臺灣博碩士論文加值系統

本前趨研究採單組重複性測量之類實驗研究設計，目的為評值聆聽愉悅熟悉音樂對社區失智症老人進食問題、進食量、營養狀況及體重的成效。共有11位社區失智症老人在家中每天晚餐時間接受經由受訓的主要照顧者提供的愉悅熟悉音樂聆聽措施，每天一小時，連續4週。使用愛丁堡餵食量表(Edinburgh feeding Evaluation in Dementia; EdFED)、迷你營養評估表(Mini Nutritional
Assessment; MNA)及體重計於前測及後測第一、二、三及四週評估失智症老人的進食問題、營養狀況及體重，並由主要照顧者使用自擬的進食記錄表記錄失智老人每天晚餐的進食量。Friedman test分析結果發現失智症老人接受一個月每天晚餐聆聽愉悅熟悉音樂後，進食問題得分顯著地降低(χ2=41.75, p<.001)，表示一個月每天晚餐聆聽愉悅熟悉音樂明顯地改善失智症老人的進食問題。Friedman test分析結果發現失智症老人接受一個月每天晚餐聆聽愉悅熟悉音樂措施後，其營養狀況得(χ2=41.02, p<.001)及體重(χ2 =28.25, p<.001)皆顯著地增加，表示一個月每天晚餐聆聽愉悅熟悉音樂明顯地改善失智症老人的營養狀況及體重。Friedman test結果也顯示失智症老人接受一個月每天晚餐一小時聆聽愉悅熟悉音樂措施，其進食量達統計上顯著差異(χ2=123.4, p<.001)。本研究結果顯示每天晚餐聆聽愉悅熟悉音樂對社區失智症老人進食問題、營養狀況、體重及進食量有顯著的成效。除此之外，失智症老人接受一個月每天晚餐聆聽愉悅熟悉音樂措施後，其主要照顧者前測及第四週後的照顧負荷得分以Wilcoxon signed rank test分析達統計上顯著差異(Z= -2.936 , p= .003)，表示照顧負荷顯著地降低。本前趨性的研究結果將能做為社區護理人員在失智症老人照護之衛教參考，以協助照顧者及家屬處理失智症老人進食問題及營養狀況，進而改善失智症老人的身體心理健康及生活品質，也能協助緩解照顧者的壓力負擔。

The pilot study aimed to evaluate the effect of pleasant familiar music listening on feeding problems, food intake, nutrition condition, and body weight in community-dwelling elders with dementia. This study used a one-group repeated-measures quasi-experimental design. Eleven participants listened to pleasant familiar music via a CD player during dinner time for 1 hour daily for 4 weeks provided by the trained caregiver at home. Feeding problems measured by Edinburgh Feeding Evaluation in Dementia Scale (EdFED Scale), nutrition condition measured by Mini Nutritional Assessment (MNA), and body weight measured by a reliable weighting scale of all participants were assessed at baseline and week 1, 2, 3, and 4, Friedman test result shown that community-dwelling elders with dementia after listening pleasant familiar music during dinner time daily for 4 weeks, had a significant decrease on their feeding problem score (χ2=41.75, p<.001), indicating the one-month daily pleasant familiar music listening intervention during dinner time significantly improved the feeding problems of the community-dwelling elders with dementia. Friedman test result also shown that community-dwelling elders with dementia after listening pleasant familiar music during dinner time daily for 4 weeks, had a significant increase on their nutrition score (χ2=41.02, p<.001) and body weight (χ2=28.25, p<.001), indicating the one-month daily pleasant familiar music listening intervention during dinner time significantly improved the nutrition status and body weight of the community-dwelling elders with dementia. Friedman test result also indicated that after receiving the one-month daily pleasant familiar music listening intervention during dinner time, the elders’ food intake also had a significant increase (χ2=123.4, p<.001)。In addition, after the elders received four weeks of daily pleasant familiar music listening intervention, Wilcoxon signed rank test shown that the caregivers’ caregiving burden score has a significant difference between baseline and post-test at week 4(Z=-2.936, p= .003), indicating that caregivers had a significant reduction on their caregiving burden at week 4. This study result revealed that listened to pleasant familiar music during dinner time for 1 hour daily for 4 weeks provided by the trained caregiver at home can significantly improve the feeding problems, nutrition status, body weight, and food intake of the community-dwelling elders with dementia. This was the first study which evaluated use of pleasant familiar music listening intervention for feeding problems of those with dementia in the community setting. This pilot study results can provide community care nurses useful information in their care for community-dwelling elders with dementia and patient education for those with dementia and their caregivers in dealing with feeding problems and nutrition status in order to improve elders’ physical and mental health and quality of life and to relieve caregivers’ burden.

目錄
致謝………………………………………………………………………………Ⅰ
中文摘要........................................................Ⅱ
英文摘要…………………………………………………………………………Ⅲ
目錄………………………………………………………………………………Ⅳ
圖目錄……………………………………………………………………………Ⅵ
表目錄……………………………………………………………………………Ⅶ
附錄目錄…………………………………………………………………………Ⅷ
第一章 緒論………………………………………………………………………1
第一節 研究背景及現況…………………………………………………………… 1
第二節 研究動機與重要性………………………………………………………… 2
第三節 研究目的…………………………………………………………………… 2
第四節 研究假設…………………………………………………………………… 3
第五節 名詞定義…………………………………………………………………… 3
第六節 總結………………………………………………………………………… 3
第二章 文獻查證…………………………………………………………………… 4
第一節 失智症……………………………………………………………………… 4
第二節 失智症的進食問題及處置………………………………………………… 5
第三節 音樂治療在失智症照護的運用…………………………………………… 8
第四節 總結………………………………………………………………………… 13
弟五節 研究架構…………………………………………………………………… 13
第三章 研究方法…………………………………………………………………… 15
第一節 研究設計…………………………………………………………………… 15
第二節 研究對象及場所…………………………………………………………… 15
第三節 研究工具…………………………………………………………………… 16
第四節 前驅性試驗………………………………………………………………… 18
第五節 正式研究及資料收集……………………………………………………… 19
第六節 主要照顧者資料收集……………………………………………………… 23
第七節 研究對象的權益保護……………………………………………………… 23
第八節 資料處理及分析…………………………………………………………… 24
第四章 研究結果…………………………………………………………………… 25
第一節 失智症老人基本屬性……………………………………………………… 25
第二節 失智症老人聆聽愉悅熟悉音樂對進食問題的成效……………………… 27
第三節 失智症老人聆聽愉悅熟悉音樂對營養狀況的成效……………………… 28
第四節 失智症老人聆聽愉悅熟悉音樂對體重的成效…………………………… 29
第五節 失智症老人聆聽愉悅熟悉音樂對進食量的成效………………………… 30
第六節 主要照顧者資料分析...........................................32
第五章 討論與結論...................................................34
第一節 愉悅熟悉音樂聆聽措施對失智症老人之成效…………………………… 34
第二節 愉悅熟悉音樂聆聽措施訓練對主要照顧者之成效……………………… 36
第三節 研究限制與建議…………………………………………………………… 37
第四節 研究結果的應用…………………………………………………………… 38
第五節論........................................................... 39
參考文獻…………………………………………………………………………… 40

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