痴呆症患者及家庭之整合性社區居家照顧模式－發展與評估

Community-Based Integrated Home Care Model for the Demented Patients and Their Families

徐亞瑛(Yea-Ing Shyu) ； 楊清姿(Ching-Tzu Yang) ； 葉炳強(Ping-Keung Yip)

《The Kaohsiung Journal of Medical Sciences》 12卷6期 (1996/06) Pp. 359-369

https://doi.org/10.6452/KJMS.199606.0359

摘要

本研究之目的在於建立社區痴呆症患者之整合性居家照顧模式，瞭解此模式對痴呆症患者家庭之影響；並同時瞭解痴呆患者心智功能及自我照顧能力間隔六個月之變化。整合性居家照顧模式中醫療團隊成員包括醫師、居家護理師、老年專科護理師、社工人員及老年社工專家，團隊工作模式向成員依角色功能及實際工作流程發展而成。研究期間提供之服務包括居家護理、電話諮詢、互助團體及門診服務，並向居家護理師任個案管理者。共有25個家庭加入此研究，其中22個家庭接受居家護理服務，20個家庭的照顧者加入互助團體。6個月前後痴呆症患者之心智功能並無統計上差異，但自我照顧能力中，刷牙洗臉及吃飯之依賴程度明顯增加。
整合性模式中大多數家庭（81 %）覺得居家護理服務對其在照顧技巧、知識和情緒支持上有幫助；但向配對樣本之t 檢定顯示，照顧者負荷在居家護理服務前後並無統計上差異。70 %的照顧者表示電話服務對其心理和情緒及資訊提供支持上很大。半數以上之出席照顧者認為此團體在其資訊及情緒支持上均有幫助，並多數表示團體符合其期待。
本研究建立之整合模式可應用於居家護理機構與社區及醫療資源之連結。研究限制為樣本太少，且有些成效出現在6個月之後，因此建議日後進一步研究需考慮更長時間之追蹤及多方面個案來源取樣，並在模式中包括更多不同的專業人員及社區服務資源。

並列摘要

The purposes of this research project were to establish an integrated home care model and understand the influence of an integrated home care model on demented elders and their families. The changes in cognitive function and self- care ability of demented elders were also explored longitudinally. The disciplines involved in the integrated home care model included doctors, home care nurses and social workers. The integrated home care model was developed according to the functions and roles of different disciplines in their actual working process. Services provided included home nursing care, telephone consultation and a support group. Home care nurses played the role of case manager in this model. Twenty-five families participated in this study. Among them, 22 received home care service, and 20 of them participated in a caregiver support group. The cognitive function of the demented elders did not significantly decrease over the 6-month period. Among their self-care ability, grooming and eating dependency were found significantly increased during this period.
Overall, 81% families reported that home nursing care sevices could help them to develop care skills, care knowledge and provided emotional support. However, the caregiver burden did not significantly decrease after the home nursing care services. Seventy percent of caregivers reported that telephone consultation could support them emotionally and provided them with information concerning care. Over half of the caregivers reported that in getting related information and receiving emotional support was helpful. This integrated model developed from this research project can be adapted and used in networking home care agencies, the community and health care resources. The small and convenient sample was one of the limitations of this study. The insignificance of some of the findings might be due to the short time period (6 months) and some effects of the model might appear later than 6 months. For further research, larger and random samples and a longer period of follow-up with more health disciplines involved were suggested.

並列關鍵字

community home care model ； dementia ； family