失智症人口逐年攀升，多數失智症患者希望能居住在自己家中。在台灣有九成以上失智症者留在家中生活。居住在熟悉的環境能延緩失智症者能力的衰退並改善幸福感與獨立性。隨著疾病造成的退化會使個人能力與居家環境無法配合，導致日常生活活動失能，這也常是失智症者需搬離原本住宅的主因。調整居家環境能支持失智症者的表現並減輕照顧者負擔，但目前的居家環境改善建議多聚焦在安全與預防跌倒，且忽略環境策略能為失智症者提供支持的潛在可能。儘管有專業的環境評估人員可為失能者及失智症家庭提供協助，但仍缺乏針對失智症特定需求的環境評估工具，同時須考量私人住宅的多樣性。本研究目的在於發展「失智友善居家環境策略檢核表」，協助評估人員提供以失智者需求為中心的環境改善建議。
過去文獻表示，包含物理與科技環境在內的環境支持能促進個體的功能表現最佳化。有別於正常老化，失智症會影響患者的知覺與認知，進而影響其日常生活功能的表現。以失智症為中心的環境改善措施應考量其特殊需求，尤其是針對認知與知覺方面的環境調整以提升活動表現。本研究應用PEOP模型(Person-Environment-Occupation-Performance model)以及老化生態學(Ecology Model of Aging)的概念，配合失智症者的獨特需求，依三階段完成。首先，透過文獻搜尋與整合，形成初步的檢核表（題庫版）及基本架構；接著進行專家審查，完成專家效度分析，並依照專家建議改善檢核表內容；最後於失智症患者家中進行實地使用，記錄使用過程，搜集評估人員與照顧者的使用建議，根據以上資料形成最終版的檢核表。
本研究分析22篇與居家環境改善相關的研究，包含指引、評估與文獻回顧。排除專為機構設置的面向之外，可將文獻中的概念區分為12個環境改造目標與12個環境改造策略及原則。利用此24個概念進一步分析文獻中之改造建議，發現最被強調的環境改造目標為安全與預防危險；但在改造建議中有超過一半的建議用於促進失智者之活動參與。此外，在文獻中察覺專用於私人住宅與通用於機構及住宅之環境改善建議間有其差異。私人住宅更注重照顧者的需求且較不強調「空間格局」、「規模尺度」、「科技和設備的使用」，且並未提及「像家一樣的概念」。在整合文獻資料與使用經驗後，建構失智友善居家環境調整之架構。該架構包含數個層次，分別為需求/改善目標、策略與原則、空間劃分、具體執行細項。在「需求/改善目標」層次，包含促進活動參與、社交、安全、定向感、安適感、人性化的照顧。在「策略與原則」層次則以檢核表為一有效工具，協助評估人員提供更完善的環境改善建議。檢核表（最終版）包含5大面向、20題檢核要點，5大面向為A.空間格局及動線、B.生理支持、C.認知支持、D.適度的感官刺激、E.空間與科技應用之彈性。專家效度之結果顯示，整體檢核表之S-CVI為0.99，五個面向的I-CVI向度在0.83-1之間。實地訪查的受訪者多為阿茲海默症患者及其家屬，環境評估人員則包含職能治療師與物理治療師。關於質性資料，評估人員表示進行環境評估過程中多依據現有之無障礙環境架構與補助項目之引導，偏重安全與動線。檢核表能在失智症居家環境評估過程中提供有效的協助，尤其在空間格局、認知支持、以及感官刺激的面向，但同時亦增加工作負擔。家屬則表示期望能獲得更多關於失智症照護的簡單環境措施以因應失智者不斷變化的病程，帶來更好的生活品質並降低對於危險發生的焦慮。
過去環境評估受眾多為肢體障礙或失能者，較少考量失智症者的需求，而文獻中對於失智症環境改善的介入則需要數次回訪。「失智友善居家環境策略檢核表」作為可快速使用的環境調整依據，能協助評估人員為失智症家庭提供更全面的環境改善建議。使用檢核表需要評估人員投入更多時間學習使用，未來可增加範例圖說以提升使用的方便性。並期望能建立施測者間信度，並拓展使用族群。進一步以量性研究設計探索使用檢核表對照顧品質的成效。

In Taiwan, over 90% of dementia patients lived at home, creating a critical need for home modifications to support their needs and reduce caregiver burden. Existing home modifications primarily focused on safety and fall prevention, and few tools addressed dementia-specific needs. This pilot study developed a “strategy checklist for a dementia-friendly home” to assist environmental assessors in making recommendations for home environmental modifications. The study proceeded in three phases: first, researchers created a preliminary checklist based on a literature review; second, it was refined through expert feedback; and third, it was implemented in patients' homes, with feedback gathered from caregivers and assessors. The finalized checklist included five key dimensions—spatial layout and circulation, physiological support, cognitive support, moderate sensory stimulation, and flexibility in space and technology application. —with a total of 20 items. Expert validity showed that the checklist had an overall S-CVI of 0.99, with I-CVI values for the five dimensions ranging from 0.83 to 1. The checklist provided a well-structured, comprehensive framework that enhanced assessors' ability to recommend modifications, creating a dementia-friendly environment with tailored suggestions. While it effectively aided assessors in evaluating home environments, it also increased their workload. Future updates are planned to include example captions to improve usability for both assessors and caregivers, ensuring the tool continues to meet the progressive needs of dementia care.

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