應用中心方式評估法於失智症長者之照護經驗

A Nursing Experience of Applying the Center Assessed Method for the Elderly with Dementia

罹患失智症的人口快速增加，隨著病程的進展，認知功能及日常生活功能日漸退化，常是不可逆的反應，增加長期照護需求，所以了解個案其行為背後的原因，除可延緩症狀的惡化，亦可降低照顧負荷。本文是描述一位91歲中重度失智症長者入住於失智專區之護理經驗，照護期間為2013年4月16日至5月13日，筆者應用日本推行的「中心方式評估法」進行評估，內容有括：基本資訊、生活資訊、身心資訊、焦點資訊及二十四小時需求評估總整理五個層面；在參與照護過程中，透過個案行為表現觀察、及重要家屬會談傾聽等方式進行個案需求評估，發現個案照護需求為：1.失智而造成認知功能退化；2.老化、失能及害怕疼痛而自我照顧功能降低；3.因入住機構導致生活動力降低。依個案需求，提供以失智長者為中心的照護，過程中藉由信任關係建立，並與重要家屬以及工作人員溝通，探討失智長者行為背後之原因、目前生活的障礙的影響因素，掌握個案可發揮的尚存功能，以認知刺激方法增加認知功能，並應用相關資源協助家庭與工作人員合作重新建立生活動力，以及提供合宜措施維持個案的日常生活能力。期許藉由本報告中心方式評估法及以失智症本人為中心的照護理念之經驗分享，提供照護人員照護失智症長者之參考，以提昇失智長者照護品質。

The population of elders with dementia is rapidly increasing in Taiwan. Dementia is an irreversible process, as cognitive function and activities of daily living reveal progressive degeneration resulting in an increasing demand for long-term care. Therefore, to understand the reasons of their behaviors among the elderly with dementia may retard the progression of illness and reduce the burden of caregivers. The aim of this article was to describe a nursing experience of taking care for a 91-year-old man with severe dementia who lived in a care center for dementia. During the nursing care period from April 16, 2013 to May 13, 2013, the authors applied the method of "person-centered assessment", which includes five domains: demographic information, lifestyle information, physical and psychological information, the focus information, and 24-hour needs assessment, to assess psychophysical issues. Based on the observation of the person-centered assessment, and listening to and interviewing with the family caregivers, we found that the health problems for the patient included: (a) degeneration of cognitive function which was caused by dementia; (b) unwillingness and inability to perform self-care related to aging, disability and fear of pain; (c) poor vitality due to unanticipated institutionalization. Through building trust relationships, and communicating with the family caregivers and staff, the person-centered care was provided to the patient’s and family-caregivers’ needs at reasons for the patient’s behaviors, removal of obstacles to living, and empowerment of the residual ability. Employing cognitive stimulation (reminiscence therapy and reality-oriented therapy), we tried to improve the cognitive ability, utilized care-related resources to assist the cooperation among family caregivers and staff, and increased the life vitality. We also provided adequate interventions to maintain the client’s ability of daily activities. In summary, this report shares an nursing experience with the person-centered assessment and the concept of person-centered care to taking care of an elderly with dementia and family care-providers in order to improve the quality of care for patients with dementia.