Department of Community and Behavioral Health, University of Iowa College of Public Health, Aging Mind and Brain Initiative.
Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland.
Gerontologist. 2018 Mar 19;58(2):e46-e55. doi: 10.1093/geront/gnx141.
Perceptions about family members not contributing enough to caregiving are documented to create psychological stress among caregivers. This study investigated whether individuals' perception that family members are under-contributing in caregiving processes was associated with their psychological well-being and explored the factors that may contribute to such perception borrowing concepts from a previous study: malfeasance, nonfeasance, and uplift.
Seventy-two members of 30 families recruited through residential and adult daycare settings provided information about 960 familial network members (e.g., family, friends). Perceived levels of participation in caregiving about each network member, whether the level met respondents' expectations, and interactions representing malfeasance, nonfeasance, and uplift were assessed.
Number of family members respondents identified as under-contributing in caregiving was associated with higher, whereas numbers of family participating in caregiving and supportive staff were associated with lower distress (Center for Epidemiologic Studies Depression Scale [CES-D]). Factor analyses identified a set of social interactions among familial network members capturing three constructs: malfeasance, nonfeasance, and uplift. Network members for whom respondents reported higher levels of nonfeasance were more likely to be identified as under-contributing in direct care (odds ratio [OR] = 1.92), care decision making (OR = 1.89), and social support (OR = 1.74) compared with those identified as contributing enough. Members with higher levels of malfeasance were more likely to be identified as under-contributing in direct care (OR = 1.19) than those identified as contributing enough.
Social interactions characterized as nonfeasance may explain the perception of unmet expectations in caregiving within families and may represent a potential focus of family-level interventions.
有文献记录表明，家庭成员在照顾方面的贡献不足会让照顾者产生心理压力。本研究调查了个体是否认为家庭成员在照顾过程中贡献不足与他们的心理健康有关，并探讨了可能导致这种看法的因素，借用了之前研究中的概念：失职、不作为和支持。
通过住宅和成人日托机构招募了 30 个家庭的 72 名成员，他们为 960 名家族网络成员（例如，家人、朋友）提供了关于照顾的信息。评估了每个网络成员的照顾参与程度、该程度是否符合受访者的期望以及代表失职、不作为和支持的相互作用。
受访者认为在照顾中贡献不足的家庭成员数量与更高的压力有关，而参与照顾的家庭成员数量和支持性工作人员数量与更低的压力有关（流行病学研究抑郁量表[CES-D]）。因素分析确定了一套家族网络成员之间的社会相互作用，捕捉到三个结构：失职、不作为和支持。受访者报告不作为水平较高的网络成员更有可能被认为在直接护理（比值比[OR] = 1.92）、护理决策（OR = 1.89）和社会支持（OR = 1.74）方面贡献不足，而被认为足够贡献的网络成员。不作为水平较高的成员更有可能被认为在直接护理（OR = 1.19）方面贡献不足，而不是被认为足够贡献的成员。
不作为的社会相互作用可能解释了家庭中照顾期望未得到满足的看法，并可能代表家庭层面干预的潜在重点。
