School of Health Sciences, Bangor University, Wales, UK.
Department of Epidemiology & Biostatistics, VU University, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2021 Jul;36(7):1020-1028. doi: 10.1002/gps.5504. Epub 2021 Mar 10.
There is a growing interest in how people living with dementia may achieve good outcomes and be resilient despite their health challenges. Understanding what might be important for resilience in this population is largely untested theory.
The analysis draws a subsample with cognitive impairment (N = 579) from two waves of the Cognitive Function and Ageing Studies Wales study, a nationally representative study of community-dwelling people aged 65+ in Wales. We constructed a measure of mental health resilience (MHR) defined as no depression, no anxiety and high well-being. Drawing on a resilience framework, we tested univariate and cumulative effects models of the factors that enable MHR, and then examined whether MHR is important for reducing loneliness over time.
Across both waves of data 22% (n = 121) met the criteria for MHR. The cumulative effects model found the odds of MHR were greater for male gender, higher self-esteem, greater social resources and no subjective memory complaints. Controlling for these significant predictors, MHR significantly predicted lower total and sub-scale scores for loneliness at wave 2. Sensitivity analysis shows these effects held at lower levels of cognitive function when the Mini-Mental State Examination score was <25, but not at <23.
This paper addresses a gap in research regarding the conceptualisation and measurement of resilience when facing cognitive impairment. Understanding what aspects of a person's life might enable good mental health despite cognitive impairment-to be resilient-could inform effective strategies for friends and families, along with health, and social policy and practice.
越来越多的人关注患有痴呆症的人如何在面临健康挑战的情况下取得良好的结果并保持韧性。了解对于这一人群的韧性而言哪些因素可能很重要，这在很大程度上还停留在理论阶段。
本分析从认知功能和年龄研究威尔士研究的两个波次中抽取了认知障碍亚组（N=579），该研究是威尔士针对 65 岁以上社区居住人群的全国性研究。我们构建了心理健康韧性（MHR）的衡量标准，定义为无抑郁、无焦虑和高幸福感。借鉴韧性框架，我们测试了实现 MHR 的因素的单变量和累积效应模型，然后研究了 MHR 是否对于缓解随时间推移的孤独感很重要。
在两波数据中，有 22%（n=121）符合 MHR 的标准。累积效应模型发现，男性性别、自尊心较高、社会资源较多且无主观记忆问题，更有可能出现 MHR。控制这些显著预测因子后，MHR 显著预测了第 2 波的总孤独感和各分量表评分较低。敏感性分析表明，当 Mini-Mental State Examination 得分<25 时，这些效应成立，但当得分<23 时则不成立。
本文针对在认知障碍情况下对韧性的概念化和衡量方面的研究空白。了解一个人的生活中哪些方面可以使人在认知障碍的情况下保持良好的心理健康——即具有韧性——可以为朋友、家人以及卫生和社会政策与实践提供有效的策略。
