以病人為中心的老年失智症安寧療護－病例報告

Patient-centered Palliative Care of Senile Dementia: A Case Report

10.6200/TCMJ.2015.12.SP.13

呂美卿(Meei-Ching Leu)；劉建良(Chien-Liang Liu)；黃怡寧(Yi-Ning Huang)；趙玉雯(Yu-Wen Chao)；余錦美(Ching-Mei Yu)；許衍道(Yen-Tao Hsu)；陳潤秋(Ran-Chou Chen)

失智症 ； 老年人 ； 以病人為中心 ； 安寧緩和照護 ； Dementia ； older people ； patient-centered ； palliative care ； supportive care

北市醫學雜誌

12卷附冊（2015 / 06 / 30）

149 - 156

繁體中文

目的：藉由報告老年失智症末期個案，接受居家安寧照顧服務後，安詳於家中過世的成功經驗，分析討論老年失智症患者的安寧緩和照護原則。病歷報告：94歲男性，因腦梗塞型中風導致活動受限合併血管性失智症。過世前4年因為肺炎、高血糖、呼吸窘迫反覆住院，具有失智精神行為症狀並依賴鼻胃管灌食，臨床失智評估量表（CDR）達5分，為末期失智個案，經居家安寧團隊介入服務，並提供一個符合病患及家屬需求的安寧照護計畫後，病患安詳在宅過世。善終指標評估、善終服務評價及家人對於善終服務滿意度均顯示安寧緩和照護大幅提升病患臨終前身心靈與家屬的照護品質。結論：失智症是生命的末期狀態，安寧緩和照護評估應從失智診斷後開始，並以病人為中心，提供多面向的完整照護。

Objective: We describe the principles of palliative and supportive care for patients with dementia through the successful experience of caring an elderly patient with end-stage dementia. Case Report: A 94-year-old male was a patient with endstage dementia. The clinical dementia rating was grade 5. He had a history of ischemic stroke, recurrent pneumonia, poor controlled diabetes and respiratory distress. He had behavioral and psychological symptoms of dementia and needed nasogastric tube for feeding. He received interdisciplinary home palliative care services and died at home. Conclusion: From the time of diagnosis, dementia patients should be assessed for a palliative care on the body, mind and spirit, and with members of family as a part to be cared. Such approach can improve the quality of life of the patients and families facing the problems associated with dementia.