School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland.
Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Switzerland.
Dementia (London). 2024 Nov;23(8):1263-1291. doi: 10.1177/14713012241264611. Epub 2024 Aug 6.
Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better . . . and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention.
A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups.
A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes.
Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia.
照顾痴呆症患者可能是一项具有挑战性的经历，通常与慢性压力和家庭照顾者的沉重负担有关。痴呆症还会影响照顾者和痴呆症患者之间的关系。这种关系的质量反过来又是影响双方幸福感的重要因素。心理教育干预“学会感觉更好……并更好地帮助”在家庭照顾者的主观负担、心理困扰和自我效能方面显示出积极的结果。然而，在这种干预的背景下，关系质量尚未得到解决。
采用纵向建构主义扎根理论方法，探讨照顾者感知的关系质量、可能的变化以及促进或阻碍这些变化的干预因素。对来自三个不同干预组的 13 名家庭照顾者进行了三次定性、半结构化访谈（干预前、干预中和干预后）。对由此产生的 39 次访谈进行了分析，以了解每个照顾者的轨迹、所有照顾者的每个时间点以及特定照顾者亚组的情况。
开发了一个专注于维持痴呆症中关系质量的模型。它展示了家庭照顾者为促进与痴呆症家庭成员的积极互动和情感联系而制定和应用的策略。它还表明，掌握这些策略需要基于特定的痴呆症知识和应对策略的反思技能，这可以通过积极的技能培训来增强，在这种培训中，照顾者被引导处理他们个人的压力情况。阻碍变化的因素包括难以接受与痴呆症相关的变化。
研究结果表明，以照顾者当前日常生活情况为基础的、基于主动技能培训的心理教育，可以为处理日常挑战提供系统的程序，并提供有关疾病影响的具体知识，这可以帮助他们发展和应用支持性策略，以维持或改善与痴呆症家庭成员的关系。
