| 摘要: | 最新根據國際失智症協會發佈2015年全球失智症報告，推估今年將有990萬新增失智症案例，平均每3秒就有1人罹患失智症。大部份的健康促進與預防多著重於慢性疾病的管理，但研究證實心智活動、體能活動、壓力抒解及健康飲食可有效的預防失智症及延緩失智退化，如何維持輕度失智症者之自我照顧與管理能力，並改變其生活習慣以達到理想健康狀態，是目前失智症預防與延緩退化非常重要的議題。然而常見團體工作坊活動內容之設計，為慢性疾病者、戒菸戒酒者、參與心理輔導與舒壓者、正念減壓課程…等，有明顯的成效作用，但少有人用此方式應用在失智症者。
本研究以先導性、試探性，初探活動方案設計內容，藉由自我管理與生活型態再設計模式，使輕度失智症者重新檢視、整合與訂出身、心、靈與社會互動的幸福計畫，並以個案訪談、家屬焦點團體，使用評估量表與心率變異(HRV)儀器來輔助探討活動內容之適用與否以及介入成效。
本研究以實驗設計法，採無控制組的方式，研究對象為輕度失智症者共9位，參與生活型態再設計之自我管理團體2016年3月到6月為期三個月之前後成效分析，就量性資料的整理與分析，然而考量研究之特定對象、事件，比起統計數據上的客觀結果，實務上的呈現更加重要，所以本研究以質量合併三角交叉之研究設計，增加研究結果的可信度。
量性結果方面，憂鬱量表、一般性自我效能量表、老年人身體活動量表，交感神經檢測數值未達統計顯著差異，但在前、後測兩者整體得分均有進展。質性結果方面，個案與家屬對於此活動參與後之成效為一致，改變項目有：(1)運動量的安排增加，提升運動之持續力。(2)會去注意飲食健康對自己的影響。(3)心情變好。(4)認同行動計畫的重要性，自發性提升。(5)與家人相處互動關係改善。
研究結果成效分析輕度失智症者是可以自我管理，其鼓勵個人學習管理自己的健康並改善自己的生活環境和條件，雖然在行動計畫之執行仍須家屬一同參與，但因家屬同時參與行動計畫，並得到成效之益處，與個案情感互動也增進。罹患失智症的人數已有愈來愈多的趨勢，所帶來了照顧壓力、醫療照護問題、經濟承受面，不得不趕快重視，預防的概念不容忽視，建議未來可做為失智症領域後續研究與臨床實務之運用與推廣。
According to the Alzheimer’s Disease International’s 2015 report, there will be estimated 9.9 million people living with dementia this year. In other words, one person is diagnosed with dementia every three seconds. While the management of chronicle diseases is emphasized in most of the health promotion and prevention, studies show that staying mentally as well as physically active, relieving stress and having a healthy diet can effectively reduce one’s risk of developing dementia and prevent patients with dementia from deterioration. Therefore, it becomes a very important issue concerning how to help patients with early stage dementia care for themselves by changing their lifestyles. The ultimate goal is to help them lead a healthy life. While the activities designed for patients with chronicle diseases, nicotine and alcohol quitters, and members of different stress-relief workshops have proven to be significantly effective, few people apply these activities to the treatments of patients with dementia.
My methodology includes pilot study, tentative trials and pilot activity design projects. With self-management and lifestyle redesign, patients with early stage dementia are able to reevaluate, organize, and make plans for their physical and mental welfare, and for reaching out to the society. Through the interviews with the patients and their relatives, as well as the help from evaluation scales and HRV, I discuss whether these activities are helpful and practical for the patients with dementias. My study is design of experiments. My subjects are nine people suffering from early stage dementia. The experiment lasted three months, from March to June in 2016, and I organize and analyze the data gathered from it. With the studies of specific cases, my study offers a more objective representation of people living with dementia, compared to the general statistics. To add credibility to my study, I adopt triangulation.
In the quantitative study, the results from Depression Rating Scale, General Self-evaluation, and Physical Activity Scale for the Elderly do not show any statistically differences. But after the activities, the results have improved. In the qualitative study, the improvement can also be found in the subjects and their relatives. First, they exercise more and grow a habit of exercising regularly. Second, they start to see the connection between their diets and their health. Third, they become happier. Fourth, they recognize the importance of action plan, and are willing to take initiative to plan their activities. Lastly, the interaction between the subject and his or her family has improvement.
My study demonstrates that patients with early stage dementia are able to care for themselves and improve their health conditions and life. Even though the action plan requires the participation of the relatives, they not only benefit from the project but also improve their relationship with the subjects. As the number of dementia patients has increased exponentially, the stress on the side of the caregivers, medication and the financial problems cannot be overlooked. I hope my study will contribute to the clinical application and the promotion for caring patients with dementia. |
