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가정환경개선 서비스가 지역사회 치매 노인의 낙상 위험성과 일상생활 독립성에 미치는 영향

Effect of Home Modification Service on Fall Prevention and Independence of Activities of Daily Living for the Elderly with Dementia Residing in the Community

박주연|한효진|유제광|주유미
한국노인작업치료학회 (Korean Society for Geriatric Occupational Therapy)|2021.12|한국노인작업치료학회지 (Korea Journal of Geriatric Occupational Therapy)|제3권 제2호|pp. 61-76|DOI 10.23189/yksgot.2021.3.2.005

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참고문헌

키워드

지역사회치매Dementia커뮤니티케어Community care작업치료Occupational therapyHome modificationCommunity-based가정환경개선

초록

목적 : 본 연구는 지역사회 거주 치매 환자를 대상으로 가정환경개선 서비스를 제공하고 효과성을 검증하기 위함이다. 연구방법 : 태안군 치매안심센터에서 총 16명의 치매 진단을 받은 노인을 연계 받아 총 8주간 가정환경개선 서비스를 진행하였다. 각 대상자 개인별로 1주일에 1회씩 총 6회기의 재가방문 서비스를 제공하였다, 사전-사후 평가를 포함하여 개인 행동평가, 가정환경 컨설팅, 가정환경개선, 일상생활 훈련, 및 인지 전략 교육 등을제공하였다. 서비스 전후 효과를 알아보기 위하여 가정환경평가 프로토콜(HEAP)과 추가로 활동-특정 균형 자신감 척도(ABC), 낙상 행동요인 척도(FaB), 한국판 일상생활활동 평가(K-ADL)과 수단적 일상생활활동 평가(K-IADL)의 독립성 변화를 평가하였다. 사전-사후 점수 비교는 Jamovi 2.2.2를 통해 분석하였다. 결과 : 중재 결과 가정 내 위험환경, 적응, 시각적 단서, 관찰에서는 통계적으로 유의미한 환경변화가 있었다(p<.001). 단, 가정환경의 편안함은 통계적으로 유의한 개선이 없었던 것으로 나타났다. 또한, 중재 후 균형자신감, 낙상 행동요인, 수단적 일상생활의 독립성에 통계적으로 유의한 변화가 있었던 것으로 나타났다(p<.001). 반면 일상생활의 독립성에는 변화가 없었다(p=.186). 전반적 서비스 만족도는 10점 만점에 9.6점으로 매우 높게 나타났다. 결론 : 지역사회 거주 치매 환자를 대상으로 하는 가정환경개선 서비스는 가정 내 생활 환경의 개선뿐만 아니라노인의 낙상을 예방하고 수단적 일상생활의 독립성을 향상하는데 효과적인 것으로 나타났다. 추후 더 많은모집단을 통해 서비스를 제공하고 서비스의 효과성을 체계적으로 분석해볼 필요가 있다.

Abstract

Objective : The aim of this study was to provide a home modification service for elderly people with dementia living in the community and to verify its effectiveness. Methods : Sixteen elderly people diagnosed with dementia participated in the home modification service provided in this study. Six home visits were provided for each individual subject. Including pre-and post-evaluation, personal behavior evaluation, home environment consulting, home environment modification, daily activities training, and cognitive strategy education were provided. To examine the effects before and after the service, changes in the environment, balance confidence, fall behavioral factors, and independence of ADL and IADL were evaluated. The preand post-score comparisons were analyzed using Jamovi 2.2.2. Results : The intervention showed statistically significant environmental changes in home hazards, adaptation, visual cues, and observation (p<.001). However, there was no statistically significant improvement in the comfort of the home environment. Also, there were statistically significant changes in activity-specific balance confidence, fall behavioral factors, and independence in IADL after intervention (p<.001). On the other hand, there was no change in independence in ADL (p=.186). Overall satisfaction with the service was very high at 9.6 out of 10. Conclusion : The home modification service for the elderly with dementia living in the community was found to be effective not only in improving the living environment at home, but also in preventing falls and improving the independence of IADL. In the future, it will be necessary to provide services to a larger population and investigate its effectiveness.

참고문헌 (42)

  1. Ainsworth, E, "An occupational therapist's guide to home modification practice" (2011), Slack Incorporated.
  2. Baillon, S, "A comparison of the effects of snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia", International Journal of Geriatric Psychiatry, 19(11), pp.1047~1052 (2004)[DOI]
  3. 차수민, "치매안심센터 작업치료 관련 연구동향 분석", 인문사회 21, 11(6), pp.1301~1313 (2020), 사단법인 아시아문화학술원
  4. Clark, F, "Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people : Results of the well elderly 2 randomised controlled trial", Journal of Epidemiology and Community Health, 66(9), pp.782~790 (2012)[DOI]
  5. Clemson, L, "Validating the Falls Behavioural(FaB)scale for older people : A rasch analysis", Disability and Rehabilitation, 30(7), pp.498~506 (2008)[DOI]
  6. Desai, A. K, "Activities of daily living in patients with dementia", CNS Drugs, 18(13), pp.853~875 (2004)[DOI]
  7. Filiatrault, J, "Evidence of the psychometric qualities of a simplified version of the activities-specific balance confidence scale for community-dwelling seniors", Archives of Physical Medicine and Rehabilitation, 88(5), pp.664~672 (2007)[DOI]
  8. Fisher, G, "Developing the residential environment impact survey instruments through faculty –practitioner collaboration", Occupational Therapy in Health Care, 26(4), pp.224~239 (2012)[DOI]
  9. Fleming, R, "‘I want to feel at home’ : Establishing what aspects of environmental design are important to people with dementia nearing the end of life", BMC Palliative Care, 14(1), pp.1~14 (2015)[DOI]
  10. Gaugler, J. E, "Early community-based service utilization and its effects on institutionalization in dementia caregiving", The Gerontologist, 45(2), pp.177~185 (2005)[DOI]
  11. Ghosh, A, "Environmental dependency behaviours in frontotemporal dementia: Have we been underrating them?", Journal of Neurology, 260(3), pp.861~868 (2013)[DOI]
  12. Gitlin, L, "Managing dementia at home : The role of home environmental modifications", Topics in Geriatric Rehabilitation, 12(2), pp.28~39 (1996)
  13. Gitlin, L. N, "Evaluating home environments of persons with dementia: Interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP)", Disability and Rehabilitation, 24(1-3), pp.59~71 (2002)[DOI]
  14. Graff, M. J, "Occupational therapy at home for older individuals with mild to moderate cognitive impairments and their primary caregivers: A pilot study", OTJR: Occupation, Participation and Health, 23(4), pp.155~164 (2003)[DOI]
  15. Graff, M. J, "Community based occupational therapy for patients with dementia and their care givers : Randomised controlled trial", BMJ, 333(7580), pp.1196~ (2006)[DOI]
  16. Graff, M. J, "How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver? : A case study", Dementia, 5(4), pp.503~532 (2006)[DOI]
  17. Hussian, R. A, "Modification of behaviors in dementia via stimulus manipulation", Clinical Gerontologist, 8(1), pp.37~43 (1988)
  18. 황명진, "인구고령 사회의 노인복지와 커뮤니티 케어", 공공사회연구, 10(2), pp.5~28 (2020), 한국공공사회학회[DOI]
  19. Iecovich, E, "Aging in place : From theory to practice", Anthropological Notebooks, 20(1), pp.21~32 (2014)
  20. 주유미, "가상현실기반 일상생활활동 중재를 병행한 가정환경개선 서비스의 효과", 대한작업치료학회지, 29(2), pp.31~44 (2021), 대한작업치료학회
  21. Lawton, M. P, "The psychology of adult development and aging", pp.619~674 (1973), American Psychological Association
  22. 이윤희, "한국치매노인 가족의 주거환경 개선요구", 한국주거학회논문집, 15(1), pp.141~152 (2004), 한국주거학회
  23. Mihailidis, A, "The use of artificial intelligence in the design of an intelligent cognitive orthosis for people with dementia", Assistive Technology, 13(1), pp.23~39 (2001)[DOI]
  24. "Commencement of community care project" (2019)[URL]
  25. "Cognitive Impairment Screening Test (CIST)" (2021)[URL]
  26. Moore, K. D, "Designing a better day: Guidelines for adult and dementia day services centers" (2006), The Johns Hopkins University Press
  27. National Institute of Dementia, "Korean dementia observatory 2019" (2019), HAN Company
  28. Oh, Y. I, "A critical perspective for the correct direction of Korean-style community integrated care (community care)", Medical Policy Forum, 17(1), pp.16~21 (2019)
  29. O’Malley, M, "Decreasing spatial disorientation in care-home settings: How psychology can guide the development of dementia friendly design guidelines", Dementia, 16(3), pp.315~328 (2017)[DOI]
  30. 박영주, "커뮤니티 케어 제도 내 작업치료사의 역할에 대한 고찰", 대한작업치료학회지, 27(1), pp.103~113 (2019), 대한작업치료학회[DOI]
  31. Pynoos, J, "Environmental coping strategies for alzheimer's caregivers", American Journal of Alzheimer's Care and Related Disorders and Research, 4(6), pp.4~8 (1989)[DOI]
  32. Samus, Q. M, "Comprehensive home-based care coordination for vulnerable elders with dementia : Maximizing independence at homeplus-study protocol", International Journal of Care Coordination, 20(4), pp.123~134 (2017)[DOI]
  33. Schiff, M. R, "Designing environments for individuals with alzheimer's disease : Some general principles", American Journal of Alzheimer's Care and Related Disorders and Research, 5(3), pp.4~8 (1990)[DOI]
  34. Schmid, A. A, "The home-based occupational therapy intervention in the Alzheimer's Disease Multiple Intervention Trial(ADMIT)", Occupational Therapy in Mental Health, 31(1), pp.19~34 (2015)[DOI]
  35. Stark, S, "Effect of home modification interventions on the participation of community-dwelling adults with health conditions : A systematic review", American Journal of Occupational Therapy, 71(2), pp.1~11 (2017)[DOI]
  36. Thinnes, A, "Effect of educational and supportive strategies on the ability of caregivers of people with dementia to maintain participation in that role", American Journal of Occupational Therapy, 65(5), pp.541~549 (2011)[DOI]
  37. Van Hoof, J, "Designing a"think-along dwelling"for people with dementia : A co-creation project between health care and the building services sector", Journal of Housing for the Elderly, 27(3), pp.299~332 (2013)[DOI]
  38. Wiles, J. L, "The meaning of"aging in place"to older people", The Gerontologist, 52(3), pp.357~366 (2012)[DOI]
  39. Won, C. W, "The validity and reliability of Korean Activities of Daily Living(K-ADL)scale", Journal of the Korean Geriatrics Society, 6(2), pp.98~106 (2002)
  40. Won, C. W, "The validity and reliability of Korean Instrumental Activities of Daily Living(K-IADL)scale", Journal of the Korean Geriatrics Society, 6(4), pp.273~280 (2002)
  41. Wong, C, "Applying the personenvironment-occupation model to improve dementia care", AOTA Continuing Education Article, 1(2), pp.65~70 (2018)[DOI]
  42. Woods, B, "Reminiscence therapy for dementia", Cochrane Database of Systematic Reviews, 3(3), pp.1~108 (2018)[DOI]

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