Duke University School of Nursing, Durham, NC, USA; Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea.
Duke University School of Nursing, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
J Am Med Dir Assoc. 2021 Jul;22(7):1435-1441.e1. doi: 10.1016/j.jamda.2021.03.032. Epub 2021 Apr 30.
To test relationships among background factors, interpersonal triggers, rejection of care, and aggression among veterans living with dementia in residential long-term care settings, based on the need-driven dementia-compromised behavior model.
A mixed methods secondary analysis of program evaluation data from the Staff Training in Assisted Living Residences-Veterans Health Administration intervention implemented by the US Department of Veterans Affairs healthcare system.
In total, 315 older veterans who participated in the 2013‒2016 Staff Training in Assisted Living Residences-Veterans Health Administration program at 76 Community Living Centers (Veterans Affairs-operated nursing homes).
Text data that captured the interdisciplinary team observations of distressed behaviors of concern and their circumstances were coded into categorical variables and then combined with existing quantitative data to test hypothesized relationships using structural equation modeling.
Rejection of care was directly affected by interpersonal triggers (β = 0.32, P < .005) and background factors such as depression (β = 0.29, P < .018), anxiety (β = -0.18, P < .023), and cognitive status (β = 0.10, P < .049). Depression also had an indirect effect on rejection of care through interpersonal triggers (α × β = 0.13 × 0.32 = 0.04, P < .012). Aggression was directly affected by both interpersonal triggers (β = 0.19, P < .009) and functional status (β = 0.17, P < .011). Both function (α × β = 0.12 × 0.19 = 0.02, P < .035) and depression (α × β = 0.13 × 0.19 = 0.03, P < .005) had indirect effects on aggression through interpersonal triggers.
Interpersonal triggers influenced rejection of care and aggression in veterans with dementia. Background factors such as depression and severity of functional impairment increased the likelihood of these symptoms. Study findings emphasize the importance of developing and implementing interventions that improve interpersonal relationships and developing targeted interventions for those with depressive symptoms.
根据需求驱动的痴呆症受损行为模型，测试居住在长期护理机构中的退伍军人的背景因素、人际触发因素、拒绝护理和攻击之间的关系。
这是对美国退伍军人事务部医疗保健系统实施的“辅助生活住宅工作人员培训-退伍军人事务部”计划的方案评估数据进行的混合方法二次分析。
共有 315 名参加 2013 年至 2016 年“辅助生活住宅工作人员培训-退伍军人事务部”计划的年龄较大的退伍军人，该计划在 76 个社区生活中心（退伍军人事务部运营的疗养院）开展。
文本数据捕获了跨学科团队对关注的困扰行为及其环境的观察结果，并将其编码为分类变量，然后将其与现有定量数据结合使用，使用结构方程模型测试假设关系。
拒绝护理直接受到人际触发因素（β=0.32，P<.005）和背景因素（如抑郁（β=0.29，P<.018）、焦虑（β=-0.18，P<.023）和认知状态（β=0.10，P<.049）的影响。抑郁也通过人际触发因素对拒绝护理产生间接影响（α×β=0.13×0.32=0.04，P<.012）。攻击直接受到人际触发因素（β=0.19，P<.009）和功能状态（β=0.17，P<.011）的影响。功能（α×β=0.12×0.19=0.02，P<.035）和抑郁（α×β=0.13×0.19=0.03，P<.005）通过人际触发因素对攻击产生间接影响。
人际触发因素影响退伍军人痴呆症患者的拒绝护理和攻击。抑郁等背景因素和功能损伤的严重程度增加了这些症状发生的可能性。研究结果强调了开发和实施改善人际关系的干预措施以及为有抑郁症状的人制定有针对性的干预措施的重要性。
