失智老年人及其照顾者使用喘息服务障碍因素的Meta整合

doi:10.3761/j.issn.0254-1769.2026.01.004

摘要/Abstract

摘要：

目的系统识别失智老年人及其照顾者使用喘息服务的障碍因素，为优化喘息服务供给策略提供参考。方法检索国内外8个中英文数据库，筛选2011年1月—2025年9月发表的关于失智老年人及照顾者使用喘息服务障碍因素的质性研究及混合研究。采用混合方法评价工具进行文献质量评价，并以Levesque服务可及性理论为框架，对结果进行整合。结果共纳入34篇文献，提取出150个研究结果，归纳形成25个障碍因素，被归纳至可接近性与感知能力（5个因素）、可接受性与寻找能力（6个因素）、可获得性与到达能力（5个因素）、可负担性与支付能力（3个因素）、适宜性与参与能力（6个因素）5个维度中。结论喘息服务的使用受多重障碍因素的制约，建议相关部门从信息传播、知识普及、文化适配、观念更新、资源优化、经济支持与服务品质提升等多方面综合施策，进而提高目标人群的生活质量。

关键词: 失智, 照顾者, 喘息服务, 障碍因素, Meta整合, 护理

Abstract:

Objective To identify the barriers to respite services use for older adults with dementia living at home and their family caregivers，so as to provide references for optimizing respite service delivery strategies. Methods Totally 8 Chinese and English databases were searched to select qualitative and mixed-method studies published between January 2011 and September 2025 on the barriers to respite service use among home-dwelling older adults with dementia and their family caregivers. The mixed methods appraisal tool was used for literature quality assessment，and the results were synthesized using the service accessibility theory as the framework. Results A total of 34 articles were included，from which 150 research findings were extracted. These were synthesized into 25 barrier factors，which were categorized into 5 dimensions：accessibility and ability to perceive（5 factors），acceptability and ability to seek（6 factors），availability and ability to reach（5 factors），affordability and ability to pay（3 factors），and appropriateness and ability to engage（6 factors）. Conclusion The utilization of respite services is constrained by multiple barrier factors. It is recommended that relevant departments adopt comprehensive strategies across multiple dimensions，such as information dissemination，knowledge popularization，cultural adaptation，renewal of elderly care concepts，resource optimization，economic support，and service quality improvement，to enhance the quality of life for the target population.

Key words: Dementia, Caregivers, Respite Care, Barriers, Meta-Synthesis, Nursing Care

高维杰, 孙玉梅. 失智老年人及其照顾者使用喘息服务障碍因素的Meta整合[J]. 中华护理杂志, 2026, 61(1): 30-37.

GAO Weijie, SUN Yumei. Barriers to the use of respite care by home-dwelling older adults with dementia and family caregivers：a meta-synthesis[J]. Chinese Journal of Nursing, 2026, 61(1): 30-37.

图/表 1

参考文献 42

[1]	Yin YH, Tam HL, Quint J, et al. Epidemiology of dementia in China in 2010-2020:a systematic review and meta-analysis[J]. Healthcare, 2024, 12(3):334. DOI URL
[2]	王洋, 顾艳荭, 龙德超, 等. 老年痴呆患者家庭照顾者创伤后成长现状及影响因素的混合研究[J]. 中华护理杂志, 2025, 60(17):2087-2094. DOI
	Wang Y, Gu YH, Long DC, et al. Posttraumatic growth status and influencing factors among family caregivers of patients with dementia:a mixed-methods study[J]. Chin J Nurs, 2025, 60(17):2087-2094.
[3]	Zhang HY, Yin M, Nan X, et al. In-home respite care in dementia:an evolutionary concept analysis[J]. Int J Nurs Sci, 2025, 12(4):352-360.
[4]	Hochgraeber I, von Kutzleben M, Bartholomeyczik S, et al. Low-threshold support services for people with dementia within the scope of respite care in Germany:a qualitative study on different stakeholders’ perspective[J]. Dementia, 2017, 16(5):576-590. DOI URL
[5]	Huang S, Griva K, Bryant CA, et al. Non-use of day care services for dementia in Singapore:a dilemma for caregivers[J]. Int Psychogeriatr, 2017, 29(3):455-466. DOI PMID
[6]	王佳怡. 上海市认知障碍老人社区居家养老服务利用及影响因素研究:以长宁区为例[D]. 上海: 上海师范大学, 2024.
	Wang JY. Study on the utilization and influencing factors of community home care services for the elderly with cognitive impairment in Shanghai:taking Changning district as an example[D]. Shanghai: Shanghai Normal University, 2024.
[7]	Yiu HC, Zang YL, Chau JPC. Barriers and facilitators in the use of formal dementia care for dementia sufferers:a qualitative study with Chinese family caregivers in Hong Kong[J]. Geriatr Nurs, 2020, 41(6):885-890. DOI URL
[8]	Levesque JF, Harris MF, Russell G. Patient-centred access to health care:conceptualising access at the interface of health systems and populations[J]. Int J Equity Health, 2013,12:18.
[9]	廖星, 胡瑞学, 李博, 等. 混合方法研究评价工具的介绍:MMAT[J]. 中国全科医学, 2021, 24(31):4015-4020. DOI
	Liao X, Hu RX, Li B, et al. An introduction to mixed methods appraisal tool[J]. Chin Gen Pract, 2021, 24(31):4015-4020.
[10]	Baghirathan S, Cheston R, Hui R, et al. A grounded theory analysis of the experiences of carers for people living with dementia from three BAME communities:balancing the need for support against fears of being diminished[J]. Dementia, 2020, 19(5):1672-1691. DOI URL
[11]	Balsinha C, Iliffe S, Dias S, et al. Dementia and primary care teams:obstacles to the implementation of Portugal’s dementia strategy[J]. Prim Health Care Res Dev, 2022,23:e10.
[12]	Bender AA, Pier E, Moore M, et al. Barriers to community service use among persons with dementia and their care partners:a focus on consumers of a novel statewide dementia care program[J]. J Appl Gerontol, 2024, 43(5):612-622. DOI URL
[13]	Berdai Chaouni S, De Donder L. Invisible realities:caring for older Moroccan migrants with dementia in Belgium[J]. Dementia, 2019, 18(7/8):3113-3129. DOI URL
[14]	Contreras M, Mioshi E, Kishita N. What are the educational and support needs of family carers looking after someone in the early stages of Alzheimer’s disease? A qualitative retrospective approach[J]. Health Soc Care Community, 2022, 30(5):1726-1734. DOI URL
[15]	Cotton QD, Kind AJH, Kim AJ, et al. Dementia caregivers’ experiences engaging supportive services while residing in under-resourced areas[J]. J Alzheimers Dis, 2021, 84(1):169-177. DOI URL
[16]	Czapka EA, Sagbakken M. “It is always me against the Norwegian system.”Barriers and facilitators in accessing and using dementia care by minority ethnic groups in Norway:a qualitative study[J]. BMC Health Serv Res, 2020, 20(1):954. DOI
[17]	Giebel C, Sutcliffe C, Darlington-Pollock F, et al. Health inequities in the care pathways for people living with young- and late-onset dementia:from pre-COVID-19 to early pandemic[J]. Int J Environ Res Public Health, 2021, 18(2):686. DOI URL
[18]	Giebel C, Robertson S, Beaulen A, et al. “Nobody seems to know where to even turn to”:barriers in accessing and utilising dementia care services in England and the Netherlands[J]. Int J Environ Res Public Health, 2021, 18(22):12233. DOI URL
[19]	Haralambous B, Dow B, Tinney J, et al. Help seeking in older Asian people with dementia in Melbourne:using the Cultural Exchange Model to explore barriers and enablers[J]. J Cross Cult Gerontol, 2014, 29(1):69-86. DOI PMID
[20]	Herat-Gunaratne R, Cooper C, Mukadam N, et al. “In the Bengali vocabulary,there is No such word as care home”:caring experiences of UK Bangladeshi and Indian family carers of people living with dementia at home[J]. Gerontologist, 2020, 60(2):331-339. DOI PMID
[21]	Johnson FU. Examining the relationship between community-based support services use and mental health in black family caregivers of persons living with dementia[D]. Michigan: University of Michigan, 2023.
[22]	Ketchum FB, Monsees J, Kim AJ, et al. Pathways of care:a qualitative study of barriers and facilitators to engaging dementia care among underserved and minority populations in the US and Germany[J]. Aging Ment Health, 2023, 27(2):389-398. DOI URL
[23]	Lee K, Cassidy J, Lee JH, et al. Examining utilization of formal supports and related impacts on overall well-being among east Asian American family caregivers of persons with dementia:a mixed-methods study[J]. Gerontologist, 2024, 64(2):gnad086.
[24]	MacLeod A, Tatangelo G, McCabe M, et al. “There isn’t an easy way of finding the help that’s available.” Barriers and facilitators of service use among dementia family caregivers:a qualitative study[J]. Int Psychogeriatr, 2017, 29(5):765-776. DOI URL
[25]	Mahomed A, Pretorius C. Availability and utilization of support services for South African male caregivers of people with Alzheimer’s disease in low-income communities[J]. Dementia, 2021, 20(2):633-652. DOI URL
[26]	Manzo AA, Segundo J, Britton M, et al. Equitable formal care access:examining processes for Hispanic/Latino family dementia caregivers’ decision-making[J]. Gerontologist, 2025, 65(8):gnaf168.
[27]	Monsees J, Schmachtenberg T, Hoffmann W, et al. Dementia in people with a Turkish migration background:experiences and utilization of healthcare services[J]. J Alzheimers Dis, 2020, 77(2):865-875. DOI URL
[28]	Nguyen TTT, Than THN, Nguyen TC, et al. Challenges,knowledge,and skills required for family caregivers of older adults with dementia:a qualitative study in Vietnam[J]. Glob Health Action, 2025, 18(1):2526929. DOI URL
[29]	Nielsen TR, Nielsen DS, Waldemar G. Barriers in access to dementia care in minority ethnic groups in Denmark:a qualitative study[J]. Aging Ment Health, 2021, 25(8):1424-1432. DOI URL
[30]	Pak A, Demanes A, Wu S, et al. Informing dementia support programs that serve low-income,multilingual communities in a safety net health system:use of focus groups to identify specific needs[J]. Geriatrics, 2024, 9(2):33. DOI URL
[31]	Richardson VE, Fields N, Won S, et al. At the intersection of culture:ethnically diverse dementia caregivers’ service use[J]. Dementia, 2019, 18(5):1790-1809. DOI URL
[32]	Roberto KA, Savla J, McCann BR, et al. Dementia family caregiving in rural Appalachia:a sociocultural model of care decisions and service use[J]. J Gerontol B Psychol Sci Soc Sci, 2022, 77(6):1094-1104. DOI URL
[33]	Robertson KJ, Thyne M, Matheson I. Barriers and facilitators of using dementia community support services provided by an Alzheimers organisation:perceptions of informal caregivers receiving services[J]. Health Soc Care Community, 2022, 30(6):2353-2361. DOI PMID
[34]	Robinson A, Lea E, Hemmings L, et al. Seeking respite:issues around the use of day respite care for the carers of people with dementia[J]. Ageing Soc, 2012, 32(2):196-218. DOI URL
[35]	Ryan L. Accessing community dementia care services in Ireland:emotional barriers for caregivers[J]. Health Soc Care Com-munity, 2021, 29(6):1980-1989.
[36]	Samsi K, Orellana K, Cole L, et al. Understanding factors influencing residential respite service use by carers of people living with dementia using Andersen’s behavioural model of health services use:a qualitative study[J]. Aging Ment Health, 2023, 27(10):1946-1955. DOI URL
[37]	Stephan A, Bieber A, Hopper L, et al. Barriers and facilitators to the access to and use of formal dementia care:findings of a focus group study with people with dementia,informal carers and health and social care professionals in eight European countries[J]. BMC Geriatr, 2018, 18(1):131. DOI PMID
[38]	Sun F, Mutlu A, Coon D. Service barriers faced by Chinese American families with a dementia relative:perspectives from family caregivers and service professionals[J]. Clin Gerontol, 2014, 37(2):120-138. DOI URL
[39]	Wong SL. Help-seeking behaviour of Chinese carers of people living with dementia[D]. Sydney: University of Technology Sydney, 2019.
[40]	尹晓彤, 朱蓝玉, 李春映. 四元联动整合照护在老年失智症患者中的应用进展[J]. 中华护理杂志, 2020, 55(12):1890-1896. DOI
	Yin XT, Zhu LY, Li CY. Application progress of quaternary linkage integrated care in elderly patients with dementia[J]. Chin J Nurs, 2020, 55(12):1890-1896.
[41]	左顺利, 吴建炜, 郭军, 等. 中国澳门地区失智症照护管理师的培养及启示[J]. 中华护理杂志, 2024, 59(6):764-769. DOI
	Zuo SL, Wu JW, Guo J, et al. Training and implications of dementia care managers in Macao,China[J]. Chin J Nurs, 2024, 59(6):764-769.
[42]	邓艺帆, 王建宁, 彭梦婷, 等. 决策辅助工具在失智症患者照护中应用的范围综述[J]. 中华护理杂志, 2024, 59(6):758-763. DOI
	Deng YF, Wang JN, Peng MT, et al. Decision aids for care deci-sion making in dementia patients:a scoping review[J]. Chin J Nurs, 2024, 59(6):758-763.