每日跟讀#710: Drugs may not be best option to ease dementia agitation

Symptoms of aggression and agitation in dementia patients may respond better to non-drug therapies such as massage, touch therapy and outdoor activities, a new study suggests.

一份新研究指出，失智症患者的攻擊性行為和躁動等症狀，對按摩、撫觸療法以及戶外活動等非藥物療法的反應可能更好。

In a reanalysis of more than 163 studies involving nearly 25,000 patients, Canadian researchers found that multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy were more effective than patients’ usual care, according to a report in the Annals of Internal Medicine.

在這份刊載於《內科醫學年鑑》的研究中，加拿大研究人員日前對超過一百六十三份、將近兩萬五千名患者參與的研究進行分析。他們發現「跨學科照護」、按摩與撫觸療法，以及加入音樂一同進行，比失智症患者通常受到的照護還要來得有效。

“Our results suggest that multidisciplinary care and non-medication therapy should be prioritized in treating our patient population and this should be incorporated into evidence-based guidelines,” said lead study author Dr. Jennifer Watt, a geriatrician and scientist at the Li Ka Shing Knowledge Institute within Unity Health Toronto.

該研究的主要作者珍妮佛‧瓦特是老年病學醫師，同時也是一名科學家，隸屬多倫多Unity醫療網絡的李嘉誠知識學院。她指出：「我們的研究結果顯示，跨學科的照護和非藥物療法在我們的病人中應該被視為優先選項，也應該被加入實證的醫學指南中。」

Antipsychotic drugs, which are often prescribed to treat these behavioral symptoms, come with some concerning side-effects, such as an increased risk of stroke and death, Watt said. That’s why she suggests caregivers try nonpharmacological treatments first.

瓦特表示，經常被用來治療這類行為症狀的抗精神病藥物，都帶有一些令人憂心的副作用，包括增加中風和死亡的風險。這也是為什麼她建議照護者先試試看非藥理學的治療方式。

In multidisciplinary therapy, a team of specialists works with patients and caregivers, Watt explained. The team might include nurses trained in geriatrics, a physician who can look at possible medical causes for the behaviors and prescribe appropriate medications, and an occupational therapist who can try to modify the patient’s environment or adapt the patient’s routine to avoid frustration.

瓦特解釋，跨學科療法會由一群專家組成的團隊，和病人與照護者一起合作。這組團隊可能包括受過老年病學訓練的護理師、能夠找到行為背後可能的醫學原因，並開立適當藥物的內科醫師，及一位物理治療師，後者可試著改變病人的環境或調整其日常作息，避免讓他們產生挫敗感。

For the new study, Watt’s team initially identified nearly 20,000 earlier studies that evaluated the effectiveness of nonpharmacological therapies. They narrowed that down to 163, which included information on 23,143 patients whose average age was 70.

為了這份新研究，瓦特的研究團隊最初檢視了將近兩萬份評估非藥理學療法效果的前行研究。他們後來把研究範圍縮小到一百六十三份，其中包含兩萬三千一百四十三名病人的資訊，平均年齡為七十歲。

The researchers found that outdoor activities were more effective than antipsychotic medications for treating physically aggressive patients. When it came to verbal aggression, massage and touch therapy were more effective than the patients’ usual care. Those techniques were also more effective than usual care in treating patient agitation. Watt points to her personal experience teaching caregivers to do hand massage when a patient is getting dialysis. “Massaging the hand can be very calming for them,” she said.

研究人員發現，比起抗精神病藥物，戶外活動對於治療身體攻擊行為的病人較為有效。至於言語攻擊行為的病人，按摩和撫觸療法比病人通常獲得的照護還來得有效。這些手法也比治療患者躁動的常見照護方式更有效果。瓦特引述自己的經驗，她曾教照護者對一名正在進行透析的病人做手部按摩。她說：「按摩手部可以讓他們感到非常平靜。」

The new results were not surprising to Dr. Milap Nowrangi, an assistant professor in the department of psychiatry at the Johns Hopkins Medical School. But “they are important,” he said, adding that aggression and agitation are the kinds of symptoms “that lead to caregiver burnout and institutionalization of patients.” While the study mostly dealt with patients in assisted living situations or nursing homes, the findings may also be helpful for family members taking care of a loved one at home, Nowrangi said.

對於約翰‧霍普金斯醫學院精神病學系的助理教授米拉普‧諾蘭基而言，新的研究結果並不讓人感到驚訝。不過，他表示「這些結果相當重要」，並補充說攻擊性行為和躁動是「會導致照護者過勞，並造成病人被送去照護機構安置」的那類症狀。諾蘭基指出，雖然這份研究的對象主要是住在有人協助的生活環境或是養護之家的病人，但是研究結果可能也會對在家照顧摯愛的家庭成員帶來助益。

(Reuters)

Because no single therapy can help every patient, he suggests families experiment with a number of options. First and foremost, caregivers should check to see if there is any physical cause for the behaviors, such as hunger, pain or discomfort. If that’s not the problem, caregivers might try “going for a walk or drive; having them do something repetitive, like folding towels or washing dishes; using a scented candle; or brushing the patient’s hair or massaging them,” Nowrangi suggested.

諾蘭基表示，沒有任何一種療法可以一體適用於所有病人，所以他建議照護家庭試驗幾種選項。首先，而且最重要的是，照護者應該確認有沒有任何可能導致行為症狀的生理原因，例如飢餓、疼痛或不適。諾蘭基建議，如果這些因素並未構成問題，照護者或許可以試試「走一走或開車載他們兜風；讓他們做一些重複性的事，例如折毛巾或洗碗盤；點薰香蠟燭；又或是幫病人梳頭髮或按摩。」

Source article: http://www.taipeitimes.com/News/lang/archives/2019/10/20/2003724259/1