失智症攻擊行為的臨床評估與處置

Clinical Assessment and Management of Aggressive Behavior in Dementia

攻擊性行為是失智症行為精神症狀中最盛行的症狀，不僅使照顧者感到困擾，還可能自傷和傷人，進而影響護病互動和照顧品質。不適切的處置策略及濫用精神科用藥，將會加重攻擊行為，更可能導致患者猝死和引發許多倫理議題。儘管高發生率的失智症攻擊性行為及其所衍生的後果逐漸受到關注，但由於臨床專業人員和家屬照顧者普遍缺乏評估與處置失智症行為精神症狀的知識和技能，使其在面對失智患者時經常感到不知所措，且造成極大的壓力與照顧負荷。為能改善失智症照顧上的困境，本文將立基於過往實證研究的累積，介紹攻擊性行為的概念和操作型定義，以及心理衡鑑較佳且具臨床可行性的行為評估工具，再進而闡述促成攻擊性行為的相關導因，以及有效的非藥物和藥物策略。期能藉由上述議題的分享，有效提高失智症正式照顧者的知識和技能，從而減少不當處理所衍生的後果，以提升患者的照顧品質及減低照顧者的身心負擔。

Aggressive behavior is a highly prevalent behavioral and psychiatric symptoms of dementia, not only disturbing caregivers but also harming themselves and others. Further, it disrupts the nurse-patient interaction and compromises the overall quality of care. Inappropriate management strategies and the misuse of psychiatric medications can exacerbate aggressive behavior, resulting in sudden death and raising ethical concerns. Despite the growing recognition of the high incidence and consequences of aggressive behavior in dementia, clinical professionals and family caregivers generally lack the knowledge and skills to assess and manage the behavioral and psychological symptoms of dementia, causing them to often feel overwhelmed and experience significant stress and caregiver burden when dealing with dementia patients. In order to improve the challenges in dementia care, this article is based on the accumulation of past empirical research, introducing the concept and operational definition of aggressive behavior, highlight behavioral assessment tools with psychometric properties and clinical feasibility, explore contributing factors to aggressive behavior, and discuss effective non-pharmacological and pharmacological strategies. By addressing these issues, the article seeks to enhance the knowledge and skills of formal caregivers in dementia care, reduce the adverse consequences of improper handling, improve the quality of care for patients, and alleviate the physical and mental burden experienced by caregivers.