| 摘要: | 目的： 本研究目的為探討戶外活動對日間照顧中心失智長者幸福感及社會功能之影響。
方法： 本研究以台北市日間照顧中心進行招募，透過篩選條件招募年齡於65歲以上的日間照顧中心輕度或中度失智長者參與本研究，於研究期間，每位參與者皆參加戶外及室內的相同的活動各一次，活動時間為60分鐘，且其中50%的參與者先參加戶外活動後隔週再進行室內活動，而另外50%的參與者則先參加室內活動後、隔週再進行戶外活動，所有參與者在每次介入前後都接受自評健康、自評快樂、老人幸福感量表及社會功能之量表的評估，並於每次介入活動實施後進行活動的回饋訪問。本研究根據研究收集的前後測數據資料，透過常態性檢定(Shapiro-Wilk test)，顯示研究數據未呈常態分佈，因此採用無母數分析為統計方法，並透過威爾卡森考驗(Wilcoxon matched-pairs signed-rank test)與卡方檢定，分別分析戶外環境與室內環境內進行介入相同的活動對日照中心的輕中度失智長者於自評健康、自評快樂、幸福感、社會功能及活動回饋的促進影響差異，並另外比較戶外環境與室內環境在上述功能改變是否有達到顯著差異。在本研究中分析各部分的結果時，若顯著性p值小於0.05，即代表到達顯著水準。
結果： 本研究共有36位日間照顧中心輕中度失智長者完整參與兩次活動，根據統計分析結果顯示，於戶外活動介入後之自評健康的平均數顯著大於活動前之數據(4.28; 3.89) (p=0.013)；於自評快樂的平均數顯著大於活動前之數據(8.64；7.28)(p<0.001) ；於幸福感平均數顯著大於活動前之數據(4.29；3.94)(p=0.001) ；於社會功能平均數也顯著大於活動前之數據(4.37；4.06) (p<0.001)。另一方面，於室內活動介入後的各項平均數雖皆略低於戶外活動的數據，但仍於自評健康(3.92; 3.50) (p=0.009)、自評快樂(7.39；6.44)(p<0.003)、社會功能(4.37；4.06) (p<0.001)之平均數皆有顯著大於活動前之數據；但幸福感方面之平均數，雖介入後有提升，但卻未能達到顯著水準(4.00；3.78) (p=0.069) 。另比較戶外活動與室內活動各自介入所提升幅度的差異來看，戶外活動在社會功能中的有關家人關係更和諧(戶外差異0.53；室內差異0.06) (p=0.020)及覺得社區有人關心(戶外差異0.53；室內差異0.14)(p=0.037)兩項社會功能變項的提升有顯著大於室內活動的幅度差異。此外，活動回饋的部分，戶外運動每一個回饋項目的平均數值皆高於室內活動的平均值，尤其於喜歡和活動夥伴同學聊天的項目上在戶外活動的平均數顯著大於室內活動之數據(8.47; 7.58) (p=0.02) 。
結論: 整體而言，參與戶外活動更可以有效提升日間照顧中心失智長者自評健康、自評快樂、幸福感及社會功能。建議將戶外活動和綠色空間的友善使用作為重要的關鍵政策，並更積極的鼓勵及提供支持日照中心、機構、居家照護定期安排充足的於戶外自然環境下的活動。
關鍵字：綠色照護、社區綠色環境、綠化失智症、團體運動、日照中心課程、輕度失智長者、中度失智長者、 自評健康、自評快樂、老人幸福感、社會支持、社會互動、社會參與、活動回饋、健康促進
Aim: This study aimed to investigate the effects of outdoor activity on the well-being and social function of older adults with dementia in day care centers.
Methods: This study recruited older adults with mild to moderate dementia people aged 65 and above in day care centers in Taipei City. Those participants were recruited through inclusion and exclusion criteria in the study. During the study period, each participant engaged once in both outdoor and indoor activity for 60 minutes. Among the participants, 50% started with outdoor activity and then switched to indoor activity after one week, while the other 50% did the opposite. Before and after each intervention, all participants completed self-rated health status, self-rated happiness, the well-being scale for older adults, and the social functioning assessment. Additionally, feedback interviews were conducted after each activity implementation. Non-parametric statistical analyses were employed due to the non-normal distribution of the collected data, as indicated by the Shapiro-Wilk test. The Wilcoxon matched-pairs signed-rank test and chi-square test were used to examine the differential impact of the same activities conducted in outdoor and indoor environments on self-rated health, self-rated happiness, the well-being scale, social functioning assessment, and activity feedback among older adults with mild to moderate dementia in day care centers. Furthermore, a comparison was made to determine if there were significant differences in the functional changes between the outdoor and indoor environments. A significance level of p<0.05 was used to determine statistical significance for each analyzed outcome in this study.
Results: A total of 36 older adults with mild to moderate dementia completed both activities. The statistical analysis showed that outdoor activity intervention resulted in significant improvements in self-rated health (mean difference: 4.28 vs. 3.89, p=0.013), self-rated happiness (8.64 vs. 7.28, p<0.001), the well-being (4.29 vs. 3.94, p=0.001), and social functioning (4.37 vs. 4.06, p<0.001) compared to pre-activity measurements. Similarly, indoor activity intervention led to significant improvements in self-rated health (3.92 vs. 3.50, p=0.009), self-rated happiness (7.39 vs. 6.44, p<0.003), and social functioning (4.37 vs. 4.06, p<0.001), but did not reach significance in the well-being (4.00 vs. 3.78, p=0.069). When comparing the magnitude of improvement between outdoor and indoor activities, outdoor activities showed significantly greater improvements in social functioning related to family relationships (0.53 vs. 0.06, p=0.020) and feeling cared for in the community (0.53 vs. 0.14, p=0.037). In terms of activity feedback, participants reported higher satisfaction with chatting with activity assistant partners during outdoor activities, with a significant difference compared to indoor activities (8.47 vs. 7.58, p=0.02).
Conclusion: Overall, participating in outdoor activities had a greater effect in enhancing self-rated health, self-rated happiness, the well-being, and social functioning among older adults with dementia in day care centers. It is recommended to prioritize the friendly utilization of outdoor activities and green spaces as key policies. Furthermore, it is important to encourage and provide support for day care centers, organizations, and home care services to regularly schedule sufficient outdoor activities in natural environments.
Keywords: Green care, community green environment, greening dementia, group exercise, day care center programs, mild dementia, moderate dementia, self-rated health, self-rated happiness, well-being for older adults, social support, social interaction, social participation, activity feedback, health promotion. |
