失智症人口急速成長已是全球許多國家所共同面臨的問題，患者因疾病或環境所引發的躁動症狀常使得照顧者身心疲憊與受挫，許多臨床專家與學者建議在使用藥物之前應優先嘗試非藥物輔療，而懷舊治療為非藥物輔療的一種。但國內外懷舊治療文獻多著重於如何改善失智症患者的認知、情緒與整體問題行為；對單項躁動症狀多侷限在焦躁行為與焦慮的改善，且多為短期效益的探討。目前國內研究尚無針對失智症患者個別躁動症狀與生活品質進行探討與長期效益的追蹤，故本研究運用團體懷舊治療於有躁動症狀的失智症長者，探討團體懷舊治療對失智症長者整體與單項躁動症狀及生活品質之成效與長期效益的追蹤。
本研究選取南部三縣市五所長照機構機構輕至中度失智症個案，進行連續十周、每週乙次、每次50分鐘、每梯10~12人、五梯次的小團體懷舊治療，共40位個案完成研究。於團體懷舊活動開始前一週內進行前測、介入措施執行完畢後一週內進行後測及第十二週內進行追蹤後測。研究工具為結構式問卷，含個案基本資料表(Demographic characteristics)、簡短智能量表(Mini-Mental State Examination；MMSE)、中文版焦躁量表(Cohen-Mansfield agitation inventory；CMAI)、失智症生活品質量表(Quality of Life-Alzheimer’s Disease Scale；QOL-AD)。研究結果顯示接受團體懷舊治療後，個案整體躁動症狀無顯著差異(P=0.81)，但在單項躁動症狀中的「漫無目的遊走」(P=0.007)，達長期正向顯著差異；與「普遍的坐立不安」(P=0.002)，達短期正向顯著差異。再區分個案為輕度躁動與重度躁動達短期與長期正向顯著差異。在分組生活品質中輕度躁動行為組，達短期與長期正向顯著差異(P=0.000)；重度躁動行為組，亦達長期正向顯著差異(P=0.03)。本研究發現團體懷舊治療能緩解失智症患者精神行為組進行分析，結果顯示重度躁動行為組的「漫無目的遊走」(P=0.000)與「普遍的坐立不安」(P=0.003)，達長期正向顯著差異。此外，在生活品質整體總得分，達長期正向顯著差異(P=0.000)；再區分個案為輕度躁動與重度躁動行為組進行分析
，結果顯示輕度躁動行為組，生活品質達長期正向顯著差異(P=0.000)。本研究發現團體懷舊治療可有效改善失智症患者躁動症狀中「漫無目的遊走」與「普遍的坐立不安」及提昇生活品質，是一值得廣泛應用的照護措施。期本研究結果可作為專業或非專業照顧者在照顧過程中妥善處理患者以上之問題行為及促進失智症患者生活品質之參考與選擇。

The Effects of Reminiscence Group Therapy on Agitated Symptoms and
Quality of Life in Elders with Dementia

Author: Fang-Yu Hsu
Advisor: Jing-Jy Sellin Wang
Department of Nursing & College of Medicine

SUMMARY
Agitated symptoms of dementia caused by illnesses or environment often make caregivers exhausted and frustrated mentally and physically. Many clinical experts and scholars believe that the use of non-pharmacological complementary therapy in patients with dementia should be prior to the use of medication. Therefore, the purpose of this study was to apply and evaluate short and long-term effects of group reminiscence on agitated symptoms and quality of life for patients' with dementia. Subjects were residents with mild to moderate dementia recruited from five long-term care facilities in southern Taiwan. Totally 40 subjects completed the study. All subjects were assessed by demographic data, CMAI, MMSE, and QOL-AD Scale one week before and after and three months after the intervention. Results showed subjects’ overall agitated symptoms did not significant change. Two agitated symptoms "wandering" and “akathisia” had significant decrease. To analyze data by mild and severe agitation groups, results showed that in severe agitation group, "wandering" and “akathisia” showed significant change. The overall and mild agitation group quality of life showed significant difference. Findings of this study indicated that reminiscence therapy is beneficial to the decrease of "wandering"and "akathisia" behaviors and the improvement of quality of life for patients with dementia.

Key words: reminiscence group therapy, dementia, agitated symptoms, quality of life

INTRODUCTION
The rapid growth in the population of dementia has become a global problem in many countries. Patients' agitated symptoms of dementia caused by illnesses or environment often make caregivers exhausted and frustrated mentally and physically. Many clinical experts and scholars believe that the use of non-pharmacological complementary therapy in patients with dementia should be prior to the use of medication. Reminiscence therapy is one of them. Taiwanese literature on reminiscence therapy for dementia emphasizes on how to improve patients' overall cognition and emotion; few focused on patients with agitated symptoms and quality of life. Therefore, the purpose of this study was to apply and evaluate short and long-term effects of group reminiscence on agitated symptoms and quality of life for patients' with dementia.

MATERIALS AND METHODS
This was a single group with repeated measure design; purposive sampling was used. Subjects were residents with mild to moderate dementia recruited from five long-term care facilities in southern Taiwan. Totally 40 subjects completed the study. Subjects received reminiscence therapy session once weekly for ten continuous weeks, each was 50 minutes in length. All subjects were assessed by demographic data, Chinese version of the Cohen-Mansfield Agitation Inventory(CMAI), Mini-Mental State Examination(MMSE), and Quality of Life-Alzheimer’s Disease(QOL-AD)Scale one week before and after and three months after the intervention.

RESULTS AND DISCUSSION
Results showed that after receiving the group reminiscence, subjects’ overall agitated symptoms did not significant change (P=0.81), yet two agitated symptoms "wandering" had long-term significant decrease (P=0.007), and “akathisia” had short-term significant decrease (P=0.002). To analyze data by mild and severe agitation groups, results showed that in severe agitation group, "wandering" (P=0.000) and “akathisia” (P=0.003) showed significant long-term positive change. In addition, the overall quality of life showed significant difference (P=0.000), the effect can last to the end of the twelfth week after reminiscence therapy. Quality of life improved significantly in mild agitation group (P=0.000), the effect can last to the end of the twelfth week after reminiscence therapy.

CONCLUSION
Findings of this study indicated that reminiscence therapy is beneficial to the decrease of "wandering"and "akathisia" behaviors and the improvement of quality of life for patients with dementia. It can be widely applied to clinical practice. Results of this study can be references for professional or non-professional caregivers when managing the above agitation behaviors. Also it is a measure to improve quality of life for this group of patients.

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