关键词: caregiver coping dementia distress mediation prognostic understanding terminal illness

来  源:   DOI:10.1002/alz.14102

Abstract:
We assessed which coping strategies (problem-focused, emotion-focused, dysfunctional) mediate the association between caregivers\' understanding of dementia as terminal and their distress. A total of 215 caregivers of community-dwelling persons with severe dementia were surveyed every 4 months over 3 years. A generalized structural equation model was used to test mediation. Caregivers who correctly understood dementia as terminal and those unsure (vs incorrect), experienced more distress (correct: β [95% confidence interval (CI)]: 0.80 [0.00 to 1.60]; unsure: 0.95 [0.04 to 1.87]). Caregivers with correct understanding of dementia as terminal (vs incorrect) employed more dysfunctional (2.01 [0.60 to 3.42]) and problem-focused coping strategies (2.56 [0.08 to 5.05]). Although dysfunctional and problem-focused coping (associated with higher distress) mediated the positive association between caregivers\' understanding that dementia is terminal and their distress, emotion-focused coping (associated with lower distress) did not offset this relationship. Results suggest that terminal illness disclosure to caregivers should be accompanied by interventions to promote emotion-focused coping strategies. Highlights Caregivers who understood dementia as terminal experienced more distress. Dysfunctional and problem-focused coping mediated the positive relationship between terminal illness understanding and caregiver distress. Emotion-focused coping did not offset this relationship.
摘要:
我们评估了哪些应对策略(以问题为中心,以情感为中心,功能失调)调解护理人员对痴呆症的理解与他们的痛苦之间的联系。在3年内,每4个月对215名社区居住的重度痴呆症患者的护理人员进行了调查。使用广义结构方程模型来检验中介。正确理解痴呆症为终末期和不确定(vs不正确)的护理人员,经历了更多的痛苦(正确:β[95%置信区间(CI)]:0.80[0.00至1.60];不确定:0.95[0.04至1.87])。正确理解痴呆症为终末期(与不正确)的护理人员采用了更多的功能失调(2.01[0.60to3.42])和以问题为中心的应对策略(2.56[0.08to5.05])。尽管功能失调和以问题为中心的应对(与更高的痛苦相关)调节了护理人员对痴呆症是晚期痴呆症及其痛苦的理解之间的正相关关系,以情绪为中心的应对(与较低的痛苦相关)并不能抵消这种关系。结果表明,向护理人员披露绝症应伴随着干预措施,以促进以情绪为中心的应对策略。强调将痴呆症理解为终末期的护理人员经历了更多的痛苦。功能失调和以问题为中心的应对方式介导了绝症理解与照顾者困扰之间的正相关关系。以情绪为中心的应对并没有抵消这种关系。
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