基于家庭的训练计划可提高照顾者的技能和痴呆症患者的攻击性行为：一项随机对照试验。

A home-based training program improves caregivers' skills and dementia patients' aggressive behaviors: a randomized controlled trial.

机构信息

Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan.

出版信息

Am J Geriatr Psychiatry. 2013 Nov;21(11):1060-70. doi: 10.1016/j.jagp.2012.09.009. Epub 2013 Apr 6.

DOI:10.1016/j.jagp.2012.09.009

PMID:23933422

Abstract

OBJECTIVE

To investigate the effects of an individualized, home-based caregiver-training program for caregivers of elderly patients with dementia and behavioral problems.

METHODS

Using a randomized clinical trial in the neurologic clinics of two hospitals and a community care management center in northern Taiwan, we tested an individualized home-based caregiver-training program for managing behavioral problems, with referrals to community services and telephone consultation. Participants were patients with dementia and their caregivers (N = 129): 63 in the intervention group and 66 in the control group. The control group received only written instructions and social telephone follow-ups. Behavioral problems of elderly dementia patients were assessed by the Chinese version of the Cohen-Mansfield Agitation Inventory, community form. Family caregivers' outcomes were measured by the Agitation Management Self-efficacy Scale and the Preparedness and Competence Scales. These instruments were administered before the program and 2 weeks, 3 months, and 6 months afterward.

RESULTS

Family caregivers who received the individualized home-based training program had better preparedness (t = 2.72, df = 127, p <0.01), competence (t = 4.77, df = 126, p <0.001), and overall self-efficacy (t = 3.81, df = 127, p <0.001) at 3 months than those in the control group. Moreover, the growth rate by treatment interaction effect was significant for caregiver competence (t = 2.25, df = 127, p <0.05) and overall self-efficacy for managing behavioral problems (t = 2.16, df = 127, p <0.05). The probability of physically aggressive behavior for patients in the intervention group decreased from 0.27 to 0.12.

CONCLUSION

Our individualized home-based caregiver-training program improved caregivers' preparedness, competence, and self-efficacy for managing problematic behaviors and decreased physical aggressiveness of elderly patients with dementia.

摘要

目的

研究个体化家庭护理员培训方案对老年痴呆症伴行为问题患者的护理员的影响。

方法

采用在台湾北部两家医院的神经科诊所和社区护理管理中心进行的随机临床试验，我们测试了一种针对行为问题的个体化家庭护理员培训方案，包括向社区服务转介和电话咨询。参与者为痴呆症患者及其护理员（N=129）：干预组 63 例，对照组 66 例。对照组仅接受书面指导和社会电话随访。采用中文版 Cohen-Mansfield 激越量表社区形式评估老年痴呆症患者的行为问题，采用激越管理自我效能感量表和准备度与能力量表评估家庭护理员的结局。这些工具在方案实施前和 2 周、3 个月和 6 个月后进行评估。

结果

接受个体化家庭培训方案的家庭护理员在 3 个月时的准备度（t=2.72，df=127，p<0.01）、能力（t=4.77，df=126，p<0.001）和总体自我效能（t=3.81，df=127，p<0.001）均优于对照组。此外，治疗交互效应的增长率在护理员能力（t=2.25，df=127，p<0.05）和管理行为问题的总体自我效能（t=2.16，df=127，p<0.05）方面具有显著意义。干预组患者发生身体攻击行为的概率从 0.27 降至 0.12。