失智症特別照護中心之環境因子對於阿茲海默氏症老人尋路行為之影響研究

The Influence of Environmental Factors on the Wayfinding of the Elderly with Alzheimer's Disease in Special Care Units

缺乏空間方向感係阿茲海默氏症患者第一個被發現的徵狀，其對患者日常生活能力有很大的負面影響。9 位罹患中度失智症的老人與其照顧者由 3 個失智症特殊照護中心被遴選出來參與本次的研究，本研究針對失智老人每天性的活動行為進行 1 星期 2 次的追蹤觀察，為期 1 個月；而對於非每天性的活動行為進行 1 星期 1 次的追蹤觀察，為期 2 個月。質性研究的描述性分析方法被用來記錄分析追蹤觀察的結果，追蹤觀察的內容包含失智老人由餐廳或公共活動空間在用完餐或活動結束後經由走廊回到自己居住房間門口以及由房間門口走到自己床位的移動路徑。環境因子影響個案尋路辨識能力之評量係透過個案尋路路徑之描繪記錄以及失智個案照護者之訪談來進行綜合分析。研究結果發現：有三分之一的失智個案迷失方向而無法找到自己的居住房間，環境因子如護理站、緊急安全門出口、傢俱、走廊端點、居住房間門口的照片、圖片、居住房間門口與電梯門口等因子已被失智老人在尋路過程引用為有用的參考點。其中，護理站的位置、房間門口或緊急安全門出口的形狀與材料、住民個人所屬的物品以及傢俱安排等將是未來環境設計主要的課題。然而由於失智老人精神徵狀的複雜性，本研究並無法證明在尋路過程被認為有效的環境因子對於每一位失智老人均是有用的參考點。

Spatial disorientation is one of the first recognizable symptoms of patients with Alzheimer's　disease because of the negative effect it has on daily function. Nine elders with moderately severe dementia and their caregivers from three special care units participated in this field study. A survey was conducted, monitoring daily activity twice weekly for one month and monitoring non-daily activity once weekly for two months. A qualitative description was applied to record the results of the survey monitoring the subjects' movement from the dining room or from the public activity space through the corridor to the entrance of their bedrooms and from the bedroom entrances to each subject's bed. The assessment of environmental factors affecting the individuals' identification ability was made through the record of tracing travel route and the caregivers' interviews with the demented elders. The results showed that about one-third of the participants got lost and failed to find their bedrooms. Environmental factors, such as the nursing station, emergency exits, furniture, ends of corridors, photos, pictures, doors and elevators have been employed as useful reference points on the wayfinding of demented elders. The location of he nursing station, the shape and material of doors or exits, residents' personal belongings and furniture arrangement were major issues for environmental design in the future. Nevertheless, because of the complexity of the psychiatric symptoms in the demented elderly, it cannot be proved that the use of environmental factors as reference points would be effective for every demented patient.