[The Advancement of Elderly Care: Development and Application of an Interdisciplinary Outpatient Dementia Care Consultation Module]

Hu Li Za Zhi. 2025 Feb;72(1):7-15. doi: 10.6224/JN.202502_72(1).02.
[Article in Chinese]

Abstract

With population aging, dementia has become a significant global health issue. Most people with dementia live in the community, are cared for by family members, and face complex and multifaceted care challenges. In line with Taiwan's Long-Term Care 2.0 policy, the Integrated Dementia Care Centers now established in many hospitals and linked with dementia clinic systems at the local level provide home care consultations and referrals. However, the primary focus of these centers remains on basic health education and post-diagnosis resource referral services. Thus, they lack an interdisciplinary approach, making it difficult to offer tailored, integrated care for people with dementia and their families. Therefore, integrating care intervention strategies from various fields to provide tailored and continuous care services is important. This article explores existing domestic and international dementia care consultation modules, introduces the integrated "Dementia Interdisciplinary Care Consultation Module" developed by our team, and discusses the applicability of and offers recommendations regarding this module. The developed module is intended to serve as a reference resource for outpatient medical staff and dementia case managers during health education consultations, and may be adopted into the training materials used by dementia care professionals and referenced in future domestic dementia care policy formulation work. The overall goal is to enhance the efficiency of outpatient dementia care consultations by ameliorating / resolving issues such as resource fragmentation, poor coordination, and service overlap, thereby improving the quality of family care provided to people with dementia.

Title: 高齡照護的推進—門診跨領域失智症照護諮詢模組的發展與應用.

隨著人口老化,失智症已然成為全球重要的健康議題。多數失智症病人生活於社區中由家人提供照顧,其所面對的照護問題是複雜且多面向的。我國長照2.0政策已於許多醫院開設失智症共同照護中心,以連結失智症門診系統,作為提供病人居家照護之照護諮詢與轉介的重要場域。然服務主軸仍在於失智診斷後的基本衛教與資源轉介服務,尚無從跨專業角度切入,較難做到為病人及家庭量身訂做的整合式照護。因此,整合各領域照護介入策略,以提供案家量身訂製及連續性的照護服務,顯得相當重要。本文查證國內外現有失智症照護諮詢模式、介紹本團隊所發展的整合式「失智症跨領域照護諮詢模組」及論述其應用性並提出建議,以做為各級醫療院所門診醫療人員及失智症個管師於衛教諮詢時的參考資源,甚或成為訓練各類失智症醫療照護專業人員的教育素材及我國失智症照護政策制定之參考。期提升門診失智症照護諮詢的效率,解決資源分散、協調不足及服務重疊等問題,進而提升失智症家庭照顧品質。.

Keywords: dementia; dementia care consultation; interdisciplinary.

Publication types

  • English Abstract

MeSH terms

  • Aged
  • Ambulatory Care
  • Dementia* / therapy
  • Humans
  • Patient Care Team
  • Referral and Consultation