探討日間照顧中心活動對認知障礙者活動量的影響

The Influences of Day Care Center Programs on Dementia Older Adults’ Activities

黃右辰(Yu-Chen Huang)

指導教授 ： 陳雅美

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2020年)

https://doi.org/10.6342/NTU202000173

摘要

研究背景：台灣65歲以上老人中以輕度認知障礙者占18.32%，確診為失智症者約7.93%。台灣失智症盛行率隨年齡增加有急速上升的趨勢。認知功能障礙者久坐、降低社交活動的特性，長時間不活動容易導致功能快速衰退，故本研究以日間照顧機構下相同活動的架構為基礎，探討認知功能障礙程度、活動興趣、活動參與度、活動類型與日間活動量的關係。
研究方法：本研究之研究對象為50歲以上且MMSE分數小於(含)24分者，共16人。使用受試者在2018年10月至12月在桃園某醫療院所之日間照顧中心期間，透過配戴手環方式記錄的日間活動量數據資料。本研究以兩組樣本T檢定、皮爾森相關係數分析、卡方檢定、單因子變異數分析進行研究變項與結果變項之雙變量分析後，再使用廣義估計方程式進行多變量分析，比較不同認知障礙程度、活動興趣、活動參與度與活動量的關係，以及各類型活動下的活動量差異。
研究結果：輕度比重度認知障礙者的活動量高，但兩組活動量下降趨勢沒有差異；高度興趣比低度興趣組活動量少，且在社會互動活動下，高度興趣活動量下降趨勢顯著多於低度興趣組；高參與度組活動量高於低參與度組，但在益智增能活動下，高參與度組活動量下降趨勢顯著多於低參與度組。所有活動量都有隨時間下降的趨勢，但未達顯著差異；各類型活動介入後都比無活動介入時的活動量下降更少，其中以文藝心理及體能促進活動可減緩最多的活動量下降，但無顯著差異。
討論：不同認知障礙程度者的活動量沒有顯著差異，但是輕度比重度者認知障礙組活動量下降多一點，推測是因為輕度認知障礙者保有較佳的自主意識，對循環性的活動安排，缺乏興趣或情緒疲乏，以致減少活動。受試者的活動興趣多被評為低度興趣，但參與度則普遍被評為高參與度，顯示日照機構工作人員推動活動參與成效。然而高參與度組比低參與度組活動量下降更多，推論在沒有興趣的支持下，受試者被動參與將無法對活動量下降的狀況產生影響。受試者被評為高度興趣的活動主要為靜態活動，因此高度興趣活動量顯著低於低度興趣組的現象推論是由於活動性質造成，造成真正參與活動者活動量反而較少。重要的是各類型活動介入後活動量都比無活動介入時來的高，且任何一類活動介入後可以減緩活動量的下降，其中以體能促進、文藝心理活動延緩下降成效最佳，因此活動介入對延緩活動量下降速度是有益的，但是仍建議未來日照中心透過經常變換不同種類活動的方式來維持長者的興趣。
結論與建議：本研究建議日照機構應重視長者興趣，傾聽長者對活動的反饋，使活動設計能符合長者興趣；活動的設計與安排應多元化並具有彈性，避免循環性的活動造成情緒疲乏，也可以透過增加活動的挑戰性，吸引輕度認知障礙者參與。對重度認知障礙者而言雖然運動功能稍弱於輕度認知障礙者，但是整體活動量並不亞於輕度認知障礙者，因此，鼓勵重度認知障礙者參與活動也非常重要。此外，在活動以外的時間受試者多呈現低活動量狀態，故建議未來日照中心應給予娛樂設施，讓長者空閒時間自由使用，減少久坐、不活動的現象。雖然無法逆轉活動量逐漸下降的趨勢，但整體而言，活動介入有助於減緩認知障礙者活動量下降的速度，因此促進各種活動參與是日照機構的重要任務，建議未來日照機構投入更多資源，積極推動不同種類的活動，滿足不同興趣、需求的長者並且思考輕度失智與中重度失智長者的活動需求差異。

關鍵字

日間照顧機構 ； 認知功能障礙 ； 活動量 ； 活動類型 ； 活動興趣 ； 參與度

並列摘要

Background: About 18.32% of the elderly over 65 years old were living with mild cognitive impairment, and 7.93% were diagnosed with dementia. The prevalence of dementia in Taiwan increased rapidly with age. Sedentary life style and low social interaction may increase the risk of dementia and increase the speed of progression toward more severe status in dementia. The purpose of this study explored the relationships among the degree of cognitive impairment, level of interest in different kind of activities, levels of participation, types of activity and amount of daily activities in a day care setting, which provided a structured activity for older adults with dementia.
Methods: We examined total of 16 subjects from a hospital-based day care center in Taoyuan, and who were over 50 years old with MMSE score less than (including) 24 between October to December in 2018 were included for study. Subject’ day-time activities were recorded by wearing a bracelet, which were sensitive to motions. The study examined relationships among the older adults’ physical activities in different types of activity classes, the degree of cognitive impairment, the activity interest, the activity participation, and various types of activities, using two sample T-test, Pearson correlation coefficient, Chi-square test, ANOVA and Generalized Estimating Equations.
Results: The amount of physical activities in the mild cognitive impairment (MCI) group was higher than the severe cognitive impairment (SCI) group, but there was no significant difference in the physical activity trend between two groups (ß=98.15, p=0.326). The amount of activities in the high interest group was less than the low interest group (ß=-7.84, p=0.772). For the social interaction classes, the physical activities of older adults’ with high interest activity decreased more than the low interest group significantly (ß=-13.18, p=0.009). The amount of activity in the high participation group was higher than the low participation group (ß=85.3, p=0.005). For the puzzle empowerment classes, the amount of physical activity in high participation group decreased significantly more than the low participation group (ß=-16.74, p=0.004). All activities in different types of classes have a decline tendency by time, but there were not significantly different. Most important of all, comparing to participants’ free time with no classes, older adults’ physical activities in all types of classes decrease less overtime. Furthermore, the analysis result showed that the psychology classes and physical classes can maintain older adults’ level of physical activity most.
Discussion: The amount of physical activity in the MCI group tended to decrease a little more than the SCI group was, was probably due to that the MCI group maintained better awareness to choose the classes which they prefer to. Thus, lack of interest or the repeated classes might lead to the lower physical activity. The older adults' interests in activities were rated low, but the participation were rated high , which could possibly due to that the staffs in the day care center had good influences on promoting the activities. The older adults’ physical activities in the high participation group decreased more than the low participation group, which was probably because that the recreational-type classes, which most older adults showed lower engagement, might be less influenced by physical activity. However, the classes which were rated as highly interested were mainly sedentary activities. So we speculate this is the reason that the physical activities in high interested classes were lower than low interested classes. After the activity intervention, the amount of activity in each type is higher than no activity intervention. In summary, it is important to note that any type of class slowed down the activity decline trend. Physical activity classes and mental activity classes particular showed promising effect on maintaining older adults’ physical activities level overtime. So the activity classes are beneficial for reducing the activity decline rate. However, keeping older adults’ interests by changing different types of classes overtime is also recommended.
Conclusions and recommendations: This study suggests that Day care center should pay attention to the older adults’ interests and observe their interest and participation closely. The activity design should be diversified and flexible, avoiding repeated activity classes. Increasing challenge in different kind classes for older adults with MCI is also recommended. For older adults with SCI, it is also important to encourage older adults with SCI to participate in activities. The older adults showed a low activity in their free time. Thus, it is recommended Day care center to provide entertainment equipment for the elderly to freely use in their free time and reduce sedentary activities in the future. Although it is impossible to pay attention to the decreasing trend of physical activity. Different kind of activity classes in the day care center seemed slow down the activity decrease for older adult with cognitive impairment. Promoting the participation of various kind of activity classes is an important task of Day care center. It is recommended that future Day care center should invest more resources to meet the older adults’ of different interests and needs. Also, the needs of different types of activities by older adults with different levels of dementia shall be taken into considerations.

並列關鍵字

day care center ； cognitive impairment ； physical activities ； activity interest ； activity participation ； type of activity classes

參考文獻

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