BACKGROUND Most people living with dementia want to remain in their own homes, supported by family and paid carers. Care at home often breaks down, necessitating transition to a care home and existing interventions are limited. To inform the development of psychosocial interventions to enable people with dementia to live well for longer at home, we qualitatively explored the views of people living with dementia, family carers and health and social care professionals, on how to achieve and maintain independence at home and what impedes this. METHODS We conducted an inductive thematic analysis of qualitative interviews with 11 people living with dementia, 19 professionals and 22 family carers in England. RESULTS We identified four overarching themes: being in a safe and familiar environment, enabling not disabling care, maintaining relationships and community connectedness, and getting the right support. For people living with dementia, the realities of staying active were complex: there was a tension between accepting support that enabled independence and a feeling that in doing so they were accepting dependency. Their and professionals' accounts prioritised autonomy and 'living well with dementia', while family carers prioritised avoiding harm. Professionals promoted positive risk-taking and facilitating independence, whereas family carers often felt they were left holding this risk. DISCUSSION Psychosocial interventions must accommodate tensions between positive risk-taking and avoiding harm, facilitating autonomy and providing support. They should be adaptive and collaborative, combining self-management with flexible support. Compassionate implementation of rights-based dementia care must consider the emotional burden for family carers of supporting someone to live positively with risk.

中文翻译：

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“我一直在想我不想依靠人。” 定性研究痴呆症患者如何在家中实现和保持独立性：利益相关者的观点。

背景技术大多数患有痴呆症的人希望在家庭和有偿看护者的支持下留在自己的家中。在家中的护理经常崩溃，需要过渡到护理所，并且现有的干预措施很有限。为了为社会心理干预措施的发展提供信息，以使痴呆症患者能够在更长的时间内更好地生活，我们定性地探讨了痴呆症患者，家庭护理人员以及卫生和社会护理专业人员对如何实现和维持家庭独立的看法。是什么阻碍了这一点。方法我们对英格兰11位痴呆症患者，19位专业人员和22位家庭护理人员进行了定性访谈的归纳主题分析。结果我们确定了四个总体主题：处于安全和熟悉的环境中，不致使护理无效，保持关系和社区联系，并获得正确的支持。对于患有痴呆症的人来说，保持活跃的现实是复杂的：在接受能够实现独立的支持与这样做的过程中，他们正在接受依赖之间存在着紧张关系。他们和专业人员的账目将自主权和“与痴呆症相处得很好”列为优先事项，而家庭照护者则优先考虑避免伤害。专业人士提倡积极承担风险并促进独立性，而家庭护理人员则常常感到自己承担了这种风险。讨论社会心理干预措施必须适应积极冒险与避免伤害之间的紧张关系，促进自主权并提供支持。他们应该具有适应性和协作性，将自我管理与灵活的支持相结合。