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| 題名: | 探討放鬆技巧介入於輕、中度失智症主要家庭照顧者憂鬱與睡眠品質的成效 |
| 作者: | 劉引玉 |
| 貢獻者: | 護理學研究所 |
| 日期: | 2010 |
| 上傳時間: | 2010-10-20 12:45:44 (UTC+8) |
| 摘要: | 研究背景：台灣的失智症人口逐年增加，於「在地老化政策」推動下，
社區式照顧益顯重要。然而，失智症主要照顧者面臨許多照顧困擾，其中睡眠品質深受影響且急待改善之。研究目的：探討社區輕、中度失智症主要家庭照顧者睡眠品質的影響因素，並透過生物回饋監測放鬆技巧在輕、中度失智症主要家庭照顧者的憂鬱與睡眠品質之成效。研究方法：本研究方法分為兩階段，第一階段為橫斷式相關性設計，採立意取樣方式，以大台北地區某醫學中心及區域醫院的神經內科門診，輕中度失智者與其主要照顧者為研究對象，完成配對收案共109位。第二階段採實驗性研究，以隨機分配方式將有睡眠品質不良的主要照顧者分成實驗組（n = 12）及對照組（n = 12）。實驗組接受為期八週計八次之生物回饋監測協助放鬆技巧；對照組接受為期八週三次之一般常規衛教。研究工具：第二版貝氏憂鬱量表（Beck Depression Inventory II, BDI-II）；匹茲堡睡眠品質量表（Pittsburgh Sleep Quality Index, PSQI）；生物回饋（Biofeedback）監測生理健康測量指標（包含：肌電位、皮膚電流反應、指溫、心跳及呼吸）。所有個案進行前測憂鬱情緒、睡眠品質，於第四及第八次進行後測。此外，生理健康測量指標則每次介入皆進行前後測量。研究資料由描述性統計和廣義估計方程式統計分析。研究結果：一、失智症主要照顧者年齡越大、憂鬱情緒越嚴重，其睡眠品質越差（r = .24, p= .01; t= -3.84, p= .00）。二、失智症神經精神症狀愈嚴重者，主要照顧者的照顧困擾（r= .89, p = .00）和憂鬱情緒（r= .22, p= .01）愈嚴重。三、生物回饋監測放鬆技巧可改善憂鬱（B = 5.00; p= .00）、睡眠品質（B = 3.25; p = .00），降低肌電位（B = 2.83; p = .00）、皮膚電流反應（B = 1.78; p= .00）、心跳（B = 4.612; p = .00）、呼吸（B = -1.81; p = .01），並可提昇指溫（B = -0.81; p = .00）。研究建議：一、研究結果呈現，失智症照顧者個人屬性與失智者認知障礙嚴重度對照顧者睡眠品質具影響性，故可作為未來護理照顧指導失智症照顧者及提供弱勢族群照護資源的方針。二、放鬆技巧之成效，可應用於主要照顧者為對象之睡眠品質與憂鬱情緒改善之照顧方案。
Background: There have been increasing numbers of patients with dementia
in Taiwan. The promotion of Aging in place, caring in community has become more important. However, dementia caregivers are facing many distresses, which greatly affect sleep quality and the urgent need to improve.
Objective: The purpose of this study was discussed with relationship between
sleep quality of major family caregivers for patients with mild or
moderate dementia, and to evaluate the effect of the relaxation techniques intervention (RTI) by biofeedback monitor on depression and sleep quality in major family caregivers of dementia patients with mild or moderate stage.
Method: This research method consisted of two phases. First, this exploratory
investigation was conducted using a cross-sectional correlation method. By random sampling, the sample population was selected from neurological outpatient department of a medical center and regional hospital in Taipei city. A total of 109 matched mild or moderate dementia and their major family caregivers were enrolled. A pre-post test experimental design was used in the second phase. Participants were randomly assigned having poor sleep quality caregivers to the experimental group (n = 12) and control group (n = 12). Experimental group received 8 biofeedback-monitor relaxation techniques sessions over a 8-week period, while the control group received 3 standard health education sessions over a 8-week period. The following data were collected: Beck Depression Inventory II (BDI-II), Pittsburgh Sleep Quality Index(PSQI), and biofeedback monitor physical health indicators which including electromyography (EMG), skin conductance (SC), finfer temperature (TEMP), heart rate (HR) ,and respiratory rate (RR). All participants were evaluated for levels of depression, and sleep quality before the training (pretest).The same evaluation was repeated after 4 and 8 weeks (posttest).In addition, all participants were evaluated for physical health indicators before and after each training session. Descriptive analysis and GEE (Generalized Estimating Equations) were used to analyze the data.
Results: 1. Major dementia caregivers were older and higher level severity of
depression, poorer sleep quality.( r = .24, p= .01; t=-3.84, p= .00) 2. Major family caregivers had more distress(r= .89, p = .00) that
associated with higher level severity of neuropsychiatric symptoms and major family caregivers had depression. ( r= .22, p= .01) 3.There was no significantly statistical between the control groups in each variable though it did show a significant immediate effects on improving depression (B = 5.00; p= .00), sleep quality (B = 3.25; p = .00), reducing EMG (B = 2.83; p = .00), SC (B = 1.78; p= .00), HR (B = 4.612; p = .00),and RR (B = -1.81; p = .01), and enhancing TEMP (B = -0.81; p = .00) in cases receiving each biofeedback- monitor relaxation techniques.
Recommendation: 1.The results show that the basic demographics of
dementia caregiver and the level severity of cognitive impairment in dementia, can be used as guidance for nursing care and dementia caregivers, and provided care for vulnerability groups. 2. From the effectiveness of relaxation training techniques of this study, it is suggested to use as care program for depression and sleep quality treatment in major family caregivers of dementia patients. |
| 關聯: | 142頁 |
| 描述: | (一)論文目次
目 錄
頁 數
致 謝 ……………………………………………………… Ⅰ
中文摘要 ……………………………………………………… Ⅱ
英文摘要 ……………………………………………………… Ⅴ
目 錄 ……………………………………………………… Ⅷ
圖表目次 ……………………………………………………… XII
第一章 緒論
第一節 研究動機及重要性…………………………………… 1
第二節 研究目的……………………………………………… 5
第三節 名詞解釋……………………………………………… 6
第二章 文獻查證
第一節 失智症的特性及照護發展…………………………… 7
第二節 失智症主要照顧者的照顧困擾……………………… 17
第三節 失智症主要照顧者的睡眠障礙特性與睡眠品質…… 20
第四節 影響失智症主要照顧者的睡眠品質的重要因素…… 25
第五節 運用放鬆技巧促進失智症主要照顧者睡眠品質
的方案………………………………………………… 27
第三章 研究方法
第一節 研究架構……………………………………………… 32
第二節 研究假說……………………………………………… 34
第三節 研究設計……………………………………………… 35
第四節 研究對象及場所……………………………………… 37
第五節 研究工具……………………………………………… 40
第六節 介入性措施…………………………………………… 47
第七節 研究步驟……………………………………………… 49
第八節 資料處理與分析……………………………………… 50
第九節 倫理考量……………………………………………… 51
第四章 研究結果
第一節 失智者及主要照顧者個人屬性資料………………… 52
第二節 失智者及主要照顧者睡眠品質現況………………… 60
第三節 智症者神經精神症狀的嚴重度與主要照顧者照
顧困擾、自覺健康狀況、憂鬱和睡睡眠品質之
關係…………………………………………………… 73
第四節 失智者認知障礙嚴重度與主要照顧者照顧困擾
、自覺健康狀況、憂鬱情緒和睡眠品質之關係…… 76
第五節 放鬆技巧介入於失智症主要照顧者憂鬱情緒、
睡眠品質及生理健康指標之關係…………………… 79
第五章 討論
第一節 失智症主要照顧者個人屬性與睡眠品質分析……… 95
第二節 失智者神經精神症狀與主要照顧者照顧困擾、
自覺健康狀況、憂鬱和睡眠品質關係……………… 97
第三節 失智者認知障礙嚴重度與主要照顧者照顧困擾
、自覺健康狀況、憂鬱和睡眠品質關係…………… 98
第四節 放鬆技巧介入於改善失智症主要照顧者憂鬱、
睡眠品質及生理健康測量指標之成效……………… 99
第六章 結論與建議
第一節 結論…………………………………………………… 101
第二節 研究限制……………………………………………… 102
第三節 研究建議……………………………………………… 103
參考資料
中文部分………………………………………………………… 106
英文部分………………………………………………………… 109
附錄
附錄一 失智者及主要家庭照顧者基本屬性問卷…………… 122
附錄二 臨床失智評估量表…………………………………… 124
附錄三 簡易智能測驗………………………………………… 125
附錄四 精神徵象量表使用同意回信………………………… 126
附錄五 巴氏日常生活功能量表……………………………… 127
附錄六 工具性日常生活活動功能量表……………………… 128
附錄七 老人憂鬱量表簡明中文版…………………………… 129
附錄八 第二版貝氏憂鬱量表使用同意書…………………… 130
附錄九 匹茲堡睡眠品質量表使用同意書…………………… 131
附錄十 台北醫學大學人體試驗同意證明書………………… 132
附錄十一 國防醫學院三軍總醫院人體試驗計畫同意函…… 133
附錄十二 臺北醫學大學人體試驗志願……………………… 134
附錄十三 國防醫學院三軍總醫院受訪者同意書…………… 136
附錄十四 國防醫學院三軍總醫院受試者同意書…………… 139
圖表目次
頁 數
圖一 研究架構……………………………………………………… 33
圖二 收案流程圖…………………………………………………… 39
表一 家庭照顧者睡眠品質相關研究與發展……………………… 22
表二 運用生物回饋促進生理（睡眠）和心理健康（憂鬱）
相關研究表…………………………………………………… 30
表三 研究設計……………………………………………………… 36
表四 失智者基本屬性資料………………………………………… 53
表五 失智症主要照顧者基本屬性資料…………………………… 55
表六 實驗組與對照組基本資料比較表…………………………… 58
表七 失智長者各層面睡眠品質分佈……………………………… 62
表八 主要照顧者之睡眠品質量表………………………………… 66
表九 失智症主要照顧者年齡與睡眠品質之相關分……………… 69
表十 失智主要照顧者的性別與睡眠品質之關係………………… 70
表十一 失智者與主要照顧者關係與睡眠品質之檢定…………… 71
表十二 失智症照顧者睡眠品質及憂鬱情緒之相關性分析……… 72
表十三 中文版精神徵象量表得分………………………………… 74
表十四 失智者神經精神症狀嚴重度與主要照顧者照顧困擾
、自覺健康情形、憂鬱與睡眠品質之相關分析………… 75
表十五 失智者認知障礙嚴重度與主要照顧者照顧困擾、憂
鬱和睡眠品質之相關分析………………………………… 77
表十六 失智者認知障礙嚴重度與主要照顧者自覺健康狀況
之相關分析………………………………………………… 78
表十七 實驗組與對照組失智症主要照顧者之憂鬱差異結果…… 80
表十八 實驗組與對照組失智症主要照顧者之睡眠品質總分
及其次量表差異結果……………………………………… 85
表十九 實驗組與對照組主要照顧者之肌電位差異結果………… 90
表二十 實驗組與對照組之皮膚電流反應差異結果……………… 91
表二十一 實驗組與對照組之指溫差異結果……………………… 92
表二十二 實驗組與對照組之心跳差異結果……………………… 93
表二十三 實驗組與對照組主要照顧者之呼吸差異結果………… 94
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