老年人憂鬱、睡眠品質與自律神經之成效－運用生理回饋為介入措施

背景：由於科技及醫療進步，人類平均餘命也逐漸延長，如何活得久且活得好便成為現今全球所共同面臨之課題。老年憂鬱症較常以非典型症狀如：食慾下降、社交退縮、身體抱怨、失眠等症狀呈現，身旁的人較難察覺，以至於延誤就醫造成無法挽回之悲劇。過去一些針對心理健康之研究常以生理回饋之方式協助引導老年人身體放鬆，進而達到睡眠品質提升，但尚未有研究使用智慧型手機為媒介提升老年人心理健康及睡眠品質。方法：本研究為類實驗設計，以隨機分派的方式將受試者分為實驗組及對照組，實驗組之受試者每週接受傳統之生理回饋並持續六週；對照組之受試者以智慧型手機之社交軟體Line傳送放鬆或深呼吸相關影片，連續介入六週。以人口學基本資料、簡易心智狀態問卷、簡易老年憂鬱量表、匹茲堡睡眠品質量表及自律神經之生理指標（心率變異、呼吸速率及皮膚電位）來進行前後測之資料蒐集。結果：本研究共有80位社區65歲以上之老年人（73.12 ± 6.08歲），實驗組與對照組各40人。在憂鬱程度部分，雖然無論在實驗組或對照組其得分都不高，但在介入措施後發現對照組之改善成效較實驗組佳並達顯著差異(t = -4.590, p < .001)；而睡眠品質部分對照組之改善成效較實驗組佳並達顯著差異(t = -4.948, p < .001)；而在自律神經方面，在經由區分有、無罹患心臟疾病後，其心率變異部分，實驗組及對照組皆未達顯著差異；呼吸速率部分，在呼吸速率最小值(RRMin) (t= 3.036, p = .004)達顯著差異；而在皮膚電位部分，實驗組及對照組皆未達到顯著差異。討論：本研究結果肯定生理回饋對於老年人心理健康、睡眠品質之成效。但隨著現代科技便利對於老年人來說，智慧型手機顯然已成為與家人、朋友互動、學習之工具。本研究建議可將相關衛教資訊及影片以智慧型手機為媒介的方式傳遞，讓老年人可輕鬆且便利的在家中學習，例如本研究之生理回饋訓練，可藉由智慧型手機播放肌肉放鬆之影片及指導語，讓老年人不論何時何地反覆多次的練習，使得老年人可藉由此過程中學習自我調節自律神經，進而提升老年人心理健康。

關鍵字

老年人；憂鬱程度；睡眠品質；自律神經；生理回饋；智慧型手機

並列摘要

Background: Owing to the advances in medical technology, the average of human lifespan is also gradually lengthening, so how to live long and well has become a common global issue. Depression in the elderly is more often characterized by atypical symptoms, such as appetite loss, social withdrawal, physical complaints, insomnia and so on. As a result, it is difficult for people around to be aware of it, and the delay of medical treatment causes irreparable tragedy. In the past, some studies on mental health often used physiological feedback to help guide the elderly to relax, so as to improve their sleep quality. However, there is no research on using smart phones as a media to improve the mental health and sleep quality of the elderly. Methods: This study was designed as a quasi-experimental design, and subjects were divided into experimental group and control group by random assignment. The experimental group received traditional physiological feedback weekly for six weeks; the control group were sent videos of relaxation or deep breathing via Line, a social software for smartphones, for six weeks. Data were collected by using the basic demographic data, Short Portable Mental State Questionnaire, Geriatric Depression Scale - short form, Pittsburgh Sleep Quality Index and the autonomic nerve physiological indexes (heart rate variability, respiratory rate and skin conductance response) make a before and after investigation and data collection. Results: A total of 80 senior citizens aged 65 and above in the community were studied (age: 73.12 ± 6.08), and there were 40 people in the experimental group and 40 people in the control group. Among the degree of depression, the improvement effect of the control group was better than the experimental group and make a significant difference(t = -4.590, p < .001); the improvement of sleep quality, the control group was better than that in the experimental group and make a significant difference(t = -4.948, p < .001); on the autonomic side, after distinguishing between those with and without heart disease, the heart rate variability, the control group was better than the experimental group, but no significant difference was showed; at respiratory rate, the effect of the experimental group was better than the control group, especially with minimum respiratory rate (RRMin) make a significant difference (t= 3.036, p = .004); at skin conductance response, no significant difference was found between the experimental group and the control group. Conclusions: The results of this study confirmed the effect of physiological feedback on mental health and sleep quality in the elderly. But with the convenience of modern technology for the elderly, smartphone has clearly become a learning tool for interacting with family and friends. This study suggests that health related information and video can be transmitted via smart phones, and that the elderly can easily and conveniently study at home. For example, physiological feedback in this study, it can play muscle relaxation videos and instructions by using smartphone, and let old people practice many times no matter when and where. Through this process, the elderly can learn to self-regulate their autonomic nerves, thus improving their mental health.

並列關鍵字

elderly ； deprssion ； sleep quality ； autonomic nervous ； biofeedback ； smartphone

參考文獻

Lee, M. B., Liao, S. C., Lee, Y. J., Wu, C. H., Tseng, M. C., Gau, S. F., & Rau, C. L. (2003). Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity. Journal of the Formosan Medical Association, 102(10), 687-694.

Vaschillo, E. G., Vaschillo, B., & Lehrer, P. M. (2006). Characteristics of resonance in heart rate variability stimulated by biofeedback. Appl Psychophysiol Biofeedback, 31(2), 129-142. doi: 10.1007/s10484-006-9009-3

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