探討放鬆技巧介入於輕、中度失智症主要家庭照顧者憂鬱與睡眠品質的成效

To Explore the Relaxation Techniques Intervention for Depression and Sleep Quality in Major Family Caregivers of Dementia Patients With Mild or Moderate Stage

劉引玉(Yin-Yu Liu)

指導教授 ： 謝佳容

臺北醫學大學/護理學院/護理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00251

摘要

研究背景：台灣的失智症人口逐年增加，於「在地老化政策」推動下，
社區式照顧益顯重要。然而，失智症主要照顧者面臨許多照顧困擾，其中睡眠品質深受影響且急待改善之。研究目的：探討社區輕、中度失智症主要家庭照顧者睡眠品質的影響因素，並透過生物回饋監測放鬆技巧在輕、中度失智症主要家庭照顧者的憂鬱與睡眠品質之成效。研究方法：本研究方法分為兩階段，第一階段為橫斷式相關性設計，採立意取樣方式，以大台北地區某醫學中心及區域醫院的神經內科門診，輕中度失智者與其主要照顧者為研究對象，完成配對收案共109位。第二階段採實驗性研究，以隨機分配方式將有睡眠品質不良的主要照顧者分成實驗組（n = 12）及對照組（n = 12）。實驗組接受為期八週計八次之生物回饋監測協助放鬆技巧；對照組接受為期八週三次之一般常規衛教。研究工具：第二版貝氏憂鬱量表（Beck Depression Inventory II, BDI-II）；匹茲堡睡眠品質量表（Pittsburgh Sleep Quality Index, PSQI）；生物回饋（Biofeedback）監測生理健康測量指標（包含：肌電位、皮膚電流反應、指溫、心跳及呼吸）。所有個案進行前測憂鬱情緒、睡眠品質，於第四及第八次進行後測。此外，生理健康測量指標則每次介入皆進行前後測量。研究資料由描述性統計和廣義估計方程式統計分析。研究結果：一、失智症主要照顧者年齡越大、憂鬱情緒越嚴重，其睡眠品質越差（r = .24, p= .01; t= -3.84, p= .00）。二、失智症神經精神症狀愈嚴重者，主要照顧者的照顧困擾（r= .89, p = .00）和憂鬱情緒（r= .22, p= .01）愈嚴重。三、生物回饋監測放鬆技巧可改善憂鬱（B = 5.00; p= .00）、睡眠品質（B = 3.25; p = .00），降低肌電位（B = 2.83; p = .00）、皮膚電流反應（B = 1.78; p= .00）、心跳（B = 4.612; p = .00）、呼吸（B = -1.81; p = .01），並可提昇指溫（B = -0.81; p = .00）。研究建議：一、研究結果呈現，失智症照顧者個人屬性與失智者認知障礙嚴重度對照顧者睡眠品質具影響性，故可作為未來護理照顧指導失智症照顧者及提供弱勢族群照護資源的方針。二、放鬆技巧之成效，可應用於主要照顧者為對象之睡眠品質與憂鬱情緒改善之照顧方案。

關鍵字

失智症 ； 家庭照顧者 ； 睡眠品質 ； 放鬆技巧訓練 ； 生物回饋

並列摘要

Background: There have been increasing numbers of patients with dementia
in Taiwan. The promotion of Aging in place, caring in community has become more important. However, dementia caregivers are facing many distresses, which greatly affect sleep quality and the urgent need to improve.
Objective: The purpose of this study was discussed with relationship between
sleep quality of major family caregivers for patients with mild or
moderate dementia, and to evaluate the effect of the relaxation techniques intervention (RTI) by biofeedback monitor on depression and sleep quality in major family caregivers of dementia patients with mild or moderate stage.
Method: This research method consisted of two phases. First, this exploratory
investigation was conducted using a cross-sectional correlation method. By random sampling, the sample population was selected from neurological outpatient department of a medical center and regional hospital in Taipei city. A total of 109 matched mild or moderate dementia and their major family caregivers were enrolled. A pre-post test experimental design was used in the second phase. Participants were randomly assigned having poor sleep quality caregivers to the experimental group (n = 12) and control group (n = 12). Experimental group received 8 biofeedback-monitor relaxation techniques sessions over a 8-week period, while the control group received 3 standard health education sessions over a 8-week period. The following data were collected: Beck Depression Inventory II (BDI-II), Pittsburgh Sleep Quality Index(PSQI), and biofeedback monitor physical health indicators which including electromyography (EMG), skin conductance (SC), finfer temperature (TEMP), heart rate (HR) ,and respiratory rate (RR). All participants were evaluated for levels of depression, and sleep quality before the training (pretest).The same evaluation was repeated after 4 and 8 weeks (posttest).In addition, all participants were evaluated for physical health indicators before and after each training session. Descriptive analysis and GEE (Generalized Estimating Equations) were used to analyze the data.
Results: 1. Major dementia caregivers were older and higher level severity of
depression, poorer sleep quality.( r = .24, p= .01; t=-3.84, p= .00) 2. Major family caregivers had more distress(r= .89, p = .00) that
associated with higher level severity of neuropsychiatric symptoms and major family caregivers had depression. ( r= .22, p= .01) 3.There was no significantly statistical between the control groups in each variable though it did show a significant immediate effects on improving depression (B = 5.00; p= .00), sleep quality (B = 3.25; p = .00), reducing EMG (B = 2.83; p = .00), SC (B = 1.78; p= .00), HR (B = 4.612; p = .00),and RR (B = -1.81; p = .01), and enhancing TEMP (B = -0.81; p = .00) in cases receiving each biofeedback- monitor relaxation techniques.
Recommendation: 1.The results show that the basic demographics of
dementia caregiver and the level severity of cognitive impairment in dementia, can be used as guidance for nursing care and dementia caregivers, and provided care for vulnerability groups. 2. From the effectiveness of relaxation training techniques of this study, it is suggested to use as care program for depression and sleep quality treatment in major family caregivers of dementia patients.

並列關鍵字

dementia ； family caregivers ； sleep quality ； relaxation techniques ； biofeedback

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