School of Nursing, Duke University, Durham, NC, USA.
Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea.
J Adv Nurs. 2021 Jul;77(7):3176-3188. doi: 10.1111/jan.14864. Epub 2021 May 10.
To explore how behavioural symptoms of dementia are manifested among veterans in residential long-term care settings, in the context of personal, interpersonal/social and environmental triggers and how the manifestations differ between veterans with and without posttraumatic stress disorder.
Secondary analysis using a mixed methods approach.
We analysed text data from a stratified random sample of 66 cases derived from the programme evaluation dataset of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention from 2013 to 2016, using framework analysis. The detailed behavioural assessment descriptions in this dataset are consistent with contemporary non-pharmacologic symptom management. Qualitative categories were converted to quantitative variables for two group comparisons.
Four patterns emerged linking specific types of triggers and behavioural symptoms: (1) unmet physical needs or emotional distress triggers non-aggressive behaviours; (2) unsolicited direct care approach triggers care refusal, resistance or combativeness; (3) interpersonal interactions interfering with self-direction trigger aggressive behaviours; and (4) uncontrolled stimulation from environments trigger non-aggressive behaviours. The organisational culture of care influenced how staff conceptualised behavioural symptoms. Veterans with co-existing posttraumatic stress disorder and dementia tended to exhibit rejection of care with aggression compared to those with dementia alone.
Contextualised accounts of behavioural symptoms of dementia revealed symptom heterogeneity, with different clusters of multi-level triggers arising from specific personal, interpersonal and environmental circumstances. Distinct patterns of symptom manifestations between veterans with and without posttraumatic stress disorder suggest a tailored approach is required to meet each veteran's unique biopsychosocial needs.
Classifying behavioural symptoms with their triggers rather than solely by behaviours provides important new information for developing person-centred, non-pharmacological interventions to improve outcomes for veterans with dementia. Multi-level interventions should be considered to meet veteran's needs that account for their earlier life history and current life circumstances.
探讨在个人、人际/社会和环境触发因素的背景下，居住在长期护理机构中的退伍军人的痴呆行为症状是如何表现的，以及患有创伤后应激障碍和没有创伤后应激障碍的退伍军人的表现有何不同。
使用混合方法进行二次分析。
我们使用框架分析方法，对 2013 年至 2016 年期间，来自“辅助生活住宅工作人员培训-退伍军人事务部（STAR-VA）”计划评估数据集的 66 例分层随机样本的文本数据进行了分析。该数据集的详细行为评估描述与当代非药物症状管理一致。定性类别被转换为两个组比较的定量变量。
有四个模式出现，将特定类型的触发因素和行为症状联系起来：（1）未满足的身体需求或情绪困扰引发非攻击性行为；（2）未经请求的直接护理方法引发护理拒绝、抵制或对抗；（3）干扰自我导向的人际互动引发攻击性行为；（4）环境中的失控刺激引发非攻击性行为。护理的组织文化影响了工作人员对行为症状的概念化方式。患有创伤后应激障碍和痴呆症的退伍军人与仅患有痴呆症的退伍军人相比，往往表现出拒绝护理时带有攻击性。
对痴呆症行为症状的情境化描述揭示了症状的异质性，具有不同聚类的多水平触发因素源于特定的个人、人际和环境情况。有创伤后应激障碍和没有创伤后应激障碍的退伍军人之间的症状表现模式不同，表明需要采取量身定制的方法来满足每个退伍军人独特的生物心理社会需求。
通过行为症状及其触发因素进行分类，而不仅仅是通过行为进行分类，为开发以患者为中心、非药物干预措施提供了重要的新信息，以改善患有痴呆症的退伍军人的结局。应考虑采取多层次干预措施来满足退伍军人的需求，这些需求既要考虑他们以前的生活经历，也要考虑他们当前的生活环境。
