Background

In residential long-term care, military service veterans with co-occurring posttraumatic stress disorder (PTSD) and dementia encounter a range of physical and social stimuli that may serve as triggers of trauma-related distress that manifests as care rejection or aggression. Yet, PTSD rarely has been examined in research to understand behaviors of care rejection and aggression in veterans with dementia.

Objectives

Guided by the need-driven dementia-compromised behavior model, we examined the moderation effect of PTSD on pathways from background factors and interpersonal triggers to rejection of care and aggression among veterans with dementia with and without co-occurring PTSD.

Design

Secondary data analysis of the Staff Training in Assisted Living Residences-Veterans Health Administration (STAR-VA) intervention evaluation by the U.S. Veterans Health Administration healthcare system.

Setting

76 Veterans Health Administration-operated nursing homes.

Participants

315 veterans with dementia who participated in STAR-VA.

Methods

We converted text data on the occurrence of care rejection and aggression to binary variables, combined them with data on sociodemographic and PTSD status obtained using medical chart review, and measured anxiety, cognition, depression, and function using validated instruments. A multi-group structural equation modeling analysis was then conducted to test the moderating effect of PTSD on rejection of care and aggression.

Results

Although multi-group structural equation modeling did not support the hypothesis of overall moderation by PTSD, distinct patterns between the two groups were observed with respect to how background factors and interpersonal triggers related to care rejection and aggression. The magnitude of the direct effects of interpersonal triggers on rejection of care was greater in veterans with PTSD (β = 0.42, p = .014 compared to those without β = 0.29, p = .008). Depression had a statistically significant indirect effect on rejection of care via interpersonal triggers only in veterans with PTSD (β = 0.09, p = .009). Functional status had a statistically significant direct effect on aggression only in the PTSD group (β = 0.28, p = .044).

Conclusions

Our study identified similar and distinct patterns of relationships among background factors, interpersonal triggers, and rejection of care and aggression between veterans with dementia with and without PTSD. The indirect effect of depression on care rejection via interpersonal triggers has implications for developing targeted interventions that focus on interpersonal triggers for veterans with dementia with PTSD who have greater depressive symptoms. This study underscores the importance of an enhanced focus on trauma-informed care for veterans with dementia and PTSD.

中文翻译：

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患有和不患有创伤后应激障碍的痴呆退伍军人的护理拒绝和攻击性：多组分析

背景

在住宅长期护理中，同时患有创伤后应激障碍 (PTSD) 和痴呆症的退伍军人会遇到一系列身体和社会刺激，这些刺激可能会引发与创伤相关的痛苦，表现为护理拒绝或攻击性。然而，PTSD 很少在研究中进行检查，以了解患有痴呆症的退伍军人的护理拒绝和攻击行为。

目标

在需求驱动的痴呆损害行为模型的指导下，我们检查了 PTSD 对从背景因素和人际触发到拒绝护理和攻击的途径的调节作用，这些途径是患有和未同时发生 PTSD 的痴呆退伍军人。

设计

美国退伍军人健康管理局医疗保健系统对辅助生活住宅员工培训-退伍军人健康管理局 (STAR-VA) 干预评估的二次数据分析。

环境

76 家退伍军人健康管理局经营的疗养院。

参与者

315 名患有痴呆症的退伍军人参加了 STAR-VA。

方法

我们将关于护理拒绝和攻击发生的文本数据转换为二元变量，将它们与使用医疗图表审查获得的社会人口学和 PTSD 状态数据相结合，并使用经过验证的仪器测量焦虑、认知、抑郁和功能。然后进行多组结构方程模型分析，以测试 PTSD 对拒绝护理和攻击的调节作用。

结果

尽管多组结构方程模型不支持 PTSD 总体缓和的假设，但在背景因素和人际触发与护理拒绝和攻击相关的方面观察到两组之间的不同模式。在患有 PTSD 的退伍军人中，人际触发对拒绝护理的直接影响更大（β = 0.42，p  = .014，与没有 β = 0.29，p  = .008 的人相比）。仅在患有 PTSD 的退伍军人中，抑郁症通过人际触发对拒绝护理有显着的间接影响（β = 0.09，p  = .009）。仅在 PTSD 组中，功能状态对攻击性有显着的直接影响（β = 0.28，p  = .044）。

结论

我们的研究确定了背景因素、人际触发因素以及对护理和攻击的拒绝在患有和不患有 PTSD 的痴呆退伍军人之间的相似和不同的关系模式。抑郁症通过人际触发对护理拒绝的间接影响对于开发有针对性的干预措施具有重要意义，这些干预措施侧重于人际触发因素，以治疗抑郁症状较严重的患有 PTSD 痴呆的退伍军人。这项研究强调了加强对患有痴呆症和 PTSD 退伍军人的创伤知情护理的重要性。