Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.
PLoS One. 2018 Mar 19;13(3):e0194178. doi: 10.1371/journal.pone.0194178. eCollection 2018.
Depression is a common issue in institutionalized elderly people. The "Attentively Embracing Story" theory is applied to help individuals transform negative thoughts into positive, and reflect on spiritual healing. This study aimed to examine the effectiveness of a "Story-Centred Care Intervention Program" based on the "Attentively Embracing Story" theory in improving depressive symptoms, cognitive function, and heart rate variability in institutionalized elderly people. Seventy long-term care residents were recruited from two long-term care facilities and randomized into the story-centred care intervention (n = 35) and control groups (n = 35). We excluded five long-term care residents who did not complete the post-test measures and five long-term care residents who had interference events on the outcome measures. Finally, sixty long-term care residents (40 women and 20 men; age 84.3±5.98 years) were included in the final analysis. Data were collected at four times (pre-intervention and post-intervention, 1 and 3-month follow-up) and analyzed with the generalized estimating equation approach.Instruments, including Geriatric Depression Scale, Short Portable Mind Status Questionnaire, and a CheckMyHeart device to measure heart rate variability, were used in study. The degree of improvement in depressive symptoms was significantly higher in the story-centred care intervention group than in the control group after providing the story-centred care intervention program (p < .001) and at 1 and 3-month follow-up (p = .001, p = .006, respectively; GDS-15 score reduced 1.816 at the 3-month follow-up). Participants receiving the story-centred care intervention program showed significantly greater improvement than those in the control group in the cognitive function at 1and 3-month follow-up (p = .009, p = .024, respectively; SPMSQ score reduced 0.345 at the 3-month follow-up). The heart rate variability parameters (SDNN, RMSSD) did not show a statistically significant increase. However an increasing trend in the parameters was observed in the intervention group (SDNN increased 16.235ms at the 3-month follow-up; RMSSD increased 16.424 ms at the 3-month follow-up). In conclusions, the story-centred care intervention program was effective on the improvement of depressive symptoms and cognitive status in institutionalized elderly people.
抑郁症是机构老年人中常见的问题。应用“用心拥抱故事”理论帮助个体将消极思维转化为积极思维，并反思精神疗愈。本研究旨在检验基于“用心拥抱故事”理论的“故事为中心的护理干预计划”对改善机构老年人抑郁症状、认知功能和心率变异性的有效性。从两家长期护理机构招募了 70 名长期护理居民，并将他们随机分为故事为中心的护理干预组（n=35）和对照组（n=35）。我们排除了 5 名未完成后测评估的长期护理居民和 5 名在结局评估上存在干扰事件的长期护理居民。最终，共有 60 名长期护理居民（40 名女性和 20 名男性；年龄 84.3±5.98 岁）纳入最终分析。数据在四个时间点收集（干预前和干预后、1 个月和 3 个月随访），并使用广义估计方程方法进行分析。研究使用了老年抑郁量表、简易精神状态检查量表和 CheckMyHeart 设备来测量心率变异性。在提供故事为中心的护理干预计划后，故事为中心的护理干预组的抑郁症状改善程度明显高于对照组（p<.001），并且在 1 个月和 3 个月随访时也更高（p=0.001，p=0.006；在 3 个月随访时 GDS-15 评分降低 1.816）。与对照组相比，接受故事为中心的护理干预计划的参与者在认知功能方面的改善更为显著，在 1 个月和 3 个月随访时均如此（p=0.009，p=0.024；在 3 个月随访时 SPMSQ 评分降低 0.345）。心率变异性参数（SDNN、RMSSD）没有显示出统计学上的显著增加，但干预组观察到参数呈增加趋势（SDNN 在 3 个月随访时增加 16.235ms；RMSSD 在 3 个月随访时增加 16.424ms）。总之，故事为中心的护理干预计划对改善机构老年人的抑郁症状和认知状态有效。
