Stacpoole Miranda, Hockley Jo, Thompsell Amanda, Simard Joyce, Volicer Ladislav
Care Home Project Team, St Christopher's Hospice, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Int J Geriatr Psychiatry. 2015 Jul;30(7):702-9. doi: 10.1002/gps.4211. Epub 2014 Oct 22.
The objective of the study was to evaluate the effects of the Namaste Care programme on the behavioural symptoms of residents with advanced dementia in care homes and their pain management.
Six dementia care homes collaborated in an action research study-one withdrew. Inclusion criteria were a dementia diagnosis and a Bedford Alzheimer's Nursing Severity Scale score of >16. Primary research measures were the Neuropsychiatric Inventory-Nursing Homes (NPI-NH) and Doloplus-2 behavioural pain assessment scale for the elderly. Measures were recorded at baseline and at three 1-2 monthly intervals after Namaste Care started.
Management disruption occurred across all care homes. The severity of behavioural symptoms, pain and occupational disruptiveness (NPI-NH) decreased in four care homes. Increased severity of behavioural symptoms in one care home was probably related to poor pain management, reflected in increased pain scores, and disrupted leadership. Comparison of NPI-NH scores showed that severity of behavioural symptoms and occupational disruptiveness were significantly lower after initiation of Namaste Care (n = 34, p < 0.001) and after the second interval (n = 32, p < 0.001 and p = 0.003). However, comparison of these measures in the second and third intervals revealed that both were slightly increased in the third interval (n = 24, p < 0.001 and p = 0.001).
Where there are strong leadership, adequate staffing, and good nursing and medical care, the Namaste Care programme can improve quality of life for people with advanced dementia in care homes by decreasing behavioural symptoms. Namaste is not a substitute for good clinical care.
本研究的目的是评估合十礼关怀计划对养老院中晚期痴呆症患者行为症状及其疼痛管理的影响。
六家痴呆症护理院参与了一项行动研究——其中一家退出。纳入标准为痴呆症诊断且贝德福德阿尔茨海默病护理严重程度量表得分>16。主要研究指标为养老院神经精神科问卷（NPI-NH）和针对老年人的多洛普斯-2行为疼痛评估量表。在基线以及合十礼关怀计划开始后的三个月内，每隔1至2个月记录一次测量结果。
所有护理院均出现管理混乱。四家护理院的行为症状、疼痛和职业干扰（NPI-NH）严重程度有所降低。一家护理院行为症状严重程度增加可能与疼痛管理不善有关，表现为疼痛评分增加以及领导不力。NPI-NH评分比较显示，合十礼关怀计划启动后（n = 34，p < 0.001）以及第二个间隔期后（n = 32，p < 0.001和p = 0.003），行为症状和职业干扰的严重程度显著降低。然而，对第二个和第三个间隔期的这些指标进行比较发现，第三个间隔期两者均略有增加（n = 24，p < 0.001和p = 0.001）。
在有强有力的领导、充足的人员配备以及良好的护理和医疗服务的情况下，合十礼关怀计划可以通过减少行为症状来改善养老院中晚期痴呆症患者的生活质量。合十礼关怀并非优质临床护理的替代品。
