中西照護活動對於社區預防及延緩失能失智之經驗探討

The Experience Explore to Prevention and Delay of Disability and Dementia with Chinese and Western Physical Exercise Care Activities

10.6516/TJTCM.202103_24(1).0005

黃柏銘(Bo-Ming Huang)；廖淇驊(Ci-Hua Liao)；周律廷(Lu-Ting Chou)；許書福(Shu-Fu Hsu)；呂怡惠(Yi-Hui Lu)；何旭華(Hsu-Hwa Her)

中醫養生 ； 八段錦 ； 預防及延緩失能 ； 失智 ； TCM Health Care ； Baduanjin ； Prevention and Delay of Disability ； Dementia

中醫藥研究論叢

24卷1期（2021 / 03 / 30）

55 - 64

繁體中文

台灣2018年已邁入高齡社會，在長照2.0「在地老化」、「在地安養」目標下，我們參與了預防及延緩失能照護計畫並執行於社區的失智據點和C級巷弄長照站，照護輕中度失智及失能民眾。文獻指出傳統中醫健身養生方法中例如八段錦、太極拳等大多屬低運動強度，可以調節身心，有益於生活品質，加強認知能力。我們以中醫養生為核心結合其他復健、語言、營養等專業專家，開展一個預防及延緩失能照護計畫，回溯2019年3期活動，159名社區民眾分成失智組與一般失能組完成參與了本方案活動。活動後結果探討，衰弱評估上失智組有顯著的改善，介護上也呈現風險降低；Kihon Checklist評量上失智組在活動後，社交困擾及認知功能兩項風險有顯著性降低，一般失能組在活動後抑鬱風險方面有顯著性降低。我們以為實施本方案在降低認知、社交及抑鬱等風險有幫助，對於獨立生活及活動運動的評量需要更多的設計探討與研究。

Taiwan has entered a senior society in 2018. Under the goals ＂Local aging＂ and ＂Aging in place＂of Long-Term Care 2.0 (LTC 2.0), we participated in the prevention and delay of disability health care plan and implemented it in dementia care center and the community point C, for people with mild to moderate dementia and disability. The study points out that TCM health exercise such as Baduanjin and Tai Chi are mostly low-intensity exercise, which can adjust the body and mind, benefit the quality of life and strengthen cognitive ability. We take Chinese medicine health care as the core and combine other professional experts in rehabilitation, speech, nutrition, etc. to carry out a plan to prevent and delay disability care. After three periods a year in 2019, 159 people in the community, dementia and disability group are included the group participates in this program activity. Post-activity analysis of the results, Study of Osteoporotic Fractures (SOF) assessment has a significant improvement in dementia group, and there is also a reduction in risk in nursing care; In addition, Kihon Checklist (KCL) criteria dementia group has a significant reduction both in the risk of social distress and cognitive function after the activity. The general disability group had a significant reduction in depression risk after the activity. We think that the implementation of this program is helpful in reducing the risk of cognition, socialization and depression. It requires more design discussion and research on the evaluation of daily living and physical strength.

1. 李雅萍,蔡兆勳,陳慶餘(2016)。肌少症簡介。長期照護雜誌，20(2)，105-114。
   連結：
2. Barnes, DE,, Santos-Modesitt, W,Poelke, G,Kramer, AF,Castro, C,Middleton, LE,Yaffe, K(2013).The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults.JAMA Internal Medicine,173(9),797-804.
3. Fukutomi, E,Okumiya, K,Wada, T,Sakamoto, R,Ishimoto, Y,Kimura, Y,Matsubayashi, K(2015).Relationships between each category of 25-item frailty risk assessment (Kihon Checklist) and newly certified older adults under Long-Term Care Insurance: A 24-month follow-up study in a rural community in Japan.Geriatrics & Gerontology International,15(7),864-871.
4. Guo, Y,Xu, MM,Ji, M,Zhang, JL,Hu, QC,Wei, ZR,Yan, J,Chen, Y,Lyu, JX,Shao, XQ,Wang, Y,, Guo, JM,, Wei, YL(2018).Effect of Liuzijue Qigong on patients with chronic obstructive pulmonary disease.Medicine,97(40),e12659.
5. Hsu, WY,Ku, Y,Zanto, TP,Gazzaley, A(2015).Effects of noninvasive brain stimulation on cognitive function in healthy aging and Alzheimer’s disease: a systematic review and meta-analysis.Neurobiology of Aging,36(8),2348-2359.
6. Li, R,Li, J,Ping, H,He, ZH,Huang, CY(2014).The Effect of Baduanjin on Promoting the Physical Fitness and Health of Adults.Evidence-Based Complementary and Alternative Medicine,1-8.
7. Rakesh, G,Szabo, ST,Alexopoulos, GS,Zannas, AS(2017).Strategies for dementia prevention: latest evidence and implications.Therapeutic Advances in Chronic Disease,8(8-9),121-136.
8. Wu, JL,Lin, ZS,Huang, BM(2010).Sub-health Status on Chinese Medicine.Journal of Tuina and Rehabilitation Sciences,7(1),1-9.
9. Yao, L,Giordani, BJ,Algase, DL,You, M,Alexander, NB(2013).Fall risk-relevant functional mobility outcomes in dementia following dyadic tai chi exercise.Western Journal of Nursing Research,35(3),281-96.
10. Ye, J,Cai, S,Zhong, W,Cai, S,Zheng, Q(2014).Effects of tai chi for patients with knee osteoarthritis: a systematic review.Journal of Physical Therapy Science,26(7),1133-1137.
11. Ye, J,Simpson, MW,Liu, Y,Lin, W,Zhong, W,Cai, S,Zou, L(2020).The Effects of Baduanjin Qigong on Postural Stability, Proprioception, and Symptoms of Patients With Knee Osteoarthritis: A Randomized Controlled Trial.Frontiers in Medicine,6,307.
12. Zheng, G,Zheng, Y,Xiong, Z,Ye, B,Tao, J,Chen, L(2018).Effect of Ba duan jin exercise on cognitive function in patients with post-stroke cognitive impairment: study protocol for a randomised controlled trial.BMJ Open,8(6),e020954.
13. Zou, L,SasaKi, JE,Wang, H,Xiao, Z,Fang, Q,Zhang, M(2017).A systematic review and meta-analysis Baduanjin Qigong for health benefits: randomized controlled trials.Evidence-Based Complementary and Alternative Medicine,1-17.
14. 尤杏雪(2009)。北京市，首都體育學院。
15. 胡倍瑜(2019)。台北市，臺灣大學健康政策與管理研究所。
16. 陳慶餘(2014)。肌少症。台灣醫學，18(3)，288-289。
17. 黃柏銘,王秀卿,沈雪娥,廖方瑜,何旭華(2018)。探討中醫養生在預防及延緩失能方案的適用性。第十五屆世界華人地區長期照護會議
18. 衛生福利部長照專區。長照 2.0/ 預防及延緩失能照護服務 / 預防及延緩失能照護計畫專區。衛生福利部 2018：https://1966.gov.tw/LTC/lp-4024-201.html。
19. 衛生福利部國民健康署。衛生福利部國民健康署。108 年預防及延緩失能輔導網絡計畫。衛生福利部2019：https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath。https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/File/Attach/10366/File_11825.pdf

1. 曾育慧,陳品璇,許中華(2022)。中醫居家醫療之現況與展望。台灣公共衛生雜誌，41(1)，16-35。
2. 廖主民,沈緯鈞,吳蕙如,廖主民,沈緯鈞,吳蕙如(2023)。歸屬需求量表中文化編製與法則網絡。體育學報，56(3)，299-317。
3. 盧易呈,鄭雅愛,蔡金川,陳冠佐,唐睿誼,林佩靜(2022)。中醫預防及延緩失能模組介入社區長者健康體能與認知功能之研究。中醫藥雜誌，33(1)，86-95。