失智症長者生活賦能活動介入之成效探討_以中部某基金會附設日照中心為例

背景：失智長者因認知障礙及身體功能退化使生活無法獨立自主，人際互動與社會參與因受阻礙，又常因伴隨週邊精神行為症狀出現造成生活品質受影響及照顧者負擔來源，本研究探討失智症長者生活賦能活動介入之成效。其目的為(1)生活賦能活動介入後在一般行為、人際互動行為、工作行為之表現成效(2)失智症週邊精神行為症狀(BPSD)緩解成效之探討進而對整體生活品質的影響。方法:本研究為實驗性，受測者共40位來自日間照顧中心之收案對象，以隨機分配為實驗組和控制組各20人。實驗組則進行生活賦能活動-美食果乾DIY活動，對照組常規性活動。兩組均為期12週，每週1堂60分鐘介入並於活動前1週(T1)、介入後第6週中測(T2)及第12週後測(T3)測量。研究工具包含：日常生活活動量表(ADLs)、工具性日常生活量表 (IADL)、簡易心智量表(MMSE)、柯恩-曼斯菲爾激動量表(CMAI)、神經精神評估量表(NPI)、康乃爾失智者憂鬱量表(CSDD)、職能治療綜合評量表(COTE)。研究資料統計以SPSS 24.0版本以獨立樣本t檢定進行分析。結果：研究結果顯示實驗組後測(T3)之ADLs、IADL、MMSE、NPI、CSDD及COTE整體成效與前測(T1)相比皆具達統計顯著差異(p<0.05)，另CAMI整體成效雖未達統計水準(p>0.05)，但實驗組後測(T3)項目分析其「踱步和漫無目的的遊走」、「不適當的穿脫衣服」、「企圖到另一個地方」、「不斷抱怨」、「反對癖」之項目與對照組後測(T3)相比，有獲得顯著改善(p<0.05)。結論：研究發現將失智長者生活背景或過往經驗作為主題活動並依照其職能表現賦予不同任務，不僅讓活動與生活更具連結性與意義性，甚至讓失智症長者重拾對生活事物的被需要感、自我認同及掌控感，進而從認知、生活自理至活動參與動機、對活動的獨立性與合作性、專注、興趣及成就感皆是顯著進步;而周邊精神行為症狀如焦慮、激動行為、憂鬱、情緒不佳、焦慮、言行失控等有顯著下降。總結從生理功能、情緒問題行為、人際互動及社會參與提升與改善，對於失智長者的生活品質具有正面積極影響，間接的對照顧者能減輕照顧負擔。

Background-Due to cognitive impairments and physical deterioration, individuals with dementia often struggle with independence, social interactions, and participation in society. These challenges, coupled with associated behavioral and psychological symptoms, significantly impact their quality of life and increase the burden on caregivers. This study investigates the effectiveness of empowerment activities for elderly individuals with dementia, aiming to assess:(1)The impact on general behavior, interpersonal interaction, and work-related behavior.(2)The alleviation of behavioral and psychological symptoms of dementia (BPSD) and its effect on overall quality of life.Methods-This experimental study involved 40 participants from a day care center, randomly divided into an experimental group and a control group, each comprising 20 individuals. The experimental group engaged in empowerment activities, specifically a DIY dried fruit food activity, while the control group participated in routine activities. Both groups underwent 12 weeks of interventions, with 60-minute sessions once a week. Measurements were taken one week before the intervention (T1), at the sixth week (T2), and at the twelfth week (T3). The tools used for assessment included:• Activities of Daily Living (ADL) Scale• Instrumental Activities of Daily Living (IADL) Scale• Mini-Mental State Examination (MMSE)• Cohen-Mansfield Agitation Inventory (CMAI)• Neuropsychiatric Inventory (NPI)• Cornell Scale for Depression in Dementia (CSDD)• Comprehensive Occupational Therapy Evaluation Scale (COTE)Results-The study revealed significant improvements (p<0.05) in the experimental group’s ADL, IADL, MMSE, NPI, CSDD, and overall COTES scores at the post-test (T3) compared to the pre-test (T1). Although the overall CMAI score did not reach statistical significance (p >0.05), specific variables such as "pacing and aimless wandering," "inappropriate dressing/undressing," "attempting to leave," "constant complaining," and "negativism" showed significant improvement (p < 0.05) in the experimental group compared to the control group at T3.Conclusion:The study demonstrates that incorporating personal background and past experiences into empowerment activities can significantly enhance the connectivity and meaningfulness of activities for individuals with dementia. These activities not only restore a sense of need, self-identity, and control but also lead to significant improvements in cognitive function, self-care abilities, motivation, independence, cooperation, focus, interest, and sense of accomplishment. Additionally, there was a notable reduction in BPSD such as anxiety, agitation, depression, mood swings, and uncontrolled verbal and physical behaviors. Overall, the findings suggest that such activities positively impact the physical functioning, emotional wellbeing, interpersonal interactions, and social participation of individuals with dementia, thereby indirectly reducing caregiver burden.