「獨智」不孤單：照顧一位獨居失智長者之社區護理經驗

Community Nursing Care Experience for a Living Alone Elderly people with Dementia

根據衛福部推估2031年失智人口將超過46萬人，約有9成失智者生活於社區中，卻缺乏合適的照護，失智者因認知衰退、肢體功能下降及缺乏支持系統，導致生活品質降低，也增加家庭負擔及社會潛在風險問題。個案本身獨居，且有高血壓、糖尿病以及失智症之健康問題，訪視期間自109年12月3日至2020年12月23日。發現個案藥物服用時間混亂，步態不穩且近半年跌倒次數增加。透過訪視、觀察、健康評估及體適能檢測等方式進行資料收集，確立主要健康問題有「無效性健康管理」、「潛在危險性衰弱長者症候群」。經由強調服藥安全、改善使用藥盒方式，提高個案藥物管理能力。另與主要照顧者合作，教導個案從事居家活動，以維持肌耐力及認知功能，降低跌倒風險，延緩失智病程影響個案日常生活能力及生活品質。期望藉由此護理經驗，強化個案的社會支持，提供社區失智者照護之參考。

According to estimates from the Ministry of Health and Welfare, the dementia population is projected to surpass 460,000 in the near future. Despite approximately 90 percent of dementia patients residing in the community, suitable care services are lacking. This deficiency is exacerbated by declining cognitive abilities, impaired physical mobility, and inadequate social support, leading to a reduced quality of life, increased familial burden, and potential societal risks. The focus of this study is a patient living alone who also grapples with hypertension, diabetes mellitus, and dementia. The home visit spanned from December 3 to December 23, 2020. During this period, it was observed that the patient struggled to adhere to medication schedules and experienced an increased frequency of falls over the past six months. Data were collected through interviews, observations, and physical assessments, revealing two primary health issues: ''Ineffective self-health management related to memory and orientation disorders due to aging'' and ''risk for geriatric frailty related to activity intolerance and cognitive changes caused by aging.'' To address these concerns, an emphasis was placed on medication safety and improving the use of a pillbox, thereby enhancing medication management. Furthermore, collaboration with the primary caregiver enabled us to instruct the patient in performing physical activities at home, aiming to preserve cognition and muscle function, reduce the risk of falls, and delay the adverse impact on basic capabilities and overall quality of life as dementia progresses. We anticipate that sharing this nursing care experience will attract more societal support for the patient and provide a valuable reference for caring for dementia patients within the community.