在中国转型至中度老龄化社会且正式照料支持有限的大背景下，由家庭提供的非正式照料仍是认知症照料的主要形式。由于认知症具有长期性、反复性和不可治愈性等特征，认知症照料者在照料和其他日常生活中面临着各种不可控因素。这些挑战给照料者带来强烈的不确定性体验，并影响了照料者的身心健康与照料质量。过往研究以静态视角看待不确定性体验，未能系统地探究照料者不确定性体验以及其与应对方式的关系，忽视了应对的针对性和过程转变。

本研究基于社会生态系统理论和压力与应对理论，采取质性研究的方法，通过社群网络抽样和滚雪球抽样，访谈12位认知症患者的家庭照料者。研究聚焦于探索认知症照料者在生活各系统（微观、中观、宏观）中的不确定性体验，所采取的有效应对方式，以及因患者病情变化所带来的不确定性体验和应对方式调整与变化的过程。

本研究得出以下结论：1.认知症照料者的不确定性体验及其应对呈现出动态发展的过程，包含了求证期、准备期、考验期、平和期四个阶段。疾病的发展是照料者不确定性体验历程的重要推力，在不同阶段，症状的变化导致照料者不确定性体验的改变，而照料者则针对不同的不确定性体验采用不同的应对策略。2.认知症照料者的不确定性体验具有系统性特征。微观系统的不确定性体验包括个体未来（人生规划、日常计划）以及个体情感（复杂情绪）方面的不确定性；中观系统的不确定性体验包括与患者互动（角色认知、关系感知）、与家庭成员互动（照料分工、照料方式）以及与专业人士互动（疾病诊断、信任关系）方面的不确定性；宏观系统的不确定性体验则呈现为与社会互动（社会边界）的不确定性。3.认知症照料者不确定性体验的应对方式可以分为三类，包括聚焦问题型（信息检验、求同存异、提前规划、自行处置），聚焦情绪型（接纳情绪、情感宣泄、积极暗示、情感支持）以及聚焦意义型（重新排定优先级、接受命运、价值遵循、构建意义、关注当下）。

本研究的创新之处体现在：1.基于社会生态系统理论全面且细致地探索认知症照料者特定的不确定性体验，丰富了相关研究；2.本研究将压力与应对模型拓展到认知症照料者的不确定性体验及其应对上，发现不确定性体验与应对策略具有针对性。同一种应对策略可能应用于不同层面的不确定性体验，不同的应对策略也可能应用于同一层面的不确定性体验；3.认知症照料者不确定性体验及其应对的动态过程拓展了以往以静态视角为主的不确定性体验研究。这些发现呈现了不同阶段认知症照料者的需求，为其相关的社会工作服务开展和干预提供启示。

Now China is transitioning to a moderately aging society and the formal care support is limited. In this context, informal care provided by families is the main form of dementia care.  Caregivers of the people with dementia face various uncontrollable factors in caring and their lives because of the chronic, repetitive and incurable characteristics of dementia. These challenges lead to strong uncertainty and affects the physical and mental health and caregiving quality. Previous studies investigate the uncertainty from a static perspective, lack of systematic exploration of the relationship between the uncertainty and coping, and ignore the specific coping in relation to uncertainty and transformation in this process. 
Based on the social ecosystem theory and stress and coping theory, this study used qualitative method and interviewed 12 family caregivers of the people with dementia. Participants were recruited by social network sampling and snowball sampling. This study aims at exploring uncertainty experience of caregivers of people with dementia in the systems of life (micro system, meso system and macro system), effective coping in relation to uncertainty, as well as their transformation as the disease progresses.
This study draws the following conclusions: 1. Uncertainty and related coping process are dynamic, which includes four stages: verification stage, preparation stage, challenging stage and peaceful stage. The development of disease highly affects caregivers' uncertainty process. In different stages, the change of symptoms leads to the change of caregivers' uncertainty, and caregivers adopt different coping strategies according to different uncertainties. 2. The uncertainty of caregivers of people with dementia is systematic. The uncertainty in micro system includes the uncertainty of future (life planning, daily planning) and the uncertainty of emotion (complex emotions). The uncertainty in meso system includes the uncertainty of interaction with patients (role cognition, relationship perception), the uncertainty of interaction with family members (care division, care mode) and the uncertainty of interaction with professionals (disease diagnosis, trust relationship). The uncertainty in macro system includes the uncertainty of social interaction (social boundary). 3. Coping of uncertainty used by caregivers of people with dementia can be divided into three types, including problem-focused coping (information checking, seeking common ground while shelving differences, planning ahead, self-management), emotion-focused coping (acceptance of emotions, emotional catharsis, positive suggestion, emotional support), and meaning-focused coping (reordering priorities, acceptance of fate, guidance of belief, meaning construction, and focusing on the present).
The innovations of this study are as follows: 1. Based on the social ecosystem theory, the present study comprehensively and accurately describes uncertainty of caregivers of people with dementia, which enriches the findings on uncertainty; 2. This study extends the stress and coping model to the uncertainty and coping strategies of caregivers of people with dementia, and reveals the specific relationship between uncertainty and coping strategies. One coping strategy may apply to different uncertainty and different coping strategies may apply to specific uncertainty；3. Findings of uncertainty and coping process of caregivers of people with dementia extend previous studies that view the uncertainty with static perspective. These findings reveal the needs of caregivers of people with dementia in different stages, which provides insights to social work practice and intervention on caregivers of people with dementia.