Whelan Sally, Teahan Áine, Casey Dympna
School of Nursing and Midwifery, National University of Ireland, Galway, Ireland.
Centre for Economic and Social Research on Dementia, National University of Ireland, Galway, Ireland.
Front Med (Lausanne). 2020 Feb 25;7:45. doi: 10.3389/fmed.2020.00045. eCollection 2020.
Resilience is a process through which people use resources to adapt to adversity. Interventions aiming to support resilience in people with dementia have been developed. However, the optimal content, structure and impact of these interventions is unclear. This literature review explores the factors through which interventions foster resilience in people with dementia and examines their efficacy. Eight databases were searched systematically, for literature published from 2000 to 2019. Following the removal of duplicate articles, the titles and abstracts of 6,749 articles were screened. Articles were selected if they: reported empirical studies in English; focused on resilience; involved people with dementia and psychosocial interventions. The full text of 53 articles were examined and three studies, reported in six papers, were included in the final review. Data were systematically extracted, and two authors critiqued the studies using the Critical Appraisal Skills Programme check lists. The studies were examined to determine how resilience was defined and operationalized and their findings were synthesized using the theoretical resilience framework. Five interventions aiming to foster resilience were identified: Dementia Advisors; Peer Support Network Services; Visual Arts Enrichment Activities; Memory Makers; and Early-Stage and Beyond Community Activities. All studies defined resilience as a process and most involved people with mild dementia who had family carers. The interventions impacted resilience by reducing the adversity of stigma and social isolation; increasing personal and social resources, providing stigma-free space and reciprocal support. Interventions empowered people with dementia, increasing their self-esteem and self-worth. Resilience can be fostered both during, and after interventions. However, the efficacy of interventions could not be determined because the research designs utilized did not measure efficacy. Interventions need facilitators to ensure they are strength-based, person-centered and they enable reciprocal social interactions. Future research needs to develop interventions that aim to foster the resilience of people with dementia who lack family carers and/or have more advanced dementia through meaningful activities that are identified by people with dementia as important to their resilience. Robust methodologies, including randomized controlled trials should be used to measure effectiveness and explore the impact of interventions regarding the: interplay between individual and community resources; the importance of reciprocity; and temporal aspects of resilience.
复原力是一个人们利用资源来适应逆境的过程。旨在支持痴呆症患者复原力的干预措施已经开发出来。然而，这些干预措施的最佳内容、结构和影响尚不清楚。这篇文献综述探讨了干预措施促进痴呆症患者复原力的因素，并检验了它们的效果。系统检索了八个数据库，以查找2000年至2019年发表的文献。在去除重复文章后，筛选了6749篇文章的标题和摘要。如果文章符合以下条件则被选中：以英文报道实证研究；关注复原力；涉及痴呆症患者和心理社会干预。对53篇文章的全文进行了审查，最终纳入了六篇论文中报道的三项研究。系统提取了数据，两位作者使用批判性评估技能计划清单对这些研究进行了评判。对这些研究进行了审查，以确定复原力是如何定义和实施的，并使用理论复原力框架对其结果进行了综合。确定了五项旨在促进复原力的干预措施：痴呆症顾问；同伴支持网络服务；视觉艺术丰富活动；记忆塑造者；以及早期及以后社区活动。所有研究都将复原力定义为一个过程，大多数研究涉及有家庭照顾者的轻度痴呆症患者。这些干预措施通过减少耻辱感和社会隔离的逆境、增加个人和社会资源、提供无耻辱感的空间和相互支持来影响复原力。干预措施增强了痴呆症患者的能力，提高了他们的自尊和自我价值感。复原力可以在干预期间和干预后得到培养。然而，由于所采用的研究设计没有衡量效果，因此无法确定干预措施的效果。干预措施需要促进者来确保它们以优势为基础、以个人为中心，并能促进相互的社会互动。未来的研究需要开发干预措施，旨在通过痴呆症患者认为对其复原力很重要的有意义活动，培养缺乏家庭照顾者和/或患有更晚期痴呆症的患者的复原力。应使用包括随机对照试验在内的稳健方法来衡量有效性，并探讨干预措施对以下方面的影响：个人和社区资源之间的相互作用；互惠的重要性；以及复原力的时间方面。
