Woods Diana Lynn, Buckwalter Kathleen
School of Nursing, Azusa Pacific University, Azusa, CA 91702, USA.
College of Nursing, University of Iowa, Iowa City, IA 52242, USA.
Healthcare (Basel). 2018 Oct 22;6(4):126. doi: 10.3390/healthcare6040126.
This article proposes taking another look at behavioral symptoms of dementia (BSDs) both from a theoretical perspective that informs research and practice and from a measurement perspective. We discuss why this rethinking of behaviors impacts current models of care and our ability to better detect outcomes from interventions. We propose that BSDs be viewed from a pattern perspective and provide some suggestions for how to identify and measure these patterns that can influence the timing and type of intervention. Evidence suggests that BSDs are complex, sequential, patterned clusters of behavior recurring repeatedly in the same individual and escalate significantly without timely intervention. However, BSDs are frequently viewed as separate behaviors rather than patterns or clusters of behaviors, a view that affects current research questions as well as the choice, timing, and outcomes of interventions. These symptoms cause immense distress to persons with the disease and their caregivers, trigger hospitalizations and nursing home placement, and are associated with increased care costs. Despite their universality and that symptoms manifest across disease etiologies and stages, behaviors tend to be underrecognized, undertreated, and overmanaged by pharmacological treatments that may pose more harm than benefit.
本文建议从为研究和实践提供信息的理论视角以及测量视角，重新审视痴呆症行为症状（BSDs）。我们讨论了为何对行为的这种重新思考会影响当前的护理模式以及我们更好地检测干预效果的能力。我们建议从模式视角看待BSDs，并就如何识别和测量这些可能影响干预时机和类型的模式提供一些建议。有证据表明，BSDs是复杂的、相继出现的、有规律的行为集群，在同一个体中反复出现，若不及时干预会显著升级。然而，BSDs常常被视为单独的行为，而非行为模式或集群，这种观点影响了当前的研究问题以及干预的选择、时机和效果。这些症状给患病个体及其照护者带来巨大痛苦，引发住院和养老院安置，还与护理成本增加相关。尽管它们具有普遍性，且症状在不同疾病病因和阶段都会出现，但这些行为往往未得到充分认识、治疗不足，且被可能弊大于利的药物治疗过度管控。
