Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/89175
標題: 定向練習與環境線索協助失智症患者尋路之研究
Using orientation training and environmental clues to assist long-term care residents with dementia in wayfinding
作者: Man-Li Liao
廖曼利
關鍵字: 失智;尋路;空間定向訓練;顏色線索;標誌;dementia;wayfinding;route training;color cues;signs
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摘要: 
With the progressing of dementia, the cognitive ability of the patients will decrease and the spacial disorientation will increase gradually, followed by the decreasing possibility to use outdoor environment independently. However, there are many benefits derived from exposure to outdoors for long-term care residents with dementia, which include opportunities for exercise and social interactions and reducing incidents of aggressive behavior. Therefore, the outdoor spaces in long-term care facilities can be seen as a therapeutic environment. Three experiments of the current study were conducted to explore how to assist long-term care residents in finding their ways in outdoor environments. These are: (1) the effects of route training on wayfinding efficiency in residents with mild dementia; (2) the effects of color cues for wayfinding in residents with mild to moderate dementia; and (3) the comprehension of textual, symbolic, and pictorial signs in older adults with different cognitive impairments.

The three experiments were conducted on Jiali and Gangshan Veterans Homes in Taiwan. In Experiment 1, 5 participants of residents were at mean age 86.6, with mild dementia, and their Clinical Dementia Rating (CDR) was 1 and the Mini-Mental State Examination scores were between 15 and 23. Participants took route training of 'L', 'ㄇ', and '口'type. In Experiment 2, 10 residents (5 mild and 5 moderate) were recruited for 'the effect of single color cue for wayfinding' test. The mean ages of participants were 85.0 (mild) and 82.8 (moderate), and the MMSE scores were 19.8 (mild) and 12.8 (moderate). Besides, 9 residents (5 mild and 4 moderate) were recruited for 'the effect of color preference for wayfinding' test. The mean ages of participants were 83.8 (mild) and 88.0 (moderate) and the MMSE Scores were 18.2 (mild) and 14.0 (moderate). In Experiment 3, the mean ages of healthy group (n=36), mild dementia group (n=36) and moderate dementia group (n=33) were 85.06, 87.22, and 87.39. The mean educated years in three groups were all within 7 to 12. There were no significant differences in mean ages and educated years, but there was a significant difference among the three groups in MMSE scores (healthy=27.33; mild=19.58; moderate =10.64).

Research results showed that the memory of walking route could be enhanced by training for those who with mild dementia, even though all participants' recall scores in MMSE were 0. Yet, the sustained intervention effect was different from each other of participants. Among route types, the '口' was the easiest one and the 'ㄇ' was the hardest one for participants to recall. Allocentric impairment was found for all of the participants, and, however, egocentric impairment was different among individuals. Results from Experiment 2 indicated that while the route was characterized by long strip of red boards, it could decrease the loading for people with mild and moderate dementia to recall the route, thus helped wayfinding. By using preferred color to assist wayfinding, there was no obvious effect for people with mild dementia, yet did some effect for people with moderate dementia. Experiment 3 sought to determine the discrepancy degree of sign comprehension, presenting with either textual, symbolic, or pictorial signs, among those who with healthy aging and the presence of cognitive impairment. Overall to say, no matter what kind of sign format was presented, sign's comprehension of healthy group was better than mild dementia group, and that of mild dementia group was also better than moderate group. Among sign formats, textual sign was the easiest one for elderly to understand, followed by pictorial sign, and the symbolic sign was the hardest one. According to the results from the current study, recommendations for landscape design, government's evaluation criteria to the environment, and facility serving programs were also suggested.

失智症患者隨著病程的發展,認知能力逐漸下降,空間失定向感的問題也逐漸加劇,因此獨立使用戶外庭園空間的機會也跟著降低。然而,失智照護機構的戶外庭園具有促進身體健康、提供社會互動機會並減少躁動問題行為等功能,是重要的療癒空間。本研究分三部份探討如何協助失智症患者在戶外空間定向尋路:(1)探討戶外定向路徑練習對輕度失智症患者認知記憶的效果;(2)顏色線索對失智症患者協助戶外尋路的助益;(3)探討失智症患者對文字及圖像標誌的認知程度。

研究地點為行政院國軍退除役官兵輔導委員會佳里榮譽國民之家失智照顧教研專區與岡山榮譽國民之家。第一部份路徑練習研究的參與者為5位輕度失智症患者,平均年齡86.6歲,臨床失智評估(Clinical Dementia Rating, CDR)分數均為1,簡易智能評估量表(Mini-Mental State Examination, MMSE) 分數介於15至23分之間。路徑練習型式包括L字型、ㄇ字型及口字型。第二部份「單一顏色線索對尋路助益效果評估」研究之參與者共10人,輕度及中度失智症患者各5人,平均年齡分別為85.0歲與82.8歲,簡易智能測驗量表(MMSE)平均分數為19.8分及12.8分;「顏色偏好對尋路的助益效果」研究參與者為5位輕度與4位中度失智患者,平均年齡分別為83.8歲與88.0歲,簡易智能測驗量表(MMSE)平均分數為18.2與14.0。第三部份研究分為認知正常組、輕度失智組及中度失智組,有效樣本各為36、36及33人,三組受測者之平均年齡為85.06、87.22及87.39歲,無顯著差異;受教育時間平均皆在7至12年之間,無顯著差異;簡易智能評估量表(MMSE)三組平均分數分別為27.33、19.58以及10.64,三者之間達顯著差異。

研究結果顯示,輕度失智患者即使在MMSE的近期記憶分數為0,仍具有以行為介入的認知訓練來促進對戶外路徑記憶的可行性,但中斷練習後的定向路徑記憶持續效果因人而異;路徑型式中,以口字型最容易記憶,ㄇ字型最為困難;五位參與者的「非自我中心」路徑辨識已完全錯誤,「自我中心」路徑辨識則呈現個人差異。第二部份研究結果顯示,當戶外庭園路徑沿途出現長條色板(紅色)時,可以減輕輕度及中度失智症患者的記憶負荷,有助於失智症患者的定向尋路;顏色偏好對輕度患者的路徑選擇無明顯的影響,但中度失智症患者似乎較傾向於選擇沿途有自己偏好顏色線索出現的路徑方向。第三部份的研究結果顯示當標誌內容以文字符號、抽象圖示符號或具象圖示符號不同型式呈現時,不同認知程度對符號理解正確率具有差異性。整體而言,不論是文字、抽象或是具象符號,皆是認知正常組正確率高於輕度失智組,輕度失智組的正確率又高於中度失智組;而以符號類別而言,則是文字符號正確率最高,其次為具象符號,最差的是抽象符號。研究最後並根據獲得的結果,對失智照護機構景觀設計面向、政府環境評鑑面向及機構服務方案面向作出建議。
URI: http://hdl.handle.net/11455/89175
其他識別: U0005-1706201513042600
Rights: 同意授權瀏覽/列印電子全文服務,2018-07-15起公開。
Appears in Collections:園藝學系

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