照光療法於失智照護之應用

Application of Light Therapy in Dementia Care

10.6224/JN.202312_70(6).04

蘇信鳳(Hsin-Feng SU)；黃淑儀(Shu-Yi HUANG)；宋惠娟(Huei-Chuan SUNG)

照光療法 ； 失智症 ； 睡眠障礙 ； 憂鬱 ； 失智症精神行為症狀 ； light therapy ； dementia ； sleep disturbance ； depression ； behavioral and psychological symptoms of dementia

護理雜誌

70卷6期（2023 / 12 / 01）

18 - 24

繁體中文;英文

失智症病人常出現睡眠障礙、憂鬱及精神行為症狀，傳統上常以精神科藥物或身體約束來處理，但易造成生理及心理的負向影響，諸多統合分析建議應優先考慮運用非藥物療法來處理失智症症狀，其中之一即照光療法。照光療法運用照光設備產生人造光源，可補強失智症病人白天照光不足並調節其晝夜節律，能有效緩解失智症病人睡眠障礙及憂鬱症狀。護理人員可評估失智症病人的需求及症狀，適時運用照光療法作為輔助的照護介入措施之一，來改善失智症病人的照護品質。

Patients with dementia often display related sleep disturbance, depression, and behavioral and psychological symptoms, which are traditionally managed through the use of antipsychotic medications or physical restraint. However, these management interventions can have negative effects on the physical and psychological health of patients. The results of several meta-analyses suggest non-pharmacological interventions, including light therapy, should be used for the first-line management of these dementia symptoms. Light therapy uses artificial light to compensate for insufficient light exposure during the daytime and to help patients with dementia properly regulate their circadian rhythms. Sleep disturbance and depression in those with dementia may be effectively relieved through the application of light therapy. Nurses should assess the needs and symptoms of patients with dementia and consider applying light therapy as a complementary care intervention to improve quality of care.

1. 詹書媛, S.-Y.,游曉微, H.-W.,楊銘欽, M.-C.,李玉春, Y.-C.,陳雅美, Y.-M.(2018)。失智症與非失智症長者之照顧者醫療服務利用之比較。台灣公共衛生雜誌，37(6)，664-675。
   連結：
2. Brasure, M.,Jutkowitz, E.,Fuchs, E.,Nelson, V. A.,Kane, R. A.,Shippee, T.,Fink, H. A.,Sylvanus, T.,Ouellette, J.,Butler, M.,Kane, R. L.(2016).Nonpharmacologic interventions for agitation and aggression in dementia.Agency for Healthcare Research and Quality (US)
3. Cerejeira, J.,Lagarto, L.,Mukaetova-Ladinska, E. B.(2012).Behavioral and psychological symptoms of dementia.Frontiers in Neurology,3,73.
4. Chen, C.-Y.,Chen, H.-W.(2022).The effect of dynamic lighting for working shift people on clinical heart rate variability and human slow wave sleep.Applied Sciences,12(5),2284.
5. Chen, C.-Y.,Wang, Y.-K.,Wang, Z.-W.(2022).Research on the application of the dynamic assisted sleep light to smart mobile devices.Applied Sciences,12(10),5191.
6. Cibeira, N.,Maseda, A.,Lorenzo-López, L.,Rodríguez-Villamil, J. L.,López-López, R.,Millán-Calenti, J. C.(2020).Application of light therapy in older adults with cognitive impairment: A systematic review.Geriatric Nursing,41(6),970-983.
7. Comtet, H.,Geoffroy, P. A.,Kobayashi Frisk, M.,Hubbard, J.,Robin-Choteau, L.,Calvel, L.,Hugueny, L.,Viola, A. U.,Bourgin, P.(2019).Light therapy with boxes or glasses to counteract effects of acute sleep deprivation.Scientific Reports,9(1),18073.
8. Costello, A.,Linning-Duffy, K.,Vandenbrook, C.,Donohue, K.,O’Hara, B. F,Kim, A.,Lonstein, J. S.,Yan, L.(2023).Effects of light therapy on sleep/wakefulness, daily rhythms, and the central orexin system in a diurnal rodent model of seasonal affective disorder.Journal of Affective Disorders,332,299-308.
9. Dyer, S. M.,Harrison, S. L.,Laver, K.,Whitehead, C.,Crotty, M.(2018).An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia.International Psychogeriatrics,30(3),295-309.
10. Faulkner, S. M.,Bee, P. E.,Meyer, N.,Dijk, D.-J.,Drake, R. J.(2019).Light therapies to improve sleep in intrinsic circadian rhythm sleep disorders and neuro-psychiatric illness: A systematic review and meta-analysis.Sleep Medicine Reviews,46,108-123.
11. Figueiro, M. G.,Hamner, R.,Higgins, P.,Hornick, T.,Rea, M. S.(2012).Field measurements of light exposures and circadian disruption in two populations of older adults.Journal of Alzheimer’s Disease,31(4),711-715.
12. Figueiro, M. G.,Plitnick, B.,Roohan, C.,Sahin, L.,Kalsher, M.,Rea, M. S.(2019).Effects of a tailored lighting intervention on sleep quality, rest-activity, mood, and behavior in older adults with Alzheimer disease and related dementias: A randomized clinical trial.Journal of Clinical Sleep Medicine,15(12),1757-1767.
13. Fong, K. N. K.,Ge, X.,Ting, K. H.,Wei, M.,Cheung, H.(2023).The effects of light therapy on sleep, agitation and depression in people with dementia: A systematic review and meta-analysis of randomized controlled trials.American Journal of Alzheimer’s Disease & Other Dementias,38
14. Forbes, D.,Blake, C. M.,Thiessen, E. J.,Peacock, S.,Hawranik, P.(2014).Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia.Cochrane Database of Systematic Reviews
15. Geoffroy, P. A.,Schroder, C. M.,Bourgin, P.(2018).Light treatment in depression: An antique treatment with new insights.Sleep Medicine Reviews,40,218-219.
16. He, X.,Hao, J.,Song, Y.,Cao, H.,Chen, Y.,Yang, H.(2023).Effectiveness of non-pharmacological interventions for sleep disturbances in people living with dementia: A systematic review and meta-analysis.Geriatric Nursing,51,76-83.
17. Hjetland, G. J.,Kolberg, E.,Pallesen, S.,Thun, E.,Nordhus, I. H.,Bjorvatn, B.,Flo-Groeneboom, E.(2021).Ambient bright light treatment improved proxy-rated sleep but not sleep measured by actigraphy in nursing home patients with dementia: A placebo-controlled randomised trial.BMC Geriatrics,21(1),312.
18. Liu, C.-R.,Liou, Y. M.,Jou, J.-H.(2021).Pilot study of the effects of bright ambient therapy on dementia symptoms and cognitive function.Frontiers in Psychology,12,782160.
19. Mavounza, C.,Ouellet, M.-C.,Hudon, C.(2020).Caregivers’ emotional distress due to neuropsychiatric symptoms of persons with amnestic mild cognitive impairment or Alzheimer’s disease.Aging & Mental Health,24(3),423-430.
20. Onega, L. L.,Pierce, T. W.(2020).Use of bright light therapy for older adults with dementia.BJPsych Advances,26(4),221-228.
21. Qu, Y.,Zhuang, L.,Zhang, H.,Liu, C.,Wang, X.(2023).The effects of light therapy for depression in dementia: A systematic review and meta-analysis.Journal of Alzheimer’s Disease,93(4),1223-1235.
22. Riemersma-van der Lek, R. F.,Swaab, D. F.,Twisk, J.,Hol, E. M.,Hoogendijk, W. J.,Van Someren, E. J. W.(2008).Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial.JAMA,299(22),2642-2655.
23. Rosenthal, N. E.,Sack, D. A.,Gillin, J. C.,Lewy, A. J.,Goodwin, F. K.,Davenport, Y.,Peter, S.,Mueller, P. S.,Newsome, D. A.,Wehr, T. A.(1984).Seasonal affective disorder: A description of the syndrome and preliminary findings with light therapy.Archives of General Psychiatry,41(1),72-80.
24. Stopa, E. G.,Volicer, L.,Kuo-Leblanc, V.,Harper, D.,Lathi, D.,Tate, B.,Satlin, A.(1999).Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia.Journal of Neuropathology & Experimental Neurology,58(1),29-39.
25. Tan, J. S. I.,Cheng, L. J.,Chan, E. Y.,Lau, Y.,Lau, S. T.(2022).Light therapy for sleep disturbances in older adults with dementia: A systematic review, meta-analysis and meta-regression.Sleep Medicine,90,153-166.
26. Van Maanen, A.,Meijer, A. M.,van der Heijden, K. B.,Oort, F. J.(2016).The effects of light therapy on sleep problems: A systematic review and meta-analysis.Sleep Medicine Reviews,29,52-62.
27. Zhang, M.,Wang, Q.,Pu, L.,Tang, H.,Chen, M.,Wang, X.,Li, Z.,Zhao, D.,Xiong, Z.(2023).Light therapy to improve sleep quality in older adults living in residential long-term care: A systematic review.Journal of the American Medical Directors Association,24(1),65-74.e1.
28. 台灣失智症協會（2023，5月）．失智人口知多少。[Taiwan Alzheimer’s Disease Association. (2023, May). Understanding dementia.] http://www.tada2002.org.tw/About/IsntDementia
29. 林宛玲, W.-L.,呂宜峰, F.-Y.,劉建良, C.-L.,翁林仲, L.-C.,楊啟正, C.-C.(2020)。失智症照護之五大重要發展方向。北市醫學雜誌，17(2)，163-173。