社區失智照護：一個地區醫院的經驗

Dementia Care in the Community:Experiences from a Local Hospital

失智症是全世界老年人殘疾和生活無法自理的主因之一，對於照顧者、家庭和社會造成生理、心理和經濟上的重大影響。本研究旨在分析竹山秀傳醫院與竹山鎮中和社區合作成立的「樂智學堂」對於輕至中度失智症個案的照護模式，並探討其成效。自民國103年至105年底，共有21位至少連續參與1年以上活動課程的個案。每次課後皆有做團體治療過程與團體成效評估的記錄並完成中文版職能治療綜合評量表。此外，每年年初及年終，皆對個案及照護家屬執行適切的評估，包括：臨床失智評估量表、簡易心智狀態問卷、簡易智能量表、老年憂鬱量表、工具性日常生活量表、巴氏量表和台灣人憂鬱症量表。在21位個案中，女性有14位，平均年齡為82.76±5.82歲。個案在活動課程前後期的表現，其出席程度、注意力、人際互動、發言次數、參與程度和享受活動方面大多持平（58.6%）或增加（38.7%）。個案在活動課程前後期的臨床失智評估量表之分數有些微下降的趨勢（平均由1.02±0.54分下降至0.95±0.59分），在簡易心智狀態問卷、簡易智能量表、老年憂鬱量表、工具性日常生活量表和巴氏量表，也都有進步的趨勢。此外，照護家屬的台灣人憂鬱症量表之分數，亦有些微下降的趨勢（平均由10.57±7.27分下降至10.29±7.22分）。本研究結果顯示整合社區醫院及社區組織的資源在輕至中度失智症的照護成效良好，失智個案其臨床失智評估量表之分數會有些微下降的趨勢，其他在心理功能及日常生活功能的評估表現，也可能有所進步；因此，這樣的照護模式值得繼續推行下去。 Dementia is one of the major causes of disability and dependency among older people worldwide; it has physical, psychological, and economical impact on carers, families and society. The objective of this study was to analyze the care model “Happy Learning School” coestablished by Chu Shang Show Chwan hospital and Chung-Ho community for taking care of individuals with mild to moderate dementia, and to evaluate its effectiveness. Twenty-one individuals who participated activities of the School continuously for at least one year from 2014 to the end of 2016 were included in the study. Records of group therapy session, group effectiveness evaluation, and scores of Comprehensive Occupational Therapy Evaluation Scale (Chinese version) were taken after each lesson. In addition, appropriate evaluations of individuals and their caring family members were performed twice each study year, which include clinical dementia rating scale (CDRS), short portable mental state questionnaire (SPMSQ), mini-mental state examination (MMSE), geriatric depression scale (GDS), instrumental activities of daily living (IADL), Barthel index (BI), and Taiwanese depression scale (TDS). Among the 21 individuals, 14 were female. The average age of individuals was 82.76±5.82 years old. The performance of individuals before and after taking lessons, their attendance records, attention spans, interpersonal relationships, numbers of making statements, levels of participation and enjoyment were mostly not changed (58.6%) or increased (38.7%). The individuals' scores of CDRS after taking the activity lessons decreased slightly (from 1.02±0.54 to 0.95±0.59); those of SPMSQ, MMSE, GDS, IADL, and BI all showed trends of improvement. In addition, the scores of TDS for caring family members also showed trend of slight decrease (from 10.57±7.27 to 10.29±7.22). The results of this study show that integration of resources from community hospital and community organization works well for caring mild to moderate demented individuals. The scores of CDRS obtained from demented individuals decreased slightly; their performance of other psychological functions and daily activities may have also improved. Thus, this type of caring model is worth pursuing.