以家庭為單位的醫務社會護理對阿爾茨海默病患者及照顧者的影響*

□ 向梅 XIANG Mei 胡國娣 HU Guo-di 魯淑芬 LU Shu-fen 姚辛敏 YAO Xin-min 王林利 WANG Lin-li

Objective To explore the influence of family-based medical social care on patients with Alzheimer's disease and their caregivers. Methods Eighty patients with Alzheimer's disease and the corresponding 80 caregivers were randomly divided into two groups. The control group adopted routine home care, and the observation group adopted family-based medical social care. The two groups were compared for several indicators of management before and after the intervention. Results Before the intervention, there was no significant difference in the scores of cognitive function, behavior, burden on caregiver and positive feeling between the two groups (p＞0.05). After the intervention, the MMSE score and the PAC score of the caregiver were higher in the observation group than in the control group. The BBS scores of the patients and the CBI scores of the caregivers in the observation group were lower than the control group, and the difference was statistically significant (p＜0.05). Conclusion Family-based medical social care can effectively improve patients' cognitive function and behaviors, significantly reduce the burden of caregivers and enhance positive feelings. It has certain positive effects and is worthy of being promoted.

阿爾茨海默病(alzheimer's disease，AD)是導致老年人死亡的重大疾病，僅次于心臟病、癌癥及腦卒中[1]。隨著我國人口老齡化日益嚴峻，阿爾茨海默病的患病率也不斷增加，如何預防及治療阿爾茨海默病不僅是亟待解決的醫學難題，更是不容忽視的社會問題。有報道顯示[2-3]，社會工作在解決阿爾茨海默病的社會問題上具有重大積極作用，目前關于阿爾茨海默病的家庭護理已廣泛開展并取得一定成效，但大部分為患者功能改善的干預，對于照顧者的研究較少，而阿爾茨海默病照顧者的正常工作及生活往往因繁重的照護事宜而受到嚴重影響，不利于家庭和社會的穩定，因此加強對患者社會方面問題及照顧者的關注十分必要。醫務社會工作模式[4]主要針對情緒負擔、醫患關系及經濟援助等方面，在阿爾茨海默病專業性社工服務中已被證實具有較強可操作性。鑒于此，本研究嘗試應用了以家庭為單位的醫務社會護理，即應用醫務社會工作模式開展阿爾茨海默病的家庭護理，并探討其對患者及照顧者的影響，效果滿意。

對象和方法

1.研究對象。選取2017年7月至12月于本院診治的阿爾茨海默病患者及照顧者作為對象。納入標準：(1)經頭顱CT、MR檢查臨床診斷為輕度、中度的阿爾茨海默病；(2)符合美國國立神經病、語言交流障礙和卒中研究所—老年性癡呆及相關疾病學會(national institute of neurological and communicative disorders and stroke and alzheimer's disease and related disorders association,NINCDS-ADRDA)的阿爾茨海默病診斷標準；(3)具有簡單的溝通交談、肢體活動的能力；……