TimeSlips對日間照顧中心失智長者憂鬱狀況與生活品質的成效

Effects of TimeSlips on Depressive Symptoms and Quality of Life in People With Dementia in Day Care Centers

葉映彤(Ying-Tung YEH) ； 林幼昉(Yu-Fang LIN) ； 劉芳(Megan F. LIU)

《護理雜誌》 66卷6期 (2019/12) Pp. 54-65

https://doi.org/10.6224/JN.201912_66(6).08

摘要

背景：日間照顧中心提供失能失智長者照顧服務，然而，認知功能障礙長者常伴有憂鬱情形。目的：探討另類懷舊治療：TimeSlips創意說故事，是否能改善日間照顧中心之輕、中度失智長者的憂鬱狀況與生活品質。方法：採隨機對照試驗無盲性設計，共20位符合收案條件的長者全程參與，以網路隨機分組器簡單隨機 分派至實驗組10位，進行為期6週，每週1次、每次1小時的TimeSlips課程，對照組10位則維持 原日常活動。測量工具有：康乃爾失智者憂鬱量表中文版（Cornell Scale for Depression in Dementia, CSDD）以及中文版EQ-5D（EuroQol-5 dimensions）生活品質量表之視覺類比量表（visual analogue scale, VAS）與效用值（utility values）。結果：（1）兩組除年齡外，其他基本屬性，並無顯著差異。（2）憂鬱狀況：以CSDD前後測改變量為依變項進行ANCOVA，發現兩組在組別效果、組別與年齡的交互作用皆達顯著差異（p ＜ .05）。（3）生活品質：以介入後之EQ-5D VAS前後測改變量為依變項進行ANCOVA，及以排序後之EQ-5D效用值前後測改變量為依變項進行ANCOVA發現，兩組皆在組別效果未有顯著差異（分別為p = .37、p = .20）。結論／實務應用：以TimeSlips介入可顯著改善日間照顧中心輕中度失智長者的憂鬱狀況，雖無法顯示生活品質的顯著改善，但仍可作為未來日間照顧中心工作人員在活動規劃上的參考。

關鍵字

TimeSlips ； 失智症 ； 日照中心 ； 憂鬱 ； 生活品質

並列摘要

Background: Day care centers provide supportive services to older individuals with disability and dementia. Those who suffer from cognitive impairment typically also suffer from depression. Purpose: To explore whether TimeSlips, a reminiscence creative storytelling approach, improves depressive symptoms and quality of life (QoL) in older individuals of day care centers who have mild to moderate cognitive impairment. Methods: A randomized non-blind controlled trial design was conducted. A total of 20 older individuals who met the inclusion criteria were recruited and randomly assigned to the experimental group and control group using the Internet randomization system, with 10 subjects in each group. The experimental group participated in the one-hour TimeSlips intervention once a week for six consecutive weeks, while the control group maintained their normal daily activities. We used the Cornell Scale for Depression in Dementia (CSDD) to measure depressive symptoms and used EQ-5D (EuroQol-5 dimensions) VAS (visual analogue scale) and utility values to measure QoL. Result: (1) With the exception of age, there were no significant differences in the demographic data between two groups. (2) Under ANCOVA, when age was used as the covariate and the change in CSDD before and after the intervention was used as the dependent variable, the score of the experimental group was significant lower than that of the control group (p ＜ .05). The interaction between group and age was also a significant difference in the change of CSDD before and after the intervention (p ＜ .05). In terms of QoL, the EQ-5D VAS and EQ-5D utility value both decreased after the intervention in the experimental group. ANCOVA was performed separately using the change of EQ-5D VAS and the ranked change of EQ-5D utility values as dependent variables, with no significant differences found between the groups (p = .37 and p = .20, respectively). Conclusion: The results indicate that using TimeSlips may significantly improve depressive symptoms in mild to moderate cognitively impaired older individuals of day care centers. However, no evidence was found to support an effect of TimeSlips on QoL. Our findings provide information to help day care centers staffs design related activities.

並列關鍵字

TimeSlips ； dementia ； day care centers ； depressive symptoms ； quality of life

參考文獻

顏啟華（2010）．台灣老人認知功能障礙危險因子研究（博士論文）．取自華藝線上圖書館。[Yen, C. H. (2010). Risk factors of cognitive impairment among the elderly in Taiwan (Doctoral dissertation). Available from Airiti Library.] https://doi.org/10.6834/CSMU.2010.00099

吳怡慧、林明憲（2017）．失智照護．臨床醫學月刊，79（1），19–25。[Wu, Y. H., & Lin, M. S. (2017). Dementia care. Clinical Medicine, 79(1), 19–25.] https://doi.org/10.6666/ClinMed.2017.79.1.005

張夙娟、胡月娟、吳佩燁、張靜雯（2015）．懷舊治療對機構老人憂鬱，自尊及生活滿意度之成效—統合分析．護理暨健康照護研究，11（1），33–42。[Zhang, S. J., Hwu, Y. J., Wu, P. I., & Chang, C. W. (2015). The effects of reminiscence therapy on depression, self-esteem and life satisfaction on institutionalized older adults: A meta-analysis. Journal of Nursing and Healthcare Research, 11(1), 33–42.] https://doi.org/10.6225/JNHR.11.1.33

楊桂芬、許哲瀚、唐憶淨、龔建吉（2012）．社區老人日常生活活動、生活品質與幸福感之相關研究．台灣老年醫學暨老年學雜誌，7（4），217–232。[Yang, K. F., Hsu, C. H., Tang, Y. J., & Kung, C. C. (2012). Correlation among activities of daily living, quality of life, and sense of well-being in elderly community dwellers. Taiwan Geriatrics & Gerontology, 7(4), 217–232.] https://doi.org/10.29461/TGG.201211.0002

梁家欣、程蘊菁、陳人豪（2014）．失智症之重點回顧．內科學誌，25（3），151–157。[Leong, K. I., Chen, Y. C., & Chen, J. H. (2014). Dementia: A focused review. Journal of Internal Medicine of Taiwan, 25(3), 151–157.] https://doi.org/10.6314/JIMT.2014.25(3).04