Caregiving Distress And Copying Strategy Of Behavioral And Psychological Symptoms In Community-dwelling Patients With Dementia

BackgroundNinety percent of patients with Senile Dementia(SD)in our country are home care.Behavioral and Psychological Symptoms of Dementia(BPSD)increase the difficulty and complexity of home care.Therefore,to explore the risk factors of psychiatric and behavioral symptoms and care disturbances of SD patients,and to understand the care distress,coping strategies and support needs of family caregivers,it is helpful to develop appropriate community support programs for SD patients and their family caregivers,and provide a theoretical basis for the formulation of SD home care policies.Objectives1.To understand the prevalence rate,severity and characteristics of caring trouble of BPSD patients in community.2.Understand the care distress,coping strategies and support needs of family caregivers for BPSD patients.MethodsA hybrid research design method was adopted in this study:1.Cross-sectional survey method.By comparing the occurrence rate,severity and care distress of BPSD patients in long-term care institutions,the differences of BPSD patients in community and the unique distress of family caregivers faced with BPSD were understood.2.Qualitative interview.Semi-structured interviews with family caregivers were conducted to understand their care experience,coping strategies and support needs for SD patients.Results1.Quantitative study found that community SD patients showed more frequent and clinically significant BPSD and caused more serious care disturbances than SD patients in long-term care institutions.Among them,139 cases(88.5%)of community SD patients and 84 cases(75%)of institutional SD patients had at least one clinically significant symptom(item score ≥4),the difference was statistically significant(x 2=8.45,P=0.004).125 cases(79.6%)of community SD patients and 30 cases(26.8%)of institutional SD patients had moderate to severe nursing distress due to at least one BPSD(care distress score ≥3 points),and the difference between groups was statistically significant(χ2=74.72,P<0.001).In community SD patients,the two major symptoms leading to moderate to severe care disturbance were agitation(44.6%)and abnormal behavior at night(38.2%).After controlling for dementia severity and drug use,family care remained an independent risk factor for clinically significant symptoms and moderate-to-severe care disturbance in SD patients.For different BPSD symptoms,the predictive ability of symptom severity to care distress varied(R2 0.36-0.82).2.The qualitative interview can be summarized into 8 topics and 21 sub-topics:(1)Observation and understanding of BPSD;(2)Care is a slow but unadaptable process;(3)Caregiving is a complex emotional experience;(4)Learn to recognize and communicate through trial and error;(5)Choose compromise in frustration;(6)The relationship with patients may affect coping;(7)Caregiving is a lonely adventure;(8)Caregivers’ needs need to be seen.ConclusionUsing a mixed approach,we found that family caregivers were more frequently exposed to clinically significant psycho-behavioral symptoms and more moderate-to-severe caregiving disturbances than formal caregivers.Combined with the qualitative research results on the care experience,coping strategies and support needs of family caregivers for BPSD,it is helpful to develop more effective home care and community support strategies for SD patients.