查詢結果分析
來源資料
頁籤選單縮合
題 名 | 建立中醫失智症照護模式計畫=Dementia Care of Traditional Chinese Medicine |
---|---|
作 者 | 黃頌儼; | 書刊名 | 中醫藥年報 |
卷 期 | 12 2023.10[民112.10] |
頁 次 | 頁(1)1-(1)46 |
分類號 | 413.28 |
關鍵詞 | 失智症; 中西醫; 整合醫學; Dementia; Chinese and Western medicine; Integrated medicine; |
語 文 | 中文(Chinese) |
中文摘要 | 研究目的: 臺灣已進入高齡化社會,且速度遠超越世界各國。根據國家發展委員會 2016 年之推估,2026 年臺灣將邁入超高齡化社會(super-aged society)。依 民國 100 年衛生福利部委託臺灣失智症協會進行之失智症流行病學調查結 果,以及 106 年 12 月內政部人口統計資料估算,臺灣 65 歲以上老人共 3,268,013 人,其中輕微認知障礙(MCI)有 598,694 人,佔 18.32%;失智 症人口有 259,013 人,佔 7.93% (包括極輕度失智症 105,180 人,佔 3.22%, 輕度以上失智症有 153,832 人,佔 4.71%)。也就是說 65 歲以上的老人每 12 人即有 1 位失智者,而 80 歲以上的老人則每 5 人即有 1 位失智者。政府戮 力推動包括長期照顧在內的高齡政策,因應這波轉瞬即至的銀色海嘯。高齡 醫學講求跨領域專業整合,中藥醫是已經使用數千年傳統醫學,具有豐富的 老年養生保健與疾病防治知識,可在高齡照護中扮演重要的角色。 與多數已開發國家不同,基於傳統孝順的美德,臺灣失智症家屬大多選 擇在家中自行照護患者,雖然患者可能獲得較好的照顧,但隨著國人平均壽 命延長,家庭的負擔也越發沉重,易造成主要照護者併發憂鬱或其他相關的 精神問題。由於初期失智症患者常因家屬對於失智症的認識不足,而忽略了 早期治療的時機,等到開始介入治療時,往往已出現使家屬感到較為困擾的 精神行為症狀,進而尋求養護機構的長期照護,產生更高的社會成本。此外, 失智症是目前造成老年醫療負擔逐漸加重的重要病症之一,由於進行性的 腦部退化,將使得患者的認知功能逐步下降,在未得到妥善治療與照顧的情 況下,更會使得患者的死亡率上升。目前失智症並未找到可完全治癒的藥物或手術方式,故治療的重點放在如何減緩腦部的退化,並盡可能地維持患者 的認知功能,增進生活品質。中醫是華人地區最為普遍被接受的輔助與替代 醫療,一般民眾認知中醫藥可以「補身體」預防疾病或退化的產生,但往往 缺乏中醫師的診治輕信偏方流傳而造成誤用等情況發生。 研究方法: 過去彰化基督教醫院中醫部偕同西醫相關單位進行多項中西醫合作治 療計畫,包括 106 年度「建構中西醫急腹症急診留院觀察照護模式及教學 機制計劃」、「探討中醫醫療與長期照護制度之發展模式研究」、「建立中醫參 與戒毒治療模式暨成效評估計畫」,及 107 年度「探討中醫醫療與長期照護 制度之發展模式研究」、「建構中西醫合作照護模式計畫-電針治療對重症加 護病房病人胃排空延遲的療效評估」、「建立中醫參與戒毒治療模式暨成效 評估計畫」等,病患皆獲得滿意療效。透過中西醫共同照護模式,一方面達 到全人照護的目的,另一方面更讓中西醫彼此了解、截長補短,將傳統中醫 與現代醫學整合,發揮更有效的治療。基於上述理由,彰化基督教醫院中醫 部與神經醫學部嘗試以中西醫結合治療的方式,提供失智症患者品質更好 的照護模式。 本計畫擬參考過去彰化基督教醫院中醫部所實施的日間失智症照護模 式等經驗,辦理完整的中醫失智症照護,建置中西醫、藥、護及個管等臨床 照護模式,評估醫療成本,並搭配現代化舌診儀器、心率變異度分析等,結 合失智症評估量表進行臨床療效監測,作為醫療品質之評估,完成中醫對於 失智症患者療效分析。此研究有過去彰化基督教醫院中醫部所執行的失智 症日間照護計畫作為基礎,並做為未來中西醫共同照護(含醫、藥、護及行 政管理)模式之政策建議。而日前失智症的日間照護計畫已有階段性成果發 表,並已於本院辦理「中西醫失智症經驗分享研討會」,可作為本研究計畫 立基點。 結果與討論: 本研究發現藉由雷射針灸此種非侵入性治療,較傳統針灸能為個案所接 受,並搭配中醫藥課程、太極拳及八段錦訓練,除了頭部穴位刺激,改善認 知功能外,以及中醫藥課程強化個案對於事物之認知與手眼協調動作,太極拳及八段錦亦能改善個案之肢體動作。經統計分析認知功能障礙 CASI 量 表,其總分在統計上並無達到顯著差異,但其中短期記憶面向有顯著改善 (p=0.013),尤其是在失智非失能者族群特別明顯(p=0.031),雖然其他面 向並無顯著差異,但其代表可能有助於失智症個案延緩認知功能延緩。另外 於 GDS-15 憂鬱量表也具有顯著改善(p=0.041),在失智非失能者較為明顯 (p=0.037)。 |
英文摘要 | Aim: Taiwan had become an aging society from 1993, and the speed of aging is far beyond the world. According to the estimation of the National Development Council in 2016, Taiwan will become a super-aged society in 2026. According to the results of the epidemiological survey of dementia conducted by the Taiwan Dementia Association commissioned by the Ministry of Health and Welfare in 2011 and the demographic estimates of Ministry of Interior in December, 2017, there are 3,268,013 elderly people over the age of 65 in Taiwan, of whom 598,694 are minor cognitive impairment (MCI), accounting for 18.32%, and the population of dementia was 259,013, accounting for 7.93% (including 105,180 people with extremely mild dementia, accounting for 3.22%, and 153,832 people with mild dementia, accounting for 4.71%). That is, every 12 people over the age of 65 have 1 person who is dementia, and those who are over 80 years old have 1 person who is dementia. The government is striving to promote the old age policy, including long-term care, in response to this wave of silver tsunami. Geriatrics emphasizes the integration of interdisciplinary, traditional chinese medicine(TCM) for the use of thousands of years of traditional medicine, rich in elderly health care and disease prevention and control content, can play an important role in the elderly care. However, unlike most developed countries, based on the traditional ethic of filial duty, most family choose home-care for dementia patient. Although getting more attention of their sons and daughters, the patients still produce many economic problems to their family along with their aging. The main caregivers even get depression or associated psychotic symptoms through the period. Besides, due to the lacks of understanding of initial dementia, patients were ignored and missed the timing of early treatment. It was usual that family might feel trouble about the psychotic behavior, then they just noticed that patient need treatment. This caused the higher social costs for severe type of dementia in longterm care agencies. Because of the progressive brain degrading, it makes a gradual decline of cognitive function. As not receiving proper care as the mortality rate increased. Nevertheless, dementia is an incurable disease by drugs or surgery. TCM is the most common used therapy of complementary and alternative medicine. Taiwan inherits traditional Chinese culture, and the people popularly accept TCM for preventing aging. The general public's cognition can “complement the body” to prevent the occurrence of disease or degeneration, but it often lacks the diagnosis and treatment of doctors and criticizes the confession and causes misuse. Method: In the past, the Department of Traditional Chinese Medicine of the Changhua Christian Hospital and the relevant units of Western medicine conducted a number of Chinese and Western medicine cooperation treatment programs, including the "Construction of the nursing care model and teaching mechanisms of Western and Chinese medicine for acute abdomen pain of inward observation in emergency department", "Exploring the development model of TCM medical care and longterm care system", and "Establishing Chinese medicine participation in drug treatment mode and effectiveness evaluation plan" in 2017, and "Exploring the development model of TCM medical care and long-term care system", "Constructing a model of Chinese and Western medicine cooperative care model of efficacy evaluation of electroacupuncture treatment for delayed gastric emptying in patients with severe intensive care unit", and "Establishing Chinese medicine participation in drug treatment mode and effectiveness evaluation plan" in 2018. Patients in these programs have achieved satisfactory results. Through the common care model of Chinese and Western medicine, on the one hand, it reduces the cost of medical care, on the other hand, it allows Chinese and Western medicine to understand each other and balance the strengths and weakness, and to make TCM more effective treatment under the modern medical system. For these reasons, the Department of Traditional Chinese Medicine and Neurology of the Changhua Christian Hospital try to provide a better care model for patients with dementia by integrated Chinese and Western medicine treatment. According to the previous experience of daytime dementia care by the Department of Traditional Chinese Medicine(TCM) of Changhua Christian Hospital, to implement the complete care of Chinese medicine for dementia, Detailed contents of this study include setting up related medical, pharmaceutical, nursing cooperation mode, evaluating medical cost, analysis of tongue diagnosis, pulse diagnosis, heart rate variability, etc., combined with the dementia assessment scale for clinical efficacy monitoring, as a medical quality assessment, complete the analysis of the efficacy of Chinese medicine for dementia patients. However,this study is based on the daytime care for dementia performed by the Department of TCM of Changhua Christian Hospital, and can be used as a policy recommendation for the future mode of care of Chinese and Western medicine. Moreover, the daytime care plan for dementia has been published in stages, this experience will be the model of the complete care of Chinese medicine for dementia. Results & Discussion: This study found that non-invasive treatments such as laser acupuncture (Head acupoint stimulation) along with Chinese Medicine recreational activities and sitting Tai-Chi would be more acceptable by the cases compared with traditional acupuncture. In conclusion, head acupoint stimulation can improve cognitive function, Chinese Medicine recreational activities can strengthen the recognition of things and hand to eyes coordination, and sitting Tai-Chi can improve the physical movements of the case. According to the statistical analysis of the CASI Scale for Cognitive Dysfunction, its total scores did not reach statistically significant differences, but the short-term memory aspect was significantly improved (p=0.013), especially in the non-disabled people with dementia (p =0.031), although there is no significant difference in other aspects, its representatives may help dementia cases to delay cognitive function delay. In addition, the GDS-15 depression scale also has a significant improvement (p=0.041), which is more obvious in the non-disabled patients with dementia (p=0.037). |
本系統中英文摘要資訊取自各篇刊載內容。