中醫藥研究論叢

251.1 中醫預防及延緩失能課程對社區長者之成效

 TJ TCM.25(1) : 1-18, 2022

中醫預防及延緩失能課程對社區長者之成效
The Effectiveness of Traditional Chinese
Medicine Prevention and Retardation Courses
for the Elderly in the Community
黃建榮1# 林舜穀2,3,4# 吳翠霞1 陳贊文1,5
陳曉鈞1,6 吳建東1,7 黃法喬1 劉潔心8*
1 台北市中醫師公會,台北,台灣
2 台北市立聯合醫院仁愛院區,台北,台灣
3 臺北市立大學,台北,台灣
4 國立陽明交通大學公共衛生研究所,台北,台灣
5 旭生中醫診所,台北,台灣
6 悅展中醫診所,台北,台灣
7 詠生中醫診所,台北,台灣
8 國立臺灣師範大學健康促進與衛生教育學系,台北,台灣
【摘要】
目的:分析12 週中醫預防及延緩失能課程對於高齡長者失能風險與日常活動能力之成效。
方法:於台北市社區招募117 位65 歲以上具有失能風險之長者,進行為期12 週的中醫預防及延緩失能課程,包含中醫健康識能、藥膳食療進補、氣功身體導引、經絡穴位按摩等中醫內容,以及認知促進課程、藝術音樂活動等課程。依據課程比例不同分為中醫課程A 組62 人與B 組55 人。中醫課程A 組氣功身體導引與藥膳食療進補比例較重,中醫課程B 組則著重於經絡穴位按摩與中醫健康識能課程。
評估內容包含骨質疏鬆性骨折指數(study of osteoporotic fractures index, SOF)、身體質量指數(Body Mass Index, BMI)、工具性日常生活活動量表(Instrumental Activities of Daily Living scale, IADL)、肌少症問卷(sluggishness, assistance in walking, rise from a chair, climb stairs, falls, SARC-F)、老年憂鬱量表(Geriatric Depression Scale, GDS),以及介護風險篩檢評估量表(Kihon Checklist)。我們計算連續性變項的平均值與標準差,類別變項則以個數及欄百分比例呈現。我們以獨立樣本t 檢定(Independent sample t-test)檢驗兩組之間的差異,成對樣本t 檢定(paired sample t test)檢驗課程前後的差距,並計算p 值和變化量。
結果:共109 位高齡長者完成課程與評估(A 組57 人、B 組52 人)。在課程進行前兩組僅有身體質量指數(BMI)有顯著差異。經12 週中醫課程後,參與個案在工具性日常生活活動量表(IADL)、肌少症問卷(SARC-F)、老年憂鬱量表(GDS),以及介護風險篩檢評估量表等各項指標上均顯著改善,但介護風險篩檢評估量表中社會功能風險則沒有達到統計顯著差異。進一步比較兩種不同的課程模式,中醫課程A 組在Kihon checklist 心理功能、認知、口腔風險,以及骨質疏鬆性骨折指數(SOF)與肌少症(SARC-F)風險較低,成對樣本t 檢定p 值小於0.05。
結論:12 週的中醫預防及延緩失能課程可以促進高齡長者的日常活動能力,減少失能風險。不同側重的中醫課程可以更有效的改善失能風險的不同變
項。
【關鍵詞】高齡、失智、失能、中醫、社區據點
 
Jian-Rong Huang1# Shun-Ku Lin2,3,4# Cui-Xia Wu1 Zan-Wen Chen1,5
Xiao-Jun Chen1,6 Jian-Dong Wu1,7 Fa-Chiao Huang1 Chieh-Hsing Liu8*
1Taipei Chinese Medical Association, Taipei, Taiwan
2Taipei City Hospital, RanAi branch, Taipei, Taiwan
3University of Taipei, Taipei, Taiwan
4Institute of Public Health, National Yang-Ming Chiao Tung University, Taipei, Taiwan
5XU-SHENG Traditional Chinese Medicine Clinic, Taipei, Taiwan
6YUE-ZHAN Traditional Chinese Medicine Clinic, Taipei, Taiwan
7YONG-SHENG Traditional Chinese Medicine Clinic, Taipei, Taiwan
8Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
【Summary】
Objective: This study aimed to analyze the effectiveness of the 12-week traditional Chinese medicine course in preventing disability and dementia in the elderly.
Method: This study is a retrospective generation study. We recruited 117 elderly people over the age of 65 exposed to the risk of disability from the Taipei City community. Participants received a 12-week course on TCM prevention and delay of disability, including TCM health awareness, TCM and diet knowledge, Qigong exercises, meridian acupoint massage, cognitive promotion courses, and appreciation of art and music. According to the content of the course, we divided the participating cases into 62 people in group A and 55 people in group B. Group A of the TCM course focuses on qigong exercise and TCM diet therapy, while Group B of the TCM course focuses on herbal medicine knowledge, meridian massage, and TCM health awareness class. We used the following scales to evaluate the effectiveness of individual cases in preventing disability: osteoporotic fractures index (SOF), body mass index (BMI), instrumental activities of daily living (Instrumental Activities) of Daily Living scale (IADL), sarcopenia questionnaire (sluggishness, assistance in walking, rising from a chair, climb stairs, falls, SARC-F), Geriatric Depression Scale (GDS), and nursing care risk screen Kihon Checklist (Kihon Checklist). We calculated the average and standard deviation of continuous variables, and categorical variables are presented as examples of number and column percentage. We used the independent sample t-test to test the difference between the two groups, paired sample t-test) to test the gap before and after the course and calculate the p-value and the amount of change.
Result: A total of 109 senior elders completed TCM courses and assessments (57 in group A and 52 in group B). Before the course, only the body mass index (BMI) was significantly different between the two groups. After a 12-week course of Chinese medicine, the participating cases improved significantly on the Instrumental Activities of Daily Living Scale (IADL), Sarcopenia Questionnaire (SARC-F), Geriatric Depression Scale (GDS), and Kihon Checklist. However, the social function risk sub-item of the Kihon Checklist did not reach a statistically significant difference. We compared the effectiveness of different Chinese medicine courses. Group A of the TCM course showed more improvement in the Kihon checklist’s mental function, cognition, oral risk, and osteoporotic fracture index (SOF), and sarcopenia (SARC-F)).
Conclusion: The 12-week course on prevention and delay of disability in traditional Chinese medicine can promote the daily activities of the elderly and reduce the risk of disability. Sports-focused Chinese medicine courses can more effectively decrease the risk of disability.
【Keywords】Old Age; Dementia; Disability; Traditional Chinese Medicine; Community Care Center