265 運用運動訓練維持失智老人如廁功能之探討 陳昱合張素嫺 * 方妙君 ** 蔡美利 *** 無法自行如廁被視為失智老人日常生活活動功能邁入嚴重依賴的關鍵之一 然而目前缺乏一個以理論為基礎的照護措施來維持或促進老人如廁功能, 繼而延緩依賴程度 運動訓練介入後, 對失智老人如廁行為能力之探討 運動介入措施設計是以 Bandura 的社會認知理論為基礎, 執行為期 8 週的步行及下肢負重運動訓練 本研究採單組 重複測試研究設計, 研究對象為 26 位失智症接受日托照顧的老人 於運動訓練介入前 介入後第四週 及第八週檢測其體適能, 與如廁能力的變化 研究結果顯示體適能及如廁功能雖有變化, 但無統計上顯著意義 如廁功能雖無顯著變化, 也未見退步, 如廁能力因運動訓練的介入, 仍保有某種程度的獨立功能 建議未來的研究, 宜採實驗性 長期追蹤性研究設計, 較能呈現本運動計畫之顯著效益 關鍵詞 : 如廁功能 失智老人 運動計畫 65 2 4% 2000 Chen et al., 2007 200690 Carpenter, Hastie, Morris, Fries, & Ankri, 2006 Global Deterioration Scale Miller, 1999/2003 Sifton 2000 * ** *** 98 7 3 98 9 15 98 9 21 71703 89 06 2674567 511 5 卷 4 期 中華民國 98 年 12 月
266 Exercise to Maintain Toileting McFarland & McFarland, 1997/1999 Jagger, Arthur, Spier, & Clarke, 2001 2007 14 Littbrand 2006 47 44 13 MMSE 10 McFarland & McFarland, 1997/1999 Rikli Jones 1997 the functional ability framework Rikli & Jones, 1999 Rikli & Jones, 1999 2003 Brach, Simonsick, Kritchevsky, Yaffe, & Newman, 2004; Rikli & Jones, 1999 Brach2004 70 79 20 30 70 Phelan, Williams, Penninx, LoGerfo, & Leveille, 2004 16 2005 3 20 30 2004 Sifton, 2000 2003 Teri, Logsdon, & McCurry, 2008 Resnick, 2001 Albert Bandura self-efficacy Bandura, 1997 Bandura 1997 performance accomplishmentsverbal persuasionvicarious experiences Physiological states 60 5 卷 4 期 中華民國 98 年 12 月
267 ㈠ 1. 0.5 1 1.5 2 Kg 315 2. 515 3. 3 15 ㈡ 1. 2. 3. ㈠ ㈡ 1. 30 2.8 8 3. 4. 5. ㈢ Refined ADL Assessment Scale Tappen 5.89.96 Tappen, 1994 Chang, Wung, & Crogan, 2008 2 9 12 0 1 6 0 54 0 720 126 3 SPSS for Windows 13 t analysis of covariance, ANCOVA 5 卷 4 期 中華民國 98 年 12 月
268 Exercise to Maintain Toileting N = 26 29 26 75.2 ± 5.8 1 25 11 6 1 22.2 ± 14.9 8 p >.05 80.6 20.5 4 818.9 18.0 8 11.5 9.0 4 0.8 8 1.4 % 8 30.8 18 69.2 1 3.8 14 53.8 11 42.3 5 19.2 13 50.0 5 19.2 2 7.7 1 3.8 20 76.9 1 3.8 5 19.2 26 100 0 0 8 N = 26 M ± SD 4 8 F 6.8 ± 13.4 4.8 ± 6.4 4.2 ± 4.8.616 6.5 ± 13.4 6.3 ± 11.9 5.4 ± 6.8.078 8.7 ± 5.2 8.7 ± 4.4 9.3 ± 4.4.134 20.5 ± 11.8 18.9 ± 7.7 18.0 ± 7.3.488 137.7 ± 26.8 141.5 ± 32.3 146.7 ± 29.6.608 140.4 ± 24.6 149.0 ± 25.8 151.9 ± 25.9 1.451 12.4 ± 10.3 13.2 ± 11.2 11.0 ± 10.6.285 5 卷 4 期 中華民國 98 年 12 月
269 N = 26 M ± SD 4 8 F 52.0 ± 5.6 53.5 ± 1.6 52.5 ± 4.2 68.7 ± 7.5 70.7 ± 2.8 69.2 ± 5.3 120.7 ± 13.2 124.2 ± 4.4 119.7 ± 13.5 1.181 2007 2007 8.7/11.8/12.7 20.50/11.35/8.50 2004 Marzilli Schuler Willhoit Stepp 2004 Stevens Killeen 2006 12 Netz Axelrad Argov 2007 2210 12 MacRae 1996 Taylor 2003 Taylor MacRae 5 30 12 22 Shimada Uchiyama 2003 10 12 25 3 10 6 Mangione et al., 1999 8 8 2006 18 5 39 48 5 卷 4 期 中華民國 98 年 12 月
270 Exercise to Maintain Toileting 2004 2007 6 5 81 91 2007 3 3 205 214 2003 7 3 364 374 2005 24 2 93 102 2000 7 157 169 2003 2004 8 3 300 310 McFarland, G. K., & McFarland, E. A. 1999 1997 Miller, C. A. 2003 399 432 1999 Bandura, A. (1997). Self-efficacy: The efficacy of control (2nd ed.). New York: W. H. Freeman and Company. Brach, J. S., Simonsick, E. M., Kritchevsky, S., Yaffe, K., & Newman, A. B. (2004). The association between physical function and lifestyle activity and exercise in the health, aging, and body composition study. Journal of the American Geriatrics Society, 52(4), 502 509. Carpenter, G. I., Hastie, C. L., Morris, J. N., Fries, B. E., & Ankri, J. (2006). Measuring changes in activities of daily living in nursing home residents with moderate to severe cognitive impairment. BMC Geriatrics, 6(7), 1 8. Chang, S. H., Wung, S. F., & Crogan, N. L. (2008). Improving activities of daily living for nursing home elder persons in Taiwan. Nursing Research, 57(3), 197 198. Chen, T. F., Chiu, M. J., Tang, L. Y., Chiu, Y. H., Chang, S. F., Su, C. L., et al. (2007). Institution type-dependent high prevalence of dementia in long-term care units. Neuroepidemiology, 28(3), 142 149. Jagger, C., Arthur, A. J., Spier, N. A., & Clarke, M. (2001). Patterns of onset of disability in activities of daily living with age. Journal of American Geriatric Society, 49(4), 404 409. Littbrand, H., Rosendahl, E., Lindelof, N., Lundin-Olsson, L., Gustafson, Y., & Nyberg, L.(2006). A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: Evaluation of the applicability with focus on cognitive function. Physical Therapy, 86(4), 489 498. MacRae, P. G., Asplund, L. A., Schnelle, J. F., Ouslander, J. G., Abrahamse A, & Morris, C. (1996). A walking program for nursing home residents: Effects on walk endurance, physical activity, mobility, and quality of life. Journal of American Geriatric Society, 44(2), 175 180. Mangione, K. K., McCully, K., Gloviak, A., Lefebvre, I., Hofmann, M. & Craik, R. (1999). The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54(4), M184 M190. Marzilli,T. S., Schuler, P. B., Willhoit, K. F., & Stepp, M. F. (2004). Effect of a community-based strength and flexibility program on performance-based measures of physical fitness in older African-American adults. Californian Journal of Health Promotion, 2(3), 92 98. Netz, Y., Axelrad, S., & Argov, E. (2007). Group physical activity for demented older adults-feasiblity and effectiveness. Clinical Rehabilitation, 21(11), 977 986. Phelan, E. A., Williams, B., Penninx, B. W. J. H., LoGerfo, J. P., & Leveille, S. G. (2004). Activities of daily living function and disability in older adults in randomized trail of the health enhancement program. Journal of Gerontology, 59A(8), 838 843. Resnick, B. (2001). Testing a model of exercise behavior in older adults. Research in Nursing & Health, 24(2), 83 92. Rikli, R. E., & Jones, C. J. (1999). Development and validation of a functional fitness test for community-residing older adults. Journal of Aging and Physical Activity, 7, 129 161. 5 卷 4 期 中華民國 98 年 12 月
271 Shimada, H., & Uchiyama, Y. (2003). Specific effects of balance and gait exercises on physical function among the frail elderly. Clinical Rehabilitation, 17(5), 472 479. Sifton, C. B. (2000). Well-being and doing: Enabling occupation with persons with dementia. Alzheimer s Care Quarterly, 1(2), 7 28. Stevens, J., & Killeen, M. (2006). A randomized controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia. Contemporary Nurse, 21(1), 32 40. Taylor, L., Whittington, F., Hollingsworth, C., King, S., Patterson, V., Diwan, S., et al. (2003). Assessing the effectiveness of a walking program on physical function of residents living in an assisted living facility. Journal of Community Health Nursing, 20(1), 15 26. Tappen, R. M. (1994). Development of the refined ADL Assessment Scale for patients with Alzheimer s and related disorders. Journal of Gerontological Nursing, 20(6), 36 42. Teri, L., Logsdon, R. G., & McCurry, S. M. (2008). Exercise interventions for dementia and cognitive impairment: The Seattle Protocols. Journal of Nutrition Health Aging, 12(6), 391 394. 5 卷 4 期 中華民國 98 年 12 月
272 Exercise to Maintain Toileting Maintaining Toileting Activities in Dementia Elders: The Efficacy of Applying an Exercise Program Yo-Ho Chen Su-Hsien Chang * Miao-Chun Fang ** Mei-Li Tsai *** ABSTRACT Background: Toileting disabilities may be a signal of declining ability to perform activities of daily living (ADLs) in the elderly with dementia. Few studies have been conducted on the effectiveness of applying theory-based caring models to maintaining or improving toileting abilities, which can delay the progress of ADL dependency. Purpose: This study was designed to examine the effectiveness in maintaining / improving toileting behaviors of an exercise program administered to elders with dementia in Taiwan. Methods: The exercise program was designed based on Bandura s Social Cognitive Theory. The program included walking and lower extremities weight training. The study employed a single study group, repeated measure research design. Twenty-six elderly individuals with dementia were recruited from a single daycare center. Data were obtained at three time points (baseline, 1-month post-intervention, and 2-months post-intervention). Results: While results showed slight changes in physical fitness scores and toileting activity, neither were statistically significant. Conclusions / Implication for Practice: Although the self-toileting abilities of participants did not improve after receiving the regular exercise training program, their toileting activity performance did not decline further. Further research using experimental and longitudinal research designs are suggested to further understand the practical potential of such targeted exercise programs. Key Words: toileting, dementia elders, exercise program. RN, BSN, Assistant Teacher, Department of Nursing, Chung Hwa University of Medical Technology; *RN, PhD, Assistant Professor, Department of Eldercare, National Tainan Institute of Nursing; **RN, MSN, Instructor, Department of Nursing, Chung Hwa University of Medical Technology; ***RN, BSN, Graduate Student, Graduate Institute of Biological Science and Technology, Chung Hwa University of Medical Technology & Assistant Teacher, Department of Nursing, Chung Hwa University of Medical Technology. Received: July 3, 2009 Revised: September 15, 2009 Accepted: September 21, 2009 Address correspondence to: Miao-Chun Fang, No. 89, Wenhwa 1st St., Rende Township, Tainan County 71703, Taiwan, ROC. Tel: +886 (6) 267-4567 ext. 511; E-mail: ruruodi@yahoo.com.tw 5 卷 4 期 中華民國 98 年 12 月