臺灣博碩士論文加值系統

研究背景：台灣的失智症人口逐年增加，於「在地老化政策」推動下，
社區式照顧益顯重要。然而，失智症主要照顧者面臨許多照顧困擾，其中睡眠品質深受影響且急待改善之。研究目的：探討社區輕、中度失智症主要家庭照顧者睡眠品質的影響因素，並透過生物回饋監測放鬆技巧在輕、中度失智症主要家庭照顧者的憂鬱與睡眠品質之成效。研究方法：本研究方法分為兩階段，第一階段為橫斷式相關性設計，採立意取樣方式，以大台北地區某醫學中心及區域醫院的神經內科門診，輕中度失智者與其主要照顧者為研究對象，完成配對收案共109位。第二階段採實驗性研究，以隨機分配方式將有睡眠品質不良的主要照顧者分成實驗組（n = 12）及對照組（n = 12）。實驗組接受為期八週計八次之生物回饋監測協助放鬆技巧；對照組接受為期八週三次之一般常規衛教。研究工具：第二版貝氏憂鬱量表（Beck Depression Inventory II, BDI-II）；匹茲堡睡眠品質量表（Pittsburgh Sleep Quality Index, PSQI）；生物回饋（Biofeedback）監測生理健康測量指標（包含：肌電位、皮膚電流反應、指溫、心跳及呼吸）。所有個案進行前測憂鬱情緒、睡眠品質，於第四及第八次進行後測。此外，生理健康測量指標則每次介入皆進行前後測量。研究資料由描述性統計和廣義估計方程式統計分析。研究結果：一、失智症主要照顧者年齡越大、憂鬱情緒越嚴重，其睡眠品質越差（r = .24, p= .01; t= -3.84, p= .00）。二、失智症神經精神症狀愈嚴重者，主要照顧者的照顧困擾（r= .89, p = .00）和憂鬱情緒（r= .22, p= .01）愈嚴重。三、生物回饋監測放鬆技巧可改善憂鬱（B = 5.00; p= .00）、睡眠品質（B = 3.25; p = .00），降低肌電位（B = 2.83; p = .00）、皮膚電流反應（B = 1.78; p= .00）、心跳（B = 4.612; p = .00）、呼吸（B = -1.81; p = .01），並可提昇指溫（B = -0.81; p = .00）。研究建議：一、研究結果呈現，失智症照顧者個人屬性與失智者認知障礙嚴重度對照顧者睡眠品質具影響性，故可作為未來護理照顧指導失智症照顧者及提供弱勢族群照護資源的方針。二、放鬆技巧之成效，可應用於主要照顧者為對象之睡眠品質與憂鬱情緒改善之照顧方案。

Background: There have been increasing numbers of patients with dementia
in Taiwan. The promotion of Aging in place, caring in community has become more important. However, dementia caregivers are facing many distresses, which greatly affect sleep quality and the urgent need to improve.
Objective: The purpose of this study was discussed with relationship between
sleep quality of major family caregivers for patients with mild or
moderate dementia, and to evaluate the effect of the relaxation techniques intervention (RTI) by biofeedback monitor on depression and sleep quality in major family caregivers of dementia patients with mild or moderate stage.
Method: This research method consisted of two phases. First, this exploratory
investigation was conducted using a cross-sectional correlation method. By random sampling, the sample population was selected from neurological outpatient department of a medical center and regional hospital in Taipei city. A total of 109 matched mild or moderate dementia and their major family caregivers were enrolled. A pre-post test experimental design was used in the second phase. Participants were randomly assigned having poor sleep quality caregivers to the experimental group (n = 12) and control group (n = 12). Experimental group received 8 biofeedback-monitor relaxation techniques sessions over a 8-week period, while the control group received 3 standard health education sessions over a 8-week period. The following data were collected: Beck Depression Inventory II (BDI-II), Pittsburgh Sleep Quality Index(PSQI), and biofeedback monitor physical health indicators which including electromyography (EMG), skin conductance (SC), finfer temperature (TEMP), heart rate (HR) ,and respiratory rate (RR). All participants were evaluated for levels of depression, and sleep quality before the training (pretest).The same evaluation was repeated after 4 and 8 weeks (posttest).In addition, all participants were evaluated for physical health indicators before and after each training session. Descriptive analysis and GEE (Generalized Estimating Equations) were used to analyze the data.
Results: 1. Major dementia caregivers were older and higher level severity of
depression, poorer sleep quality.( r = .24, p= .01; t=-3.84, p= .00) 2. Major family caregivers had more distress(r= .89, p = .00) that
associated with higher level severity of neuropsychiatric symptoms and major family caregivers had depression. ( r= .22, p= .01) 3.There was no significantly statistical between the control groups in each variable though it did show a significant immediate effects on improving depression (B = 5.00; p= .00), sleep quality (B = 3.25; p = .00), reducing EMG (B = 2.83; p = .00), SC (B = 1.78; p= .00), HR (B = 4.612; p = .00),and RR (B = -1.81; p = .01), and enhancing TEMP (B = -0.81; p = .00) in cases receiving each biofeedback- monitor relaxation techniques.
Recommendation: 1.The results show that the basic demographics of
dementia caregiver and the level severity of cognitive impairment in dementia, can be used as guidance for nursing care and dementia caregivers, and provided care for vulnerability groups. 2. From the effectiveness of relaxation training techniques of this study, it is suggested to use as care program for depression and sleep quality treatment in major family caregivers of dementia patients.

目 錄
頁 數
致 謝 ……………………………………………………… Ⅰ
中文摘要 ……………………………………………………… Ⅱ
英文摘要 ……………………………………………………… Ⅴ
目 錄 ……………………………………………………… Ⅷ
圖表目次 ……………………………………………………… XII

第一章 緒論
第一節 研究動機及重要性…………………………………… 1
第二節 研究目的……………………………………………… 5
第三節 名詞解釋……………………………………………… 6
第二章 文獻查證
第一節 失智症的特性及照護發展…………………………… 7
第二節 失智症主要照顧者的照顧困擾……………………… 17
第三節 失智症主要照顧者的睡眠障礙特性與睡眠品質…… 20
第四節 影響失智症主要照顧者的睡眠品質的重要因素…… 25
第五節 運用放鬆技巧促進失智症主要照顧者睡眠品質
的方案………………………………………………… 27
第三章 研究方法
第一節 研究架構……………………………………………… 32
第二節 研究假說……………………………………………… 34
第三節 研究設計……………………………………………… 35
第四節 研究對象及場所……………………………………… 37
第五節 研究工具……………………………………………… 40
第六節 介入性措施…………………………………………… 47
第七節 研究步驟……………………………………………… 49
第八節 資料處理與分析……………………………………… 50
第九節 倫理考量……………………………………………… 51
第四章 研究結果
第一節 失智者及主要照顧者個人屬性資料………………… 52
第二節 失智者及主要照顧者睡眠品質現況………………… 60
第三節 智症者神經精神症狀的嚴重度與主要照顧者照
顧困擾、自覺健康狀況、憂鬱和睡睡眠品質之
關係…………………………………………………… 73
第四節 失智者認知障礙嚴重度與主要照顧者照顧困擾
、自覺健康狀況、憂鬱情緒和睡眠品質之關係…… 76
第五節 放鬆技巧介入於失智症主要照顧者憂鬱情緒、
睡眠品質及生理健康指標之關係…………………… 79
第五章 討論
第一節 失智症主要照顧者個人屬性與睡眠品質分析……… 95
第二節 失智者神經精神症狀與主要照顧者照顧困擾、
自覺健康狀況、憂鬱和睡眠品質關係……………… 97
第三節 失智者認知障礙嚴重度與主要照顧者照顧困擾
、自覺健康狀況、憂鬱和睡眠品質關係…………… 98
第四節 放鬆技巧介入於改善失智症主要照顧者憂鬱、
睡眠品質及生理健康測量指標之成效……………… 99
第六章 結論與建議
第一節 結論…………………………………………………… 101
第二節 研究限制……………………………………………… 102
第三節 研究建議……………………………………………… 103
參考資料
中文部分………………………………………………………… 106
英文部分………………………………………………………… 109

附錄
附錄一 失智者及主要家庭照顧者基本屬性問卷…………… 122
附錄二 臨床失智評估量表…………………………………… 124
附錄三 簡易智能測驗………………………………………… 125
附錄四 精神徵象量表使用同意回信………………………… 126
附錄五 巴氏日常生活功能量表……………………………… 127
附錄六 工具性日常生活活動功能量表……………………… 128
附錄七 老人憂鬱量表簡明中文版…………………………… 129
附錄八 第二版貝氏憂鬱量表使用同意書…………………… 130
附錄九 匹茲堡睡眠品質量表使用同意書…………………… 131
附錄十 台北醫學大學人體試驗同意證明書………………… 132
附錄十一 國防醫學院三軍總醫院人體試驗計畫同意函…… 133
附錄十二 臺北醫學大學人體試驗志願……………………… 134
附錄十三 國防醫學院三軍總醫院受訪者同意書…………… 136
附錄十四 國防醫學院三軍總醫院受試者同意書…………… 139

圖表目次
頁 數
圖一 研究架構……………………………………………………… 33
圖二 收案流程圖…………………………………………………… 39
表一 家庭照顧者睡眠品質相關研究與發展……………………… 22
表二 運用生物回饋促進生理（睡眠）和心理健康（憂鬱）
相關研究表…………………………………………………… 30
表三 研究設計……………………………………………………… 36
表四 失智者基本屬性資料………………………………………… 53
表五 失智症主要照顧者基本屬性資料…………………………… 55
表六 實驗組與對照組基本資料比較表…………………………… 58
表七 失智長者各層面睡眠品質分佈……………………………… 62
表八 主要照顧者之睡眠品質量表………………………………… 66
表九 失智症主要照顧者年齡與睡眠品質之相關分……………… 69
表十 失智主要照顧者的性別與睡眠品質之關係………………… 70
表十一 失智者與主要照顧者關係與睡眠品質之檢定…………… 71
表十二 失智症照顧者睡眠品質及憂鬱情緒之相關性分析……… 72
表十三 中文版精神徵象量表得分………………………………… 74
表十四 失智者神經精神症狀嚴重度與主要照顧者照顧困擾
、自覺健康情形、憂鬱與睡眠品質之相關分析………… 75
表十五 失智者認知障礙嚴重度與主要照顧者照顧困擾、憂
鬱和睡眠品質之相關分析………………………………… 77
表十六 失智者認知障礙嚴重度與主要照顧者自覺健康狀況
之相關分析………………………………………………… 78
表十七 實驗組與對照組失智症主要照顧者之憂鬱差異結果…… 80
表十八 實驗組與對照組失智症主要照顧者之睡眠品質總分
及其次量表差異結果……………………………………… 85
表十九 實驗組與對照組主要照顧者之肌電位差異結果………… 90
表二十 實驗組與對照組之皮膚電流反應差異結果……………… 91
表二十一 實驗組與對照組之指溫差異結果……………………… 92
表二十二 實驗組與對照組之心跳差異結果……………………… 93
表二十三 實驗組與對照組主要照顧者之呼吸差異結果………… 94

中文部分
內政部統計處（2007）‧九十七年第三十四週內政統計通報（97年6月底身心障礙者人數統計）‧2008年10月5日，取自http://www .moi.gov.tw/
files/news_file/week9734
王慶福、王郁茗、石芬芬（2000）‧生理回饋訓練對大一新生焦慮反應傾向之影響效果‧中山醫學雜誌，11，107－116。
王慶福、游顯妹、王郁茗、何應瑞、曾淑梅（2007）‧配合生理回饋之放鬆訓練對重症加護病房護理人員焦慮反應之影響效果研究‧中山醫學雜誌，18，241－253。
王慶福、鍾麗珍、王郁茗、何應瑞、賴德仁（2007）‧生理回饋訓練與放鬆訓練對大學生焦慮與憂鬱反應之影響效果‧中山醫學雜誌，18，255－270。
吳淑瓊、莊坤洋（2001）‧在地老化：台灣二十一世紀長期照護的政策方向‧臺灣公共衛生雜誌，20（3），192-201。
李明濱、李宇宙（1996）‧精神官能症之行為治療‧台北：健康。
李淑霞、吳淑瓊（1998）‧家庭照顧者負荷與憂鬱之影響因素‧護理研究，6（1），57-67。
周美鵑、楊淵韓、劉景寬（2007）‧智能狀態檢查‧Acta Neurologica Taiwanica，16（1），41-49。
林俊宏、林冠成、許家榮、蔡中平、楊國強、馮木蘭（1990）‧生物回饋‧師大體育，30，16-24。
林婉婷、林麗嬋（2004）‧失智症患者躁動行為評估之問題-北部某一機構為例‧長期照護雜誌，8（4），451-466。
邱啟潤、許淑敏、吳瓊滿（2002）‧主要照顧者負荷、壓力與因之國內研究文獻回顧‧醫護科技學刊，4（4），273-290。
邱逸榛、黃舒萱、徐亞瑛（2004）‧阿茲海默氏症患者照顧者之疲憊、負荷、憂鬱之間的關係‧長期照護雜誌，7（4），338-351。
邱麗蓉、謝佳容、蔡欣玲（2007）‧失智老人家屬照顧者壓力源、評價、因應與健康狀況之探討‧長期照護雜誌，2（2），31－44。
張鈺姍、鍾素英、簡政軒、劉景寬、陳明招（2004）‧輕、中度阿茲海默型失智症非認知症狀之相關因素‧臺灣精神醫學，18（1），19－29。
郭乃文、劉秀枝、王珮芳、徐道昌（1989）‧中文版「簡短式智能評估」（MMSE）之簡介‧臨床醫學月刊，23（1），39－42。
陳心怡（2000）‧貝克憂鬱量表第二版指導手冊‧台北：中國行為科學社。
陳國威（1992）‧生物回饋與慢性疼痛控制‧當代醫學，19（3），70－72。
陳達夫、邱銘章、湯麗玉、林忠蔚、史宛玉、陳榮基（2006）•臺灣長期照護機構失智症患者之盛行率調查之摘要‧臺灣失智症協會會訊，9，6－7。
曾令儀、李引玉（1999）。放鬆治療在護理上的應用‧護理雜誌，46（5），68－74。
湯麗玉、毛家聆、周照芳、陳榮基、劉秀枝（1992）‧癡呆老人照顧者的負荷及其相關因素之探討‧護理雜誌，39（3），89－98。
黃正平（2006）‧失智症之行為精神症狀‧臺灣精神醫學，20（1），3－18。
黃惠玲、徐亞瑛、黃秀梨、陳獻宗（2008）‧失智症照顧服務之可行模式‧研考雙月刊，32（6），22－33。
雷啟文、林旭龍（2003）‧中年婦女身體活動與睡眠品質之相關研究‧衛生教育學報，20，151－169。
廖妙淯、侯承伯、蔡宏明、廖益聖‧（2007）‧阿茲海默氏症的危險因子、早期診斷及治療新進展‧當代醫學，34（4），302－308。
劉秀枝（2001）‧當父母變老：關心失智症關心中風及其他神經疾病‧台北：天下。
劉景寬、戴志遠、林瑞泰、賴秋蓮（2000）‧台灣失智症的流行病學‧應用心理研究，7，157－169。
潘璦琬、許瑋玲（2008）‧羅序模式檢定貝氏憂鬱量表第二版之建構效度‧台灣醫學，12，284－91。
鄧世雄（2004）‧失智症社區照顧服務‧社區發展季刊，106，237－244。
謝文順（2001）‧身體活動與睡眠品質的關係‧中華體育，14（4），97－106。
謝昌成、劉昱志、劉鎮嘉（2007）‧失智症的行為及精神症狀處理‧基層醫學，22（4），116－122。
蘇麗瓊、黃雅鈴（2005）‧老人福利政策再出發－推動在地老化政策‧社區發展季刊，110，5－13。

英文部分
Almberg, B., Jansson, W., Grafstrom, M., & Winblad, B. (1998). Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non-caregivers of non-demented elderly people. Journal of Advanced Nursing, 28(4), 849-858.
Alzheimer’s Australia. (2008) Dementia Facts & Statistics. Retrieved January 11, 2009, from http://www.alzheimers.org.au/upload
Alzheimer’s Disease International. (2007, Aug 14). Annual Report 2006- 2007, from http://www.alz.co.uk/alzheimers/faq.html#/howmany
Ancoli-Israel, S. (2005). Sleep and aging: prevalence of disturbed sleep and treatment considerations in older adults. The American journal of Geriatric Psychiatry, 66, 24-30.
Anesbensel, C.S., Pearlin, L. I., Mullan, J. T., Zarit, S. H., & Whitlatch, C. J. (1995). Profiles in Caregiving. The Unexpected Career. California: Academic.
Annerstedt, L., Elmstahl, S., Ingvad, B., & Samuelsson, S. M. (2000). Family caregiving in dementia--an analysis of the caregiver''s burden and the "breaking-point" when home care becomes inadequate. Scandinavian Journal of Public Health, 28(1), 23-31.
Bain, K. T. (2006). Management of chronic insomnia in elderly persons. The American Journal of Geriatric Pharmacotherapy, 4(2), 168-192.
Benson, H., Beary, J. F., & Carol, M. P. (1974). The relaxation response. Psychiatry, 37(1), 37-46.
Brown, E. (2007). Care recipients'' psychological well-being: the role of sense of control and caregiver type. Aging and Mental Health, 11(4), 405- 414 .
Burns, A., Jacoby, R., & Levy, R. (1990). Psychiatric phenomena in Alzheimer''s disease. IV: Disorders of behaviour. The British Journal of Psychiatry, 157, 86-94.
Buysse, D. J. (2004). Insomnia, depression and aging. Assessing sleep and mood interactions in older adults. Geriatrics, 59(2), 47-51.
Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
Caswell, L. W., Vitaliano, P. P., Croyle, K. L., Scanlan, J. M., Zhang, J., & Daruwala, A. (2003). Negative associations of chronic stress and
cognitive performance in older adult spouse caregivers. Experimental Aging Research, 29(3), 303-318.
Chan, A. C. (1996). Clinical validation of the geriatric depression scale (GDS): Chinese version. Journal of Aging and Health, 8(2), 238-253.
Chapman, D. P., Williams, S. M., Strine, T. W., Anda, R. F., & Moore, M. J. (2006). Dementia and its implications for public health. Preventing Chronic Disease, 3(2), 1-13.
Chen, W. C., Chu, H., Lu, R. B., Chou, Y. H., Chen, C. H., Chang, Y. C., et al. (2009). Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. Journal of Clinical Nursing, 18(15), 2187-2196.
Chiu, L., Shyu, W. C., & Chen, T. R. (1997). A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families. Journal of Advanced Nursing, 26(5), 872-878.
Chiu, L., Shyu, W. C., Liu, Y. H., Wang, S. P., & Chang, T. P. (2001). Factors determining the attitudes of family caregivers of dementia patients toward nursing home placement in Taiwan: comparisons between urban and semiurban areas. Public Health Nursing, 18(4), 281-291.
Chou, K. R., LaMontagne, L. L., & Hepworth, J. T. (1999). Burden experienced by caregivers of relatives with dementia in Taiwan. Nursing Research, 48, 206-214.
Chumbler, N. R., Grimm, J. W., Cody, M., & Beck, C. (2003). Gender, kinship and caregiver burden: the case of community-dwelling memory impaired seniors. International Journal of Geriatric Psychiatry, 18(8), 722-732.
Clark, P. C., & King, K. B. (2003). Comparison of family caregivers. Stroke survivors vs. person with Alzheimer''s disease. Journal of Gerontological Nursing, 29(2), 45-53.
Clyburn, L. D., Stones, M. J., Hadjistavropoulos, T., & Tuokko, H. (2000). Predicting caregiver burden and depression in Alzheimer''s disease. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 55(1), S2-13.
Coen, R. F., O''Boyle, C. A., Coakley, D., & Lawlor, B. A. (2002). Individual quality of life factors distinguishing low-burden and high-burden caregivers of dementia patients. Dementia and Geriatric Cognitive Disorders, 13(3), 164-170.
Creese, J., Bedard, M., Brazil, K., & Chambers, L. (2008). Sleep
disturbances in spousal caregivers of individuals with Alzheimer''s disease. International Psychogeriatrics, 20(1), 149-161.
Cuijpers, P. (2005). Depressive disorders in caregivers of dementia
patients: a systematic review. Aging and Mental Health, 9(4), 325-330.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308-2314.
Davis, L. L., Buckwalter, K., & Burgio, L. D. (1997). Measuring problem behaviors in dementia: developing a methodological agenda. Advances in Nursing Science, 20(1), 40-55.
Deutsch, L. H., Bylsma, F. W., Rovner, B. W., Steele, C., & Folstein, M. F.
(1991). Psychosis and physical aggression in probable Alzheimer''s disease. The American Journal of Psychiatry, 148(9), 1159-1163.
Dunkin, J. J., & Anderson-Hanley, C. (1998). Dementia caregiver burden: a
review of the literature and guidelines for assessment and intervention. Neurology, 51(1 Suppl 1), S53-60; discussion S65-57.
Eloniemi-Sulkava, U., Notkola, I. L., Hentinen, M., Kivela, S. L., Sivenius, J., & Sulkava, R. (2001). Effects of supporting community-living demented patients and their caregivers: a randomized trial. Journal of the American Geriatrics Society, 49(10), 1282-1287.
Fillenbaum, G. G. (1985). Screening the elderly. A brief instrumental activities of daily living measure. Journal of the American Geriatrics Society, 33(10), 698-706.
Foley, D. J., Monjan, A. A., Brown, S. L., Simonsick, E. M., Wallace, R. B., & Blazer, D. G. (1995). Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep, 18(6), 425-432.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198.
Freedman, R., & Papsdorf, J. D. (1976). Biofeedback and progressive relaxation treatment of sleep-onset insomnia: a controlled, all-night investigation. Biofeedback and Self-regulation, 1(3), 253-271.
Fuh, J. L. (2006). Study of behavioral and psychological symptoms of dementia in Taiwan. Acta Neurologica Taiwanica, 15(3), 154-160.
Fuh, J. L., Liu, C. K., Mega, M. S., Wang, S. J., & Cummings, J. L. (2001). Behavioral disorders and caregivers'' reaction in Taiwanese patients with Alzheimer''s disease. International Psychogeriatrics, 13(1), 121-128.
Gallicchio, L., Siddiqi, N., Langenberg, P., & Baumgarten, M. (2002). Gender differences in burden and depression among informal caregivers of demented elders in the community. International Journal of Geriatric Psychiatry, 17(2), 154-163.
George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: a multidimensional examination of family caregivers of demented adults. Gerontologist, 26(3), 253-259.
Gerdner, L. A., Buckwalter, K. C., & Reed, D. (2002). Impact of a psychoeducational intervention on caregiver response to behavioral problems. Nursing Research, 51(6), 363-374.
Gilley, D. W., Whalen, M. E., Wilson, R. S., & Bennett, D. A. (1991). Hallucinations and associated factors in Alzheimer''s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 3(4), 371-376.
Glass, J., Lanctot, K. L., Herrmann, N., Sproule, B. A., & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. British Medical Journal, 331(7526), 1169.
Gort, A. M., Mingot, M., Gomez, X., Soler, T., Torres, G., Sacristan, O., et al. (2007). Use of the Zarit scale for assessing caregiver burden and collapse in caregiving at home in dementias. International Journal of Geriatric Psychiatry, 22(10), 957-962.
Gunning, M. J., & Espie, C. A. (2003). Psychological treatment of reported sleep disorder in adults with intellectual disability using a multiple baseline design. Journal of intellectual disability research, 47(3), 191-202.
Hamel, M., Gold, D. P., Andres, D., Reis, M., Dastoor, D., Grauer, H., et al.
(1990). Predictors and consequences of aggressive behavior by community-based dementia patients. Gerontologist, 30(2), 206-211.
Harmat, L., Takacs, J., & Bodizs, R. (2008). Music improves sleep quality in
students. Journal of advanced nursing, 62(3), 327-335.
Henderson, S. (1998). Epidemiology of dementia. Annales de Medecine Interne, 149(4), 181-186.
Hershko, E., Tauber, C., & Carmeli, E. (2008). Biofeedback versus physiotherapy in patients with partial weight-bearing. American Journal of Orthopedics, 37(5), 92-96.
Hill, J. W., Futterman, R., Duttagupta, S., Mastey, V., Lloyd, J. R., & Fillit, H. (2002). Alzheimer''s disease and related dementias increase costs of comorbidities in managed Medicare. Neurology, 58(1), 62-70.
Hope, T., Keene, J., Gedling, K., Fairburn, C. G., & Jacoby, R. (1998). Predictors of institutionalization for people with dementia living at home with a carer. International Journal of Geriatric Psychiatry, 13(10), 682-690.
Hosaka, T., & Sugiyama, Y. (1999). A structured intervention for family caregivers of dementia patients: a pilot study. The Tokai Journal of Experimental and Clinical Medicine, 24(1), 35-39.
Hosaka, T., & Sugiyama, Y. (2003). Structured intervention in family caregivers of the demented elderly and changes in their immune function. Psychiatry and Clinical Neurosciences, 57(2), 147-151.
Hsueh, I. P., Lee, M. M., Hsieh, C. L.(2001). The psychometric characteristics of the Barthel ADL index in patients with stroke. Journal of the Formosan Medical Association, 100, 526-532.
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A., & Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British journal of Psychiatry, 140, 566-572.
Jacobs, P., & McDermott, S. (1989). Family caregiver costs of chronically ill and handicapped children: method and literature review. Public Health Reports, 104(2), 158-163.
Jonsson, L., Eriksdotter Jonhagen, M., Kilander, L., Soininen, H., Hallikainen, M., Waldemar, G., et al. (2006). Determinants of costs of care for patients with Alzheimer''s disease. International Journal of Geriatric Psychiatry, 21(5), 449-459.
Jonsson, L., Jonsson, B., Wimo, A., Whitehouse, P., & Winblad, B. (2000). Second International Pharmacoeconomic Conference on Alzheimer'' s Disease. Alzheimer Disease and Associated Disorders, 14(3), 137-140.
Kim, S. D., & Kim, H. S. (2005). Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nursing, 28(1), 79-83.
Krach, P., & Brooks, J. A. (1995). Identifying the responsibilities & needs of working adults who are primary caregivers. Journal of Gerontological Nursing, 21(10), 41-50.
Kuzu, N., Beser, N., Zencir, M., Sahiner, T., Nesrin, E., Ahmet, E., et al. (2005). Effects of a comprehensive educational program on quality of life and emotional issues of dementia patient caregivers. Geriatric Nursing, 26(6), 378-386.
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179-186.
Lenze, E. J., Mulsant, B. H., Shear, M. K., Houck, P., & Reynolds, I. C. (2002). Anxiety symptoms in elderly patients with depression: what is the best approach to treatment? Drugs Aging, 19(10), 753-760.
Mahoney F. I. & Barthel D. W. (1965). Functional evaluation: the Barthel index. Maryland State Medical Journal, 14(2), 61-65.
Mahoney, E. K., Trudeau, S. A., Penyack, S. E., & MacLeod, C. E. (2006). Challenges to intervention implementation: lessons learned in the Bathing Persons with Alzheimer''s Disease at Home study. Nursing Research, 55, 10-16.
Malphurs, J. E., & Cohen, D. (2005). A statewide case-control study of spousal homicide-suicide in older persons. The American Journal of Geriatric Psychiatry, 13(3), 211-217.
Manjunath, N. K., & Telles, S. (2005). Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. The Indian Journal of Medical Research, 121(5), 683-690.
Mausbach, B. T., Patterson, T. L., Von Känel, R., Mills, P. J., Dimsdale, J. E., Ancoli-Israel, S., et al. (2007). The attenuating effect of personal mastery on the relations between stress and Alzheimer caregiver health: A five-year longitudinal analysis. Aging and Mental Health, 11(6), 637-644.
McCurry, S. M., & Teri, L. (1995). Sleep disturbance in elderly caregivers of dementia patients. Clinical Gerontologist, 16(2), 51-65.
McCurry, S. M., Gibbons, L. E., Logsdon, R. G., Vitiello, M., & Teri, L. (2003). Training caregivers to change the sleep hygiene practices of patients with dementia: the NITE-AD project. Journal of the American Geriatrics Society, 51(10), 1455-1460.
McCurry, S. M., Logsdon, R. G., Teri, L., & Vitiello, M. V. (2007). Sleep disturbances in caregivers of persons with dementia: contributing factors and treatment implications. Sleep Medicine Reviews, 11(2), 143-153.
McCurry, S. M., Logsdon, R. G., Vitiello, M. V., & Teri, L. (1998). Successful behavioral treatment for reported sleep problems in elderly caregivers of dementia patients: a controlled study. The Journals of Gerontology, 53(2), P122-129.
McCurry, S. M., Vitiello, M. V., Gibbons, L. E., Logsdon, R. G., & Teri, L. (2006). Factors associated with caregiver reports of sleep disturbances in persons with dementia. The American Journal of Geriatric Psychiatry, 14(2), 112-120.
McDowell, J. A., Mion, L. C., Lydon, T. J., & Inouye, S. K. (1998). A nonpharmacologic sleep protocol for hospitalized older patients. Journal of the American Geriatrics Society, 46(6), 700-705.
McKibbin, C. L., Ancoli-Israel, S., Dimsdale, J., Archuleta, C., von Kanel, R., Mills, P., et al. (2005). Sleep in spousal caregivers of people with Alzheimer''s disease. Sleep, 28(10), 1245-1250.
Means, M. K., Lichstein, K. L., Epperson, M. T., & Johnson, C. T. (2000). Relaxation therapy for insomnia: Nighttime and day time effects. Behaviour Research and Therapy, 38(7), 665-678.
Mendelson, W. B. (2005). A review of the evidence for the efficacy and safety of trazodone in insomnia. The Journal of Clinical Psychiatry, 66(4), 469-476.
Middelkoop, H. A., Smilde-van den Doel, D. A., Neven, A. K., Kamphuisen, H. A., & Springer, C. P. (1996). Subjective sleep characteristics of 1,485 males and females aged 50-93: effects of sex and age, and factors related to self-evaluated quality of sleep. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 51(3), 108-115.
Willette-Murphy, K., Todero, C., & Yeaworth, R. (2006). Mental health and sleep of older wife caregivers for spouses with Alzheimer''s disease and related disorders. Issues in Mental Health Nursing, 27, 837-852.
Mitty, E., & Flores, S. (2008). Aging in place and negotiated risk agreements. Geriatric Nursing, 29(2), 94-101.
Morris, C. H., Hope, R. A., & Fairburn, C. G. (1989). Eating habits in dementia. A descriptive study. The British Journal of Psychiatry, 154, 801-806.
Moura, V. L. (2005). Mind-body skills group experience: a case report. Explore, 1(6), 459-463.
Neundorfer, M. M., McClendon, M. J., Smyth, K. A., Stuckey, J. C., Strauss, M. E., & Patterson, M. B. (2001). A longitudinal study of the relationship between levels of depression among persons with Alzheimer''s disease and levels of depression among their family caregivers. The Journals of Gerontology, 56(5), 301-313.
O''Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellows, J. L., Miller, N. D., Brook, C. P., et al. (1989). The reliability and validity of the Mini-Mental State in a British community survey. Journal of Psychiatric Research, 23(1), 87-96.
Onishi, J., Suzuki, Y., Umegaki, H., Nakamura, A., Endo, H., & Iguchi, A. (2005). Influence of behavioral and psychological symptoms of dementia (BPSD) and environment of care on caregivers'' burden. Archives of Gerontology and Geriatrics, 41(2), 159-168.
Pang, F. C., Chow, T. W., Cummings, J. L., Leung, V. P., Chiu, H. F., Lam, L. C., et al. (2002). Effect of neuropsychiatric symptoms of Alzheimer''s disease on Chinese and American caregivers. International Journal of Geriatric Psychiatry, 17(1), 29-34.
Payne, J. L., Lyketsos, C. G., Steele, C., Baker, L., Galik, E., Kopunek, S., et al. (1998). Relationship of cognitive and functional impairment to depressive features in Alzheimer''s disease and other dementias. The Journal of Neuropsychiatry and Clinical Neurosciences, 10(4), 440-447.
Payne, R. A. (2000). Relaxation Techniques: A Preactical Handbook for the Health Care Professional (2nd ed.). NY: Churchill Livingstone.
Prasher, V. P., & Filer, A. (1995). Behavioural disturbance in people with Down''s syndrome and dementia. Journal of Intellectual Disability Research, 39 (5), 432-436.
Pruchno, R. A., & Potashnik, S. L. (1989). Caregiving spouses. Physical and mental health in perspective. Journal of the American Geriatrics Society, 37(8), 697-705.
Reiner, R. (2008). Integrating a portable biofeedback device into clinical practice for patients with anxiety disorders: Results of a pilot study. Applied Psychophysiology Biofeedback, 33 (1), 55-61.
Schulz, R., Boerner, K., Shear, K., Zhang, S., & Gitlin, L. N. (2006). Predictors of complicated grief among dementia caregivers: a prospective study of bereavement. The American Journal of Geriatric Psychiatry, 14(8), 650-658.
Schulz, R., O''Brien, A. T., Bookwala, J., & Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist, 35(6), 771-791.
Sheikh, V. I., & Yesavage, V. A. (1986). Geriatric depression scale (GDS): Recent evidence and development of a shorter version. (Eds.), Clinical gerontology: A guide to assessment and intervention (2nd ed., pp. 165-174). New York: Haworth Press.
Skillet, S. (2005). A caregiver''s perspective: the family''s life is changed forever. International Journal of Clinical Practice. Supplement, 146, 15-16.
Sloman, R. (1995). Relaxation and the relief of cancer pain. Nursing Clinics of North America, 30(4), 697- 709.
Soares, C. N. (2005). Insomnia in women: an overlooked epidemic? Archives of Women''s Mental Health, 8(4), 205-213.
Spruytte, N., Van Audenhove, C., & Lammertyn, F. (2001). Predictors of institutionalization of cognitively-impaired elderly cared for by their relatives. International Journal of Geriatric Psychiatry, 16(12), 1119-1128.
Srikanth, S., Nagaraja, A. V., & Ratnavalli, E. (2005). Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer''s disease, vascular dementia and frontotemporal dementia. Journal of the Neurological Sciences, 236(1-2), 43-48.
Stommel, M., Given, C. W., & Given, B. A. (1993). The cost of cancer home care to families. Cancer, 71(5), 1867-1874.
Stride, N. M. (1988). An investigation of the dependence of severely disabled people in a hospital. Journal of Advanced Nursing, 13(5), 556-564.
Tractenberg, R. E., Singer, C. M., Cummings, J. L., & Thal, L. J. (2003). The Sleep Disorders Inventory: an instrument for studies of sleep disturbance in persons with Alzheimer''s disease. Journal of Sleep Research, 12(4), 331-337.
Tsai, P. S., Wang, S. Y., Wang, M. Y., Su, C. T., Yang, T. T., Huang, C. J., et al. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943-1952.
United Nations.(2008, November 12). The State of World Population 2008. Retrieved January 10, 2009, from http://www.unfpa.org/swp/ - 17k
Vitaliano, P. P., Russo, J., Young, H. M., Teri, L., & Maiuro, R. D. (1991). Predictors of burden in spouse caregivers of individuals with Alzheimer''s disease. Psychology and Aging, 6(3), 392-402.
Vitiello, M. V., Larsen, L. H., & Moe, K. E. (2004). Age-related sleep change: Gender and estrogen effects on the subjective-objective sleep quality relationships of healthy, noncomplaining older men and women. Journal of Psychosomatic Research, 56(5), 503-510.
Vitiello, M. V., Moe, K. E., & Prinz, P. N. (2002). Sleep complaints cosegregate with illness in older adults: clinical research informed by and informing epidemiological studies of sleep. Journal of Psychosomatic Research, 53(1), 555-559.
Vuori, I., Urponen, H., Hasan, J., & Partinen, M. (1988). Epidemiology of exercise effects on sleep. Acta physiologica Scandinavica. Supplementum, 574, 3-7.
Walker, R. J., & Pomeroy, E. C. (1996). Depression or grief? The experience of caregivers of people with dementia. Health and Social Work, 21(4), 247-254.
Wilcox, S., & King, A. C. (1999). Sleep complaints in older women who are family caregivers. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 54(3) , 189-198.
Wilson, R. S., McCann, J. J., Li, Y., Aggarwal, N. T., Gilley, D. W., & Evans, D. A. (2007). Nursing home placement, day care use, and cognitive decline in Alzheimer''s disease. The American Journal of Psychiatry, 164(6), 910-915.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., et al. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49.