- 學位論文
身心整合活動對輕度認知障礙長者的成效
The effect of integrative physical and cognitive activity on older adults with mild cognitive impairment
摘要
研究動機與目的： 輕度認知障礙（Mild Cognitive Impairment, MCI）為失智症的高危險群，雖然目前還未有臨床試驗證明藥物可以治癒失智症或延緩從輕度認知障礙發展至阿茲海默症的病程進展，但有研究指出，透過非藥物的認知與身體訓練治療，可協助促進認知功能，並有助於對行為症狀的改善。因此，本研究的目的在探討輕度認知障礙長者參與或不參與「身心整合活動」前後在個人認知功能表現、衰弱表現及日常生活功能與工具性日常生活功能表現的差異。 研究方法： 本研究採準實驗研究設計，以臺中市某區域醫院確診為輕度認知障礙長者為收案對象，以立意取樣法依長者意願分配至活動組及對照組，活動組接受12周「身心整合活動」，每周2次，每次2小時，對照組則維持原有日常活動。兩組均以中文版簡易認知功能量表、衰弱評估量表、日常生活功能量表與工具性日常生活活動量表為前後測工具，在研究開始前及十二周後進行填答。使用SPSS 24.0統計軟體並以卡方檢定、獨立t檢定、成對t檢定和廣義估計方程式檢測活動組與對照組在認知功能、衰弱表現與日常生活功能與工具性日常生活功能表現的差異。 研究結果： 本研究共32位輕度認知障礙長者參與(活動組17位，對照組15位)。由前後測分數差異顯示參與身心整合活動的輕度認知功能障礙長者較未參與的長者在認知功能有顯著改善(P=0.001)，尤其是在記憶面向得分(P<0.05)；在衰弱表現部分，參與活動者較未參與者有明顯進步(P<0.001)，尤其在社交(P<0.05)與情緒(P<0.05)得分；在生活功能表現方面，參與活動者較未參與者之日常生活功能得分明顯改善(P<0.05)，但兩組在工具性日常生活功能前後測分數沒有明顯差異；此外本研究深入訪談主要照顧某一活動組的長者家屬發現，輕度認知障礙長者參與「身心整合活動」後的社交生活、身體功能及情緒狀態均有正向表現，此外對主要照顧者亦產生正面影響效果，例如:照護壓力減輕、獲得喘息、及增加照護識能等。 結論： 本研究結果發現輕度認知功能障礙長者參加後整體認知功能、衰弱表現與生活功能表現均有明顯改善，推論此「身心整合活動」可以成為醫療藥物處置外的護理輔助措施，以加強全人醫療照謢延緩認知功能退化與降低身體功能衰弱的效益，建議未來可將身心整合活動加入輕度認知功能障礙之非藥物治療介入的參考。
並列摘要
Objectives Mild cognitive impairment (MCI) is a high-risk group that develops into elderly dementia. Several studies have demonstrated that cognitive and behavioral symptoms can be improved through cognitive and/or physical training. Therefore, the objective of this study is to test the effect of physical and cognitive integration activity intervention on cognitive functions, performance of frailty and performance of Daily Living of older adults with mild cognitive impairment. Methods The study used a quasi-experimental design. The research participate were collected from 65 years old and above with MCI from geriatrics clinics or dementia integrated memory clinics in a regional hospital in Taichung, Taiwan. The experimental group enter a well-designed “integrative physical and cognitive activity” that is two hours, twice a week, 12 weeks long program. The control group maintain original daily activities. Chinese version of Mini-Mental State Examination (CMMSE), Kihon Checklist (KCL), Katz ADL and IADL were used to measure the effect of the intervention. Pre and post-testing was performed at the beginning of the study and after 12 weeks. The software SPSS 24.0 is used, descriptive statistics, Chi-square test, independent t-test, paired t-test and generalized estimating equation (GEE) is used to estimate the parameters of a generalized linear model with a possible unknown correlation between outcomes. Result A total of 32 older adult with MCI participated in this study, 17 in the experimental group and 15 in the control group. The results of the study demonstrate that experimental group improved cognitive function (CMMSE) than the control group (P = 0.001), especially in memory scores (P=0.04). In the performance of frailty (KCL) section, the experimental group were significantly improved compared with the control group (P<0.001), especially in social (P = 0.008) and emotional (P = 0.001) scores. In terms of performance of Daily Living, experimental group were significantly better than control group in Katz ADL scores (P=0.001), but there is no significantly difference between the two groups in the IADL scores. However, the results of qualitative interviews demonstrate the activity not only has a positive performance in the social life, physical function, and emotional state of the participate self, but also has an benefit on the caregivers, including care stress reduction, get respite, and improve care of knowledge. Conclusion The results of this study verify that older adults with MCI have significantly improved overall cognitive function, performance of frailty and performance of Daily Living after participating in "integrative physical and cognitive activity ". Inferring that this "integrative physical and cognitive activity" can be a supplementary nursing measure outside the treatment of medical drugs. To strengthen the medical care of the whole person, delay the deterioration of cognitive function and reduce the effectiveness of physical weakness. It is suggested that in the future" integrative physical and cognitive activity "can be added to the reference of non-pharmacological interventions for MCI.