Feast Alexandra, Orrell Martin, Charlesworth Georgina, Melunsky Nina, Poland Fiona, Moniz-Cook Esme
Alexandra Feast, MPhil, Division of Psychiatry, University College London, and Research and Development Department, North East London National Health Service (NHS) Foundation Trust, Ilford; Martin Orrell, PhD, Research and Development Department, North East London NHS Foundation Trust, Ilford, and Institute of Mental Health, University of Nottingham; Georgina Charlesworth, PhD, Research and Development Department, North East London NHS Foundation Trust, Ilford, and Research Department of Clinical, Educational, and Health Psychology, University College London; Nina Melunsky, MSc, Research and Development Department, North East London NHS Foundation Trust, Ilford; Fiona Poland, PhD, Faculty of Medicine and Health Sciences, University of East Anglia; Esme Moniz-Cook, PhD, Faculty of Health and Social Care, University of Hull, UK
Alexandra Feast, MPhil, Division of Psychiatry, University College London, and Research and Development Department, North East London National Health Service (NHS) Foundation Trust, Ilford; Martin Orrell, PhD, Research and Development Department, North East London NHS Foundation Trust, Ilford, and Institute of Mental Health, University of Nottingham; Georgina Charlesworth, PhD, Research and Development Department, North East London NHS Foundation Trust, Ilford, and Research Department of Clinical, Educational, and Health Psychology, University College London; Nina Melunsky, MSc, Research and Development Department, North East London NHS Foundation Trust, Ilford; Fiona Poland, PhD, Faculty of Medicine and Health Sciences, University of East Anglia; Esme Moniz-Cook, PhD, Faculty of Health and Social Care, University of Hull, UK.
Br J Psychiatry. 2016 May;208(5):429-34. doi: 10.1192/bjp.bp.114.153684. Epub 2016 Mar 17.
Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes.
To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered.
A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012.
We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in 'feeling bereft'; and perceptions of transgressions against social norms associated with 'misunderstandings about behaviour' in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging.
Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their 'personhood'. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.
量身定制的社会心理干预措施有助于家庭应对痴呆症的行为和心理症状（BPSD），但照顾者对其亲属行为的反应会影响支持项目的成效。
了解为何一些家庭照顾者在应对BPSD时存在困难，以便提高所提供的个性化护理质量。
对1980年至2012年间的高质量定量和定性研究进行了系统评价和元民族志综合分析。
我们确定了25项高质量研究，家庭照顾者报告行为具有挑战性的两个主要原因：沟通和关系的变化，导致“感到失落”；以及对与痴呆症亲属“行为误解”相关的社会规范违反行为的认知。家庭照顾者认为其亲属因痴呆症而失去或不可避免地会失去身份，这是他们将行为视为具有挑战性的根本原因。
家庭照顾者将BPSD视为具有挑战性，与关系下降感、违反社会规范以及认为痴呆症患者不可避免地失去“人格”的潜在信念有关。在家庭环境中管理具有挑战性的行为的干预措施应承认家庭照顾者未得到满足的心理需求。
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