痴呆患者抗拒护理评估工具的研究进展

doi:10.12114/j.issn.1007-9572.2023.0132

摘要/Abstract

摘要： 抗拒护理（RTC）是在照护痴呆患者过程中发现的一种常见的异常行为表现，对患者及其照顾者可造成较严重的负面影响。国外对痴呆患者RTC评估工具的研究起步较早，研究内容更加深入和全面，自1999年阿尔茨海默病抗拒护理量表（RTC-DAT）被开发以来，国外研究者对其进行了多次评价内容和方法上的修订，打造出适用于不同护理情境且各具特色的痴呆患者RTC评估工具。本文对国外开发的痴呆患者RTC评估工具进行综述，着重探讨不同评估工具在评价内容和方法上的差异，分析其特点、优势和不足，旨在为我国开发或引入适合国情的痴呆患者RTC评估工具提供借鉴。当前，国外学者在开展痴呆患者RTC相关研究时，多由研究人员基于RTC-DAT使用观察法评估痴呆患者RTC行为发生情况，而这种方法在实际推广应用的过程中面临诸多挑战。2022年被开发的抗拒护理信息提供者量表（RoCIS）允许研究人员使用在其他领域常见的咨询照顾者的方法评价痴呆患者RTC行为发生情况，这为国内引入或开发适用于我国痴呆患者RTC行为评估的工具提供了新的借鉴。医务人员应在综合考虑不同类型评估工具适用性的基础上选择适宜工具评估痴呆患者RTC行为发生情况。

关键词: 痴呆, 抗拒护理, 行为和精神症状, 评估工具, 综述

Abstract:

Resistiveness to care (RTC) is a common abnormal behavioral symptom in dementia patients during the care process, which seriously negatively impacts the patients and their caregivers. The research on assessment tools for RTC started earlier in foreign countries, and has explored relevant aspects more deeply and comprehensively. Since the Resistiveness to Care Scale for Dementia of the Alzheimer's Type (RTC-DAT) came out in 1999, overseas researchers have made several revisions to its content and methods, and have expanded it to include different scales for assessing RTC in different care settings. In this paper, we present a review of the tools developed overseas to assess RTC in patients with dementia, focusing on the differences in contents and methods of the tools, and the characteristics, strengths and weaknesses of each tool, which may offer insights into China's development of such a tool or introduction of a foreign tool applicable to China. The evaluation method of the assessment tools currently used in foreign research on RTC in patients with dementia is mostly based on the researcher-observed method used in the initial RTC-DAT, which faces many limitations in its practical application. The Refusal of Care Informant Scale (RoCIS) developed in 2022 attempts to use the method of evaluation by consulting caregivers, which is commonly used in other fields, providing a new way for China's introduction or development of a RTC assessment tool applicable to Chinese dementia patients. Considering various types of these tools, we recommend that the tool should be selected according to its applicability assessed comprehensively.

Key words: Dementia, Resistiveness to care, Behavioral and psychological symptoms, Assessment tools, Review

王鑫源,王笑蕾,刘艳丽,等. 痴呆患者抗拒护理评估工具的研究进展[J]. 中国全科医学, 2023, 26(22): 2816-2822. DOI: 10.12114/j.issn.1007-9572.2023.0132.
WANG Xinyuan,WANG Xiaolei,LIU Yanli, et al. Advances in Evaluation Tools for Resistiveness to Care in Patients with Dementia[J]. Chinese General Practice, 2023, 26(22): 2816-2822. DOI: 10.12114/j.issn.1007-9572.2023.0132.

参考文献 45

[1]	LARSON E B, STROUD C. Meeting the challenge of caring for persons living with dementia and their care partners and caregivers：a report from the national academies of sciences，engineering，and medicine[J]. JAMA，2021，325（18）：1831-1832.
[2]	ZHANG M, CHANG Y P, LIU Y J，et al. Burden and strain among familial caregivers of patients with dementia in China[J]. Issues Ment Health Nurs，2018，39（5）：427-432.
[3]	GUZMAN-MARTINEZ L, MACCIONI R B, FARíAS G A，et al. Biomarkers for Alzheimer's disease[J]. Curr Alzheimer Res，2019，16（6）：518-528. DOI：10.2174/1567205016666190517121140.
[4]	ZHANG X, CLARKE C L, RHYNAS S J. Tensions in dementia care in China：an interpretative phenomenological study from Shandong Province[J]. Int J Older People Nurs，2020，15（1）：e12291.
[5]	GALE S A, ACAR D, DAFFNER K R. Dementia[J]. Am J Med，2018，131（10）：1161-1169. DOI：10.1016/j.amjmed.2018.01.022.
[6]	SEFCIK J S, MADRIGAL C, HEID A R，et al. Person-centered care plans for nursing home residents with behavioral and psychological symptoms of dementia[J]. J Gerontol Nurs，2020，46（11）：17-27. DOI：10.3928/00989134-20201012-03.
[7]	NORDGREN A. How to respond to resistiveness towards assistive technologies among persons with dementia[J]. Med Health Care Philos，2018，21（3）：411-421. DOI：10.1007/s11019-017-9816-8.
[8]	ZHANG M, ZHAO H, MENG F P. Elderspeak to resident dementia patients increases resistiveness to care in health care profession[J]. Inquiry，2020，57：46958020948668.
[9]	MORTENSEN A H, STOJILJKOVIC M, LILLEKROKEN D. Strategies to manage cognitive dissonance when experiencing resistiveness to care in people living with dementia：a qualitative study[J]. J Adv Nurs，2022，78（2）：486-497. DOI：10.1111/jan.15030.
[10]	王永红，邢庄婕，李焕焕，等. 模拟存在疗法对痴呆患者激越行为干预的研究进展[J]. 中国护理管理，2019，19（5）：744-747. DOI：10.3969/j.issn.1672-1756.2019.05.02.
[11]	周娜. 阿尔茨海默病患者居家护理方案的构建与应用[J]. 中国实用神经疾病杂志，2022，25（7）：880-885.
[12]	NEWBOULD L, TUCKER S, WILBERFORCE M. Enabling older people with mental health needs to engage with community social care：a scoping review to inform a theory of change[J]. Health Soc Care Community，2022，30（4）：1286-1306. DOI：10.1111/hsc.13648.
[13]	CUNNINGHAM J, WILLIAMS K N. A case study of resistiveness to care and elderspeak[J]. Res Theory Nurs Pract，2007，21（1）：45-56.
[14]	KOVACH C R, NOONAN P E, SCHLIDT A M，et al. A model of consequences of need-driven，dementia-compromised behavior[J]. J Nurs Scholarsh，2005，37（2）：134-140.
[15]	JABLONSKI R A, MUNRO C L, GRAP M J，et al. The role of biobehavioral，environmental，and social forces on oral health disparities in frail and functionally dependent nursing home elders[J]. Biol Res Nurs，2005，7（1）：75-82.
[16]	SPIGELMYER P C, HUPCEY J, KITKO L. A concept analysis of resistiveness to care[J]. Clin Nurs Res，2021，30（1）：50-58. DOI：10.1177/1054773818789862.
[17]	VOLICER L, CITROME L, VOLAVKA J. Measurement of agitation and aggression in adult and aged neuropsychiatric patients：review of definitions and frequently used measurement scales[J]. CNS Spectr，2017，22（5）：407-414.
[18]	JABLONSKI R A, WINSTEAD V, GELDMACHER D S. Description of process and content of online dementia coaching for family caregivers of persons with dementia[J]. Healthcare（Basel），2019，7（1）：13. DOI：10.3390/healthcare7010013.
[19]	VOLICER L, BASS E A, LUTHER S L. Agitation and resistiveness to care are two separate behavioral syndromes of dementia[J]. J Am Med Dir Assoc，2007，8（8）：527-532.
[20]	Centers for Medicare & Medicaid Services. Minimum Data Set（MDS）3.0[EB/OL]. （2010-10-01）[2022-10-15].
[21]	WILLIAMS K N, PERKHOUNKOVA Y, HERMAN R，et al. A communication intervention to reduce resistiveness in dementia care：a cluster randomized controlled trial[J]. Gerontologist，2017，57（4）：707-718. DOI：10.1093/geront/gnw047.
[22]	THOMAS K S, DOSA D, WYSOCKI A，et al. The Minimum Data Set 3.0 Cognitive Function Scale[J]. Med Care，2017，55（9）：e68-72.
[23]	MCCREEDY E, OGAREK J A, THOMAS K S，et al. The Minimum Data Set Agitated and Reactive Behavior Scale：measuring behaviors in nursing home residents with dementia[J]. J Am Med Dir Assoc，2019，20（12）：1548-1552.
[24]	MAHONEY E K, HURLEY A C, VOLICER L，et al. Development and testing of the Resistiveness to Care Scale[J]. Res Nurs Health，1999，22（1）：27-38.
[25]	MOR V, BERG K, ANGELELLI J，et al. The quality of quality measurement in U.S. nursing homes[J]. Gerontologist，2003，43（s2）：37-46. DOI：10.1093/geront/43.suppl_2.37.
[26]	VOLICER L, HURLEY A C, BLASI Z V. Scales for evaluation of end-of-life care in dementia[J]. Alzheimer Dis Assoc Disord，2001，15（4）：194-200. DOI：10.1097/00002093-200110000-00005.
[27]	KROENKE K, GAO S, MOSESSO K M，et al. Prevalence and predictors of symptoms in persons with advanced dementia living in the community[J]. J Palliat Med，2022，25（9）：1376-1385.
[28]	RAY W A, TAYLOR J A, LICHTENSTEIN M J，et al. The Nursing Home Behavior Problem Scale[J]. J Gerontol，1992，47（1）：M9-16. DOI：10.1093/geronj/47.1.m9.
[29]	DRACHMAN D A, SWEARER J M, O'DONNELL B F，et al. The Caretaker Obstreperous-behavior Rating Assessment（COBRA）Scale[J]. J Am Geriatr Soc，1992，40（5）：463-470.
[30]	LAGERLUND H, THUNBORG C, SANDBORGH M. Behaviour-directed interventions for problematic person transfer situations in two dementia care dyads：a single-case design study[J]. BMC Geriatr，2022，22（1）：261. DOI：10.1186/s12877-022-02952-5.
[31]	RESNICK B, BOLTZ M, GALIK E，et al. Testing the impact of FFC-AL-EIT on psychosocial and behavioral outcomes in assisted living[J]. J Am Geriatr Soc，2021，69（2）：459-466.
[32]	KIM B, LEE K H, CHO E，et al. Behaviors of care providers and resistiveness to oral care of persons living with dementia[J]. Geriatr Nurs，2021，42（4）：915-918.
[33]	JABLONSKI R A, KOLANOWSKI A M, AZUERO A，et al. Randomised clinical trial：efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care[J]. Gerodontology，2018，35（4）：365-375.
[34]	JABLONSKI-JAUDON R A, WINSTEAD V, JONES-TOWNSEND C，et al. Revising the Resistiveness to Care Scale[J]. J Nurs Meas，2016，24（2）：72-82.
[35]	GALIK E, RESNICK B, VIGNE E，et al. Reliability and validity of the Resistiveness to Care Scale among cognitively impaired older adults[J]. J Am Med Dir Assoc，2017，18（1）：59-64.
[36]	RESNICK B, KOLANOWSKI A, VAN HAITSMA K，et al. Current psychotropic medication use and contributing factors among nursing home residents with cognitive impairment[J]. Clin Nurs Res，2021，30（1）：59-69. DOI：10.1177/1054773819838678.
[37]	RESNICK B, GALIK E, KOLANOWSKI A，et al. The relationship between pain，function，behavioral，and psychological symptoms of dementia and quality of life[J]. Pain Manag Nurs，2022，23（1）：55-61. DOI：10.1016/j.pmn.2021.07.001.
[38]	GALIK E M, RESNICK B, HOLMES S D，et al. A cluster randomized controlled trial testing the impact of function and behavior focused care for nursing home residents with dementia[J]. J Am Med Dir Assoc，2021，22（7）：1421-1428.e4.
[39]	BACKHOUSE T, KHONDOKER M, KILLETT A，et al. Most common refusals of personal care in advanced dementia：psychometric properties of the Refusal of Care Informant Scale（RoCIS）[J]. Gerontologist，2022：gnac066. DOI：10.1093/geront/gnac066.
[40]	FAUTH E B, FEMIA E E, ZARIT S H. Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia：associations with informal caregivers' stress and well-being[J]. Aging Ment Health，2016，20（9）：888-898. DOI：10.1080/13607863.2015.1049114.
[41]	SINHA P, DESAI N G, PRAKASH O，et al. Caregiver burden in Alzheimer-type dementia and psychosis：a comparative study from India[J]. Asian J Psychiatr，2017，26：86-91.
[42]	徐永能，卢少萍，符霞，等. 老年性痴呆病人家居安全的护理干预[J]. 中华护理杂志，2004，39（3）：28-30.
[43]	RESNICK B, GALIK E, MCPHERSON R，et al. Gender differences in disease，function，and behavioral symptoms in residents with dementia[J]. West J Nurs Res，2022，44（9）：812-821.
[44]	RESNICK B, GALIK E, PAUDEL A，et al. Reliability and validity testing of the quantified quality of interaction schedule[J]. J Nurs Meas，2021，29（2）：e95-109.
[45]	SHAW C A, WARD C, GORDON J，et al. Elderspeak communication and pain severity as modifiable factors to rejection of care in hospital dementia care[J]. J Am Geriatr Soc，2022，70（8）：2258-2268.