現實導向療法對於改善失智症病人照護之成效

The Effects of Reality Orientation Therapy among Dementia Patients Care

蔣妃玫(Fei-Mei Chiang) ； 王守玉(Shou-Yu Wang) ； 葉淑惠(Shu-Hui Yeh) ； 林麗味(Li-Wei Lin)

《長庚護理》 26卷1期 (2015/03) Pp. 29-40

https://doi.org/10.3966/102673012015032601004

摘要

失智症病人的盛行率逐年升高，不僅增加老人的死亡率及醫療照護成本，也造成家屬的負擔。非藥物介入為減緩失智症病人退化之第一線策略，而現實導向療法屬於心理社會介入措施之一，近年來許多學者探究其對於失智症病人認知功能、問題行為等處置之成效。因此，本文將以文獻回顧方式探討現實導向療法對於改善失智症照護之成效及執行此療法之相關注意事項。護理人員及照顧工作人員為現實導向療法常見執行人員，介入方式以現實導向板最常見，並搭配定向感訓練、大時鐘、日曆及環境改造。現實導向療法適合輕度至中度失智症病人，每週執行三次，每次30－60分鐘，至少持續四週以上，可顯著改善病人認知功能，雖然少數研究探討其在病人行為、憂鬱及日常生活活動之成效，然而各研究結果不一致，難以證實其介入之成效；而對於照顧者憂鬱、焦慮、照顧負荷及生活品質之改善未達正向效果；當現實導向療法合併Donepezil對於失智症病人的認知改善有加成效果。現實導向療法介入之成本效益分析發現當病人認知功能提升，則每年可節省醫療花費。本文可提供長期照護工作人員在應用現實導向療法於病人照護之參考，期待工作人員嘗試使用此簡單、非藥物處置於失智症臨床照護中，藉以改善病人的認知功能及照護品質。

關鍵字

現實導向療法 ； 失智症 ； 照護

並列摘要

The prevalence of dementia has increased gradually. Dementia not only increased mortality and costs of health care for the elderly, but also caused burden on family caregivers. Non-pharmacological interventions have been regarded as first-line therapy to slow brain degradation of dementia. Reality orientation therapy belongs to psychosocial interventions. In the recent years, some researchers explored the effectiveness of reality orientation therapy (ROT) on cognitive function and behavioral problems in patients with dementia. This literature review explored the effectiveness of ROT for dementia care and relevant considerations regarding ROT. Nurses and care staff are often ROT performers. Interventional approach used reality orientation board, combining with orientation training, a large clock, calendar, and environment modification. The ROT has been shown to be effective in subjects with mild to moderate dementia. Implementation of three times a week, 30-60 minutes each time, and last at least 4 weeks can significantly improve patients' cognitive function. Although some literatures reported the effectiveness of ROT on behavior, depression, and activities of daily living, the findings were inconsistent. There is no substantial evidence supporting the positive effects of ROT on caregivers' depression, anxiety, care burden, and quality of life. ROT combining with donepezil have been shown to have additive effects on cognitive improvement. Cost-effectiveness analysis has shown that ROT is cost-saving if patient's cognitive function can be improved. The results provided fundamental knowledge for dementia care with application of a simple and non-pharmacological interventions in clinical care to improve cognitive function and quality of care for dementia.

並列關鍵字

reality orientation therapy ； dementia ； care

參考文獻

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