Demanslı Yaşlılarda Oyuncak Bebek Terapisinin Bilişsel Durum ve Ajitasyona Etkisi

Öz

Amaç: Demanslı kişilerde bilişsel bozulma ile birlikte görülen ve kişinin hayatını etkileyen en önemli nöropsikiyatrik semptomlardan biri ajitasyondur. Oyuncak Bebek Terapisi (OBT), genellikle demansın orta veya ağır dönemlerinde olan kişiler için ajitasyon gibi davranışsal belirtilerin yönetiminde kullanılan farmakolojik olmayan yöntemdir. Bu doğrultuda bu çalışma uzun süreli kurumsal bakım alan demanslı yaşlılarda OBT’nin bilişsel durum ve ajitasyona etkisinin incelenmesi amacıyla deneysel tasarımda yürütülmüştür. Gereç ve Yöntemler: Araştırmanın evrenini, bir ilde bir kurumsal bakım merkezinde yaşayan 110 yaşlı birey oluşturmuştur. Uygulama grubunun büyüklüğü güç analizi yöntemi ile hesaplanarak OBT ve Kontrol (K) grubuna sırasıyla 16 ve 19 olmak üzere toplam 35 yaşlı birey alınmıştır. Veri toplama aracı olarak Cohen-Mansfield Ajitasyon Envanteri (CMAE) ve Mini Mental Durum Değerlendirme Testi (MMT) kullanılmıştır. Bulgular: Araştırmanın sonuçları başlangıçta (T0), OBT’den hemen sonraki hafta (T1), 3 ay sonra (T2) ölçülmüştür. Gruplardaki yaşlılar sosyo-demografik değişkenler, kurumsal bakım alma özellikleri, psikiyatrik ve fiziksel hastalıkları, bilişsel ve ajitasyon düzeyleri yönünden benzerdir. Bu çalışmada OBT ve K grubu arasında CMAE toplam ajitasyon düzeyi ve Fiziksel Agresif Olmayan ajitasyon düzeyi OBT grubu lehine anlamlı olarak farklı bulunmuştur. Ancak CMAE Sözel Agresif Olmayan, Sözel Agresif Olan ve Fiziksel Agresif Olan ajitasyon alt boyutlarındaki ve MMT düzeyindeki değişimin gruplararası farkı anlamlı bulunmamıştır. Sonuç: Sonuçlar, OBT’nin geriletici değil ama durdurucu etkisini ortaya koymuştur.

Anahtar Kelimeler

• Oyuncak bebek terapisi
• demans
• yaşlı
• ajitasyon
• bilişsel durum

The Effect of Doll Therapy on Cognitive Status and Agitation among Elderly with Dementia

Öz

Aim: Agitation is one of the most important neuropsychiatric symptoms which affect the daily life of the patients along with cognitive decline among people with dementia. Doll therapy is a non-pharmacological method utilized in the management of behavioral symptoms like agitation for people diagnosed with moderate to severe dementia. In this respect, this study was conducted as an experimental design in order to test the effect of DT on cognitive state and agitation among long term institutionalized dementia patients. Material and Methods: The universe of the study is 110 elderly patients hospitalized in an institutionalized care center in a city. The size of the sampling was calculated using power analysis. The sample of the study consisted of DT (Doll Therapy) Group and C (Control group) including 16 and 19 patients respectively. Cohen-Mansfield Agitation Inventory (CMAI) and Mini Mental State Examination (MMSE) were used as data gathering tools. Results: The results were categorized as the beginning (T0), the week right after DT (T1), and as 3-months application (T2). The elderly in the group are similar in their socio-demographic features, nature of their institutional care, psychiatric and physical diseases, cognitive and agitation levels. A meaningful difference was found between DT and K groups in their CMAI total agitation level and Physical Non-Aggressive agitation level in favor of DT sample. However, the difference among CMAI Verbal Non-Aggressive, Verbal Aggressive and Physical Aggressive agitation sub dimensions and the change in MMSE levels did not prove to be significant. Conclusion: The results proved DT effective in stopping the progression of dementia but not the reversal of the process.

Anahtar Kelimeler

• Doll therapy
• dementia
• elderly
• agitation
• cognitive status

Kaynakça

1. Profiles of ageing 2015 [Updated: 2019 Oct 20; Cited: 2015 July 9]. Available from: https://www.un.org/en/development/desa/population/theme/ageing/WPA2015.asp.
2. İstatistiklerle yaşlılar, 2015. Sayı: 21520 [Updated: 2019 Nov 20; Cited: 2016 Mar 17]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2015-21520.
3. Engelli ve yaşlı bireylere ilişkin istatistiki bilgiler. İstatistik Bülteni [Updated: 2019 Oct 10; Cited: 2018 Dec 10]. Available from: https://eyh.aile.gov.tr/uploads/pages/engelli-ve-yasli-bireylere-iliskin-istatistiki-bilgiler.
4. The global impact of dementia 2013- 2050: Policy brief for heads of government [Updated: 2019 Nov 30; Cited: 2013 Dec 11]. Available from: http://alz.co.uk/research/GlobalImpactDementia2013.pdf.
5. Alzheimer ve diğer demans hastalıkları klinik protokolü [Updated: 2021 Feb 20]. Available from: https://dosyamerkez.saglik.gov.tr/Eklenti/38985,alzheimerkpyayin-verspdf.pdf?0
6. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011; 7(3): 270-9.
7. Medical subject headings: Dementia [Updated: 2019 Sept 12]. Available from: https://www.ncbi.nlm.nih.gov/mesh?Db=mesh&Cmd=DetailsSearch&Term=C10.228.140.380%5BAll+Fields%5D.
8. World Health Organization and Alzheimer’s Disease International. Dementia: A public health priority [Updated: 2019 Nov 22]. Available from: https://www.who.int/mental_health/publications/dementia_report_2012/en/.

9. Bruen P, McGeown W, Shanks M, Venneri A. Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer' s disease. Brain. 2008; 131(9): 2455-63.
10. Cohen-Mansfield J. Agitated behaviors in the elderly. II. Preliminary results in the cognitively deteriorated. J Am Geriatr Soc. 1986; 34(10): 722-7.
11. Hodge M. The agitated & violent patient. In: Hans L, Mawji Y, editors. The ABC's of emergency medicine. University of Toronto; 2012. p. 104-9.
12. Kales HC, Gitlin LN, Lyketsos CG. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014; 62(4): 762-9.
13. Livingston G, Barber J, Marston L, Rapaport P, Livingston D, Cousins S. et al. Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study. BJPsych Open. 2017; 3(4): 171-8.
14. Ikeda M, Fukuhara R, Shigenobu K, Hokoishi K, Maki N, Nebu A, et al. Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study. J Neurol Neurosurg Psychiatry. 2004; 75(1): 146-8.
15. Craig D, Mirakhur A, Hart DJ, Mcllroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer’s disease. Am J Geriatr Psychiatry. 2005; 13(6): 460-8.
16. Wetzels RB, Zuidema SU, De Jonghe JFM, Verhey FRJ, Koopmans RTCM. Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. Am J Geriatr Psychiatry. 2010; 18(12): 1054-65.
17. Selbaek G, Engedal K, Benth JS, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Psychogeriatr. 2014; 26(1): 81-91.
18. Bayram S, Usta E, Altınbaş Akkaş Ö, Şık T. The determination of agitation behaviors among the elderly people receiving long-term institutional care and the influencing factors. FNJN. 2019; 27(2): 173-87.
19. Samus QM, Rosenblatt A, Steele C, Baker A, Harper M, Brandt J, et al. The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia. The Gerontologist. 2005; 45(Suppl 1): 19-26.
20. Suzuki M, Kurata S, Yamamoto E, Makino K, Kanamori M. Impact of fallrelated behaviors as risk factors for falls among the elderly patients with dementia in a geriatric facility in Japan. J Alzheimers Dis. 2012; 27(6): 439-46.
21. Kirkevold O, Sandvik L, Engeldal K. Use of constraints and their correlates in Norwegian nursing homes. Int J Geriatr Psychiatry. 2004; 19(10): 980-8.
22. Matsumoto N, Ikeda M, Fukuhara R, Shinagawa S, Ishikawa T, Mori T, et al. Caregiver burden associated with behavioral and psychological symptoms of dementia in elderly people in the local community. Dement Geriatr Cogn Disord. 2007; 23(4): 219-24.
23. Gates D, Fitzwater E, Succop P. Relationships of stressors, strain, and anger to care-giver assaults. Issues Ment Health Nurs. 2003; 24(8): 775-93.
24. Gerberich SG, Church TR, McGovern PM, Hansen HE, Nachreiner NM, Geisser MS, et al. An epidemiological study of the magnitude and conse-quences of work related violence: the Minnesota Nurses' Study. Occup Environ Med. 2006; 61(6): 495-503.
25. Franz S, Zeh A, Schablon A, Kuhnert S, Nienhaus A. Aggression and violence against health care workers in Germany - a cross sectional retrospective survey. BMC Health Serv Res. 2010; 10(1): 1-8.
26. Mitchell G, O’Donnell H. The therapeutic use of doll therapy in dementia. Br J Nurs. 2013; 22(6): 329-34.
27. Shin JH. Doll therapy: an intervention for nursing home residents with dementia. J Psychosoc Nurs Ment Health Serv. 2015; 53(1):13-8.
28. Mackenzie L, James I, Morse R, Makaetova-Ladinska E, Reichett F. A pilot study on the use of dolls for people with dementia. Age & Aging. 2006; 35(4): 441-4.
29. James I, Mackenzie L, Makaetova-Ladinska E. Doll use in care homes for people with dementia. Int J Geriatr Psychiatry. 2006; 21(11): 1093-8.
30. Cohen-Mansfield J, Marx M, Dakbeel-Ali Regier N, Theina K. Can persons with dementia be engaged with stimuli? Am J Geriatr Psychiatry. 2010; 18(4): 351-62.
31. Ready R, Ott B. Quality of Life measures for dementia. Health Qual Life Outcomes. 2003; 1(1): 1-13.
32. Miller B. Doll therapy & dementia [Updated: 2018 Feb 20]. Available from: http://www.ehow.com/about_6515768_doll-therapy-dementia.html.
33. Braden BA, Gaspar PM. Implementation of a baby doll therapy protocol for people with dementia: Innovative practice. Dementia (London). 2015; 14(5): 696-706.
34. Mitchell G, McCormack B, McCance T. Therapeutic use of dolls for people living with dementia: A critical review of the literature. Dementia (London). 2016; 15(5): 976-1001.
35. Higgins P. Using dolls to enhance the well-being of people with dementia. Nurs Times. 2010; 106(39): 18-20.
36. Mitchell G, Templeton M. Ethical considerations of doll therapy for people with dementia. Nurs Ethics. 2014; 21(6): 720-30.
37. Demircioğlu Özal M. Alzheimer hastalarında Cohen-Mansfield Ajitasyon Envanteri’nin (Cohen-Mansfield Agitation Inventory-CMAI) Türkçe uyarlaması, geçerlik ve güvenirliği [Yüksek lisans tezi]. İstanbul: İstanbul Üniversitesi; 2014.
38. Cohen-Mansfield J, Marx MS, Rosenthal AS. A description of agitation in a nursing home. J Gerontol. 1989; 44(3): 77-84.
39. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3): 189-98.
40. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Türk Psikiyatri Dergisi. 2002; 13(4): 273-81.
41. Lary-Waller, J. Implementation of doll therapy for agitated residents with dementia [PhD dissertation]. Georgia: Georgia College and State University; 2020.
42. Moyle W, Murfield J, Jones C, Beattie E, Draper B, Ownsworth T. Can lifelike baby dolls reduce symptoms of anxiety, agitation, or aggression for people with dementia in long-term care? Findings from a pilot randomised controlled trial. Aging Ment Health. 2019; 23(10): 1442-50.
43. Bayram S, Usta E, Altınbaş Akkaş Ö. Türkçe’ye uyarlanan Mini-Cog testinin kurumsal bakım alan yaşlı bireylerde psikometrik uygunluğu. In: Aras G, editor. Proceedings of the 1st International Congress Active Aging and Inter-Generational Solidarity; 2019 Mar 14; Güven Plus; 2019. p. 31-8.