Resistance-to-care behaviors and associated factors among people with dementia in nursing homes based on latent profile analysis and user personas

BackgroundResistance-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.ObjectiveTo 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.MethodsThis 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.ResultsFour 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.ConclusionsThis 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.