| Summary: | 博士 === 長庚大學 === 臨床醫學研究所 === 99 === The purpose of this study was to model the agitated behaviors of the elderly with dementia and the self-efficacy of the family caregiver to manage this behavior in the illness stage. Secondary data analysis was performed of two databases for advanced analysis. The data were analyzed using exploratory factor analysis, one way analysis of variance, hierarchical regression, and structural equation modeling.
The results showed that among the 221 participants the majority of the agitated behaviors were presented by the elderly with moderate to severe dementia. Verbally and physically, non-aggressive agitated behaviors were the most frequently presented agitated behaviors for all stages. Aggressive behaviors increased significantly in the case of severe dementia. The self-efficacy of the family caregiver for managing agitated behaviors was lowest in the case of mild dementia. The results also showed that the caregivers’ self-efficacy for managing destructed behaviors was the lowest among agitated behaviors in all stages of dementia.
Hierarchical regression analysis revealed that the characteristics of the family caregiver, the stage of the illness, physical function of the patient, care involvement, care relationship, and the self-efficacy of the caregiver were all significant predictors of agitated behavior. Moderate and severe dementia, better activity of daily living of the demented elder, younger caregiver, care rotations, hired helper, poorer relationship quality, more care distress, and lower levels of caregiver self-efficacy for managing verbally agitated behavior predicted more agitated behaviors of the demented elder. The final regression model including all variables explained 37% of the variance in agitated behaviors of the demented elder.
The illness stage, care relationship and agitated behavior were the significant predictors for the caregivers’ self-efficacy to manage the patient’s agitated behavior. Severe dementia, less physically agitated behaviors of the demented elder and less care distress predicted better caregiver self-efficacy for managing agitated behavior. The final regression model including all variables explained 24% of the variance in caregiver self-efficacy.
A structural equation model was used to test the theoretical models. The overall model fit of the agitated behaviors and the caregiver’s self-efficacy was a fair fit. Agitated behavior was directly influenced by the characteristics of the caregiver (β= .27; p<.01) and the care relationship (β=- .614; p<.001). Younger caregiver and having more care distress predicted more agitated behavior of the demented elder.
The self-efficacy of the caregiver was directly influenced by the illness stage (β= .61; p<.05) and the care relationship (β= .47; p<.01). The more progressive illness stage of the demented elder and less care distress of caregiver predicted the better caregiver self-efficacy for managing agitated behavior.There was no mediating effect in the agitated behavior nor in the caregivers’ self-efficacy model.
The results of this study will help family caregivers and medical professionals to understand the changes and the predictors of the agitated behaviors of the elderly with dementia as well as the self-efficacy of the caregiver for managing this behavior in the different stages of the illness. The Agitated Behavior Model (ABM) and the Agitation Management Self-efficacy Model (AMSM) can serve as a guideline for professional caregivers to manage the agitated behaviors and to provide health care suggestions to the family caregiver of the elderly person with dementia. In the future, both ABM and AMSM models could be used for developing an agitation management manual as well as a caregiver training program.
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