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

摘要： 背景　中重度老年期痴呆患者家庭面对着照顾患者及家庭自身的多重压力，尤其是在以成年子女为主要照顾者的家庭中。家庭对压力的适应程度决定了老年期痴呆患者的生活质量。确定我国以成年子女为主要照顾者的老年期痴呆患者家庭适应的影响因素，进而促进家庭适应尤为重要。目的　确定以成年子女为主要照顾者的中重度老年期痴呆患者家庭适应的影响因素、影响路径及影响效果。方法　采用横断面调查的方法，便利选取2017年10月—2018年3月在北京协和医院、首都医科大学宣武医院、首都医科大学中日友好医院记忆专科门诊、首都医科大学安定医院老年精神科门诊及记忆专科门诊就诊或开药的符合纳入标准的家庭。基于McCubbin的家庭调整与适应的抗逆力模型（简称家庭抗逆力模型），采用老年期痴呆患者家庭情况调查问卷对患者及其家庭的一般人口学资料进行调查；采用修订版记忆行为问题量表等对家庭抗逆力模型中的12个影响因素进行测量；采用家庭适应量表对家庭适应进行测量。使用结构方程模型进行影响因素的筛选、影响因素路径及影响效果分析。结果　共有223个老年期痴呆患者家庭参与调查，回收有效问卷203份，有效回收率为91.03%。根据验证并修订后的模型，“家庭抗逆力模型”中的12个因素（压力源、家庭架构、家庭世界观、家庭范式、家庭赋予情境的意义、家庭情境评估、家庭资源、家庭支持、亲属支持、社区支持、社会支持、解决问题与应对）对家庭适应的直接与间接路径回归系数均具有统计学意义（P<0.05），均为老年期痴呆患者家庭适应的影响因素。其中内层支持系统（由家庭支持和亲属支持组成）、家庭情境评估、家庭资源为直接影响因素，其余因素为间接影响因素。各影响因素对于家庭适应的影响总效应绝对值从大到小的排列顺序及总效应值依次为：内层支持系统（0.673）、压力源（-0.427）、外层支持系统（0.326）、家庭资源（0.305）、认知系统（0.067）、家庭情境评估（0.045）、解决问题与应对（0.035）。结论　基于McCubbin的家庭抗逆力模型，家庭支持、亲属支持等因素均对家庭适应起到了影响作用。其中家庭支持、亲属支持形成的内层支持系统对家庭适应的影响作用最强且直接，提示未来通过促进中重度老年期痴呆患者家庭的家庭支持和亲属支持来促进家庭适应尤为重要。

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