| 摘要: | 背景：隨著長照2.0服務量能增加以及當今非藥物治療對失智症之重要性日增，日間照顧機構不僅提供失智及失能長者生活照顧需求，更規劃多樣化的活動以達到在地老化和預防延緩失能。每家日間照顧機構的活動種類多元，包含團體及個人活動，且長者參與活動的頻率、類型（如認知活動、體能活動、藝術與藝文活動、音樂活動）也會因本身因素和各家日間照顧機構的安排而有不同。然而，過去研究鮮少探討日間照顧機構對失智症長者各面向之變化及影響變化之因子，造成日間照顧機構活動安排之參考資料較缺乏。
目的：本研究目的有二，首先為探討參與日間照顧機構活動之失智症長者其認知功能、身體功能、日常生活功能、憂鬱症狀於3個月間之變化；目的二為探討參與日間照顧機構活動之失智症長者其認知功能、身體功能、日常生活功能、憂鬱症狀於3個月間變化之影響因素。
方法：本研究為觀察型研究，於臺北市及新北市混和型日間照顧機構，以蒙特利爾認知測驗招募65歲以上符合輕度至中度之失智症長者，以定期追蹤評估的方式觀察3個月後長者參與日間照顧機構提供之團體及個人活動後之功能變化，評估工具包含結構式問卷（日間照顧個案基本資料表、活動紀錄表）、認知功能（簡易心智狀態問卷、蒙特利爾認知評估中文台灣版、阿茲海默氏認知評估中文版、彩色路徑描繪測驗）、身體功能（65歲以上銀髮族體適能評估表）、日常生活功能（巴氏量表、工具性日常生活活動量表）、憂鬱症狀（康乃爾失智者憂鬱量表中文版）。統計分析使用相依樣本t檢定檢驗認知功能、身體功能、日常生活功能、憂鬱症狀之前後測變化差異，並使用複迴歸檢驗影響功能變化之可能因素。
結果：共有33位平均年齡81.6歲的失智症長者參與研究。3個月內長者之功能改變包含：彩色路徑描繪測驗第二部分 (p=0.03)、椅子坐立30秒 (p=0.03)、右腳坐姿體前彎 (p=0.01)及左腳坐姿體前彎 (p=0.01)具顯著提升，巴氏量表為顯著下降 (p<0.01)。功能改變之影響因素包含：年齡越大在彩色路徑描繪測驗第一部分表現越差 (p<0.01)，亦在彩色路徑描繪測驗第二部分表現越差 (p=0.03)；教育程度越高在彩色路徑描繪測驗第二部分表現越好 (p=0.01)。參與團體音樂活動越多，阿茲海默氏認知評估分數越差 (p=0.03)；參加個人音樂活動越多，彩色路徑描繪測驗第二部分完成時間越快、雙手柔軟度越差 (p<0.01)、左腳平衡越差 (p=0.02)；參加個人體能活動越多，右腳平衡越佳 (p=0.04)、左腳平衡越佳 (p=0.01)。
結論：失智症長者參與日間照顧機構活動3個月後，部分認知功能及身體功能有所進步，然而日常生活功能下降，相關影響因素包含年齡、教育程度以及參與活動類型。本研究結果可作為未來日間照顧機構安排活動之參考依據。
Background: With the increase of long-term care 2.0 service capacity and the importance of non-pharmacological treatment for dementia, day care centers not only provide life care needs for elderly with dementia and disability, but also plan diverse activities to achieve aging in place and prevent or delay disability. Each day care center has various types of activities, including group and individual activities, and the frequency and type of activities (such as cognitive activities, physical activities, art and cultural activities, and music activities) that the elderly participate in may vary depending on their own factors and the arrangements of each day care center. However, previous studies have rarely explored the changes in various aspects of elderly with dementia in day care centers and the factors that affect the changes, resulting in a lack of reference data for the activity arrangements of day care centers.
Objectives: This study had two objectives. The first was to explore the changes in cognitive function, physical function, daily living function, and depressive symptoms of elderly with dementia who participated in day care center activities within three months. The second objective was to explore the factors that affected the changes in cognitive function, physical function, daily living function, and depressive symptoms of elderly with dementia.
Methods: This study was an observational study conducted in mixed-type day care centers in Taipei City and New Taipei City. Elderly aged 65 and above who met the criteria for mild to moderate dementia were recruited by the Montreal Cognitive Assessment, and their functional changes after participating in group and individual activities provided by the day care centers for three months were observed by regular follow-up assessments. The assessment tools included structured questionnaires (day care case basic information table, activity record table), cognitive function measures (Mini-Mental State Examination, Montreal Cognitive Assessment, Alzheimer’s Disease Assessment Scale-Cognitive, Color Trails Test), physical function measures (Senior Fitness Test for individuals aged 65 and above, daily living function (Barthel Index and Instrumental Activities of Daily Living Scale), and depressive symptoms (Cornell Scale for Depression in Dementia). Statistical analysis used paired t-test to examine the pre-post differences in cognitive function, physical function, daily living function, and depressive symptoms, and multiple regression to examine the possible factors affecting functional changes.
Results: A total of 33 elderly with dementia with an average age of 81.6 years participated in the study. The functional changes of the elderly within three months included: significant improvement in Color Trails Test Part 2 (p=0.03), 30-second chair stand (p=0.03), right leg sit-and-reach (p=0.01) and left leg sit-and-reach (p=0.01), and significant decline in Barthel Index (p<0.01). The factors affecting functional changes included: older age was associated with worse performance in Color Trails Test Part 1 (p<0.01)and Part 2 (p=0.03); higher education level was associated with better performance in Color Trails Test Part 2 (p=0.01). More participation in group music activities was associated with lower scores in Alzheimer’s Disease Assessment Scale-Cognitive (p=0.03); more participation in individual music activities was associated with faster completion time in Color Trails Test Part 2, worse hand flexibility (p<0.01), and worse left leg balance (p=0.02); more participation in individual physical activities was associated with better right leg balance (p=0.04)and left leg balance (p=0.01).
Conclusions: After participating in day care center activities for three months, elderly with dementia improved in some cognitive and physical functions, but declined in daily living function. The related influencing factors included age, education level, and type of participation activities. The results of this study can serve as a reference for future day care centers to arrange activities. |
