不同主要照顧者對阿茲海默症患者失智病程發展影響之研究

Research on the Impact of Caregiver Pattern on Dementia Progression in Alzheimer''s Disease

劉盈嘉(Ying-chiia Liu)

指導教授 ： 劉偉文

中臺科技大學/管理學院/健康產業管理研究所/碩士(2010年)

摘要

失智症之類型以阿茲海默症患者居多，而失智症通常伴隨著多重認知功能缺損、情緒行為異常及日常生活功能障礙，因此失智病患比正常老人消耗更多社會資源，並造成更多照顧者的壓力與困擾。傳統社會失智病患的照顧以家人為主，隨著就業環境改變與外籍看護工的引進，主要照顧者的結構有逐漸轉向非家屬的趨勢。不同的主要照顧者，尤其是在家外勞，對患者認知功能和情緒與行為的影響並未完全了解也鮮少研究，因此本研究目的在於探討不同類型之主要照顧者對阿茲海默症患者之失智病程發展的影響。研究對象以台灣中部地區某區域醫院阿茲海默症門診患者分為家屬照顧組、外籍看護人員組及機構照顧人員組等三組，共109位患者為受試者作一年的前趨性追蹤研究。
　　本研究方法以訪談法結合問卷調查法，使用臨床失智症量表（Clinical Dementia Rating, CDR）、工具性日常生活工具量表(Instrumental Activities of Daily Living, IADL)、巴氏量表（Barthel Index , BI）、神經精神症狀量表（Neuropsychiatric Inventory, NPI）、漢氏憂鬱量表（Hamilton Depression Rating Scale, HDRS）、認知功能篩檢量表（Cognitive Abilities Screening Instrument , CASI）及簡易智能評量表（Mini-Mental State Examination, MMSE）來評估其照顧成效。
　　本研究發現家屬照顧組對患者情緒與行為最為顯著改善，其次為外籍看護人員組，機構照顧人員組則無顯著改善。不管主要照顧者為何皆明顯看出患者在日常生活功能(IADL)及認知功能（CASI及MMSE）上仍持續退化，不同主要照顧者與患者失智病程發展有顯著差異。
　　本研究建議依阿茲海默症失智病程建立照顧標準作業流程，並給予主要照顧者適當的教育訓練，以提升長期照顧品質，減輕社會負擔。

關鍵字

失智病程 ； 阿茲海默症 ； 主要照顧者

並列摘要

Alzheimer’s Disease (AD) is the leading cause of dementia. Dementia is a mental disorder characterized by multiple cognitive impairment, emotional and behavioral disturbances and dysfunction of activities of daily living. The social and financial costs for dementia care are growing as the gradual awareness of this disease. Traditionally, the primary caregivers are family members. However, there is a tendency that foreign in-home caregivers substitute family members as the primary caregivers in recent years in Taiwan as well as many other countries. Study on impact of caregiver pattern on cognitive function of AD patients is still pending; therefore, the purpose of this study is to investigate this issue as well as to explore the relationship between caregiver pattern and dementia progression of AD patients.
　　This is a longitudinal study and a consecutive series of 109 patients with AD visit in a dementia clinic of a regional hospital in mid-Taiwan were included in this study. The patients were divided into 3 groups: family caregiver group, nursing home caregiver group and foreign in-home caregiver group. All of the patients were assessed by Clinical Dementia Rating(CDR), Instrumental Activities of Daily Living (IADL), Barthel Index (BI), Neuropsychiatric Inventory(NPI), Hamilton Depression Rating Scale(HDRS), Cognitive Abilities Screening Instrument( CASI), and Mini-Mental State Examination(MMSE).
　　This study found out that family caregiver group led to the most significant improvement on AD patients’ emotional and behavioral disturbances, followed by foreign in-home caregiver group, and had no significant improvement by nursing home caregiver group. Regardless of caregiver pattern, the IADL, CASI and MMSE are continuously degradation. There are significant differences among the three caregiver patter on dementia progression in AD patients.
　　The finding of this study suggest that the medical-related institutions managers should establish the standard operating procedures (SOP) of caring the AD patients, and provide education and training courses of dementia to improve the quality of long term care of AD patients.

並列關鍵字

Alzheimer''s disease ； caregivers ； progression of dementia

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