School of Psychology, Bangor University, UK.
Neuropsychol Rehabil. 2012;22(1):113-33. doi: 10.1080/09602011.2011.640467.
Signs of sensory and perceptual awareness can be observed in people with very severe dementia, and may be influenced by the extent to which the environment offers appropriate stimulation. We developed an observational tool, AwareCare, which care staff can use to identify signs of awareness in residents with very severe dementia, based on the concept of the Wessex Head Injury Matrix (WHIM). Using WHIM items as a guide, and following focus groups with care staff and family members, an expert panel identified 28 environmental stimuli and 35 response categories for the initial version of AwareCare. After baseline assessments of cognition, well-being and quality of life were taken, 40 residents were observed individually for 30 minutes on 5 occasions. Based on the observational data, 10 stimulus categories and 14 response categories were identified for further analysis and formed the final version of AwareCare. All participants showed awareness to varying degrees. Social stimuli elicited the most responses. Greater awareness was associated with better cognitive function, self-care, mobility, and responsiveness, but not with proxy-rated quality of life. Understanding the nature of awareness in this group is an important element in ensuring appropriate levels of interaction and stimulation, and hence enhancing quality of care.
在患有非常严重痴呆症的人中，可以观察到感觉和知觉意识的迹象，并且这些迹象可能受到环境提供适当刺激的程度的影响。我们开发了一种观察工具，即 AwareCare，护理人员可以根据 Wessex 头部损伤矩阵 (WHIM) 的概念，使用该工具来识别患有非常严重痴呆症的居民的意识迹象。根据 WHIM 项目作为指导，以及与护理人员和家属的焦点小组，一个专家小组确定了 AwareCare 的初始版本的 28 种环境刺激物和 35 种反应类别。在进行认知、幸福感和生活质量的基线评估后，对 40 名居民进行了 5 次每次 30 分钟的单独观察。根据观察数据，确定了 10 个刺激类别和 14 个反应类别进行进一步分析，并形成了 AwareCare 的最终版本。所有参与者都表现出不同程度的意识。社会刺激引发了最多的反应。更高的意识与更好的认知功能、自我护理、移动性和反应能力相关，但与代理评定的生活质量无关。了解这一群体意识的本质是确保适当的互动和刺激水平的重要因素，从而提高护理质量。
