Clare Linda, Rowlands Julia, Bruce Errollyn, Surr Claire, Downs Murna
Bangor University, Bangor, Gwynedd, UK.
Soc Sci Med. 2008 Jun;66(11):2366-77. doi: 10.1016/j.socscimed.2008.01.045. Epub 2008 Mar 5.
While awareness among people with mild to moderate dementia residing in the community has been extensively studied, little evidence has been presented regarding the extent to which people with moderate to severe dementia living in residential care show awareness of their own situation and functioning. The present study aimed to explore how differing degrees of awareness are manifested in the conversations and interactions of people with dementia living in residential care settings, and to identify theoretical and practical implications. Transcripts of 304 conversations with 80 individuals with dementia living in residential care homes in England and Wales were analysed using a grounded theory approach. All 80 participants demonstrated a degree of retained awareness, and there was considerable evidence of retained awareness throughout the conversations, expressed in relation to the three domains of self, relationship, and the environmental context. Two-thirds of participants also demonstrated at least one instance of unawareness, although demonstrations of retained awareness outweighed indications of unawareness. Unawareness was evident in relation to appraisal of functioning and the meaning ascribed to the situation. A grounded theory model of awareness in people with moderate to severe dementia who still communicate verbally proposes that demonstration of awareness involves a set of analytic and behavioural processes, a scope or timescale, and a focus. Awareness is demonstrated in relation to a given focus and scope through the involvement of cognitive processes of varying degrees of complexity, ranging from registering through appraising and interpreting to reflection. Unawareness may be demonstrated in relation to some elements of process, focus or scope, while other aspects remain unaffected. Understanding more about the capacity for retained awareness and the specific ways in which awareness can be compromised may assist care staff in responding effectively to residents' needs.
虽然对居住在社区中的轻度至中度痴呆症患者的认知情况已有广泛研究，但对于居住在养老院中的重度至中度痴呆症患者对自身状况和功能的认知程度，几乎没有相关证据。本研究旨在探讨居住在养老院中的痴呆症患者在对话和互动中如何表现出不同程度的认知，并确定其理论和实际意义。采用扎根理论方法，对与英格兰和威尔士养老院中80名痴呆症患者进行的304次对话记录进行了分析。所有80名参与者都表现出一定程度的保留认知，并且在整个对话过程中有大量证据表明存在保留认知，这在自我、人际关系和环境背景这三个领域中均有体现。三分之二的参与者还表现出至少一次认知缺失的情况，不过保留认知的表现多于认知缺失的迹象。在功能评估和对自身状况的理解方面，认知缺失较为明显。一个针对仍能进行言语交流的重度至中度痴呆症患者的认知扎根理论模型提出，认知的表现涉及一系列分析和行为过程、一个范围或时间尺度以及一个焦点。通过不同程度复杂的认知过程的参与，从登记到评估、解释再到反思，在给定的焦点和范围内表现出认知。在过程、焦点或范围的某些方面可能表现出认知缺失，而其他方面则不受影响。更多地了解保留认知的能力以及认知可能受损的具体方式，可能有助于护理人员有效满足居民的需求。
