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正常化的泡沫:对未寻求诊断帮助的痴呆症患者照顾者的定性研究。

The Bubble of Normalisation: A Qualitative Study of Carers of People With Dementia Who Do Not Seek Help for a Diagnosis.

机构信息

Division of Nursing, 4895City University of London, London, UK.

School of Health Sciences, 4895City University of London, London, UK.

出版信息

J Geriatr Psychiatry Neurol. 2022 Sep;35(5):717-732. doi: 10.1177/08919887211060018. Epub 2021 Dec 24.

Abstract

OBJECTIVE

Improving dementia diagnosis rates are a key feature of dementia strategy and policy worldwide. This study aimed to explore the experience of carers of people diagnosed with dementia during or following a hospital admission in order to identify factors that had prevented them from seeking help beforehand. Semi-structured interviews were conducted with 12 informal carers including adults caring for a parent, a friend or a spouse diagnosed with dementia between 2010-2019, following an acute hospital admission for a physical health problem, having not sought help previously.

MAIN FINDINGS

Carers created a 'bubble of normalisation' around themselves and the person living with dementia (PLWD) to reject the label of dementia and protect the PLWD from a loss of independence, discrimination and prejudice they felt would be the result of a diagnosis. Carers struggled to talk to the PLWD about dementia reinforcing denial and stigma. Post-diagnosis carers felt unsupported and questioned the value of diagnosis.

PRINCIPAL CONCLUSIONS

Stigma related to images of dementia as a disease that takes away independence and identity prevented discussion about dementia between carers and the PLWD. A lack of open discussion about memory concerns between health care professionals and carers also served to delay diagnosis.

摘要

目的

提高痴呆症的诊断率是全球痴呆症战略和政策的一个关键特征。本研究旨在探讨在医院住院期间或之后被诊断为痴呆症的患者的照顾者的经验,以确定哪些因素导致他们之前没有寻求帮助。对 12 名非正式照顾者进行了半结构化访谈,包括 2010-2019 年期间因身体问题住院,此前未寻求过帮助,照顾患有痴呆症的父母、朋友或配偶的成年人。

主要发现

照顾者在自己和患有痴呆症的人与生活者(PLWD)周围营造了一个“正常化的泡沫”,拒绝痴呆症的标签,并保护 PLWD 免受他们认为诊断会导致的独立性丧失、歧视和偏见。照顾者难以与 PLWD 谈论痴呆症,这加剧了否认和耻辱感。诊断后,照顾者感到无人支持,并质疑诊断的价值。

主要结论

与痴呆症是一种夺走独立性和身份的疾病相关的耻辱感,阻止了照顾者和 PLWD 之间对痴呆症的讨论。医疗保健专业人员和照顾者之间缺乏关于记忆问题的公开讨论,也导致了诊断的延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a21f/9386763/ad6e3ef066f5/10.1177_08919887211060018-fig1.jpg

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