Reliability,Validity Of Chinese Version Of The Challenging Behavior Scale And Its Application

BackgroundChina has the largest population of people with dementia in the world:9.5 million in 2015,and this number is projected to increase to 27 million by 2050.Compared with other chronic diseases,AD patients have strong demand for health care.In the middle and late stage of AD,challenging behavioral changes caused by cognitive impairment and mental and behavioral symptoms are very common.Challenging Behaviour was defined as 'a manifestation of distress experienced by that person,whose cognitive impairment increasingly limits their ability to carry out desired actions,to express their needs or to inhibit their own behaviour'.It brings pain to the patient and caregivers,which seriously affects the quality of life of both sides,and poses a great challenge to the staffs of long-term care institution.At present,the research about behavioral problem of Alzheimer's patients is the dynamic observation of mental behavior and the evaluation of curative effect.Less attention is paid to the care challenge for the caregivers of the AD patients.The definition and classification of the challenging behavior of the AD patients are unknown in China,and the staff of the long term care institutions in China are still lack of the awareness and ability to monitor,evaluate and manage challenging behavior.The challenging behavior scale includes some of the most common behaviors of AD patients.Therefore,quantitative assessment of the challenging behaviors and its care challenges of AD patients can provide reference for its behavioral management and clinical intervention,but there is no report on the simplified Chinese version of the challenging behavior scale.Objective1.To introduce and translate the Challenging Behavior Scale,and evaluate the reliability and validity of the simplified Chinese version of CBS.2.To explore the frequency,management difficulty and its influencing factors of the challenging behavior of the senile dementia patients in three long-term care institutions in Guangzhou.Methods1.Taking CBS as the research object and using the Cohen-Mansfield agitation questionnair'e(CMAI)as the calibration tool,244 dementia patients in 2 long-term nursing institutions were investigated.After data collection,the reliability and validity of the revised edition of CBS was analyzed.2.Apply the Chinese Version of CBS to 340 dementia patients in 3 long-term care institutions in Guangzhou from October 2017 to December 2017,and questionnaires was conducted by convenient sampling.After data collection,the incidence,frequency,difficulty and the difficulty of management of Challenging behavior and its influencing factors was analyzed.Results1.The identification and homogeneity of Chinese version of CBS is good.After two rounds of expert consultation of Chinese version of CBS,item 25 was deleted,item 4 and item 5 was merged,item 10 and item 11 was merged.Two common factors were extracted by exploratory factor analysis.The cumulative variance contribution rate was 56.567%,and the item whose factor load less than 0.4 were eliminated,including item 8 and item22.Finally,there are 20 items left in the Chinese version of the CBS.The correlation coefficient between the total score of the Chinese version of CBS and the total score of the CMAI scale is 0.815;Cronbach's a for the incidence,frequency,difficulty,and challenge were 0.844,0.868,0.857 and 0.827.The retest reliability for the incidence,frequency,difficulty,and challenge were 0.709,0.770;,0.736 and 0.827.2.Within 340 elderly dementia patients in 3 long-term care,99.1%of the those have challenging behavior and the difficulty of management.The lack of self-care ability was the most frequency and most troubling symptom to the caregiver.The acceptance of psychiatric services,the level of self-care ability and the number of other physical disease may affect the challenge of dementia care in long-term care institutions.Conclusions1.Chinese version of CBS was a scale with a total of 20 items,2 dimensions(positive symptom behavior and negative symptom behavior).Chinese version of CBS has good reliability and validity,which is suitable for the senile dementia patients in Chinese long-term nursing institutions.2.There is a high incidence of challenging behavior and a general care challenges in patients with AD in long-term care institutions in Guangzhou.The lack of psychiatric services,the level of self-care ability and the number of combined physical disease are the factors affecting the care challenging of behavior problems in long-term care institutions.