影響失智症者面子之因素探討──系統性文獻回顧

Factors Influencing ＂Face＂ in People With Dementia: A Systematic Review of the Literature

背景：面子是一種內外在的自我形象，當中包含社會賦予的地位、角色確認以及自我形象的管理和維持。失智症者與家人因感覺「失去面子」而產生社交隔離甚至影響疾病進展。因此，了解影響失智症者面子相關因素，有助於協助照護人員維護失智症者面子並建立社會大眾對失智症者的了解與同理。目的：本研究以系統性文獻回顧之實證模式，探討影響失智症者面子問題的相關因素。方法：採系統性文獻回顧法，收錄發表於PubMed、CINAHL、華藝線上圖書館及Cochrane Library等四個資料庫的實證文獻，設立關鍵字與同義字為失智症、面子、自尊、尊重、自我概念等，發行年限為2018年9月前，共搜尋出3,050篇文獻，經篩選、刪除重複及評讀後，納入8篇符合主題之文章進行分析，並以喬安娜布里格斯學會（Joanna Briggs Institute）出版的評讀工具進行評析文獻品質，再依據Melnyk和Fineout-Overholt證據分級將所有文獻有所歸類，並萃取實證證據。結果：從文獻歸納出影響失智症者面子問題的相關因素分二個主軸：其一為「喪失自我認同」：失智症者因逐漸失去認知功能與記憶能力，而對於現階段的角色任務產生無法勝任與管理。其二為「社會大眾負向概念」：社會大眾認為失智症者對他人會有危險性與其行為不可預測而致使失智症者原該享有的權利或地位被剝奪。結論／實務應用：失智症者因疾病關係致使其逐漸失去自我認同而無法維持合宜人生階段角色任務，加上社會大眾對疾病的負向概念而產生偏差觀念，促成失智症者與其家人感覺「沒面子」。本回顧結果可作為未來進行失智症個別性照護時，加入影響失智症者面子問題之因素，提供以「人」為中心的照護，並結合政府與民間打造友善失智環境。

Backgrounds: Face (self-esteem) is an issue that involves socially endowed status, identity roles, and self-image management and maintenance. People with dementia and their family members often experience social isolation due to diminished self-image, which affects disease progression. Better understanding the factors that influence the self-image of people with dementia may promote the ability of caregivers to maintain self-image and promote public understanding and empathy toward people with dementia. Purpose: The aim of this study was to explore the factors influencing self-image in people with dementia using a systematic review of the literature. Methods: A systematic review was used. Articles were retrieved from electronic databases including PubMed, CINAHL, Airiti Library, and Cochrane Library. The following keywords and MeSH terms were used to search for articles on dementia, face, self-esteem, respect, and self-concept. A total of 3,050 articles published prior to September 2018 that matched the search criteria were extracted. After screening the topics, deleting repetitions, and doing critical appraisals, eight articles were selected for analysis. Research quality was appraised using the Joanna Briggs Institute and the Melnyk and Fineout-Overholt for Evidence-Based Medicine Level of Evidence. Results: Two themes related to the factors influencing self-image in people with dementia were extracted from the selected articles. The first theme was ＂loss of self-identity＂. As people with dementia gradually lose their cognitive function and memory ability, they are increasingly incapable of handling and managing their current role tasks. The second theme was ＂negative public perception＂. The public believes that people with dementia are at risk to others and that their behaviors are unpredictable, resulting in the deprivation of the rights to which people with dementia are entitled. Conclusions/ Implications for Practice: Because of disease progression, people with dementia gradually lose their self-identity and become unable to perform their life-role tasks. This is accompanied by negative perceptions of the disease among the public, which, in turn, damages the self-image of people with dementia and their families. The results of this review may provide a reference for caregivers planning future person-centered care approaches for people with dementia. In addition, these results may help facilitate the establishment of a more friendly environment for people with dementia in both public and private spaces.