臺灣南部護理之家失智症住民口腔健康與問題行為之相關探討

Correlations between Oral Health and Problematic Behavior of Nursing Home Demented Residents in Southern Taiwan

10.6317/LTC.21.303

邱逸榛(Yi-Chen Chiu)；蔡宜燕(Yi-Yen Tsai)；李佳琳(Chia-Lin Li)；劉彥君(Yen-Chun Liu)

失智症 ； 護理之家 ； 口腔健康 ； 問題行為 ； dementia ； nursing home ； oral health ； problematic behavior

長期照護雜誌

21卷3期（2017 / 12 / 01）

303 - 317

繁體中文

背景：口腔健康問題在護理之家相當普遍，失智症住民因疾病病程變化，逐漸失去口腔照護能力，因此產生口腔健康不佳，而以問題行為表達其需求，例如：口腔疼痛。目前國內缺乏運用理論架構來探討口腔健康與失智症問題行為的相關研究。目的：運用認知缺損危害需求驅動之行為模式為理論架構，探討在控制相關因素後，護理之家失智住民口腔健康狀況與問題行為的關係。方法：以橫斷性相關性的研究方式，採方便取樣法選取116位臺灣南部四所護理之家失智症住民為研究對象。收案期間為2013年10月至2014年4月，研究工具包括基本屬性問卷、口腔健康評估量表、巴氏量表、認知功能評量表及中文版神經精神病徵問卷蒐集。以SPSS18.0版套裝軟體進行建檔與分析，統計方式包括百分比、平均值、標準差、獨立樣本t檢定、單因子變異數分析、皮爾森積差關係、階層迴歸。結果：一、牙痛與問題行為（CNPI總分）達顯著負相關（r = -0.184, p＜0.05）；二、階層迴歸模式結果顯示：牙痛能顯著預測問題行為，而口腔健康狀況能顯著預測淡漠行為，解釋總變異量（R^2）達18.9%，表示失智症住民口腔健康狀況與其問題行為有相關。結論/實務運用：建議臨床工作人員可運用認知缺損危害需求驅動之行為模式，定期評估失智症住民口腔健康狀況及牙痛，未來發展合宜的介入措施以改善口腔照護品質，降低問題行為的發生。

Background: Oral health issues are very common in nursing homes. Due to disease progression, residents with dementia gradually lose their abilities to perform oral health care, leading to poor oral health and problematic behaviors to express their needs (e.g. oral pain). However, there were not many theory-based studies to explore the relationship between oral health and problematic behaviors of residents with dementia in nursing homes. Purpose: Based on the theoretical framework of ＂Need- Driven Dementia-Compromised Behavior Model＂ (NDB Model), we explored the relationship between oral health of residents with dementia in nursing homes and their problematic behaviors through controlling associated factors. Method: This was a cross-sectional correlation study design using convenience sampling method to recruit 116 residents with dementia from four nursing homes in southern Taiwan. The recruitment period was from October 2013 to April 2014. The tools used in this study included Demographic Questionnaires, Oral Health Assessment Tool (OHAT), Barthel Index, Mini-Mental State Examination (MMSE) and Chinese Neuropsychiatric Symptom Inventory (CNPI). A statistical software package SPSS version 18.0 was used for data entry and analysis. Descriptive statistical results included percentages or mean values ± standard deviations, while inferential statistical analyses included independent samples t-test, one-way ANOVA, Pearson correlation coefficient and hierarchical regression model. Results: 1. The correlation coefficient between toothache and problematic behavior measured using CNPI was negative and significant (r = -0.184, p ＜ 0.05). 2. The results of hierarchical regression analysis showed that the level of toothache significantly predicted problematic behaviors, while the overall oral health significantly predicted apathy behavior. The total explained variance (R^2) was up to 18.9%. In sum, the oral health significantly predicted problematic behaviors of residents with dementia in nursing homes in southern Taiwan. Conclusions/Clinical Applications: Clinical practitioners may use the need-driven dementia compromised behavioral model to assess oral health, toothache and problematic behaviors of nursing home residents with dementia. Future research can focus on appropriate interventions to improve the quality of oral health care and reduce the occurrence of problematic behaviors.

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