發展非藥物性措施用於老年人睡眠困擾臨床照護指引

睡眠困擾是臨床上老年人常見的症狀，不僅對其生活品質、認知、情緒等造成負面的影響，長期的失眠更會加速老年人身體功能衰退及增加發生意外事件的風險。本文以實證為基礎發展非藥物性措施於住院老年人睡眠困擾照護指引，於南部某醫學中心成立指引發展小組，分析現有老年人睡眠困擾非藥物處置措施及建構臨床問題，進行系統性文獻回顧與文獻評析，共納入12篇非藥物治療於睡眠品質之系統性文獻及統合分析，包括：按摩3篇、音樂治療1篇、光照治療6篇及2篇臨床照護指引，透過GRADE評核系統之方法學進行證據品質評估與建議，初擬非藥物性措施於老年人睡眠困擾照護指引。經由修正型德菲法專家共識決策後，完成指引適用範圍及2個議題非藥物性被動式介入措施，內容包含穴位按摩（每一個穴位點按壓約1～4分鐘，一次完整按摩時間約5～20分鐘，一周三次持續4周；強度建議，中度證據品質）及音樂治療（睡前聽音樂20分鐘持續2天或3周；強度建議，中度證據品質）。至於光照治療對於老年人的睡眠困擾改善上需要進一步評估（弱建議，低度證據品質）。最後由2位外部及2方法學專家對於非藥物性措施於老年人睡眠困擾照護指引評價為建議使用；同時調查30位一般內科醫護同仁本指引之臨床適用性，均為可行且容易做到。期以此臨床照護指引提供醫護人員，讓睡眠困擾的老年人能優先考慮非藥物性的介入措施，進而降低鎮靜安眠藥物的使用。

關鍵字

老年人；睡眠困擾；非藥物性措施；穴位按摩；音樂治療；照護指引

並列摘要

Sleep disturbance is a common problem among older adults. It leads to poor quality of life as well as cognitive and emotional impairments. Additionally, it increases the risks of functional decline and fall-related injuries. The aim of this study was to develop evidence-based clinical practical guidelines for nonpharmacological interventions for older adults with sleep disturbances. A panel was formed at a medical center in southern Taiwan, and a systematic review of existing evidence-based nonpharmacological strategies for the evaluation and management of sleep disturbances in older adults was conducted. In total, 12 systematic reviews and a meta-analysis of randomized controlled trials, including acupressure (n=3), music therapy (n=1), bright light therapy (n= 6), and clinical practice guidelines (n=2), were analyzed. The grading of recommendations, assessment, development, and evaluation was used to evaluate the quality of evidence and guide recommendations. A modified Delphi method was used to develop guidelines for the applicability of different nonpharmacological interventions, such as acupressure (1-4 minutes at each point for 5-20 minutes, thrice a week for 4 weeks; strong recommendation, moderate-quality evidence) and music therapy (20 minutes before sleep and 2 days per week for 3 weeks; strong recommendation, moderate-quality evidence). The efficacy of bright light therapy for older adults with sleep disturbances requires further evaluation (weak recommendation, low-quality evidence). There were two clinical and two methodological experts in the panel, who recommended the application of nonpharmacological intervention guidelines in clinical practice. Thirty health care providers also opined that the guidelines were feasible for implementation. The efficacy of nonpharmacological strategies to resolve sleep disturbances in older adults were defined in the guidelines. The implementation of these guidelines might reduce the demand of sedatives and sleep medications.

並列關鍵字

sleep disturbance ； older adults ； nonpharmacological interventions ； acupressure ； music therapy ； clinical guideline

參考文獻

楊秋月、邱愛富（2012）‧北台灣地區社區老年人的睡眠品質預測因子．護理研究，20(4)，249-260。[Yang, C. Y., & Chiou, A. F. (2012). Predictors of sleep quality in community-dwelling older adults in northern Taiwan. The Journal of Nursing Research, 20(4), 249-260.] https://doi:10.1097/JNR.0b013e3182736461

陳杰峰、邱文達（2008）‧AGREE臨床指引之評估工具‧台灣醫學，12(5) ，584-590。[Chen, C.F., & Chiu, W. T. (2008). Appraisal of Guidelines Research and Evaluation (AGREE) clinical practice guidelines. Formosan Journal of Medicine, 12(5), 584-590.] https://doi 10.6320/FJM.2008.12(5).12

AGREE Collaboration. (2003). Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Quality and Safety in Health Care, 12(1),18-23. http://doi:10.1136/qhc.12.1.18

Andrade, C. (2018). Sedative hypnotics and the risk of falls and fractures in the elderly. Journal of Clinical Psychiatry, 79(3).https://doi:10.4088/JCP.18f12340

Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D.,Kunz, R., Brozek, J., ... Guyatt, G. H. (2011). GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology, 64(4), 401–406. https://doi:10.1016/j.jclinepi.2010.07.015

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發展非藥物性措施用於老年人睡眠困擾臨床照護指引

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