照顾者准备程度对一项针对痴呆症患者行为症状的非药物干预措施效果的影响。
Impact of caregiver readiness on outcomes of a nonpharmacological intervention to address behavioral symptoms in persons with dementia.
作者信息
Gitlin Laura N, Rose Karen
机构信息
Department of Community Public Health, School of Nursing, Joint appointments, Department of Psychiatry, and Division of Geriatrics and Gerontology, School of Medicine, Director, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA.
Department of Psychology, Widener University, Chester, PA, USA.
出版信息
Int J Geriatr Psychiatry. 2016 Sep;31(9):1056-63. doi: 10.1002/gps.4422. Epub 2016 Feb 2.
BACKGROUND
Previous research shows that nonpharmacological strategies may effectively manage behavioral symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. We examine the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
METHODS
Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioral symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviors) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups.
RESULTS
By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviors (β = -.180, p = .041) and higher confidence (β = .27, p = .009). Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks.
CONCLUSION
By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioral symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioral management but not other caregiver outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
背景
先前的研究表明，非药物策略可能有效管理痴呆症患者的行为症状（躁动、徘徊）并改善照料者的幸福感。然而，这些策略的实施依赖于照料者。我们研究了照料者使用非药物策略的准备程度对治疗结果的影响。
方法
数据来自一项随机试验，治疗组有110名家庭照料者，他们接受了管理行为症状的非药物策略。干预者在治疗开始和结束时将照料者使用非药物策略的准备程度评定为行动前（未考虑、考虑、准备）或行动阶段。在16周和24周的随访中，比较了治疗结束时（16周）处于行动前和行动阶段的照料者在近端（目标行为的频率、照料者的困扰和信心）和更远端（照料者负担和幸福感）结果方面的差异。
结果
到治疗结束时，分别有28.2%（n = 31）和71.8%（n = 79）的照料者被评定为处于行动前和行动阶段。在16周和24周时，两组近端结果的均值有所不同；处于行动阶段的照料者在所有近端和远端结果上都有更大的改善。分层回归显示准备程度与目标结果之间存在显著关系。到24周时，照料者的准备程度预测了目标行为的较低频率估计值（β = -.180，p = .041）和较高的信心（β = .27，p = .009）。在16周或24周时，准备程度不是照料者负担和幸福感的显著预测因素。
结论
到治疗结束时，超过25%的参与者未被激活使用非药物策略。与未被激活的参与者相比，被激活的照料者报告令人苦恼的行为症状有更大程度的减轻，且信心更强。需要激活来影响行为管理，但对其他照料者结果没有影响。版权所有© 2016约翰威立父子有限公司。
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