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系統識別號 U0026-2601201016561400
論文名稱(中文) 阿茲海默氏症老人問題行為相關因素及意義探討
論文名稱(英文) Factors and underlining meanings of problem behaviors of elders with Alzheimer’s disease
校院名稱 成功大學
系所名稱(中) 老年學研究所
系所名稱(英) Institute of Gerontology
學年度 98
學期 1
出版年 99
研究生(中文) 林韋伶
研究生(英文) Wei-Ling Lin
學號 tc696105
學位類別 碩士
語文別 中文
論文頁數 112頁
口試委員 指導教授-王靜枝
口試委員-白明奇
口試委員-陳麗光
中文關鍵字 失智症  阿茲海默症  失智者溝通  失智者問題行為  需求代償行為模式 
英文關鍵字 Dementia  Alzheimer’s disease  communication  problematic behavior  Need-Driven Dementia-Compromised Behavior (NDB) 
學科別分類
中文摘要 失智症為老年精神疾病最具代表性之一。然而,外界對於失智老人問題行為的看法卻隱藏著許多迷思,加上探討問題行為相關的研究也多以照顧者角色出發,較少以失智老人及其問題行為為中心做深入了解。再則,失智症問題行為狀況會因罹病種類之不同而有不同,因此探討特定問題行為的相關因素及其所代表的背後意義可為以病人為中心之照護的第一步。本研究以失智症中具代表性的阿茲海默氏症患者為主,參酌需求代償行為模式(Need-Driven Dementia-Compromised Behavior;NDB)為基礎架構,探討阿茲海默氏症老人二項常見問題行為藏匿與重複言行的相關因素與背後意義。
本研究採立意取樣,以南部某教學醫院神經內科門診阿茲海默氏症患者家屬及某失智症協會失智家屬為對象,共訪談12位主要照顧者。經個別訪談的方式與家屬個案進行深度訪談,並採質性內容分析方法進行資料分析。於分析主題形成後,並再邀集6位曾參與個別訪談之家屬進行個案檢視,以增加研究之嚴謹度。
研究結果發現患者問題行為中藏匿行為與重覆言語及重覆行為最為常見及干擾家人最甚。其中因重複言語與重複行為研究結果類似,故將之合併稱之為「重複言行」。在藏匿行為的相關因素方面,本研究發現四主題,分別為:疾病本身的生理表徵、自身個性的表露、自身習慣的沿襲、經濟危機感的表達。重覆言行方面的相關因素分別為:疾病本身的生理表徵、生活習慣的沿流襲往、處於缺乏安全感的境遇、誘發注意力的生活狀況、生活重心的單調缺乏等五主題。此兩種問題行為所代表之患者背後需求涵意極為相似,為安全感的企求、抓住與外界連帶、尋獲內心的慰藉等三主題。
雖然兩種問題行為相關因素及需求頗有相似之處,然相同的影響因素卻會因個體的獨特性而有不同的行為表現模式。因此患者過去背景及目前生活情境是了解其行為的基礎,透過對其行為的了解,有助於滿足其需求,減少疾病的標籤化,維持老人應有的自尊,也延緩機構安置的可能性。

關鍵詞:失智症、阿茲海默症、失智者溝通、失智者問題行為、需求代償行為模式。
英文摘要 Dementia is a remarkable gero-psychological disease, and its associated behavior problems re-main mysteriously to non-professional. Although previous researches have explored these behavior problems, most were caregiver-centered with few focused on patient. In addition, problem behaviors vary by types of dementias. Therefore, to explore factors and their underlining meanings of certain problem behaviors can be a first step for pursuing patient-centered care. Two selective frequently presented problem behaviors of Alzheimer’s elders, harboring and repetitive behavior , were studied. The Need-Driven Dementia-Compromised Behavior (NDB) model was referenced.
Purposive sampling was conducted to recruit participants. Family caregivers of
domestic Alzheimer patients from one outpatient clinic and one dementia association in southern Taiwan were invited and totally eleven family caregivers participated in this study. Individual in-deep interview and qualitative content analysis were used. After the formation of themes, six family caregivers who had been individually interviewed were invited to participate in a da-ta-check-up group for the assurance of the accuracy and richness of the data.
The preliminary results of this study showed that harboring, repetitive vocalization and repeti-tive behavior are the most frequent and troublesome behaviors. Since repetitive vocalization and re-petitive behavior are similar, a merged name “repetitive vocalization and behavior” was used. Four associated factors of harboring were found, they are “ manifeastion of the disease per se”, “ reveal of personal characters”, “continuance of personal habits”, and ”expression of economical insecurity”. Five associated factors of repetitive vocalization and behavior were identified, they are “manifesta-tion of the disease per se “, “continuance of habits in daily living”, “circumstances in which security is lacking”, “attention induced situations” and “lack of the focus of live”. The underlining meanings of these two types of behavior are similar, they are: ”desire for security”, “grasp the connect with the external world”, and ”search for the consolation”.
Although findings presenting with certain levels of similarity on the associated factors and and of underlining meanings of the two types of problem behaviors, unique manifestation of each prob-lem behavior may be varied from individual to individual. Therefore, understanding patients’ back-ground characteristics and their present situation will contribute to meeting their needs, reducing the societal label of the disease, maintaining patient self-respect, and decreacing the chance of institu-tionalization.

Key words: Dementia, Alzheimer’s disease, communication, problematic behavior, Need-Driven Dementia-Compromised Behavior (NDB)
論文目次 中文摘要………………………………………………………II
英文摘要………………………………………………………III
誌謝…………………………………………………………… V
目次……………………………………………………………VI
表目錄…………………………………………………………IX
圖目錄…………………………………………………………X
第一章 緒論
第一節 研究動機及重要性…………………………………1
第二節 研究問題……………………………………………3
第三節 名詞解釋……………………………………………4
第二章 文獻回顧
第一節 失智症………………………………………………5
第二節 失智者的溝通………………………………………11
第三節 失智者問題行為……………………………………15
第四節 需求代償行為模式..………………………………24
第三章 研究方法
第一節 研究設計……………………………………………27
第二節 研究對象……………………………………………28
第三節 資料收集方式………………………………………28
第四節 研究工具………………………………………………30
第五節 研究對象之權益維護…………………………………31
第六節 研究方法之嚴謹度……………………………………31
第七節 資料處理及分析方法…………………………………34
第四章 研究結果
第一節 訪談個案及老人基本屬性…………………………36
第二節 研究結果……………………………………………42
第五章 討論
第一節 個案及阿茲海默症患者基本屬性探討……………62
第二節 阿茲海默症老人藏匿及重複言行相關因素………64
第三節 阿茲海默症老人藏匿及重複言行之需求及意涵…73
第六章 結論與建議
第一節 結論…………………………………………………76
第二節 研究限制……………………………………………77
第三節 研究之應用與建議…………………………………77
參考文獻…………………………………………………………79
附錄
附錄一 同意臨床試驗證明書…………………………………93
附錄二 參與研究同意書…………………………………………94
附錄三 家屬及患者基本資料問卷……………………………96
附錄四 失智患者行為評量表…………………………………100
附錄五 深度訪談大綱…………………………………………104
附錄六 焦點團體訪談大綱……………………………………105
附錄七 焦點團體實施記錄表…………………………………106
附錄八 主題命名修改……………………………………………107
附錄九 研究參與者回饋表………………………………………109
附錄十 研究檢證記錄……………………………………………112
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