“关系迅速化为乌有”:痴呆症患者及其护理伙伴的孤独感、社会隔离和适应不断变化的社交生活。

"Relationships, Very Quickly, Turn to Nothing": Loneliness, Social Isolation, and Adaptation to Changing Social Lives Among Persons Living With Dementia and Care Partners.

机构信息

Division of Geriatrics, University of California, San Francisco, California, USA.

Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs, San Francisco, California, USA.

出版信息

Gerontologist. 2024 Apr 1;64(4). doi: 10.1093/geront/gnae014.

Abstract

BACKGROUND AND OBJECTIVES

Persons with dementia and their care partners have known risks for loneliness and social isolation throughout the disease trajectory, yet little is described about social lives in a population heterogeneous for disease stage, syndrome type, and setting.

RESEARCH DESIGN AND METHODS

We conducted a secondary analysis of qualitative interviews from multiple studies to triangulate responses from a cohort of persons with dementia (n = 24), and active (n = 33) or bereaved (n = 15) care partners diverse in setting, dementia type and stage, and life experience. Interviews explored challenges related to social lives and were analyzed thematically.

RESULTS

Persons with dementia were on average 80 years old (range: 67-94), 38% female, and 78% diagnosed with Alzheimer's dementia; care partners were on average 67 years old (range: 40-87) and 69% female. We identified 3 primary themes. First, dyads lost external social networks due to complex factors, including discomfort of surrounding social networks, caregiving responsibilities, and progressive cognitive deficits. Second, care partners described disruptions of meaningful dyadic relationships due to progressive cognitive and functional deficits, leading to loneliness and anticipatory grief. Third, adaptive strategies centered on care partners facilitating shared social activities and programs addressing caregiver burden. An overarching theme of disease-course accumulation of barriers to social interactions and constant adaptations was present in all themes.

DISCUSSION AND IMPLICATIONS

Isolation and loneliness are a shared experience and source of distress for persons with dementia and care partners. Results can inform interventions tailored to individual needs and disease stages of dyads that enhance social connectedness.

摘要

背景与目的

痴呆症患者及其照护者在疾病进程中存在已知的孤独和社会隔离风险,但对于处于疾病阶段、综合征类型和环境多样化的人群的社交生活,描述甚少。

研究设计与方法

我们对多项研究的定性访谈进行了二次分析,以从一组痴呆症患者(n=24)和活跃(n=33)或丧亲(n=15)的照护者中三角验证来自队列的响应,这些照护者在环境、痴呆症类型和阶段以及生活经历方面存在差异。访谈探讨了与社交生活相关的挑战,并进行了主题分析。

结果

痴呆症患者的平均年龄为 80 岁(范围:67-94 岁),38%为女性,78%被诊断为阿尔茨海默病;照护者的平均年龄为 67 岁(范围:40-87 岁),69%为女性。我们确定了 3 个主要主题。首先,由于复杂因素,包括周围社交网络的不适、照护责任和认知功能逐渐下降,患者与照护者的外部社交网络丧失。其次,照护者描述了由于认知和功能逐渐下降导致的有意义的双人关系中断,从而导致孤独和预期性悲伤。第三,以照护者为中心的适应策略促进了共享社交活动,并解决了照护者的负担问题。在所有主题中,疾病进程中社交互动障碍的积累和不断适应的主题都是存在的。

讨论与启示

隔离和孤独是痴呆症患者及其照护者共同的经历和痛苦来源。结果可以为针对个体需求和双体疾病阶段的干预措施提供信息,以增强社交联系。

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