Covinsky K E, Eng C, Lui L Y, Sands L P, Sehgal A R, Walter L C, Wieland D, Eleazer G P, Yaffe K
Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco 94121, USA.
J Gerontol A Biol Sci Med Sci. 2001 Nov;56(11):M707-13. doi: 10.1093/gerona/56.11.m707.
Without family caregivers, many frail elders who live at home would require nursing home care. However, providing care to frail elders requires a large time commitment that may interfere with the caregiver's ability to work. Our goal was to determine the patient and caregiver characteristics associated with the reduction of employment hours in caregivers of frail elders.
This was a cross-sectional study of 2806 patients (mean age 78, 73% women, 29% African American, 12% Hispanic, 54% with dementia) with at least one potentially working caregiver (defined as one who is either currently employed or who would have been employed if they had not been providing care) and their 4592 potentially working caregivers. Patients were enrollees at 11 sites of the Program of All-Inclusive Care for the Elderly (PACE). Social workers interviewed patients and caregivers at the time of PACE enrollment. Caregivers were asked if they had reduced the hours they worked or had stopped working to care for the patient. Nurses interviewed patients and caregivers to assess independence in activities of daily living (ADLs) and the presence of behavioral disturbances. Comorbid conditions were assessed by physicians during enrollment examinations.
A total of 604 (22%) of the 2806 patients had at least one caregiver who either reduced the number of hours they worked or quit working to care for the patient. Patient characteristics independently associated with a caregiver reducing hours or quitting work were ethnicity, 95% confidence interval [CI] 1.14-1.78 for African American;, 95% CI 1.43-2.52 for Hispanic), ADL function below the median (, 95% CI 1.44-2.15), a diagnosis of dementia (, 95% -2.17 if associated with a behavioral disturbance;, 95% CI 1.06-1.63 if not associated with a behavioral disturbance), or a history of stroke (OR = 1.42, 95% CI 1.16-1.73). After controlling for these patient characteristics, caregiver characteristics associated with reducing work hours included being the daughter or daughter-in-law of the patient (OR = 1.69, 95% CI 1.37-2.08) and living with the patient (OR = 4.66, 95% CI 3.65-5.95 if no other caregiver lived at home, OR = 2.53, 95% CI 2.03-3.14 if another caregiver lived at home).
Many caregivers reduce the number of hours they work to care for frail elderly relatives. The burden of reduced employment is more likely to be incurred by the families of ethnic minorities and of patients with specific clinical characteristics. Daughters and caregivers who live with the patient are more likely to reduce work hours than other caregivers. Future research should examine the impact of lost caregiver employment on patients' families and the ways in which the societal responsibility of caring for frail elders can be equitably shared.
若没有家庭照顾者，许多居家的体弱老年人将需要入住养老院接受护理。然而，照顾体弱老年人需要投入大量时间，这可能会影响照顾者的工作能力。我们的目标是确定与体弱老年人照顾者工作时长减少相关的患者及照顾者特征。
这是一项对2806名患者（平均年龄78岁，73%为女性，29%为非裔美国人，12%为西班牙裔，54%患有痴呆症）及其4592名潜在工作照顾者进行的横断面研究。这些患者是老年人综合照护计划（PACE）11个站点的登记参与者。社会工作者在PACE登记时对患者和照顾者进行了访谈。询问照顾者是否为了照顾患者而减少了工作时长或停止工作。护士对患者和照顾者进行访谈，以评估日常生活活动（ADL）的独立性以及是否存在行为障碍。医生在入组检查时评估了合并症情况。
2806名患者中共有604名（22%）至少有一名照顾者减少了工作时长或停止工作以照顾患者。与照顾者减少工作时长或停止工作独立相关的患者特征包括种族（非裔美国人的比值比[OR]为1.14 - 1.78，95%置信区间[CI]；西班牙裔为1.43 - 2.52，95% CI）、ADL功能低于中位数（OR = 1.44 - 2.15，95% CI）、痴呆症诊断（若与行为障碍相关，OR = 2.17，95% CI；若与行为障碍无关，OR = 1.06 - 1.63，95% CI）或中风病史（OR = 1.42，95% CI 1.16 - 1.73）。在控制了这些患者特征后，与减少工作时长相关的照顾者特征包括是患者的女儿或儿媳（OR = 1.69，95% CI 1.37 - 2.08）以及与患者同住（若家中没有其他照顾者，OR = 4.66，95% CI 3.65 - 5.95；若家中有其他照顾者，OR = 2.53，95% CI 2.03 - 3.14）。
许多照顾者会减少工作时长以照顾体弱的老年亲属。就业减少的负担更有可能由少数族裔家庭以及具有特定临床特征的患者家庭承担。与患者同住的女儿和照顾者比其他照顾者更有可能减少工作时长。未来的研究应考察照顾者失业对患者家庭的影响，以及如何公平分担照顾体弱老年人的社会责任。
