一位躁鬱症老年住院病患躁期的社會心理議題與照護

Psychosocial and Caring Issues with a Bipolar Disorder Senior Inpatient during a Manic Episode

本案例分析乃針對一位男性老年躁鬱症病患，在急性躁期住院三週，以參與觀察提供他個別化的護理過程。護理評估方面，著重從個案躁症症狀內容與社會心理議題之連結，將護理行為過程紀錄，依Reiser等人（2008）提出之老年躁鬱症病患社會心理的五個層面，經由內容分析法呈現五個主題：沈浸於年少時代的生活回憶（世代信念）、顯現老當益壯的身體功能（自覺健康狀況）、展現學習的企圖與能力（社會文化脈絡）、提供工作專長的服務與能力（角色轉變）、扮演熱心助人的好長者（代間關係）。個案躁症症狀的內容與社會心理議題是企圖展現其仍像年輕人一般的身心狀態並維持其社會價值，以補償伴隨老化在某些領域上的失去。在急性躁症的護理措施，需留意病患在躁症發作時過度身體活動的負荷及預防跌倒，並且適時補充水分及營養、提醒休息。在症狀緩解時，則可以嘗試同理與瞭解其在老年階段的社會心理需求與自我概念，以協助個案統整其疾病與生活經驗，達到老年人自我統合的發展任務。

This case analysis focuses on a male elderly inpatient with bipolar disorder during an acute manic episode. During the case's 3-week hospitalization, we used a participant observation approach to provide individualized nursing care. Our nursing assessment focused on linking this case's manic symptoms and psychosocial issues. Based on a content analysis of our nursing process record and the five psychosocial issues of elderly bipolar disorder reported by Reiser et al (2008), five major themes were presented. These themes included indulging the memory of youth-hood (cohort beliefs); presenting his old but still strong physical function (physical health); making an attempt to learn and showing the ability (socio-cultural context); providing working expert service and ability (transition in role investments); and playing a positive role as a warm-heartedness senior person (intergenerational relationship). This case's manic symptoms and psychosocial issues showed that he wished to perform as a young man to compensate for his ageing physical state and psychological loss, which revealed he want to maintain his social value. In view of the nursing intervention for this case during the acute manic state, we needed to pay attention to preventing the patient from physical overexertion and falls. We further needed to remind him to drink sufficient water, eat food, and take adequate rest. When the acute symptoms were in remission, we tried to empathize with and understand his psychosocial issues and self-concept and to help him integrate his illness and life experience to accomplish the elderly development task.