帕金森病及相关疾病中对护理人员的攻击行为：一项混合方法研究。
Aggression Towards Caregivers in Parkinson's Disease and Related Disorders: A Mixed Methods Study.
作者信息
Macchi Zachary A, Seshadri Sandhya, Ayele Roman, Bock Meredith, Long Judith, Coats Heather, Miyasaki Janis, Pantilat Steven Z, Katz Maya, Santos Elizabeth J, Sillau Stefan H, Lum Hillary D, Kluger Benzi M
机构信息
Behavioral Neurology|Neuropalliative Sections, Department of Neurology University of Colorado Anschutz Aurora Colorado USA.
Department of Neurology and Medicine University of Rochester Medical Center Rochester New York USA.
出版信息
Mov Disord Clin Pract. 2022 Sep 7;9(7):920-931. doi: 10.1002/mdc3.13555. eCollection 2022 Oct.
BACKGROUND
Aggression is one manifestation of behavioral disturbances in neurodegenerative disease with emerging literature suggesting a high prevalence in Parkinson's disease and related disorders (PDRD).
OBJECTIVES
Our aim was to describe characteristics, associated factors, and consequences of aggression towards caregivers in PDRD.
METHODS
This is a convergent mixed methods study, leveraging data from 296 PDRD patient-caregiver dyads in a clinical trial of palliative care and semi-structured interviews with a subgroup of 14 caregivers who reported aggression. The primary outcome was baseline caregiver-reported aggression. Using multivariate linear regression, baseline dyad characteristics (eg, measures of disease, psychosocial issues, caregiver strain) were examined to identify factors associated with aggression. Thematic analysis of interviews was used to augment these findings.
RESULTS
Associated variables included disease duration ( = 0.15, < 0.05), patient grief ( = 0.22, < 0.001), symptom burden ( = 0.18, < 0.01), resistance to care ( = 0.40, < 0.01), caregivers' depression ( = 0.16, < 0.05), and caregiving burden ( = 0.34, < 0.001). We identified five themes: (1) Aggressive behaviors range from verbal abuse to threats of physical violence; (2) Caregivers believe that aggressive behaviors result from the difficulty patients experience in coping with disease progression and related losses; (3) Caregivers' stress and mental health are worsened by aggressive behaviors; (4) Aggressive behaviors negatively affect patient-caregiver relationships; (5) Caregivers are ill-prepared to manage aggressive behaviors and cope with the consequences on their own.
CONCLUSIONS
Aggression in PDRD is driven by diverse factors (eg, grief, fluctuations in cognition) with serious consequences for caregivers. Neurologists and movement specialists should consider screening for aggression while prioritizing caregiver education and wellbeing.
背景
攻击行为是神经退行性疾病中行为障碍的一种表现，新出现的文献表明帕金森病及相关疾病（PDRD）中攻击行为的患病率很高。
目的
我们的目的是描述PDRD患者对照料者攻击行为的特征、相关因素及后果。
方法
这是一项收敛性混合方法研究，利用了姑息治疗临床试验中296对PDRD患者 - 照料者二元组的数据，以及对14名报告有攻击行为的照料者亚组进行的半结构化访谈。主要结局是基线时照料者报告的攻击行为。使用多元线性回归分析基线二元组特征（如疾病测量、心理社会问题、照料者压力），以确定与攻击行为相关的因素。通过对访谈的主题分析来补充这些发现。
结果
相关变量包括疾病持续时间（β = 0.15，P < 0.05）、患者悲伤情绪（β = 0.22，P < 0.001）、症状负担（β = 0.18，P < 0.01）、对护理的抗拒（β = 0.40，P < 0.01）、照料者的抑郁（β = 0.16，P < 0.05）以及照料负担（β = 0.34，P < 0.001）。我们确定了五个主题：（1）攻击行为范围从言语辱骂到身体暴力威胁；（2）照料者认为攻击行为是患者在应对疾病进展和相关损失时遇到困难所致；（3）攻击行为使照料者的压力和心理健康状况恶化；（4）攻击行为对患者 - 照料者关系产生负面影响；（5）照料者对管理攻击行为及独自应对后果准备不足。
结论
PDRD中的攻击行为由多种因素驱动（如悲伤情绪、认知波动），给照料者带来严重后果。神经科医生和运动专家应考虑筛查攻击行为，同时优先进行照料者教育并关注其福祉。
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