音樂治療對改善社區失智症長者行為問題成效之探討

失智症長者除認知功能障礙外，常伴隨行為問題及精神症狀，其行為問題常是造成照顧者最主要的壓力源。本研究目的在探討音樂治療對改善社區失智症長者行為問題之成效，本研究採實驗性研究設計，以立意取樣方式對台北市某醫學中心神經內科門診，選取符合選樣條件的失智症長者，以隨機分配方式分至實驗組與對照組各21人。實驗組及對照組均於研究開始及結束時接受家訪一次，及每週電訪一次，對照組的指導內容為一般失智症的照護，實驗組的指導則包括請家屬執行每週2次，每次30分鐘的音樂治療，研究共為期六週。在研究開始時對兩組進行前測，6週後再進行後測，測量工具包含人口學基本資料表、簡易智能量表、中文版機構型CMAI躁動行為量表及中文版神經精神徵量表，實驗組在音樂介入前並以TES1350A數位式噪音基測量住家環境外在噪音情形。研究數據資料以SPSS19.0 for windows進行分析。研究結果顯示實驗組後測之行為問題總分，身體攻擊行為、身體非攻擊行為、語言攻擊行為及語言非攻擊行為分數均較前測時顯著下降。實驗組神經精神病徵量表(Neuropsychiatric Inventory, NPI)總分及其12次項目分數顯著低於控制組。聽音樂的次數與行為問題次數無顯著相關性。本研究發現音樂治療對減少社區失智症長者的行為問題有成效，建議醫療照護人員將音樂納入護理照護中，並指導家屬在家也可以自行播放音樂，改善失智症長者的行為問題。

關鍵字

音樂治療；社區；老人；失智症；行為問題；精神行為症狀

並列摘要

In addition to cognitive impairment, the senior suffering from dementia usually has to deal with other problems such as a behavioral problem and psychiatric symptoms. Their behavior problem turns out to be the key source of all pressure of those caregivers. This research is based on how to explore music therapy and its result to solve the behavioral problem of the senior suffering from dementia to make more progress. It adopted the empirical research methods by making use of purposive sampling taken from a Neurology Clinic at a particular medical center in Taipei City. The research selected a few more samplings that fit in the requirements of the senior suffering from dementia. The senior was divided into an experimental group and a control group through randomization and each group consisted of 21 people. Both the experimental group and the control group allow for a home interview once in the beginning of the research and at the end of the research. A weekly telephone interview is required as well. The content of instruction for the control group was based on regular care of the dementia. The instruction for the experimental group contains a 30-minute music therapy twice a week. It took about 6 weeks to complete this research. In the beginning of this research, both groups carried out a pre-test, and then carried out a post-test 6 weeks later. The instrument for evaluation is composed of a basic information sheet of demography, mini-mental state examination (MMSE), an instructional Cohen-Mansfield Agitation Inventory (CMAI) in Chinese version, and Neuropsychiatric Inventory (NCI) in Chinese version. The experimental group utilized TES1350A digital noise machine to estimate the external noise in living environment before music is involved. The research data showed that everything is analyzed with SPSS19.0 for windows. The result showed that there is an abrupt decline in the post-test carried out by the experimental group on the subject of the total points of behavioral problem, physical aggression, non-physical aggression, verbal aggression, and non-verbal aggression. The total points of the Neuropsychiatric Inventory (NPI) from the experimental group and its scores from 12 items are lower than the points owned by the control group. The times of listening to music and behavioral problem do not have a significant correlation with each other. This research finds out that musical therapy will work out at last to reduce the behavioral problem of the senior suffering from dementia in the community. It is suggested that the medical staffs of eldercare shall incorporate music into health care. The staffs are asked to teach the dependents to play music at home by themselves as well so that the behavior problem of the senior suffering from dementia can be improved.