Study On Abuse Tendency And Preliminary Construction Of Its Risk Assessment Model Among Caregivers Of Elders With Dementia In Long-term Care Facilities

BACKGROUNDSince the aging society is coming,the population of elders has continued to show a rapid growth trend and the population of elders with dementia is growing rapidly.Elders with dementia are at high risk of being abuse because of the decline of cognitive function and self-care ability,accompanied by mental and behavioral symptoms,and the deterioration of physical function.Previous studies have shown that the incidence of abuse among caregivers of elders with dementia is 37%to 55%.Exposure to being abuse in elders with dementia can lead to physical impairment and mental health problem,decrease quality of life and even death,as well lead to increased caring burden,and thus affecting the quality of care.In 2016,the World Health Organization General Assembly adopted the Global Strategy and Plan of Action on Ageing and Health 2016-2020,emphasizing the importance of preventing abuse and strengthening countermeasures.Therefore,elder abuse as a common and serious social health problem needs urgent attention.Therefore,the abuse tendency among caregivers of elders with dementia is a public health problem,which needs urgent attention.At present,most of the research focuses on the related factors of abuse tendency of family caregivers of elders with dementia,while few studies focus on the related factors of abuse tendency among caregivers of elders with dementia in long-term care facilities.Therefore,this study aims to obtain the incidence of abuse tendency and its influencing factors among caregivers of elders with dementia in long-term care facilities by methods of quantitative and qualitative research.A risk assessment model for abuse tendency of caregivers in long-term care facilities is preliminarily constructed,which provides important reference for early intervention and prevention of abuse,and has certain theoretical and practical significance.OBJECTIVE1.To obtain the incidence rate,characteristics and its influencing factors of abuse tendency among caregivers of elders with dementia through quantitative survey and qualitative interview.2.To construct a risk assessment model of abuse tendency for caregivers of elders with dementia by logistic stepwise regression analysis which provides research reference for early identification and intervention of elder abuse among caregivers of elders with dementia in the future.METHODSThe research consisted of two parts:1.By methods of the questionnaire survey,total of 307 caregivers from 8 long-term care facilities in Guangdong Province were investigated using the Chinese version of Caregivers Abuse Screening for Elderly from July to December 2018.The characteristic and influencing factors of abuse tendency among caregiver of elders with dementia were analyzed.A risk assessment model for abuse tendency among caregivers of elders with dementia in long-term care facilities was constructed according to these influencing factors.2.By methods of semi-structured interview,16 caregivers of elders with dementia whose score more than 3 were recruited from November to December 2018 to discuss the related factors of caregivers of elders with dementia in long-term care facilities.STATISTICS AND ANALYSIS1.Quantitative data:Data are collated by two-person input and checked and SPSS20.0 software is used for statistical analysis.The general data of caregivers of elders with dementia and care recipients were described by frequency,percentage,mean±standard deviation;univariate analysis(non-normal or uneven variance using non-parametric test)and binary logistic regression analysis were used to analyze related factors of abuse tendency.Logistic stepwise regression analysis was used to select the related factors of abuse tendency among caregivers,and a risk assessment model of caregivers' abuse tendency for elders with dementia was established.The fitness of the evaluation model was analyzed by ROC curve analysis and Hosmer-Lemeshow test.The prediction efficiency of the model was evaluated by Fisher discriminant analysis.2.Qualitative data:Within 24 hours after the end of the interview,transcribe the transcripts of the recording.Colaizzi's seven-step phenomenological data analysis method is used,which includes careful reading,refining,coding and summarizing views,summarizing topics,checking with the interviewees,and sorting out the topics.RESULTS1.Results of quantitative research:The incidence of abuse tendency among caregivers of elders with dementia in long-term care facilities was 49.80%.Most of them were women(88.2%),45?59 years old(75.8%),care time less than one year(34.0%),the number of care recipient shared less than five(81.7%),living in rural area(84.3%),primary school and below(56.2%),general knowledge of dementia(40.5%),general occupational satisfaction(49%),self-rated care difficulty(51%).Caregiver's care time more than five years(OR=2.208,95%CI 1.178?4.136),occupational satisfaction was unsatisfacted(OR=1.942,95%CI 1.116?3.378),self-rated care difficulty was difficult(OR=7.332,95%CI 3.082?17.394)and care recipients' partial self-care ability(OR=3.747,95%CI 1.211?11.602)were risk factors of abuse tendency among caregivers of elders with dementia.Elders with dementia who are without behavioral and psychological symptoms of dementia(OR=0.200,95%CI 0.111?0.362),caregiver's agreeability(OR=0.862,95%CI 0.801?0.928),openness(OR=0.941,95%CI 0.889?0.997)were protective factors of abuse tendency among caregivers of elders with dementia.Results of model construction:Multivariate regression analysis showed that difficulty in self-rated care difficulty(OR=8.668,95%CI 3.494-21.509),care recipients'behavioral and psychological symptoms of dementia(OR=4.412,95%CI 2.455?7.932),agreeable(OR=0.888,95%CI 0.837?0.942)and openness(OR=0.940,95%CI 0.896?0.987)of caregivers were the related factors of abuse tendency among caregivers of elders with dementia.Based on the above factors and variable assignment,a preliminary risk assessment model for abuse tendency of caregivers of senile dementia was established.Y=15xX1+10xX2-8xX3-4xX4Note:X1= difficulty in self-rated care difficulty;X2 = care recipients'behavioral and psychological symptoms of dementia;X3 = agreeableness;X4 = opennessResults of model effectiveness evaluation:The area under ROC curve was 0.856,and the 95%confidence interval was 0.815-0.898.The statistical test results showed that there was significant difference between AUC in this study and AUC = 0.5(P<0.001).When the model score more than 43 was the best critical value for high-risk population.Fisher discriminant analysis showed that the sensitivity of the model was 81.00%,specificity was 68.20%,and the total coincidence rate was 74.60%.3.Results of qualitative research:The abuse types of caregivers of elders with dementia were psychological or verbal abuse and neglect.The respondents indicated that the abuse tendencies happened during the period of occurrence of behavioral and psychological symptoms of dementia.Besides,when abuse tendencies occurred,the psychological experience of caregivers of elders with dementia mainly increased negative emotions,accompanied by a decrease in the value of care and a sense of resignation.Moreover,the coping style of violence,avoidance and seeking help from others are often adopted.Moreover,seven related factors leading to abuse tendency of caregivers of elders with dementia:personal factors(caregiver's personality,unclear understanding of abuse,care recipients' behavioral and psychological symptoms of dementia),organizational factors(organizational climate,organizational connivance)and social factors(low occupational status of caregivers and common perception of abuse).CONCLUSION1.The occurrence rate of abuse tendency among caregivers of elders with dementia was 49.8%.2.Influencing factors among caregivers of elders with dementia including caregivers'factors:caregiver's care time,occupational satisfaction,self-rated care difficulty,caregiver's personality,understanding of abuse,elders with dementia factors:care recipients'behavioral and psychological symptoms,self-care ability,organizational factors:organizational climate,organizational connivance,and social factors:low occupational status of caregivers and common perception of abuse.3.The risk assessment model of abuse tendency of caregivers of elders with dementia in this study has good diagnostic and discriminatory efficacy,and can be considered for the preliminary application of the model to identify abuse tendency among caregivers in long-term care facilities in this region.However,multi-center prospective cohort and follow-up studies should be carried out in the future,to validate and revise the model in order to improve the prediction efficiency of the model.