音樂療法對社區老人的自覺健康狀態、睡眠品質、情緒狀態與功能性體適能之成效

Effects of Music Therapy on Self-Perceived Health Status, Sleep Quality, Emotional States, and Functional Fitness of Community Older Adults

詹淑雅(Shu-Ya Chan)

指導教授 ： 陳桂敏

高雄醫學大學/護理學院/護理學系博士班/博士(2018年)

摘要

背景：身心健康、睡眠品質、情緒狀態及功能性體適能是社區老人常見的健康議題，音樂是一種非語言的溝通工具，傳達一些人類需求的層次，能抒發無法用語言說出的情感，可有技巧地使用音樂來改善個人的身體、心理與情緒問題。
目的：測試三個月主動式音樂療法對社區老人的自覺健康狀態、睡眠品質、情緒狀態及功能性體適能之成效。
方法：採類實驗設計重複測量，以方便集束取樣方式，選取南台灣7個社區老人活動中心的老人為研究對象。以社區老人活動中心為單位，分配該活動中心之所有參與個案至實驗組(3個社區老人活動中心，n = 77)或對照組(4個社區老人活動中心，n = 69)。實驗組接受三個月主動式音樂療法，每週2次，每次1小時；對照組維持原有活動。於研究進行前、一個月、三個月進行資料收集。研究工具包括：12項簡式健康調查量表、匹茲堡睡眠品質量表、情緒狀態量表、2分鐘踏步測驗、抓背測驗、坐姿體前彎測驗、手握力測驗、60秒椅子坐站測驗、張眼單腳站立測驗。
結果：總計有133位社區老人完成3個月的研究(實驗組，n = 71；對照組，n = 62)。於1個月主動式音樂療法介入後，實驗組的自覺身體健康、自覺心理健康；整體睡眠品質及其睡眠潛伏期、睡眠時數、睡眠效率、睡眠困擾和白天功能障礙等因素；情緒狀態及其快樂滿足、傷心害怕、生氣厭惡和期待等因素；功能性體適能之心肺耐力、上半身柔軟度、下半身柔軟度、上肢肌力、靜態平衡感及下肢肌耐力等改善幅度皆顯著優於對照組（所有p值皆 < .05），且這些改善幅度持續至3個月主動式音樂療法之介入（所有p值皆 < .05）。在1個月主動式音樂療法介入，實驗組的個人主觀睡眠品質和安眠藥之使用等因素改善幅度與對照組相較並無顯著差異(所有p > .05)，但介入滿3個月之改善幅度則顯著優於對照組(所有p值皆＜ .05) 。
結論/實務應用：主動式音樂療法對改善社區老人的自覺身體健康、自覺心理健康、整體睡眠品質、情緒狀態及功能性體適能有正面成效，建議健康照護專業人員可將主動式音樂療法納入社區老人健康促進活動安排項目之一。

關鍵字

主動式音樂療法 ； 社區老人 ； 自覺健康狀態 ； 睡眠品質 ； 情緒狀態 ； 功能性體適能

並列摘要

Background: Health issues common among older adults living in community settings include physical health, psychological health, sleep quality, emotional states, and functional fitness. Music is a non-verbal communication tool to convey some level of human needs. Music is an art of expression of feelings that can’t be described with language. People are able to skillfully use music to improve the individual's physical, mental and emotional problems.
Purpose: To test the effectiveness of a 3-month active music therapy program on the self-perceived health status, sleep quality, emotional states and functional fitness of community older adults.
Methods: A quasi-experimental design with repeated measures was applied. A convenience cluster sample of older adults was drawn from seven senior-citizen activity centers in southern Taiwan. Participants were assigned to either an experimental group (3 centers, n = 77) or a comparison group (4 centers, n = 69) based on the senior-citizen activity centers they attended. The participants in the experimental group carried out the active music therapy program for 3 months (twice per week and 60 minutes per session) in addition to their daily activities. The participants in the comparison group maintained their daily activities. The participants’ self-perceived health status, sleep quality, mood states and functional fitness were examined at the baseline, 1-month interval, and 3-month interval. The measurements included: 12-Item Short-Form Health Survey (SF-12), Pittsburg Sleep Quality Index (PSQI), Questionnaire of Emotional States, 2-minute step test, back scratch test, chair sit-and-reach test, hand grip test, 60 seconds chair stand test, and open-eye single-leg stand test.
Results: In total, 133 participants completed the 3-month study: 71 constituted the experimental group and 62 constituted the comparison group. At the 1-month interval, participants in the experimental group had greater improvements in self-perceived physical health, self-perceived mental health, overall sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, emotional states, happy and satisfaction, sad and fear, angry and disgust, expectation, cardiopulmonary fitness, upper body flexibility, lower body flexibility, upper limb muscle power, balance, and lower limb muscle endurance compared with those in the comparison group (all p < .05); these significant changes continued throughout the 3-month intervention (all p < .05). At the 1-month interval, participants in the experimental group had no greater improvements in subjective sleep quality and use of sleep medications compared with those in the comparison group (both p > .05); however, significant difference were found at the 3-month interval (both p < .05).
Conclusions/ Relevance to Clinical Practice: The active music therapy program showed promising effects in improving the self-perceived physical health, self-perceived mental health, global sleep quality, emotional states, and functional fitness of community older adults. Health care professionals can incorporate the active music therapy program as one of the health promotion activities for older adults living in community settings.

並列關鍵字

active music therapy ； community older adults ； self-perceived health status ； sleep quality ； emotional states ； functional fitness

參考文獻

中文部份

內政部統計處(2017，7月18日)•內政部統計月報：現住人口數按三段六歲年齡組分•取自http://sowf.moi.gov.tw/stat/month/list.htm[Department of Statistics, Ministry of Interior, Taiwan. (2017, July18). Monthly bulletin of interior statistics: Resident population by age of 0-14, 15-64, 65+ and by 6-year age group. Retrieved from http://sowf.moi.gov.tw/stat/month/list.htm]

朱秀芳(2004)•醫療利用與健康相關生活品質探討─獨居老人與非獨居老人之比較(未發表的碩士論文)•高雄醫學大學公共衛生學研究所。[Ju, H. F. (2004). The survey of medical utilization and quality of life─the comparison of solitary and non-solitary elders(Unpublished master’s thesis). Kaohsiung Medical University.]

李百麟、王巧利(2012)•老人情緒與調適•危機管理學刊， 9 (2)，95-104。[Lee, P. L., & Wang, C. L. (2012). Emotional management for the elderly. Journal of Crisis Management, 9(2), 95-104.]

李祐綺、顏君彰、楊景文、李世昌(2012)•北部地區參與音樂舞蹈活動之老年人心理效益、快樂程度及身體活動能力之研究• 亞洲高齡健康休閒及教育學刊 ，1(1)，12 – 25。[Lee, Y. C., Yen, C. C.,Yang, J. W. Lee, S. C. (2012). A study of the elderly participation of dancing with music on psychological benefits, happiness degrees, and physical abilities in northern Taiwan. A.S.H.L.E Journal,1(1), 12 – 25.]