機構老年住民的神經精神症狀對睡眠滿意度的影響之初探

The Impact of Neuropsychiatric Symptoms on Satisfaction of Sleep in Institutionalized Elderly Residents: A Pilot Study

謝佳容(Chia‐Jung Hsieh) ； 許家寧(Chia‐Ning Hsu) ； 巫秀鳳(Hsiu‐Feng Wu) ； 劉引玉(Yin‐Yu Liu) ； 陳美麗(Mei‐Li Chen) ； 蕭伃伶(Yu‐Ling Hsiao)

《護理暨健康照護研究》 11卷4期 (2015/12) Pp. 298-307

https://doi.org/10.6225/JNHR.11.4.298

摘要

背景：影響機構老人睡眠品質的危險因素如身體的疾患、心理因素及認知功能等，然而，針對神經精神症狀對睡眠滿意度的影響，於目前研究仍然有限。目的：本初探研究旨在探討（1）機構老年住民的睡眠特性（睡眠潛伏期、睡眠效率、睡眠品質滿意度）；以及（2）神經精神症狀是否為睡眠品質滿意度之主要解釋因子。方法：採橫斷性研究設計，以臺北某二個長期照護機構的住民為對象，採取隨機分層抽樣原則，共收案80位。研究工具包括：住民基本屬性、簡易智能量表、老人憂鬱量表、中文版精神徵象量表和自述睡眠滿意度與睡眠總時數（引用睡眠品質量表的部分題目），並使用SPSS 20.0套裝軟體進行各項統計分析。結果：（一）研究對象有22.5%自述對睡眠品質不滿意，睡眠潛伏期差者（潛伏期大於30分鐘）有42.5%，睡眠效率＜84%者占三成。（二）研究對象的神經精神症狀表現，症狀排序前三位分別為妄想（佔30%）、焦慮（佔26.3%）、情緒激動／攻擊性（佔25%），但以怪異動作（8.86±3.98）與睡眠／夜間行為（7.50±4.35）的干擾得分較為嚴重。（三）研究對象的性別、神經精神症狀和睡眠滿意狀態具有統計顯著性差異；且男性的睡眠品質不滿意度勝算比（95% CI [1.402, 18.969]）是女性的5.158倍，神經精神症狀每增加一個單位，睡眠品質不滿意的勝算比（95% CI [1.003, 1.082]）為原來的1.042倍，然而研究對象服用安眠藥與否並不會顯著影響住民的睡眠滿意度。結論／實務應用：本研究可提供長期照護人員瞭解精神神經症狀對睡眠滿意度的影響，建議未來在職訓練宜增加症狀評估的辨識，也應將神經精神症狀的評估納入於常規性長期照護的照顧評估項目，且主動評估老年住民對於自覺睡眠狀態的滿意度，以發展適合的照顧計畫與處置。

關鍵字

神經精神症狀 ； 睡眠滿意度 ； 睡眠潛伏期 ； 睡眠效率 ； 住民

並列摘要

Background: The risk factors related to quality of sleep in institutionalized elderly residents such as physical illness, psychological factors, and cognitive function have been well identified in previous studies. However, information regarding the relationship between neuropsychiatric symptoms and sleep satisfaction in this population is lacking in the recent literature. Purpose: This pilot study was designed to: (1) explore the characteristics of sleep (sleep latency, sleep efficiency, and satisfaction of sleep) and (2) discover the explanatory factors (neuropsychiatric symptoms) that underlie satisfaction with sleep among the institutionalized elderly. Methods: A cross‐sectional method was utilized. Eighty subjects were selected from two long‐term care institutes in Taipei using stratification random sampling. The research instruments used included the basic resident datasheet, Mini Mental Status Examination, Geriatric Depression Scale, Chinese Neuropsychological Inventory, and the self‐reported sleep satisfaction and length of sleep components of the Pittsburgh Sleep Quality Index. Data were analyzed using SPSS 20.0. Results: Findings included: (1) Nearly one‐quarter (22.5%) of subjects were dissatisfied with their self‐perceived quality of sleep, 42.5% reported poor sleep latency (＞30 min.), and 30.0% reported poor sleep efficiency (＜84%). (2) The top three frequencies of neuropsychiatric symptoms included delusion, anxiety, and agitation/aggression. However, aberrant motor behavior and sleep disorders earned the top scores for symptom severity. (3) The two variables of gender and neuropsychiatric symptoms associated significantly with sleep satisfaction. The present study found that males were 5.158 times more likely to be dissatisfied with their self‐perceived sleep quality than females (95% CI [1.402, 18.969]). Furthermore, subjects with neuropsychiatric symptoms were more likely to be dissatisfied with their sleep quality than those without these symptoms (OR=1.042; 95% CI [1.003, 1.082]). Moreover, the use of hypnotics was not significantly associated with self-perceived sleep satisfaction. Conclusions/Implications for Practice: The findings of the present study may assist long‐term care staffs to better understand the associations between neuropsychiatric symptoms and sleep satisfaction in elderly residents. Our findings suggest that further education training is needed, especially in the area of neuropsychiatric-symptom assessment, and that this assessment should be incorporated into routine care. Finally, satisfaction with sleep should be more comprehensively studied in order to develop an appropriate care plan and interventions for elderly residents.

並列關鍵字

neuropsychiatry symptom ； sleep satisfaction ； sleep latency ； sleep efficiency ； residents

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