School of Health Sciences, University of East Anglia, UK.
Norwich Medical School, University of East Anglia, UK.
J Alzheimers Dis. 2022;88(4):1605-1614. doi: 10.3233/JAD-220155.
The identification and understanding of the discrepancy between caregivers' reports of people with dementia's (PwD) performance of activities of daily living (ADLs) and observed performance, could clarify what kind of support a PwD effectively needs when completing tasks. Strategies used by caregivers have not been included in the investigation of this discrepancy.
To (1) investigate if caregivers' report of PwD's ADL performance are consistent with PwD's observed performance; (2) explore if caregiver management styles, depression, and anxiety, contribute to this discrepancy.
PwD (n = 64) were assessed with standardized performance-based (Assessment of Motor and Process Skills, AMPS) and informant-based (Disability Assessment for Dementia, DAD) ADL assessments. Caregivers completed depression (PHQ-9), anxiety (GAD-7), and dementia management style (DMSS: criticism, active-management, and encouragement) questionnaires. Cohen's kappa determined agreement/disagreement in ADL performance. To investigate the potential discrepancy between the DAD and AMPS, a continuous variable was generated: comparative ADL score. Multiple linear regression analysis explored whether caregivers' management styles, depression or anxiety could explain the ADL discrepancy.
Poor level of agreement between observed and reported ADL performance [k = -0.025 (95% CI -0.123 -0.073)] was identified, with most caregivers underestimating ADL performance. The combined model explained 18% (R2 = 0.18, F (5,55) = 2.52, p≤0.05) of the variance of the comparative ADL score. Active-management (β= -0.037, t (60) = -3.363, p = 0.001) and encouragement (β= 0.025, t (60) = 2.018, p = 0.05) styles made the largest and statistically significant contribution to the model.
Encouragement style could be advised for caregivers who underestimate ADL performance, while active management style for those who overestimate it. Findings have scope to increase caregivers' abilities to support PwD activity engagement in daily life.
识别和理解护理人员对痴呆症患者（PwD）日常生活活动（ADL）表现的报告与观察到的表现之间的差异，可以阐明 PwD 在完成任务时实际需要哪种支持。护理人员使用的策略尚未纳入对这种差异的调查。
（1）调查护理人员对 PwD 的 ADL 表现的报告是否与 PwD 的观察到的表现一致；（2）探讨护理人员的管理风格、抑郁和焦虑是否导致了这种差异。
对 64 名 PwD 进行了标准化基于表现（评估运动和过程技能，AMPS）和基于知情人（痴呆症评估问卷，DAD）的 ADL 评估。护理人员完成了抑郁（PHQ-9）、焦虑（GAD-7）和痴呆症管理风格（DMSS：批评、积极管理和鼓励）问卷。柯恩氏kappa 确定了 ADL 表现的一致性/不一致性。为了研究 DAD 和 AMPS 之间的潜在差异，生成了一个连续变量：比较 ADL 评分。多元线性回归分析探讨了护理人员的管理风格、抑郁或焦虑是否可以解释 ADL 差异。
观察到的和报告的 ADL 表现之间的一致性水平较差[kappa=-0.025（95%置信区间-0.123 至-0.073）]，大多数护理人员低估了 ADL 表现。综合模型解释了比较 ADL 评分方差的 18%（R2=0.18，F(5,55)=2.52，p≤0.05）。积极管理（β=-0.037，t(60)=-3.363，p=0.001）和鼓励（β=0.025，t(60)=2.018，p=0.05）风格对模型的贡献最大且具有统计学意义。
对于低估 ADL 表现的护理人员，可以建议使用鼓励风格，而对于高估 ADL 表现的护理人员，则可以建议使用积极管理风格。研究结果有可能提高护理人员支持 PwD 参与日常生活活动的能力。
