探討音樂律動結合本土化認知刺激訓練於日間照顧中心長者之成效—前驅式研究

Testing Effectiveness of Localized Cognitive Stimulation Training With Musical Rhythm Courses Among Older People in Day Care Centers: A Pilot Study

10.6224/JN.202312_70(6).05

周家伶(Chia-Ling CHOU)；黎昱伶(Yu-Ling LI)；余慶仁(Cing-Len YU)；張素嫺(Su-Hsien CHANG)

認知刺激訓練 ； 日間照顧中心 ； 認知 ； 自我照顧能力 ； 憂鬱 ； cognitive stimulation training ； day care center ； cognition ； self-care ability ； depression

護理雜誌

70卷6期（2023 / 12 / 01）

25 - 35

繁體中文;英文

背景：日間照顧中心工作人員提供長者許多活動，但缺乏一個能符合台灣民情文化且有系統的課程，來提升長者認知功能及自我照顧能力，並改善憂鬱心情。目的：發展一系列音樂律動結合本土化認知刺激訓練課程，並檢測其對於日間照顧中心長者的認知功能及自我照顧能力的提升，以及改善憂鬱情緒之成效。方法：本研究採群體隨機對照實驗研究設計，用隨機方式將5家日間照顧中心分為實驗組、對照組和控制組。實驗組的長者接受由中心的直接照顧者提供音樂律動及結合腦力活化的本土化結構性認知刺激訓練。之後檢測不同組別參與者的認知功能、自我照顧能力，以及憂鬱情緒狀態。結果：研究結果發現實驗組研究參與者在注意力、進食、及憂鬱情緒出現顯著性改變外；在控制活動參與次數及參與度後，對照組的長者在第三次認知功能得分較第二次認知功能得分呈現顯著性的降低。結論／實務應用：研究證實該介入措施可運用於日間照顧中心長者預防自我照顧能力的衰退，同時也可預防長者認知功能衰退或憂鬱的情緒發生；未來需擴大收案樣本，以提高介入措施的成效之驗證。

Background: Staff caregivers of day care centers provide many activities for older people. However, there is a lack of a systematic curriculum based on Taiwanese culture to improve cognitive function, self-care ability, and depressive mood status in these individuals. Purpose: This study was designed to test the effectiveness of a series of localized cognitive stimulation training courses implemented by direct caregivers and aimed at improving cognitive function, self-care ability, and depressive mood in older people at day care centers. Methods: This cluster-randomized controlled trial research was conducted over a four-month period. The participants were randomly assigned to the experimental, comparison, or control groups based on their day care center affiliation. The experimental group received a series of localized cognitive stimulation training sessions with musical rhythm courses from day care center direct caregivers. The cognitive function, self-care ability, and depression mood state of the three groups were then tested. Results: The experimental group reported statistically significant changes in average scores for attention, feeding, and depressive mood. After controlling for time and degree of participation in activities, the comparison group reported a lower average score for cognitive function at timepoint 3. Conclusions/Implications for Practice: The results of this study support caregivers at day care centers implementing a series of localized cognitive stimulation training course interventions to prevent declines in activities of daily living and cognitive function and ameliorate depressive mood in older adults. In the future, a larger sample size should be used to improve the effectiveness of the intervention.

1. 葉怡成, I.-C.,胡夢鯨, M.-C.(2014)。健腦方案介入對機構高齡者認知功能之研究。嘉大體育健康休閒期刊，13(2)，119-129。
   連結：
2. 鄭駿樺, C. H.,李百麟, P. L.(2021)。社區高齡者預防跌倒、憂鬱與提升認知能力之健康促進計畫－一個10週社區據點活動成效探討．危機管理學刊。危機管理學刊，18(1)，47-58。
   連結：
3. 謝瓊儀, C.-Y.,王秀華, H.-H.(2017)。多元運動課程介入對輕度認知功能障礙高齡者之成效研究。嘉大體育健康休閒期刊，16(2)，13-32。
   連結：
4. Almeida, O. P.,Almeida, S. A.(1999).Short versions of the geriatric depression scale: A study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV.International Journal of Geriatric Psychiatry,14(10),858-865.
5. Bahar-Fuchs, A.,Martyr, A.,Goh, A. M. Y.,Sabates, J.,Clare, L.(2019).Cognitive training for people with mild to moderate dementia.Cochrane Database of Systematic Reviews
6. Berg-Weger, M.,Stewart, D. B.(2017).Non-pharmacologic interventions for persons with dementia.Missouri Medicine,114(2),116-119.
7. Chang, S.-H.,Wung, S.-F.,Crogan, N. L.(2008).Improving activities of daily living for nursing home elder persons in Taiwan.Nursing Research,57(3),191-198.
8. Erickson, K. I.,Voss, M. W.,Prakash, R. S.,Basak, C.,Szabo, A.,Chaddock, L.,Kim, J. S.,Heo, S.,Alves, H.,White, S. M.,Wojcicki, T. R.,Mailey, E.,Vieira, V. J.,Martin, A.,Pence, B. D.,Woods, J. A.,McAuley, E.,Kramerv, A. F.(2011).Exercise training increases size of hippocampus and improves memory.Proceedings of the National Academy of Sciences,108(7),3017-3022.
9. Folstein, M. F.,Folstein, S. E.,McHugh, P. R.(1975).Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.Journal of Psychiatric Research,12(3),189-198.
10. Gan, D. R. Y.,Wister, A. V.,Best, J. R.(2022).Environmental influences on life satisfaction and depressive symptoms among older adults with multimorbidity: Path analysis through loneliness in the Canadian longitudinal study on aging.The Gerontologist,62(6),855-864.
11. Iwasa, H.,Yoshida, Y.,Kai, I.,Suzuki, T.,Kim, H.,Yoshida, H.(2012).Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: A 5-year prospective cohort study.Journal of PsychosomaticResearch,72(2),159-164.
12. Lee, H. S.,Park, S. W.,Park, Y. J.(2016).Effects of physical activity programs on the improvement of dementia symptom: A meta-analysis.BioMed Research International
13. Lisko, I.,Kulmala, J.,Annetorp, M.,Ngandu, T.,Mangialasche, F.,Kivipelto, M.(2021).How can dementia and disability be prevented in older adults: Where are we today and where are we going?.Journal of Internal Medicine,289(6),807-830.
14. Sheikh, J. I.,Yesavage, J. A.(1986).Geriatric depression scale (GDS): Recent evidence and development of a shorter version.Clinical Gerontologist,5(1-2),165-173.
15. Tappen, R. M.(1994).Development of the refined ADL assessment scale for patients with Alzheimer’s and related disorders.Journal of Gerontological Nursing,20(6),36-42.
16. Woods, B.,Aguirre, E.,Spector, A. E.,Orrell, M.(2012).Cognitive stimulation to improve cognitive functioning in people with dementia.Cochrane Database of Systematic Reviews
17. Yeh, T. L.,Liao, I. C.,Yang, Y. K.,Ko, H. C.(1995).Geriatric depression scale (Taiwanese and Mandarin translations).Clinical Gerontologist,15(3),58-60.
18. Yesavage, J. A.,Brink, T. L.,Rose, T. L.,Lum, O.,Huang, V.,Adey, M.,Leirer, V. O.(1983).Development and validation of a geriatric depression screening scale: A preliminary report.Journal of Psychiatric Research,17(1),37-49.
19. 內政部統計處（無日期）．人口數三段年齡組。2023年9月23日取自https://is.gd/0Oeefb [Department of Statistics, Ministry of the Interior, Taiwan, ROC. (n.d.). Population by three age segments. Retrieved September 23, 2023, from https://is.gd/0Oeefb]
20. 行政院主計總處（2021，9月）．109年人口及住宅普查初步統計結果提要分析。[Directorate-General of Budget, Accounting and Statistics, Executive Yuan, Taiwan, ROC. (2021, September). Summary analysis of preliminary statistics from the 2020 census and housing census.] https://www.stat.gov.tw/public/Data/1112144316VT5YTOVB.pdf
21. 吳麗芬（校閱）, L.-F.(Ed.)(2015).新編老人護理學.華格那=Wagner.
22. 呂莉婷, L.-T.(2017)。探討社區高齡者參與「樂智課程」之主觀需求：應用深度訪談形成Q陳述句的歷程研究．健康生活與成功老化學刊。健康生活與成功老化學刊，9(1)，23-35。
23. 李新民, H.-M.,許震宇, C.-Y.,陳美伶, M.-L.,鄭博真, B.-J.(2021)。社區失智服務據點懷舊團體活動方案之實施成效。華醫學報，55，112-134。
24. 林添富, T.-F.,邱柏豪, P.-H.,秦秀蘭, H.-L.,陳鈺艷, Y.-Y.,劉以慧, Y.-H.,劉家勇, H. C.-Y.(2019).老人學概論.華都文化=Far Du Publishing.
25. 陳佳微, C.-W.(2013)。臺北醫學大學=Taipei Medical University。
26. 陳柏宏, P.-H.(2016)。失智症照護，物理治療幫忙您，藥物非萬能，搭配運動會更好，要活就要動 Part I。彰基院訊，33(12)，12-13。
27. 傅中玲, J.-L.(2015)。動腦護腦，輕度認知障礙不失智。健康世界，468，50-52。
28. 楊雅媛, Y.-Y.,張元玫, Y.-M.,陳培豪, P.-H.,鄭方瑜, F.-Y.(2022)。桌上遊戲合併有氧運動對衰弱高齡者認知和身體功能之成效。馬偕護理雜誌，16(1)，1-12。
29. 衛生福利部（2021，9月27日）．高齡社會白皮書。[Ministry of Health and Welfare, Taiwan, ROC. (2021, September 27). White paper on aging society.] https://www.sfaa.gov.tw/SFAA/Pages/Detail.aspx?nodeid=1372&pid=11419
30. 衛生福利部（2023）．長期十年計畫 2.0相關統計表。[Ministry of Health and Welfare, Taiwan, ROC. (2023). Ten-year plan for long term care 2.0, statistical tables.] https://1966.gov.tw/LTC/lp-6485-207.html
31. 衛生福利部統計處（2018，9月）．106年老人狀況調查。[Department of Statistics, Ministry of Health and Welfare, Taiwan, ROC. (2018, September). Survey of elderly status, 2017.] https://dep.mohw.gov.tw/dos/lp-5095-113-xCat-y106.html
32. 賴意櫻, Y.-Y.,吳嘉畇, C.-Y.(2016)。認知復健對於失智症患者成效之統合分析初探。健康生活與成功老化學刊，8(1)，29-39。
33. 韓尚錡, S.-C.,張為晴, W.-C.,邱敬雅, C.-Y.,林湘芸, H.-Y.,高嘉妤, J.-Y.,車慧蓮, H.-L.(2020)。銀髮活動服務方案介紹-以不老頑童環遊寶島為例。台灣老人保健學刊，1(1&2)，33-47。