臺灣博碩士論文加值系統

隨著人類平均壽命日漸增長，人們罹患多重慢性病的機率大增，而罹患多重慢性病再罹患失智症的機率較一般人高，照護多重慢性病的失智症患者所需的照護技巧較高。故本研究以中部某醫學中心之罹患多重慢性病的失智症患者為例，探討罹患多重慢性病的失智症患者所需之照護目標。
本研究收集對象為中部某醫學中心，收案時間為 2020 年 9 月至 2021年 7 月有效多重慢性病失智症患者資料 83 筆。運用關聯規則 Apriori 演算法為多重慢性病的失智症患者找出所需的照護目標，並且主要分成兩部分去探討，第一部分的探討是將 26 項照護目標同時放入演算法的前項及後項，設定最小信賴度 90%，最小支持度 5%，提升度為大於 1，經過篩選後得到17 條關聯規則。第二部分的探討是將 26 項照護目標放入演算法的前項與後項，人口統計變數放入演算法的前項，設定最小信賴度 90%，最小支持度 5%，提升度為大 1，經過篩選後得到 2720 條關聯規則，由於其規則數眾多，較無法歸納其關聯性，因此，本研究針對其支持度大於 10%，共 93條關聯規則進行詳細的整理，並整理出 36 條通則具有高度重複性。
在第一部分的研究結果發現大部分患有多重慢性病的都有社會福利資源需求、認知不足-用藥、記憶問題、預防跌倒照護需求，這四項照護目標，而第二部分加入人口統計變數分析後的研究結果發現除了第一部分所提及的社會福利資源需求、認知不足-用藥、記憶問題、預防跌倒照護需求，這四項照護目標外，還需要增加認知不足-疾病、照顧負荷及心理調適、血壓偏高，這三項照護目標。同時也發現到三項能簡易辨別之特徵，當患者出現以下任一項特徵時：男性或是年齡層位於 65 歲-74 歲或是需輪椅輔助，都需要社會福利資源需求，因此，若醫院遇到符合通則之患者組合時，即可提供照護者基本的四項照護目標，之後再延伸至這七項照護目標，讓患者與照護者得到適切的協助，延緩及減輕患者的病情，且降低照護者壓力，與增進多重慢性病失智症患者之照顧品質。
關鍵詞：多重慢性病、失智症照護、照護目標

As the average human life expectancy increases, the risk of people with multiple chronic diseases increases, and the risk of people living with dementia who already have multiple chronic diseases is higher than that of the ordinal people. The care skills required for patients with dementia who have multiple chronic diseases are higher. In this study, dementia patients with multiple chronic diseases at a medical center in central Taiwan were selected as examples to explore the care needs of dementia patients with multiple chronic diseases.
This study collected 83 valid data of dementia patients with multiple chronic diseases from September 2020 to July 2021 in a medical center in central Taiwan. The Apriori algorithm of association rules was used to find out the care needs for dementia patients with multiple chronic diseases, and the research results were divided into two parts. The first part was to put 26 care needs into antecedent and consequent at the same time by setting up the minimum confidence of 90%, the minimum support of 5%, and lift greater than 1. Seventeen association rules were obtained. In the second part, 26 care needs were put into both antecedent and consequent, whereas the demographic variables were put into antecedent. The minimum confidence was set at 90%, the minimum support was set at 5%, and lift was greater than 1. There were 2720 association rules obtained. Due to the complexity of association rules, only 93 association rules with a support greater than 10% were discussed in this study, and 36 general rules were summarized based on the similarities of rules.
The results of the first part of the study found that most of the dementia patients with multiple chronic diseases had the need for social resources referral, drug knowledge education, memory problem care, and fall prevention, which could be concluded as the four basic care needs. The second part of the results found that in addition to the four basic care needs, disease knowledge education, care for the mood of the caregiver, and hypertension care were the additional care needs. When patients had any of the followings: male patient, the patient was 65-74 years old, or the patient needs wheelchair, social resources referral were required. Therefore, the hospital could offer dementia patients the four basic care needs and, later, provide additional three care needs to reduce caregiver’s stress and to improve quality of care for dementia patients with multiple chronic dementia.

Keywords: Multiple chronic diseases, Dementia care, Care need

摘要 I
ABSTRACT II
誌謝 IV
目錄 V
表目錄 VI
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 多重慢性病介紹 3
第二節 多重慢性病與失智症關聯性 4
第三節 失智症嚴重程度 6
第四節 失智症照護目標 7
第五節 關聯規則 10
第三章 研究方法 13
第一節 研究對象與資料來源 13
第二節 分析方法 17
第四章 研究結果 19
第一節 探討照護目標的關聯性 19
第二節 探討多重慢性病失智症患者照護目標組合 21
第五章 結論 32
第一節 研究結論 32
第三節 研究限制 33
參考文獻 34
附錄 93條規則整理 41
 
表目錄
表2-1　15項照護目標 8
表2-2　26項照護目標 9
表3-1　人口統計變數 14
表3-2　初次追蹤情形 15
表4-1　Apriori產生17條規則 19
表4-2　支持度滿30%至未滿40%的兩條通則 21
表4-3　支持度滿20%至未滿30%的六條通則 21
表4-4　支持度滿10%至未滿20%的二十八條通則 23

 

一、中文部分
吳信宏(2019)，失智症照護在台灣的重要性，品質月刊，55(7)，4-7。
林克能、劉秀枝(2003)，臨床失智評量表，Acta Neurologica Taiwanica，12(3)，154-165。
林佳靜、陳建勳(2022)，應用資料探勘探討共同基金績效之持續性與從眾行為。管理資訊計算，11(1)，216-228。
林雅嫻、林哲瑋、王文甫、王釧如、張凱茗、張倩蜜、葉瓊鈺、康宜靜、陳富滿、呂郁蕙、吳信宏(2020)，女性阿茲海默症病人之照護目標組合的研究：以中部某醫學中心為例，品質學報，26(6)，351-377。
邱逸榛、何玉婷、陳婉庭、徐亞瑛(2004)，簡介阿茲海默氏症與其照護，長期照護雜誌，7(4)，289-304。
侯東旭、周琬禎、林素鉁(2018)，使用模糊 Apriori 演算法於數值型資料關聯規則探勘之研究-以糖尿病資料為例，醫療資訊雜誌，27(3)，25-48。
梁家欣、程蘊菁、陳人豪(2014)，失智症之重點回顧，內科學誌，25(3)，151-157。
梁煙純(2004)，我國多重慢性病患盛行率及醫療利用分析，國立陽明大學醫務管理研究所碩士論文。
陳玟均、陳富滿、王文甫、王釧如、呂郁蕙、張凱茗、張倩蜜、葉瓊鈺、林哲瑋、康宜靜、吳信宏(2019)，利用Apriori演算法探討失智症患者於照護者壓力之影響：以中部醫學中心為例，品質學報，26(6)，395-418。
陳柏琪、許聖民、林幸君、陳肇男、張靜貞(2020)，臺灣縣市別長照需求之中長期推計及趨勢分析，人文及社會科學集刊，32(4)，523-558。
陳韋良、張耀文、高東煒(2017)，失智症之診斷與治療，源遠護理，11(2)，12-17。
廖述賢、溫志皓(2019)，資料探勘：人工智慧與機器學習發展以SPSS Modeler為範例，新北市：博碩文化。
羅翊邦(2017)，評值以病人為中心有氧運動訓練對多重慢性病中老年人身體活動量、體適能、生活品質及生理行為指標之成效：隨機對照試驗，國立國防醫學院護理研究所碩士論文。
二、英文部分
Agrawal, R., Imilienski, T., & Swami, A. (1993). Mining association rules between sets of items in large databases. Proceedings of the ACM SIGMOD International Conference on the Management of Data, 207-216.
Anderson, G. F. (2010). Chronic care: making the case for ongoing care. Robert Wood Johnson Foundation.
Atella, V., Mortari, A. P., Kopinska, J., Belotti, F., Lapi, F., Cricelli, C., & Fontana, L. (2019). Trends in age-related disease burden and healthcare utilization. Aging Cell, 18(1), e12861.
Biessels, G. J., & Despa, F. (2018). Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nature Reviews Endocrinology, 14(10), 591-604.
Boyd, C. M., & Fortin, M. (2010). Future of multimorbidity research: how should understanding of multimorbidity inform health system design?. Public Health Reviews, 32(2), 451-474.
Brandlmeier, P. (1976). Multimorbidity among elderly patients in an urban general practice. Zeitschrift fur Allgemeinmedizin, 52(25), 1269-1275.
Bucki, A., Marcinkowska, M., Śniecikowska, J., Zagórska, A., Jamrozik, M., Pawłowski, M., Głuch-Lutwin, M., Siwek, A., Jakubczyk, M., Pytka, K., Jastrzębska-Więsek, M., Partyka, A., Wesołowska, A., Mierzejewski, P., & Kołaczkowski, M. (2020). Multifunctional 6-fluoro-3-[3-(pyrrolidin-1-yl)propyl]-1,2-benzoxazoles targeting behavioral and psychological symptoms of dementia (BPSD). European Journal of Medicinal Chemistry, 191, 112149.
Bugnicourt, J. M., Godefroy, O., Chillon, J. M., Choukroun, G., & Massy, Z. A. (2013). Cognitive disorders and dementia in CKD: the neglected kidney-brain axis. Journal of the American Society of Nephrology, 24(3), 353-363.
Bunn, F., Burn, A. M., Goodman, C., Rait, G., Norton, S., Robinson, L., Schoeman, J., & Brayne, C. (2014). Comorbidity and dementia: a scoping review of the literature. BMC Medicine, 12(1), 1-15.
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73.
Chae, Y.M., Kim, H.S., Tark, K.C., Park, H.J., & Ho, S.H. (2003). Analysis of healthcare quality indicator using data mining and decision support system. Expert Systems with Applications, 24(2), 167-172.
Chireh, B., & D’Arcy, C. (2020). Contrasting trends in prevalence of chronic diseases and multimorbidity, Canada 1978–2014. SN Comprehensive Clinical Medicine, 2(9), 1563-1572.
Chang, C. C., Wang, W. F., Li, Y. Y., Chen, Y. A., Chen, Y. J., Liao, Y. C., Jhang, K. M., & Wu, H. H. (2021). Using the Apriori Algorithm to Explore Caregivers’ Depression by the Combination of the Patients with Dementia and Their Caregivers. Risk Management and Healthcare Policy, 14, 2953-2963.
Deckers, K., Schievink, S. H., Rodriquez, M. M., van Oostenbrugge, R. J., van Boxtel, M. P., Verhey, F. R., & Köhler, S. (2017). Coronary heart disease and risk for cognitive impairment or dementia: systematic review and meta-analysis. Plos One, 12(9), e0184244.
Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(suppl_1), S10-S19.
Feinstein, A. R. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23(7), 455-468.
Garfinkel, D., Ilhan, B., & Bahat, G. (2015). Routine deprescribing of chronic medications to combat polypharmacy. Therapeutic Advances in Drug Safety, 6(6), 212-233.
Gupta, M., Singh, R., Singh, K., & Lehl, S. S. (2013). Reversible dementia and gait disturbance as a result of polypharmacy. Case Reports, 2013, bcr2013008932.
Han, J., & Kamber, M. (2006). Data Mining: Concepts and Techniques, 2nd Edition, Morgan Kaufmann Publishers, San Francisco.
Hopman, P., Schellevis, F. G., & Rijken, M. (2016). Health-related needs of people with multiple chronic diseases: differences and underlying factors. Quality of Life Research, 25(3), 651-660.
Ishikawa, H., & Yano, E. (2008). Patient health literacy and participation in the health-care process. Health Expectations, 11(2), 113-122.
Jennings, L. A., Palimaru, A., Corona, M. G., Cagigas, X. E., Ramirez, K. D., Zhao, T., Hays, R. D., Wenger, N. S., & Reuben, D. B. (2017). Patient and caregiver goals for dementia care. Quality of Life Research, 26(3), 685-693.
Jhang, K. M., Chang, M. C., Lo, T. Y., Lin, C. W., Wang, W. F., & Wu, H. H. (2019). Using the apriori algorithm to classify the care needs of patients with different types of dementia. Patient preference and adherence, 13, 1899–1912.
Johnston, M. C., Crilly, M., Black, C., Prescott, G. J., & Mercer, S. W. (2019). Defining and measuring multimorbidity: a systematic review of systematic reviews. European Journal of Public Health, 29(1), 182-189.
Kingston, A., Comas-Herrera, A., & Jagger, C. (2018). Forecasting the care needs of the older population in England over the next 20 years: estimates from the population ageing and care simulation (PACSim) modelling study. The Lancet Public Health, 3(9), e447-e455.
Lai, S. W., Lin, C. H., Liao, K. F., Su, L. T., Sung, F. C., & Lin, C. C. (2012). Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatrics & Gerontology International, 12(3), 491-498.
Lau, D. T., Mercaldo, N. D., Harris, A. T., Trittschuh, E., Shega, J., & Weintraub, S. (2010). Polypharmacy and potentially inappropriate medication use among community-dwelling elders with dementia. Alzheimer Disease and Associated Disorders, 24(1), 56-63.
Marengoni, A., & Onder, G. (2015). Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. BMJ, 350, h1059.
Miranda, A. S., Cordeiro, T. M., dos Santos Lacerda Soares, T. M., Ferreira, R. N., & Simoes e Silva, A. C. (2017). Kidney-brain axis inflammatory cross-talk: from bench to bedside. Clinical Science, 131(11), 1093-1105.
Namara, K. M., Alzubaidi, H., & Jackson, J. K. (2019). Cardiovascular disease as a leading cause of death: how are pharmacists getting involved?. Integrated Pharmacy Research & Practice, 8, 1-11.
Park, H. Y., Park, J. W., Song, H. J., Sohn, H. S., & Kwon, J. W. (2017). The association between polypharmacy and dementia: a nested case-control study based on a 12-year longitudinal cohort database in South Korea. Plos One, 12(1), e0169463.
PhridviRaj, M. S. B., & GuruRao, C. V. (2014). Data mining–past, present and future–a typical survey on data streams. Procedia Technology, 12, 255-263.
Shabir, O., Moll, T. A., Matuszyk, M. M., Eyre, B., Dake, M. D., Berwick, J., & Francis, S. E. (2020). Preclinical models of disease and multimorbidity with focus upon cardiovascular disease and dementia. Mechanisms of Ageing and Development, 192, 111361.
Sprangers, M. A., de Regt, E. B., Andries, F., van Agt, H. M., Bijl, R. V., de Boer, J. B., Foets, M., Hoeymans, N., Jacobs, A. E., Kempen, G. I., Miedema, H. S., Tijhuis, M. A., & de Haes, H. C. (2000). Which chronic conditions are associated with better or poorer quality of life?. Journal of Clinical Epidemiology, 53(9), 895-907.
Willadsen, T. G., Bebe, A., Køster-Rasmussen, R., Jarbøl, D. E., Guassora, A. D., Waldorff, F. B., Reventlow, S., & Olivarius, N. (2016). The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review. Scandinavian Journal of Primary Health Care, 34(2), 112–121.
World Health Organization. (2004). The World health report: 2004: changing history. World Health Organization.
World Health Organization. (2008). The world health report 2008: primary health care now more than ever. World Health Organization.
Wu, C. Y., Ouk, M., Wong, Y. Y., Anita, N. Z., Edwards, J. D., Yang, P., Shah, B. R., Herrmann, N., Lanctôt, K. L., Kapral, M. K., MacIntosh, B. J., Rabin, J. S., Black, S. E., & Swardfager, W. (2020). Relationships between memory decline and the use of metformin or DPP4 inhibitors in people with type 2 diabetes with normal cognition or Alzheimer's disease, and the role APOE carrier status. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 16(12), 1663–1673.
Yan, G.J., Wang, W.F., Jhang, KM., Lin, C.W., & Wu, H.H. (2019). Association between patients with dementia and high caregiving burden for caregivers from a medical center in Taiwan. Psychology Research and Behavior Management, 12, 55-65.
三、網路資源
Alzheimer’s Disease International (2019), World Alzheimer Report 2019 Attitudes to dementia, https://www.alzint.org/u/WorldAlzheimerReport2019-Summary.pdf。
台灣失智症協會(2021)，失智人口知多少，2021年4月， http://www.tada2002.org.tw/About/IsntDementia#bn1。
行政院主計總處(2021)，國情統計通報(第037號)，2021年3月2日，https://www.stat.gov.tw/public/Data/132162358VPAVQ8D.pdf。
衛生福利部國民健康署(2021)，民國106年國民健康訪問調查，2021年1月29日，https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=364&pid=13636。