Duke University School of Nursing, Durham, NC, United States; Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea.
Duke University School of Nursing, Durham, NC, United States; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States.
Int J Nurs Stud. 2022 Nov;135:104330. doi: 10.1016/j.ijnurstu.2022.104330. Epub 2022 Jul 25.
In residential long-term care, military service veterans with co-occurring posttraumatic stress disorder (PTSD) and dementia encounter a range of physical and social stimuli that may serve as triggers of trauma-related distress that manifests as care rejection or aggression. Yet, PTSD rarely has been examined in research to understand behaviors of care rejection and aggression in veterans with dementia.
Guided by the need-driven dementia-compromised behavior model, we examined the moderation effect of PTSD on pathways from background factors and interpersonal triggers to rejection of care and aggression among veterans with dementia with and without co-occurring PTSD.
Secondary data analysis of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention evaluation by the U.S. Veterans Health Administration healthcare system.
76 Veterans Health Administration-operated nursing homes.
315 veterans with dementia who participated in STAR-VA.
We converted text data on the occurrence of care rejection and aggression to binary variables, combined them with data on sociodemographic and PTSD status obtained using medical chart review, and measured anxiety, cognition, depression, and function using validated instruments. A multi-group structural equation modeling analysis was then conducted to test the moderating effect of PTSD on rejection of care and aggression.
Although multi-group structural equation modeling did not support the hypothesis of overall moderation by PTSD, distinct patterns between the two groups were observed with respect to how background factors and interpersonal triggers related to care rejection and aggression. The magnitude of the direct effects of interpersonal triggers on rejection of care was greater in veterans with PTSD (β = 0.42, p = .014 compared to those without β = 0.29, p = .008). Depression had a statistically significant indirect effect on rejection of care via interpersonal triggers only in veterans with PTSD (β = 0.09, p = .009). Functional status had a statistically significant direct effect on aggression only in the PTSD group (β = 0.28, p = .044).
Our study identified similar and distinct patterns of relationships among background factors, interpersonal triggers, and rejection of care and aggression between veterans with dementia with and without PTSD. The indirect effect of depression on care rejection via interpersonal triggers has implications for developing targeted interventions that focus on interpersonal triggers for veterans with dementia with PTSD who have greater depressive symptoms. This study underscores the importance of an enhanced focus on trauma-informed care for veterans with dementia and PTSD.
在长期居住的护理机构中，患有共病创伤后应激障碍（PTSD）和痴呆症的退伍军人会遇到各种身体和社会刺激，这些刺激可能成为与创伤相关的痛苦的触发因素，表现为拒绝护理或攻击。然而，在研究中，PTSD 很少被用来了解痴呆症退伍军人拒绝护理和攻击的行为。
根据需求驱动的痴呆症受损行为模型，我们研究了 PTSD 对痴呆症退伍军人中背景因素和人际触发因素与护理拒绝和攻击之间关系的调节作用，这些退伍军人患有或不患有共病 PTSD。
美国退伍军人事务部医疗保健系统对退伍军人事务部辅助生活住所员工培训（STAR-VA）干预评估的二次数据分析。
76 家退伍军人事务部运营的疗养院。
315 名患有痴呆症的退伍军人参加了 STAR-VA。
我们将护理拒绝和攻击发生的文本数据转换为二进制变量，将其与使用病历审查获得的社会人口统计学和 PTSD 状况数据相结合，并使用经过验证的工具测量焦虑、认知、抑郁和功能。然后进行多组结构方程建模分析，以测试 PTSD 对护理拒绝和攻击的调节作用。
虽然多组结构方程建模不支持 PTSD 总体调节的假设，但在两组之间观察到了关于背景因素和人际触发因素与护理拒绝和攻击之间关系的不同模式。人际触发因素对护理拒绝的直接影响在 PTSD 组中更大（β=0.42，p=0.014，与无 PTSD 组的β=0.29，p=0.008 相比）。只有在 PTSD 组中，抑郁通过人际触发因素对护理拒绝有统计学上显著的间接影响（β=0.09，p=0.009）。只有在 PTSD 组中，功能状态对攻击有统计学上显著的直接影响（β=0.28，p=0.044）。
我们的研究确定了痴呆症退伍军人中 PTSD 患者和非 PTSD 患者之间背景因素、人际触发因素与护理拒绝和攻击之间关系的相似和不同模式。抑郁通过人际触发因素对护理拒绝的间接影响提示，对于那些有更多抑郁症状的 PTSD 痴呆症退伍军人，应制定有针对性的干预措施，重点关注人际触发因素。这项研究强调了为患有痴呆症和 PTSD 的退伍军人提供以创伤为中心的护理的重要性。
