关键词: 痴呆, 照顾者, 适应, 应对, 压力, 抗逆力模型, 影响因素分析

Abstract: Background　Providing care for elderly patients with moderate to severe dementia always lays great deal of stress on families，especially the families in which adult children act as the primary caregivers.Family adaptation to stress determines the patient's quality of life.Therefore，improving the adaptation to stress among families of elderly dementia patients （who were taking care primarily by their adult children） in China through finding out the corresponding influence factors is of great significance.Objective　To identify the factors and the pathways associated with the adaptation to stress among families of elderly patients with moderate to severe dementia.Methods　We conducted this cross-sectional study from October 2017 to March 2018.In accordance with the inclusion criteria，using convenience sampling，we selected 223 elderly patients with moderate to severe dementia who visited the doctor for medical consultation or only for prescribing drugs from Memory Disorders Clinic of hospitals，including Peking Union Medical College Hospital，Xuanwu Hospital Capital Medical University，China-Japan Friendship Hospital，and Old Age Psychiatry Clinic and Memory Disorders Clinic of Beijing Anding Hospital.After enrolled their family members，self-developed General Demographic Questionnaire was used to collect the demographic characteristics of the patients and their family members.A set of measurements，such as Chinese version of Revised Memory and Behavior Problems Checklist （RMBPC） were adopted to measure 12 influence factors of family adaptation to stress derived from the framework of McCubbin's Resiliency Model of Family Stress，Adjustment and Adaptation（hereinafter referred to as Family Resilience Model）.The Chinese version of Family Adaptation Scale was used to measure family adaptation.Structural equation modeling （SEM） was performed to identify the influence factors of family adaptation to stress，and analyze their pathways and effects.Results　A total of 203 families who returned eligible questionnaires were included in the final analysis，with a response rate of 91.03%.After verification and revision，the pathways regression coefficients of 12 factors （stressor，family schema，family coherence，family paradigms，meanings，situational appraisal，family resources，family support，kin support，community support，social support，problem solving and coping） included in the Family Resilience Model were found to be statistically significant（P<0.05），indicating that all of them were significantly associated with family adaptation.Among these factors，internal support system （consisting of family support and kin support），situational appraisal and family resources were direct influence factors，the others were indirect influence factors.The path coefficients of total effect of the determinants to family adaptation were as follows（from largest to smallest）：internal support system（0.673），stressor （-0.427），external support system（0.326），family resources（0.305），appraisal system（0.067），situational appraisal（0.045），problem solving and coping （0.035）.Conclusion　The results suggest that all the factors included in our Family Resilience Model developed with reference of McCubbin's Family Resilience Model，influence family adaptation，in particular，family support and kin support （internal support system） produce the strongest effect in a direct way，indicating that the adaptation of the families of elderly patients with moderate to severe dementia can be promoted by increasing the family support and kin support.

Key words: Dementia, Caregivers, Adaptation, Coping, Stress, Resilience model, Root cause analysis