The Journal of the Korea Contents Association (한국콘텐츠학회논문지)

The Korea Contents Association (한국콘텐츠학회)
권호 표지
DOI QR코드

DOI QR Code

The Effect of Nonpharmacologic Interventions on Behavioral and Psychological Symptoms of Dementia : A Meta-Analysis

치매환자의 행동심리증상에 비약물적 중재가 미치는 효과 - 메타분석

  • 권미화 (건양대학교 일반대학원 작업치료학 전공) ;
  • 이재신 (건양대학교 작업치료학과)
  • Received : 2017.02.22
  • Accepted : 2017.03.27
  • Published : 2017.06.28
Download PDF
⟨ Previous Next ⟩

Abstract

To investigate a variety of nonpharmacologic interventions have confirmed what the symptoms and effects, mainly interventions by acting on behavioral and psychological symptoms of dementia was conducted a meta-analysis. Data were collected from online search engines using search words from domestic and foreign article database. The researcher independently and among the pre-post experimental studies published from January 2000 to June 2016, recalled applying for the elderly with dementia presents the effect of treatment group and the control group RCT in this study were included in the study. The results of this meta-analysis showed that, effect size of the nonpharmacologic interventions of total -0.33, occupational therapy - 0.26, multi-sensory stimulation intervention -0.65 was significant beneficial effects to elderly with dementia(p<.05). According to interventions as a major affected the symptoms associated with behavioral problems, mainly aggression, memory-related problem behavior in the home-based program. Also, reminiscence therapy and occupational therapy is generally apathy, multi-sensory stimulation and music therapy was confirmed that there was a major change in behavior anxiety or agitation. The results of this study confirmed that various nonpharmacologic interventions were effective on behavioral psychological symptoms of dementia patients and confirmed the main symptoms of intervention.

본 연구는 치매환자의 행동심리증상에 미치는 다양한 비약물적 중재의 효과를 확인하고, 중재 별로 주요하게 작용된 증상이 무엇인지를 알아보고자 메타분석을 실시하였다. 자료 수집은 국 내외 검색엔진을 이용하였으며, 2000년 1월부터 2016년 6월까지 출판된 연구를 대상으로 하였다. 치매환자에게 적용한 비약물적 중재의 효과를 제시한 사전-사후실험연구 가운데 실험군과 대조군이 있는 무작위통제실험연구(Randomized Controlled Trial; RCT)를 대상으로 하였다. 최종 선정된 23편의 연구를 분석한 결과, 치매환자에게 적용한 다양한 비약물적 중재 연구 전체의 효과크기는 -0.33으로 "보통"의 효과크기가 나타났다. 세부적인 비약물적 중재 별 효과크기는 작업치료가 -0.26로 "보통"의 효과크기, 다감각자극이 -0.65로 "보통이상"의 효과크기로 임상적으로 유의한 차이가 있음이 증명되었다(p<.05). 중재 별로 주요하게 작용된 행동심리증상으로는 가정기반 프로그램에서는 주로 공격성, 기억력과 관련된 문제행동에 영향을 주었다. 또한, 회상치료와 작업치료는 대체적으로 무감정, 다감각자극과 음악치료는 불안이나 초조행동에 주요 변화가 있었음을 확인할 수 있었다. 본 연구 결과를 통하여 다양한 비약물적 중재가 치매환자의 행동심리증상에 효과가 있음을 확인할 수 있었으며, 중재 별로 주요하게 작용된 증상을 확인 할 수 있었다. 따라서 추후 임상에서 치매환자를 위한 비약물적 중재 시, 각 환자의 행동심리증상에 적합한 중재를 선택하여 접근하는 노력이 필요 할 것이다.

Keywords

References

  1. H. Brodaty and M. Donkin, "Family caregivers of people with dementia," Dialogues in Clinical Neuroscience, Vol. 11, No. 2, p.217, 2009.
  2. 장서진, 사회자본과 사회적 지지의 지각수준이 치매 예방 행동의도에 미치는 영향 : 한국 문화적 특성인 가족건강성의 조절효과, 이화여자대학교 대학원, 석사학위논문, 2014.
  3. 조현, 고준기, "치매노인의 현황과 노인장기요양 보험법 상의 개선방안," 한국산학기술학회논문지, 제13권, 제12호, pp. 5816-5825, 2012. https://doi.org/10.5762/KAIS.2012.13.12.5816
  4. 조맹제, 김진영, 한국인 치매환자의 행동 및 심리 증상의 횡문화적 특성, 서울대학교출판부, 2006.
  5. L. Teri, "Behavior and caregiver burden: behavioral problems in patients with Alzheimer disease and its association with caregiver distress," Alzheimer Disease and Associated Disorders, Vol. 11, No. 4, pp. S35-38, 1997.
  6. 송준아, 박재원, 김효진, "치매의 행동심리증상이 요양시설 간호제공자의 부담감에 미치는 영향," 노인간호학회지, 제15권, 제1호, pp. 62-74, 2013.
  7. 이동영, 김기웅, "치매에서 나타나는 초조 증상의 임상적 이해와 치료," 정신병리학, 제10권, 제2호, pp. 87-96, 2001.
  8. L. S. Schneider, K. S. Dageman, and P. Insel, "Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials," JAMA, Vol. 294, No. 15, pp. 1934-1943, 2005. https://doi.org/10.1001/jama.294.15.1934
  9. 황재영, 치매 케어 텍스트북, 노인연구정보센터, 2010.
  10. 김덕주, 김미경, "노인장기요양보험제도의 치매 정책에 관한 고찰," 한국고령친화건강정책학회지, 제3권, 제1호, pp. 33-43, 2011.
  11. 김춘미, 박명숙, 김선호, "국내 치매노인을 위한 비약물요법 중재연구 동향분석," 노인간호학회지, 제14권, 제2호, pp. 129-141, 2012.
  12. B. Henry, "Meta-Analysis of Nonpharmacological Interventions for Neuropsychiatric Symptoms of Dementia," The American journal of Psychiatry, Vol. 169, No. 9, pp. 946-953, 2012. https://doi.org/10.1176/appi.ajp.2012.11101529
  13. S. Y. Kim, E. Y. Yoo, M. Y. Jung, S. H. Park, and J. H. Park, "A systematic review of the effects of occupational therapy for persons with dementia: a meta-analysis of randomized controlled trials," NeuroRehabilitation, Vol. 31, No. 2, pp. 107-115, 2012.
  14. E. H. Kong, L. K. Evans, and J. P. Guevara, "Nonpharmacological intervention for agitation in dementia: A systematic review and meta-analysis," Aging & Mental Health, Vol. 13, No. 4, pp. 512-520, 2009. https://doi.org/10.1080/13607860902774394
  15. A. R. Jadad, R. A. Moore, D. Carroll, C. Jenkinson, D. J. Reynolds, D. J. Gavaghan, and H. J. McQuay, "Assessing the quality of reports of randomized clinical trials: is blinding necessary?," Controlled Clinical Trials, Vol. 17, No. 1, pp. 1-12, 1996. https://doi.org/10.1016/0197-2456(95)00134-4
  16. R. Rosenthal and D. B. Rubin, "Comparing effect sizes of independent studies," Psychological Bulletin, Vol. 92, No. 2, pp. 500-504, 1982. https://doi.org/10.1037/0033-2909.92.2.500
  17. L. V. Hedges and I. Olkin, Statistical methods for meta-analysis, Academic Press, 1985.
  18. H. R. Rothstein, "Publication bias as a threat to the validity of meta-analytic results," Journal of Experimental Criminology, Vol. 4, pp. 61-81, 2008. https://doi.org/10.1007/s11292-007-9046-9
  19. J. Lau, J. Ioannidis, and C. H. Schmid, "Quantitative synthesis in systematic reviews," Annals of Internal Medicine, Vol. 127, No. 9, pp. 820-826, 1997. https://doi.org/10.7326/0003-4819-127-9-199711010-00008
  20. J. Cohen, Statistical power analysis for the social sciences, Erlbaum, 1988.
  21. R. Baker, S. Bell, E. Baker, S. Gibson, J. Holloway, R. Pearce, Z. Dowling, P. Thomas, J. Assey, and L. A. Wareing, "A randomized controlled trial of the effects of multi-sensory stimulation(MSS) for people with dementia," British Journal of Clinical Psychology, Vol. 40, pp. 81-96, 2001. https://doi.org/10.1348/014466501163508
  22. R. Baker, J. Holloway, C. C. Holtkamp, A. Larsson, L. C. Hartman, R. Pearce, B. Scherman, S. Johansson, P. W. Thomas, L. A. Wareing, and M. Owens, "Effects of multi-sensory stimulation for people with dementia," Journal of Advanced Nursing, Vol. 43, No. 5, pp. 465-477, 2003. https://doi.org/10.1046/j.1365-2648.2003.02744.x
  23. J. Ferrero-Arias, M. Goni-Imίzcoz, J. Gonzalez-Bernal, F. Lara-Ortega, A. da Silva-Gonzalez, and M. Diez-Lopez, "The Efficacy of Nonpharmacological Treatment for Dementia-related Apathy," Alzheimer Disease & Associated Disorders, Vol. 25, No. 3, pp. 213-219, 2011. https://doi.org/10.1097/WAD.0b013e3182087dbc
  24. L. N. Gitlin, M. Corcoran, L. Winter, A. Boyce, and W. W. Hauck, "A randomized, controlled trial of a home environmental interventioneffect on efficacy and upset in caregivers and on daily function of persons with dementia," Gerontologist, Vol. 41, No. 1, pp. 4-14, 2001. https://doi.org/10.1093/geront/41.1.4
  25. L. N. Gitlin, L. Winter, M. Corcoran, M. P. Dennis, S. Schinfeld, and W. W. Hauck, "Effects of the Home Environmental Skill-Building Program on the Caregiver-Care Recipient Dyad: 6-Month Outcomes From the Philadelphia REACH Initiative," Gerontologist, Vol. 43, No. 4, pp. 532-546, 2003. https://doi.org/10.1093/geront/43.4.532
  26. L. N. Gitlin, L. Winter, J. Burke, N. Chernett, M. P. Dennis, and W. W. Hauck, "Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study," The American journal of geriatric psychiatry, Vol. 16, No. 3, pp. 229-239, 2008. https://doi.org/10.1097/01.JGP.0000300629.35408.94
  27. L. N. Gitlin, L. Winter, M. P. Dennis, N. Hodgson, and W. W. Hauck, "A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial," The Journal of the American Medical Association, Vol. 304, No. 9, pp. 983-991, 2010. https://doi.org/10.1001/jama.2010.1253
  28. N. Gormley, D. Lyons, and R. Howard, "Behavioural management of aggression in dementia: a randomized controlled trial," Age Ageing, Vol. 30, No. 2, pp. 141-145, 2001. https://doi.org/10.1093/ageing/30.2.141
  29. R. Hebert, L. Levesque, J. Vezina, J. P. Lavoie, F. Ducharme, C. Gendron, M. Preville, L. Voyer, and M. F. Dubois, "Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial," Journal of Gerontology, Vol. 58, No. 1, pp. 58-67, 2003. https://doi.org/10.1093/geronb/58.1.S58
  30. C. J. Hsieh, C. Chang, S. F. Su, Y. L. Hsiao, Y. W. Shih, W. H. Han, and C. C. Lin, "Reminiscence group therapy on depression and apathy in nursing home residents with mild-to-moderate dementia," Journal of Experimental and Clinical Medicine, Vol. 2, No. 2, pp. 72-78, 2010. https://doi.org/10.1016/S1878-3317(10)60012-5
  31. M. H. Hsu, R. Flowerdew, M. Parker, J. Fachner, and H. Odell-Miller, "Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study," BioMed Central Geriatrics, pp. 1-19, 2015.
  32. H. L. Huang, L. M. Kuo, Y. S. Chen, J. Liang, H. L. Huang, Y. C. Chiu, S. T. Chen, Y. Sun, W. C. Hsu, and Y. I. Shyu, "A home-based training program improves caregivers' skills and dementia patients' aggressive behaviors: a randomized controlled trial," The American journal of geriatric psychiatry, Vol. 21, No. 11, pp. 1060-1070, 2013. https://doi.org/10.1016/j.jagp.2012.09.009
  33. 황기철, 감진아, "의도적인 다감각환경 프로그램이 치매노인의 이상행동에 미치는 효과," 특수교육재활과학연구, 제49권, 제3호, pp. 109-130, 2010.
  34. T. Ito, K. Meguro, K. Akanuma, H. Ishii, and E. Mori, "A randomized controlled trial of the group reminiscence approach in patients with vascular dementia," Dementia Geriatric Cognitive Disorders, Vol. 24, No. 1, pp. 48-54, 2007. https://doi.org/10.1159/000103631
  35. 권미화, 정다해, 김수경, "집단 회상치료가 시설 거주 치매노인의 사회적 상호작용과 문제행동에 미치는 효과," 고령자.치매작업치료학회지, 제6권, 제2호, pp. 11-18, 2012.
  36. L. C. Lam, V. W. Lui, D. N. Luk, R. Chau, C. So, V. Poon, P. Tam, R. Ching, H. Lo, J. Chiu, A. Fung, and F. S. Ko, "Effectiveness of an individualized functional training program on affective disturbances and functional skills in mild and moderate dementia-a randomized control trial," International Journal of Geriatric Psychiatry, Vol. 25, No. 2, pp. 133-141, 2010. https://doi.org/10.1002/gps.2309
  37. Y. Lin, H. Chu, C. Y. Yang, C. H. Chen, S. G. Chen, H. J. Chang, C. J. Hsieh, and K. R. Chou, "Effectiveness of group music intervention against agitated behavior in elderly persons with dementia," International Journal of Geriatric Psychiatry, Vol. 26, No. 7, pp. 670-678, 2010. https://doi.org/10.1002/gps.2580
  38. T. Majic, H. Gutzmann, A. Heinz, U. E. Lang, and M. A. Rapp, "Animal-assisted therapy and agitation and depression in nursing home residents with dementia: a matched case-control trial," The American journal of geriatric psychiatry, Vol. 21, No. 11, pp. 1052-1059, 2013. https://doi.org/10.1016/j.jagp.2013.03.004
  39. W. Moyle, M. L. Cooke, E. Beattie, D. H. Shum, S. T. O'Dwyer, and S. Barrett, "Foot massage versus quiet presence on agitation and mood in people with dementia: a randomised controlled trial," International Journal of Nursing Studies, Vol. 51, No. 6, pp. 856-864, 2014. https://doi.org/10.1016/j.ijnurstu.2013.10.019
  40. M. Sakamoto, H. Ando, and A. Tsutou, "Comparing the effects of different individualized music interventions for elderly individuals with severe dementia," International Psychogeriatrics, Vol. 25, No. 5, pp. 775-784, 2013. https://doi.org/10.1017/S1041610212002256
  41. L. Teri, S. M. McCurry, R. Logsdon, and L. E. Gibbons, "Training community consultants to help family members improve dementia care: a randomized controlled trial," Gerontologist, Vol. 45, No. 6, pp. 802-811, 2005. https://doi.org/10.1093/geront/45.6.802
  42. Y. Treusch, T. Majic, J. Page, H. Gutzmann, A. Heinz, and M. A. Rapp, "Apathy in nursing home residents with dementia: results from a cluster-randomized controlled trial," European Psychiatry, Vol. 30, No. 2, pp. 251-257, 2015. https://doi.org/10.1016/j.eurpsy.2014.02.004
  43. J. J. Wang, "Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan," International Journal of Geriatric Psychiatry, Vol. 22, No. 12, pp. 1235-1240, 2007. https://doi.org/10.1002/gps.1821
  44. E. Grasel, J. Wiltfang, and J. Kornhuber, "Non-drug therapies for dementia: and overview of the current situation with regard to proof of effectiveness," Dementia and Geriatric Cognitive Disorders, Vol. 5, No. 3, pp. 115-125, 2003.
  45. L. Gill, K. Lynsey, L. H. Elanor, B. Gianluca, M. Stephen, P. Nishma, Z. O. Rumana, K. Cornelius and C. Claudia, "Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials," The British Journal of Psychiatry, Vol. 205, No. 6, pp. 436-442, 2014. https://doi.org/10.1192/bjp.bp.113.141119
  46. A. M. de Oliveira, M. Radanovic, P. C. de Mello, P. C. Buchain, A. D. Vizzotto, D. L. Celestino, F. Stella, C. V. Piersol, and O. V. Forlenza, "Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review," BioMed Research International, Vol. 2015, pp. 1-9, 2015.