(IADL), and Neuropsychiatric Inventory Questionnaire(NPI-Q) over 3 months of study period. Statistical method used Paired-Samples t-test to analyze whether pre-test scores and post-test scores of the functional scales within the group progressed or declined. In addition, the study used One-Way ANCOVA with pre-test scores and demographic characteristics controlled to analyze whether there was a difference in the post-test scores between the two groups. Research Result：A total of 64 people with dementia were surveyed from three Family of Wisdom and four Adult Day Care. Fifty-three valid questionnaires were returned, including 27 of Family of Wisdom and 26 of Adult Day Care. Firstly, there were no significant differences in pre-test scores and post-test scores in people with dementia using Family of Wisdom or Adult Day Care respectively. Both groups improved their functions on different perceives, including physical and cognitive function, but not for Instrumental Activities of Daily Living Scale (IADL) scores. IADL scores of people with dementia in Family of Wisdom improved after three months, but the scores for people with dementia in Adult Day Care showed the opposite direction of development. However, the changes were not significantly different. After controlling the pre-test scores and demographic characteristics, there were no significant differences in cognitive functions, physical functions, and behavioral symptoms between people with dementia after using 3 months of Family of Wisdom and Adult Day Care. Conclusion and Recommendations：Both Family of Wisdom and Adult Day Care can maintain cognitive functions, physical functions, and behavioral symptoms of people with dementia, and most of these functional performances also slightly improved over the 3 months of study period. Our research findings suggested future policies to include Family of Wisdom into the dementia community-based LTC service again, and increase the number of Family of Wisdom continuously and maintain the service quality, therefore promote service accessibility for people with dementia and their caregiver who have different types of needs for services. Furthermore, it’s suggested that future research could extend the study period and increase the number of subjects to determine whether both services can maintain functional performance in the long-term run.