| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 98 === Aim：The purpose of this study is to gain an appreciation
of the facial expressions of dementia patients
experiencing pain or depressive symptoms, and compare
between them.
Background：The need for palliative care in dementia
patients has often been underestimated, primarily
because the pain scale evaluation of their facial
expressions rely on very course indicators, such as:
sad look, frowning, etc., which are also very
frequently present in the facial expressions of
geriatric depression patients, so the inability to
appropriately distinguish and classify the relative
intensity of facial expressions of pain or to confuse
pain expressions with those of other emotional face
expressions may be the reason behind the
underestimation of actual patient pain levels.
Method: This studies employs a quantitative approach with
data collection through survey interviews and
behavioral observation, for samples from the Veterans
Homes in Taipei, Taitung, and Taoyuan, selecting data
on 105 residents with dementia and 94 residents from
the care centers for aging, beginning with their
demographic data, MMSE, and ADL, followed by a five-
day observational period to collect data regarding
their facial expressions and depressive symptoms, as
well as clinical interviews and administration of a
self-scoring pain scale and depression symptom scale.
All of the collected data were then analyzed with
descriptive statistics methods and Kappa consistency
statistics, to elucidate the relations among pain and
depressive symptoms in various facial expressions.
Results：In the cognitively unimpaired control group and
dementia residents, the prevalence of existing pain
was 41.9% and 51.6% respectively. Comparing the
cognitively unimpaired group and dementia residents’
pain facial expressions and self-scores, there are
significant relations in the following Action Unit
(AU), AU4 Brow lowerer and AU6+7 Orbit tightening, as
well as for AU43 Eyes Closure and AU45 Blink in the
cognitively unimpaired group, and AU25+26+27 Open
mouth show a significant relationship in the dementia
residents. In regard to depressive symptoms, the
cognitively unimpaired exhibited significant
relationships between their facial expressions and
CSDD for the following: AU1+4 omega sign, AU15 Lip
corner depressor,and AU24 Lip Pressor. For the
Geriatric Depression Scale (GDS) components,
significant relations involved: AU1+4 omega sign,AU7
Lid tightener, AU15 Lip corner depressor, and AU24 Lip
Pressor. Among the dementia patients, significant
relationships were only observed among depressive
facial expressions and CSDD for AU15 Lip corner
depressor, with no significant Action Units (AU)
pairings with GDS.
Conclusion：This study deploys the FACS (Facial Action
Coding System) assessment methods, to help establish
better clarity in facial movement descriptive
classifications of facial activity indicating pain or
depressive symptoms, and the findings should
contribute to further efforts in developing and
evaluating pain scales, advancing the accuracy and
consistency of pain assessment, as well as its
clinical utility.
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