Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants

Introduction: Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience.Objective: This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia.Methods: Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia.Results and conclusions: Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress.

研究背景：尽管痴呆症（dementia）患者的照护者往往面临诸多困境，但部分积极的照护体验或许与韧性（resilience）存在关联。
研究目的：本研究旨在系统梳理与痴呆症照护者韧性相关的定义、研究方法及决定因素模型。
研究方法：检索2003年至2014年间发表于ISI、PubMed/MEDLINE、SciELO及Lilacs数据库的相关文献，检索词为韧性（resilience）、照护者（caregivers）及痴呆症（dementia）。
结果与结论：现有研究将韧性定义为应对逆境的积极适应能力、灵活性、心理福祉、力量感、健康生活状态、照护负担、社会网络及社会支持满意度。目前学界尚未就痴呆症相关韧性的定义达成共识。本研究将韧性的决定因素划分为生物学、心理学及社会学三类模型。较高的韧性水平与更低的抑郁发生率及更佳的躯体健康状况相关。其余与较高韧性水平相关的生物学因素包括高龄、非裔美国人种族及女性性别。较低的照护负担、压力水平、神经质特质与感知控制力则是与韧性相关的主要心理学因素。社会支持是韧性的调节因素，不同类型的社会支持似乎可缓解由压力引发的躯体与心理过载。