a College of Nursing, The University of Utah , Salt Lake City , UT , USA.
b Benjamin Rose Institute on Aging/Center for Research and Education , Cleveland , OH , USA.
Aging Ment Health. 2018 Apr;22(4):489-496. doi: 10.1080/13607863.2017.1280766. Epub 2017 Jan 27.
Many difficult decisions are made in the inpatient hospital setting regarding the daily care of persons with dementia (PWDs). Incongruent perceptions of the PWD's care values limit the family caregiver's ability to make surrogate decisions. The objectives of this pilot study were to describe and identify determinants of incongruent perceptions in the hospital setting.
Using multilevel modeling (MLM), we examined cross-sectional data collected from 42 PWD-family caregiver dyads.
There was a significant amount of incongruence, on average, for all four subscales representing the PWD's care values: autonomy = -0.33 (p < .001); burden = -.49 (p < .001); safety/quality of care = -.26 (p < .001); and social interactions = -.21 (p = .004). Family caregivers (CG) rated the importance of care values to the PWD as lower than the PWD rated the importance. Determinants of greater incongruence included higher relationship strain and fewer positive dyadic interactions.
Our findings reveal significant levels of incongruence in perceptions of the PWD's values among dementia care dyads in the hospital setting. Our analysis suggests a potential impact of relationship variables on incongruence. Further research is needed around this overlooked interpersonal context for supporting the dementia care dyad in the hospital setting.
在住院医院环境中，针对痴呆症患者（PWD）的日常护理做出了许多艰难的决策。对 PWD 的护理价值观的认知不一致限制了家庭照顾者做出代理决策的能力。本试点研究的目的是描述和确定医院环境中认知不一致的决定因素。
使用多层线性模型（MLM），我们检查了从 42 对 PWD-家庭照顾者对收集的横断面数据。
在代表 PWD 的护理价值观的所有四个分量表上，平均存在大量的不一致：自主性= -0.33（p<.001）；负担= -.49（p<.001）；安全性/护理质量= -.26（p<.001）；社会互动= -.21（p=.004）。家庭照顾者（CG）对 PWD 护理价值观的重视程度低于 PWD 对其重视程度。更大不一致的决定因素包括更高的关系紧张和较少的积极对偶互动。
我们的研究结果揭示了在医院环境中痴呆症护理对认知不一致的水平显著。我们的分析表明，关系变量对不一致性有潜在影响。需要进一步研究这一被忽视的人际背景，以支持痴呆症护理对在医院环境中的支持。
