원예 프로그램이 치매 노인의 문제행동, 인지기능, 수면상태 및 일상생활수행능력에 미치는 효과

Abstract

Advanced medical treatment and improved economic standards have extended the life expectancy. Therefore, the number of older adults with dementia and the frequency of use for sanitarium service have dramatically increased. The importance of non-pharmacology has emerged in long term care facilities to improve cognitive skills and to decrease behavioral and psychological symptoms by means of psychological and social medical approaches while preserving the function of older adults with dementia. Focusing on the effect of horticultural therapy for older adults with dementia through researches are required. The study was designed to use a nonequivalent control group pretest-posttest design. The subjects of the study were older adults with dementia who were currently staying in long term care facilities in Jeju island, whose MMSE-K scores were higher than 15 and less than 23. The 25 older adults with dementia were assigned to the experimental group and 25 to the control group, in two long term care facilities. Horticultural therapy programs were implemented to the experimental group twice per week (fifty minutes) for 4 weeks. Research data were collected from December 28th, 2013 to January 30th, 2014. The dependant variables of the research were used in each session to observe and record the reaction of the participants; the use of maladaptive behavior was supported by the Problematic behavior measuring tool developed by Kim Kyung-ae in 2003, the use of cognition has been supported by MMSE-K developed by Kwon Yong-chul and Park Jong-han in 1989, the use of sleep has been aided by the sleep scale revised by Oh Jin-joo, Song Mi-soon, and Kim Shin-mi in 1998, and the use of activities of daily living has been aided by Barthel ADL Index revised by Park Jong-han in 1995. The data analysis has utilized t-test, Chi-square test, Fisher exact test, and independent t-test using the SPSS WIN 21.0 program. The results were as follows.

1) "The first hypothesis, that the group with the horticultural therapy will show a decrease in Problematic behavior compared to the other group without therapy, has been supported because the statistical difference between the groups was significant" (t=-3.02, p=.004).

2) "The second hypothesis, that the group with the horticultural therapy will show a increase in cognition compared to the group without therapy, has been supported because the statistical difference between the groups was significant" (t=3.16, p=.003).

3) "The third hypothesis, that the group with the horticultural therapy will pose a better sleep state compared to the group without therapy, has been supported because the statistical difference between the groups was significant" (t=2.78, p=.008).

4) "The fourth hypothesis, that the group with the horticultural therapy will show an improvement in activities of daily living compared to the group without therapy, has not been supported because the statistical difference between the groups was rejected" (t=0.71, p=.479).

The results have revealed that receiving horticultural therapy affected the problematic behavior to decrease, improved cognition and sleep state, and advocated the scientific evidence that supports the use of horticultural therapy as nursing intervention. The utilization of this therapy is positive in the fact that it not only considers the state of older adults with dementia economic conditions, and older adults' preference, but also does not require new technologies.

Keywords : Dementia, Horticultural therapy, Problematic behavior, Cognition, Sleep, Activities of daily living