一位輕度認知功能障礙合併多重慢性疾病個案之護理經驗

Nursing Experience of a Mild Cognitive Impairment Patient with Multiple Chronic Diseases

10.6386/CGN.201803_29(1).0013

賴雩衿(Yu-Chin Lai)；邱逸榛(Yi-Chen Chiu)；魏碧美(Bih-Mei Wei)；徐文俊(Wen-Chuin Hsu)

周全性老年評估 ； 輕度認知功能障礙 ； 多重慢性疾病 ； comprehensive geriatric assessment ； mild cognitive impairment ； multiple chronic diseases

長庚護理

29卷1期（2018 / 03 / 01）

142 - 151

繁體中文

本報告運用周全性老年評估(Comprehensive Geriatric Assessment, CGA)，描述照護一位輕度認知功能障礙合併多重慢性疾病個案之護理經驗，筆者於2015年9月16日至2016年1月13日護理期間，藉由觀察、訪談、傾聽、家庭訪視等方式，確認個案護理問題包括：(1)慢性病自我管理不當，藥物遵從性差；(2)營養高於所需；(3)社交活動減少，危險性跌倒風險增加，並提供適當之護理措施，使個案能維持基本日常生活及活動功能，預防及減緩衰弱情形的發生。

This case report described an application of comprehensive geriatric assessment (CGA) on a mild cognitive impaired case with multiple chronic diseases. The author provided nursing care and gathered information by observation, interview, listening, and home visiting from September 16, 2015 to January 13, 2016. Based on CGA, the author identified patient's health problems as follows: (1) chronic disease self-management deficit and poor medication adherence; (2) nutrition imbalance due to excessive intake more than body requirement; (3) reduced social activities, and increased the risk of falling. The author provided appropriate nursing interventions to patient and helped to keep his basic activities of daily living and functional ability, then prevented and reduced the level of frailty.

1. Alexopoulos, G. S.,Abrams, R. C.,Young, R. C.,Shamoian, C. A.(1988).Cornell scale for depression in dementia.Biological Psychiatry,23(3),271-284.
2. Aliberti, M.,Kikuchi, E.,Magaldi, R.,Paschoal, S.,Filho, W. J.(2007).Comprehensive geriatric assessment in elderly outpatients with dementia.Dementia Neuropsychologia,3,303-310.
3. Alzheimer's association (2011)．Cognitive impairment: The Impact on Health in Iowa. Retrieved July 31, 2016, from http://www.cdc.gov/aging/pdf/cognitive_impairment/cogImp_ia_final.pdf
4. Clarnette, R. M.,Almeida, O. P.,Forstl, H.,Paton, A.,Martins, R. N.(2001).Clinical characteristics of individuals with subjective memory loss in Western Australia: results from a cross sectional survey.International Journal of Geriatric Psychiatry,16(2),168-174.
5. 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.
6. Fried, L. P.,Tangen, C. M.,Walston, J.,Newman, A. B.,Hirsch, C.,Gottdiener, J.,McBurnie, M. A.(2001).Frailty in older adults evidence for a phenotype.The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,56(3),M146-M157.
7. Hudani, Z. K.,Rojas-Fernandez, C. H.(2016).A scoping review on medication adherence in older patients with cognitive impairment or dementia.Research in Social and Administrative Pharmacy,12(6),815-829.
8. Hughes, C. P.,Berg, L.,Danziger, W. L.,Coben, L. A.,Martin, R.(1982).A new clinical scale for the staging of dementia.The British Journal of Psychiatry,140(6),566-572.
9. Jessen, F.,Amariglio, R. E.,Van Boxtel, M.,Breteler, M.,Ceccaldi, M.,Chételat, G.,Glodzik, L.(2014).A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease.Alzheimer's & Dementia,10(6),844-852.
10. Oskoei, A. S.,Nejati, V.,Ajilchi, B.(2013).The effectiveness of cognitive rehabilitation on improving the selective attention in patients with mild cognitive impairment.Journal of Behavioral andBrain Science,3(6),474-478.
11. Patel, M.,Coshall, C.,Rudd, A. G.,Wolfe, C. D.(2003).Natural history of cognitive impairment after stroke and factors associated with its recovery.Clinical Rehabilitation,17(2),158-166.
12. Petersen, R. C.(2004).Mild cognitive impairment as a diagnostic entity.Journal of Internal Medicine,256(3),183-194.
13. Reisberg, B.,Borenstein, J.,Salob, S. P.,Ferris, S. H.(1987).Behavioral symptoms in Alzheimer's disease: Phenomenology and treatment.Journal of Clinical Psychiatry,48,9-15.
14. Riccio, D.,Solinas, A.,Astara, G.,Mantovani, G.(2007).Comprehensive geriatric assessment in female elderly patients with Alzheimer disease and other types of dementia.Archives of Gerontology and Geriatrics,44,343-353.
15. Vella, B.,Villars, H.,Abellan, G.,Soto, M. E.,Rolland, Y.,Guigoz, Y.,Garry, P.(2006).Overview of MNA-its history and challenges.Journal of Nutrition, Health, and Aging,10(6),456-465.
16. Yesavage, J. A.,Brink, T. L.,Rose, T. L.,Lum, O.,Huang, V.,Adey, M.,Leirer, V. O.(1982).Development and validation of a geriatric depression screening scale: a preliminary report.Journal of Psychiatric Research,17(1),37-49.
17. 內政部統計處(2017)．內政統計通報． 取自http://www.moi.gov.tw/stat/news_list.aspx?page=0[Department of Statistics, Ministry of the Interior, Taiwan, ROC. (2017). Interior National Indicators. Retrieved from http://www.moi.gov.tw/stat/news_list.aspx?page=0]
18. 林智偉、劉文俊、吳風鈴、陳慶餘(2013)。老人主觀記憶力障礙與功能缺損有關─以社區醫院病人為對象的研究。台灣老年醫學暨老年學雜誌，8(1)，14-27。
19. 翁菁甫、林坤霈、詹鼎正(2014)。老人憂鬱與認知功能障礙。內科學誌，25(3)，158-164。
20. 黃楷雯、陳清惠(2012)。找回生活動力：一位失智老人的護理經驗。長庚護理，23(1)，73-79。
21. 潘玉玲、張耀文、李忠興、羅子評、高東煒(2014)。運用周全性評估於急性病房高齡患者功能性評估分析。中華職業醫學雜誌，21(4)，215-226。
22. 蔡欣霓(2013)。台南=Tainan City, Taiwan, ROC.，成功大學政治經濟學研究所專班=National Cheng Kung University。
23. 蔡惠如、王桂芸、賴嘉敏、李雅欣(2011)。老人周全性評估運用於阿茲海默症個案之居家護理經驗。榮總護理，28(1)，90-96。