Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.).
Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).
J Adv Nurs. 2021 May;77(5):2278-2292. doi: 10.1111/jan.14747. Epub 2021 Jan 12.
The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes.
A correlational longitudinal design was used.
Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation.
Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group.
Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group.
Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.
本研究采用“寻找平衡点”框架，探讨了中国台湾地区痴呆患者家庭照顾者的照顾过程随时间的变化。本研究旨在：（a）确定台湾地区照顾者不同的平衡轨迹；（b）探讨轨迹组归属的预测因素；（c）检验不同平衡轨迹与照顾结果的关联。
采用相关性纵向设计。
数据来自 200 名家庭照顾者的自填问卷，对其进行了为期 2 年（2015 年 6 月至 2017 年 5 月）的随访。通过基于群组的轨迹建模确定离散平衡轨迹。使用多元逻辑回归从照顾特征和照顾因素的潜在预测因素中确定轨迹组归属的预测因素。使用广义估计方程探讨轨迹组与照顾结果（抑郁症状和健康相关生活质量）的关联。
平衡轨迹最符合两群组轨迹模型（较差和较好）。竞争需求之间平衡感较差的照顾者更有可能出现较多的抑郁症状（b=11.71，95%置信区间[9.04，14.38]，p<.001）、较差的身体健康状况（b=-6.22，95%置信区间[-8.71，-3.74]，p<.001）和较差的心理健康状况（b=-11.1，95%置信区间[-13.58，-8.63]，p<.001），而平衡感较好的照顾者则没有。经历较低角色压力（b=-1.45，SE=0.48，p=.003）或较高可预测性（b=2.83，SE=0.76，p<.001）的照顾者更有可能属于平衡较好的组。
竞争需求之间平衡感较差的照顾者更有可能出现较差的照顾结果。角色压力和可预测性显著预测平衡轨迹组。照顾任务难度较低且/或对照顾者了解较好的家庭照顾者更有可能处于平衡较好的轨迹组。
本研究结果支持“寻找平衡点”框架，并阐明了痴呆患者的家庭照顾过程。该框架可用于为家庭护理护士量身定制干预措施，以改善家庭照顾者的照顾结果。
