Resistance-to-care behaviors and associated factors among people with dementia in nursing homes based on latent profile analysis and user personas
Tingting Xie, Xiyan Xie, Xinyu Chen, Jie Jiang, Hongtao Cheng, Haiyuan Li, Xiulian Zhang, Min Liu, Xiwen Wang, Bei Wu, Jun-e ZhangBackground
Resistance-to-care behaviors are prevalent among people with Alzheimer's disease and related dementia (ADRD), significantly impeding care delivery and causing distress for residents and care workers. However, knowledge regarding scenario-specific resistance-to-care patterns in Chinese nursing homes remains limited.
Objective
To identify latent profiles and personas of resistance-to-care behaviors among people with ADRD in Chinese nursing homes and examine associations with background and interpersonal factors based on the need-driven dementia-compromised behavior model.
Methods
This cross-sectional study recruited 574 people with ADRD from six Chinese nursing homes between March 2023 and March 2024. Data on sociodemographics, care worker-initiated communication, resistance-to-care behaviors, cognitive function, functional independence, depression, and pain were collected. Zero-inflated Poisson mixture models identified latent profiles. Personas were developed as group-level summaries integrating profile-defining resistance-to-care patterns with associated descriptive characteristics. Multivariate logistic regression examined factors associated with profile membership.
Results
Four profiles and personas emerged: stable collaborators (low-resistance profile, 77.0%), mealtime resisters (eating-resistance-dominant profile, 6.6%), bathing defenders (bathing-resistance-dominant profile, 13.8%), and high-resistance care responders (high-resistance profile, 2.6%). Eating- and bathing-resistance-dominant profiles were associated with lower cognitive function and absence of care worker-initiated communication during corresponding activities. The high-resistance profile was associated with greater depression and pain.
Conclusions
This study identified latent resistance-to-care profiles and personas, elucidating relationships between background factors, interpersonal factors, and resistance-to-care behaviors. Findings support a culturally informed, scenario-specific framework for dementia care and highlight the potential relevance of regular cognitive monitoring, culturally adapted communication strategies, and systematic depression and pain management for addressing resistance-to-care behaviors.