人本環境對失智症住民之精神行為問題之成效-系統性文獻回顧

Effectiveness of Humanistic Environments upon Residents with Behavioral and Psychological Symptoms of Dementia: A Systematic Review

失智症個案之精神行為症狀（Behavioral and Psychological Symptoms of Dementia, BPSD）容易造成照顧者的負荷，其中針對攻擊行為及躁動行為，更是家屬將之送至機構照顧的主因。臨床上最常使用物理性約束、精神科藥物和降低刺激源以因應。特殊專區（Special Care Unit, SCU）可提供失智症者個別化的照護模式，本文之目的即依據護理實證的步驟探討「人本環境對失智症住民之精神行為問題是否具改善成效」之議題。設定PICO為：P：機構中的失智症老人；I：住在SCU；C：未住在SCU；O：住在SCU之失智老人可有效改善躁動及攻擊行為。透過PubMed、CochraneLibrary、CINAHL Plus、CEPS等資料庫進行蒐集資料，關鍵字則為「失智症（Dementia）」、「特殊專區（Special Care Units）」、「團體（GroupLiving）」、「護理機構（Nursing Facility）」、「環境（Environment）」，並透過收入及排除條件，以隨機試驗和類實驗研究為篩選條件，共獲得8篇文獻。研究結果：一、確實可以透過特殊專區的環境，改善住民的攻擊及躁動行為問題（p<0.05至0.0005）。二、小單元以人為中心的照護模式，能滿足失智症的多元化需求，降低攻擊與躁動行為（agitated behavior）。人本環境設計對失智症住民之精神行為問題的確具改善成效。目前世界各國推動的情形、國家政策的支持度皆不一，這是國際失智症照護應努力的方向。

Behavioral and psychological symptoms of dementia (BPSD) can cause a burdenon caretakers. In particular, attack behavior and agitated behavior are the major reasonswhy family members send their relatives with BPSD to nursing facilities. In clinics, themost common treatments for BPSD are physical restraints, administration of psychotropicdrugs, and reduced stimulation. Special Care Units (SCUs) can provide personalized carefor patients with BPSD. This study aimed to assess whether a humanistic environmentwould have a positive effect on residents with BPSD. PICO was designated as follows:“P,” elderly patients with dementia in nursing facilities; “I,” admission of elderly patientswith dementia to SCUs; “C,” elderly patients with dementia not admitted to SCUs; “O,”improvement in agitated and attack behavior in elderly patients with dementia in SCUs.Data were collected from databases (i.e., PubMed, Cochrane Library, CINAHL Plus, andCEPS) using the following keywords: “Dementia”, “Special Care Units”, “Group Living”,“Nursing Facility” and “Environment”. The inclusion criteria included randomizedcontrolled trials and quasi-experimental studies. A total of eight studies were selected forthe analysis. The results were as follows: 1. Attack behavior and agitated behavior was,indeed, improved by an SCU environment (p<0.05 to 0.0005); 2. A small-unit humancenteredcare mode was able to satisfy the various requirements of patients with dementia,and in turn ameliorated attack and agitated behavior. Thus, a humanistic environment canimprove the BPSD of patients with dementia. Given that the degree of national promotionand national policy support of humanistic environments in the treatment of dementiahave not been consistent among different nations to date, the international dementia carecommunity should be committed to establishing a consensus regarding these in the future.