阿茲海默氏症是造成失智最主要的原因，而失智病人的行為與精神症狀常令家屬與照顧者感到困擾且難以處置，更讓家屬因而做出提早將病人安置於機構的決定，影響病人及照顧者的生活品質甚劇。而妄想症狀是失智病人常見的精神症狀之一，其可能與病人過去生活經歷、環境或需求有關聯，但這方面的實證研究仍缺乏。因此本研究目的為探討阿茲海默氏症病人妄想症狀之相關因素與背後需求意涵。採探索性質性研究法，以立意取樣，從南部某醫學中心門診選取12位經醫師診斷為阿茲海默氏症伴隨妄想症狀的病人，運用自擬半結構式問卷指引深度訪談這些病患之照顧者，並以內容分析法進行資料分析。研究結果分為妄想症狀之相關因素與此症狀背後的可能需求等兩大部分。在相關因素方面共得到三大主題及八項子題，分別為：「其他病徵的干擾」所含子題有「繼發於認知症狀」與「繼發於行為精神症狀」；「過去生活經驗的牽引」所含子題有「回溯昔日的負面經歷」與「重現以前的生活情境」；最後「現存環境的刺激」所含子題有「親人久未探望」、「日落黃昏時」、「環境聲光的刺激」與「照顧者的言行舉止」。而在病人可能需求方面共得到出三個主題包含「身體安適需求」、「安全感的企求」與「歸屬感的需求」。本研究有助於臨床醫護人員與照顧者瞭解妄想症狀之相關因素，儘早移除刺激因子、而能適時調整自己的照顧心態，建立出與病人相處及溝通的橋梁，並滿足其身心需求，進而減輕自身的身心負荷，而達到提升彼此生活品質的最高目的。

Alzheimer’s disease is the major cause of dementia. Behavioral and psychological symptoms of dementia are not only troublesome to home caregivers but also the major reason for the decision of the patient’s relocation. They affect the quality of life for both patients and their caregivers. Delusion is one of the common psychiatric symptoms in patients with dementia. It is believed that the syndromes of delusion are associated with patients’ past life experiences, environment and need; however, scientific evidence is still lacking. Therefore, the purpose of this study was to explore the related factors and the underlying meanings of delusions in patients with Alzheimer's disease. Qualitative research approach and purposive sampling were used. Twelve patients who were diagnosed with Alzheimer's disease with delusion syndromes from the medical institutions in southern part of Taiwan were recruited. In-depth interview with a semi-structured questionnaire was used and data were analyzed by directed content analysis method. The results of this study were categorized into related factors of delusions and possible needs. There were three themes and eight sub-themes in the related factors of delusions. The first theme was“the interference of other symptoms”including two sub-themes: “secondary to cognitive symptoms”and“secondary to other behavioral and psychological symptoms of dementia”. The second theme was “traction of past life experiences”including two sub-themes:“tracing back the past negative experiences”and “reappearance of previous life situation”. The last theme was “ existing environment stimulation”including four sub-themes: “relatives not visit for a long time”, “sunset time ”, “sound and light stimulation in the environment”, “speech and behavior of caregivers”. Besides, under the category of “possible needs of patient with delusions”, three themes were extracted, including (1) physical comfort need, (2) sense of security, and (3) sense of belongingness. Findings of this study facilitate health care providers and caregivers to understand the related factors of delutions so as to manage such factors and adjust to the symtoms. Furthermore, effective communication based on the information found will satisfy patients’ needs, reduce caregiving load and improve quality of life for both patients and caregivers.

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