Gruetzner Howard, Ellor James W, Back Nicole
North Central Texas Office of the Alzheimer Association, Waco, Texas, USA.
J Soc Work End Life Palliat Care. 2012;8(2):151-64. doi: 10.1080/15524256.2012.685439.
Various dementias alter many aspects of the life and interactions between older adults and their families. This is particularly true even in a context in which the emotion is one that is expected. One such experience is the grief related to the loss of a family member. Physicians, nurses, and family members in long-term care report that they frequently have residents for whom a primary loved one, such as a spouse, has died. Questions quickly surface as to whether or not to tell the senior with dementia, how to tell the person, and how that person's response will impact the family. In two separate focus groups these questions were discussed with a group of family members and an interdisciplinary group of physicians, nurses, nurse aides, and social workers connected to long-term care facilities in one mid-sized community. Three patterns of resident response were identified. "Self-threat" describes situations in which the individual responds to the announcement of the death by questioning who will take care of them now; substitution refers to the individual's inability to remember who has died and substitution with a relative who died years ago; and metaphone, substitution of an object or unrelated item for the loss of a loved one. The authors suggest that persons with dementia should be told in most circumstances that their loved one has died, but that behavioral interventions need to be designed to address the confusion that this announcement can initiate. Families need to be prepared that the senior may not respond in the ways they once would have to this loss.
各种痴呆症会改变老年人及其家人生活与互动的许多方面。即便在预期会出现某种情绪的情况下，情况依然如此。其中一种体验就是与失去家庭成员相关的悲痛。长期护理机构的医生、护士和家庭成员报告称，他们经常会遇到主要亲人（如配偶）去世的居民。关于是否告知患有痴呆症的老年人、如何告知以及此人的反应会如何影响家庭等问题很快就浮现出来。在两个不同的焦点小组中，与一组家庭成员以及一个由与一个中等规模社区的长期护理机构相关的医生、护士、护工和社会工作者组成的跨学科小组讨论了这些问题。确定了居民的三种反应模式。“自我威胁”描述的是个体在得知亲人去世的消息后质疑现在谁来照顾他们的情况；替代是指个体记不起谁去世了，并用多年前去世的亲属来替代；而“近音词错用”则是用一个物品或无关的事物来替代失去的亲人。作者建议，在大多数情况下应该告知患有痴呆症的人其亲人已经去世，但需要设计行为干预措施来应对这一消息可能引发的困惑。家人需要做好准备，即老年人可能不会像过去那样对这种失去做出反应。
