【作者】 李燕；

【导师】 冯晓娟；

【作者基本信息】 河南农业大学 ， 社会工作（专业学位）， 2022， 硕士

【摘要】 目前全世界大约有5000万人患有失智症,我国患者人数大约有1300万。据预测,全球失智症患者总数到2030年将达8200万,2050年将达1.52亿。2015年失智症相关医疗和照护支出占据全球GDP的1.1%,失智症已经成为全球应对老龄化过程的重要挑战。随之而来的是老人产生照护依赖,自我效能感逐渐降低,家庭照顾压力、经济压力增加,生活节奏被打乱,社会的照护成本增加,劳动率降低。在失智症药物治疗效果不佳的背景下,学者们开展了非药物干预失智症的研究探索,并且获得一定成效,但对于失智症老人的自我效能感关注还比较少。本研究主要着眼于轻中度失智症老人的自我效能感,采用行动研究,以EPS社会工作介入模式为基础,小组工作为主要介入方法,通过园艺疗法增加老人积极的情绪体验,提升老人对自我能力的正向评价,从而提升老人的自我效能感,探索园艺疗法在提升早中期失智症老人自我效能感方面的有效性。以期为园艺疗法介入早中期失智症患者自我效能感提升提供理论方面的创新和循证依据。本研究以Z市J社区为例,首先对该社区自述有记忆力下降的老人进行半结构化访谈、简易精神智能状态量表(后简称MMSE量表)和一般自我效能感量表(后简称GSES量表)测试。筛选16位MMSE量表分数大于等于10分,小于27分的老人参与准实验研究,对实验组的8位老人开展园艺治疗小组,以提升其自我效能感。服务内容以EPS模式为框架,依据自我效能感影响因素:个人成功经验、替代性经验、他人的正向评价和鼓励、情绪状态和情景条件五个方面设计园艺疗法操作内容。实验组共计进行6次小组活动干预,对照组只进行前后测,不做干预。通过对小组进行过程评估和结果评估,发现基于EPS模式的园艺疗法小组对于轻中度失智老人的自我效能感提升有一定的效果,实验组失智老人的参与意愿、自我评价有了明显改变,自我效能感得到提升,获得了积极正向的情绪体验,而对照组个别老人出现失智症情况更加严重,自我效能感下降,多数老人改变不明显。研究启示:其一,园艺疗法小组适用于不同程度的失智症老人,其二,EPS社会工作干预模式,聚焦服务对象的强项,有助于提升服务对象的参与动机,形成正向循环,提升服务对象的自我效能感。在条件允许的情况下,未来的实践可以进行更长时间的连续性服务,结合室内与室外园艺治疗活动,促进失智症老人与自然的充分互动,在适合其身体特征的园艺活动操作中提升其自我效能感。更多还原

【Abstract】 About 50 million people worldwide suffer from dementia,and about 13million in China.It is predicted that the total number of people living with dementia worldwide will reach 82 million by 2030 and 152 million by 2050.In 2015,spending on medical and care related to dementia accounted for 1.1%of global GDP.Dementia has become an important challenge in the global response to the aging process.As a result,elderly people become dependent on care,their sense of self-efficacy gradually decreases,family care pressure and economic pressure increase,the pace of life is disrupted,social care cost increases,and labor rate decreases.In the context of poor efficacy of drug therapy for dementia,scholars have carried out research and exploration on non-drug intervention for dementia,and achieved some results,but there is still less attention to the self-efficacy of dementia elderly.This research mainly adopts action research,on the basis of EPS intervention of social work mode,team work as the main intervention methods,and Horticultural Therapy will be used to increase the positive emotional experience of the elderly,improve their positive evaluation of their self-ability,so as to improve their sense of self-efficacy,and explore the effectiveness of Horticultural Therapy in improving the self-efficacy of the elderly with early and middle dementia.In order to provide theoretical innovation and evidence-based basis for Horticultural Therapy to improve the self-efficacy of patients with early and middle dementia.Taking J Community in Z City as an example,this study first conducted semi-structured interviews,mini-mental state examination(MMSE)and General self-efficacy Scale(GSES Scale)for the elderly in the community who reported memory decline.Sixteen elderly people with MMSE scores greater than or equal to 10 points and less than 2 7 points were selected to participate in the quasi-experimental study.Eight elderly people in the experimental group received Horticultural Therapy to improve their self-efficacy.The service content of Horticultural Therapy was designed according to the influencing factors of self-efficacy:personal successful experience,vicarious experience,positive evaluation and encouragement of others,emotional state and situational conditions.The experimental group underwent 6 group activities intervention,while the control group only underwent pre-and post-test without intervention.Through the process evaluation and result evaluation of the group,it was found that EPS based Horticultural Therapy group had a certain effect on the improvement of self-efficacy of the elderly with mild to moderate dementia.In the experimental group,the participation intention and self-evaluation of the elderly with dementia were significantly changed,and the sense of self-efficacy was improved and positive emotional experience was obtained.At the same time,the dementia situation of individual elderly in the control group was more serious,and the sense of self-efficacy was decreased.Research implications:First,Horticultural Therapy group is suitable for the elderly with dementia of different degrees;second,EPS social work intervention mode focuses on the strengths of service objects,which helps to improve their participation motivation,form a positive cycle,and improve their sense of self-efficacy.If conditions permit,the future practice can provide longer continuous service,combine indoor and outdoor Horticultural Therapy activities,promote the full interaction between the elderly with dementia and nature,and improve their sense of self-efficacy in horticultural activities suitable for their physical characteristics.更多还原