| Summary: | 博士 === 國立陽明大學 === 護理學系 === 104 === Abstract
Background and Objectives: Hyperphagia increases eating-associated risks for people with dementia and distress for caregivers. The purpose of this study was to develop various forms of memory training programs and compare their effects on improving the hyperphagic behavior, meal amount, anthropometric measurements, agitation, and depressed mood among institutionalized residents with dementia, as well as distress to caregivers.Method: The research design was a longitudinal study using a single blind randomized controlled trial, which was conducted by employing the pre- and post-evaluation methods of two experiment groups and one control group, and three consecutive follow-up comparisons over a span of six months. The sample included 140 residents with dementia suffering from hyperphagia. They were recruited from eight dementia special care units in long-term care facilities in Taiwan. After they were divided according to the level of severity of their hyperphagic behavior, cluster random sampling was used to split them into Experimental Group I (E-I, 46 subjects), Experimental Group II (E-II, 49 subjects), and a control group (45 subjects). E-I and E-II each underwent a one-on-one spaced retrieval (SR) memory training program and an SR combined with Montessori activities (SR+M) memory training program for at least 40 minutes, five times a week for six consecutive weeks, while the control group was not involved in any activity. The research process used a structured questionnaire and field observation, collecting data on the three groups’ hyperphagic behavior, pica, changes in eating habits, short meal frequency, average meal amount, body weight, body mass index (BMI), agitation, and depression, as well as distress to caregivers. Using SPSS 20.0 statistics software, descriptive and inferential tests were conducted, regression analysis and generalized estimating equation analysis (GEE) were employed to analyze 6-month follow-up data.Results: Results showed: 1.) E-I and E-II both experienced obvious improvements in hyperphagic behavior, pica, short meal frequency, and such behaviors as “rapid eating” and “excessive eating.” However, as for changes in eating habits, there was no significant difference compared to the control group. 2.) E-I and E-II experienced a slight decrease in meal amount, but in terms of anthropometric measurements, there was no significant change. 3.) E-I and E-II experienced a significant decrease in agitation behaviors, especially aggressive behavior and physical non-aggressive behavior, but there was no difference in verbally aggressive behavior compared to the control group. 4.) The improvement in the depression of E-II was more obvious. 5.) Distress to caregivers for E-I and E-II showed improvement, but the effects only lasted until the post-evaluation stage of the training. 6.) E-I and E-II experienced long-term improvements in cognitive status, E-II also experienced improvements in hyperphagic behavior and depressed mood at follow-up 6 months later.Conclusions and Suggestions: Both forms of memory training programs are capable of correcting the hyperphagic behavior of institutionalized residents with dementia, slowing their eating rate, increasing meal duration, and improving inappropriate agitation behavior. At the same time, both programs enabled the anthropometric measurements of the residents with dementia to remain stable during their training. The SR + M training program is particularly beneficial for the improvement of rapid eating. Caregivers can choose a suitable memory training program according to the eating problems of their residents in order to maintain the quality of eating and safety in eating.
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