本土化老人憂鬱評估及篩檢臨床指引發展研究

吳曼阡^a蔡欣晏^b宋惠娟c

摘要

憂鬱及失智是老年人最常見的精神問題，老人的憂鬱情形是最常且易被忽略的問題且未得合適的診斷及處理。文獻指出老年憂鬱患者可能同時有認知障礙，與失智症之症狀很相似，故增加老人憂鬱症評估的困難度。台灣老人人口逐年劇增，老人罹患憂鬱症及失智症的比率也越來越高，但仍未見一具實證之本土化的臨床照護指引來做為評估及照護老人的憂鬱之指標，做為臨床照護人員在臨床實務遵循之參考，以提供憂鬱症老人合適的處置及照護。

本篇報告運用系統性文獻回顧之方法，搜尋2000-2009年間國內外發表之臨床照護指引及系統性文獻回顧之文章，再由三位研究者依據文獻評析工具，進行文獻評析、資料統合及分析，再撰寫結果。將依據系統性文獻查證結果，擬定本土化臨床照護指引及建議未來研究方向。研究結果呈現一以人為本之臨床指引，此指引共包括確認老人憂鬱的高危險群、評估老人認知功能程度、老人憂鬱的評估、篩檢結果及轉介標準、治療及照護措施，共62個策略。為能取得國際認同並展現台灣臨床以人為本之照護特質，未來實證照護之發展方向仍可朝向以下方向努力：1、全國宜建構跨領域合作的實證照護中心，著力於依據實證基礎建立老人憂鬱品管指標、及健保給付的標準，亦可資源共享於全國民。2、強化以人為本的老人憂鬱臨床照護指引，並於實證中加入成本概念。3、該臨床指引需定期進行更新。

關鍵字：老人憂鬱、老人憂鬱評估及篩檢、臨床指引

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Development of Guideline for screening and detecting depression in older adults

Mann-Chian Wu^a Shin-Yann Tsai^b Huei-Chuan Sung^c

Abstract

Depression and dementia are common mental problems among aging population. Depression in older adults is often ignored and inadequately diagnosed and managed. Literature indicates that older patients with depression may also have cognitive impairment which has similar symptoms with dementia. Therefore, this makes the assessment of depression more difficult among older adults. There is a lack of guideline which can assist clinicians make better assessment and care plan for older adults with depression in Taiwan.

This report used a systematic review method and searched published guidelines and systematic reviews from 2000-2009. Guidelines and reviews were appraised by three certified reviewers using appraisal tools and further analyzed. With the results and suggestions from expert focus group, we developed the guideline protocol for screening depression suitable for older adults in Taiwan. This guideline protocol were evaluated by 12 psychiatric experts and assessed by 357 clinical health care professionals in psychiatrics using a questionnaire survey method for its feasibility and possible obstacles in implementing the guideline in the clinical settings.

The final version of guideline has 62 recommendations, including identifying high-risk factors for older adults with depression, assessing cognitive function for older adults, assessing depression level of older adults, screening results and referral requirements, treatments and interventions.

Key words: depression in older adults, screening and detecting for depression in older adults, Guideline

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