Abstract

Objectives:Emotional expressions in late-stage dementia have traditionally been studied within a deficit paradigm. Moving the narrative of the dementia trajectory from a solely negative pathological experience to one that acknowledges the potential for positive experiences aligns with international recommendations for living well with dementia. The purpose of this study was to extend prior research by examining the pattern of well-being using affect balance, the ratio of positive to negative affect, in nursing home residents living with dementia over 12 months and its association to factors that could potentially influence resident well-being.

Method:This study was a secondary analysis of baseline, 4 and 12-month data from a pragmatic clinical trial. A total of 536 residents with moderate to severe cognitive impairments from 55 nursing homes were included in the multivariable linear mixed model regression analyses.

Results:Resident function, the number of registered nurse hours devoted to care in the facility, and the quality of staff interaction predicted higher affect balance over time after controlling for other variables.

Conclusion:The findings provide support for the utility of affect balance as a meaningful outcome measure of well-being for persons living with dementia. In addition, results point to specific interventions (i.e. maintaining/improving resident function, providing adequate nurse staffing levels, and improving staff communications skills) that can serve as the focus for both research and practice to help residents live well with dementia. Clinicaltrials.gov (NCT03014570).

摘要

目的：传统上，晚期痴呆的情绪表达是在缺陷范式中研究的。将痴呆症轨迹的叙述从单纯的消极病理体验转变为承认积极体验的潜力，这与国际上关于痴呆症患者生活的建议保持一致。本研究的目的是扩展先前的研究，通过使用情感平衡、积极与消极情感的比率、在 12 个月内患有痴呆症的疗养院居民及其与可能影响居民的因素的关联来扩展先前的研究福利。

方法：本研究是对来自实用临床试验的基线、4 个月和 12 个月数据的二次分析。来自 55 家疗养院的总共 536 名中度至重度认知障碍的居民被纳入多变量线性混合模型回归分析。

结果：在控制其他变量后，住院医师功能、专门用于护理的注册护士小时数以及员工互动的质量预测随着时间的推移会有更高的影响平衡。

结论：研究结果支持将情感平衡作为一种有意义的结果衡量痴呆症患者的幸福感。此外，结果表明具体的干预措施（即维持/改善住院医师功能、提供足够的护士人员配备水平和提高员工沟通技巧）可以作为研究和实践的重点，以帮助住院医师与痴呆症患者过得更好。Clinicaltrials.gov (NCT03014570)。