結構性團體活動對失智症老人照顧效益之研究

A Study on the Effect of Structured Group Activities on Dementia Care

研究目的：失智症照顧是長期照顧機構重要課題，過去大多強調生理療護效果，但文獻指出團體活動介入對失智症老人具有正向效益，本研究提出結構性團體活動對失智症老人照顧效益之討論與建議，做為社會工作者施行失智症老人團體工作之參考。研究方法：進行每週1次結構性團體活動介入，共12次。分析10位失智症老人參與團體活動前後生理、認知、情緒、行為變化，以及12次團體活動觀察記錄與7位家屬及照顧工作者個別質性訪談。研究結果：團體活動成員年齡78.8±11.5歲，活動出席率100％，團體介入前後MMSE、ADL、IADL、GDS、及CAPE-BRS呈現生理穩定退化，情緒與問題行為些微改善，但均未達顯著差異。團體觀察顯示成員在第4週以後有較佳專注度，較多主動人際互動、語言表達、自主選擇與操作活動素材。訪談分析結果，照顧者認為失智症老人沒有變差就是好，團體對個別成員效益不同，包括延後與緩和躁動行為、穩定與愉悅的情緒、增加人際互動與語言表達、提高主動性與參與度。對家庭照顧者同樣有幫助，也幫助照顧機構減輕照顧壓力、延展團體活動效果、提供照顧模式的參考、以及提昇照顧品質。結論與建議：失智症老人處於認知與生理功能持續退化病程，穩定施行結構性團體活動有助失智症老人建立較佳的心智圖像，提昇照顧品質；社會工作人員可以納入大專院校資源合作，使團體活動融入常態生活照顧；建議未來研究可以跨機構比較不同結構性團體活動元素的效益差異。

Objective: Because of the rapid increase of people with dementia in the population of Taiwan, dementia care has become crucial in long-term care. Previously, the emphasis in dementia care was on the physiological aspect, but the literature regarding group activity interventions has proven that structured group activities can benefit people with dementia. We proposes that implementing structured group activities yields benefits for dementia patients, and the results are a valuable reference for social group workers. Methods: We implemented a series of structured group activities once per week for 12 weeks and analyzed 10 participants' physical, cognitive, emotional, and behavioral changes before and after group intervention. We also kept group activity observation records and conducted individual qualitative interviews with 7 family members and care workers. Results: The average age of group members is 78.8 ± 11.5, and they had achieved 100% attendance rate. Compared their MMSE, ADL, IADL, GDS, and CAPE-BRS scores before and after intervention, the data showed stable degradation in physiology, slight improvement in emotional and behavioral problems, but has no significant differences. Group observation records showed that, after 4 weeks of intervention, the participants became greater focus, increased social interaction initiation, increased language expression, and autonomously selected and operated provided materials. The findings of the interviews can be generalized as follows: the caregivers considered that the elderly people with dementia can stay stability is good enough. Many benefits were observed, including postponed and eased agitation, stable and pleasant moods, increased social interaction and language expression, and improved initiative and participation. The introduction of group activity interventions reduced the pressure on family members, caregivers, and the staffs of long-term care institutions, thereby extending the effectiveness of the group activity, providing a reference or model for care, and enhancing the quality of care provided. Conclusions and discussion: Elderly people with dementia experience continuing degradation of cognitive and physiological functions. A well-designed and consistently executed structured group activity can help them build a better mental image, thus enhancing the quality of care. Social workers can work with college resources to integrate group activity interventions into their daily care procedures. Additional interagency comparative studies are suggested.