Burns Robert, Nichols Linda O, Martindale-Adams Jennifer, Graney Marshall J, Lummus Allan
VAMC (11-H), 1030 Jefferson Avenue, Memphis, TN 38104, USA.
Gerontologist. 2003 Aug;43(4):547-55. doi: 10.1093/geront/43.4.547.
This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer's disease. The interventions, using targeted educational materials, were patient behavior management only, and patient behavior management plus caregiver stress-coping management. We hypothesized that the addition of the stress-coping component would improve caregiver outcomes.
A randomized clinical trial of 167 caregiver-care recipient dyads was run, of whom 76 completed the study without bereavement or placement.
During 24 months, caregivers who received the patient behavior management component only, compared with those who also received the stress-coping component, had significantly worse outcomes for general well-being and a trend toward increased risk of depression (i.e., a score of >16 on the Center for Epidemiological Studies Depression scale). There was a studywide improvement for bother associated with care recipient behaviors (according to the Revised Memory and Behavior Problems Checklist).
Our data suggest that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of the dementia patient. They further suggest that interventions that focus only on care recipient behavior, without addressing caregiving issues, may not be as adequate for reducing caregiver distress.
本研究开发并测试了两种为期24个月的初级保健干预措施，以缓解阿尔茨海默病患者照料者所遭受的心理困扰。这些干预措施使用针对性的教育材料，一种仅为患者行为管理，另一种为患者行为管理加照料者压力应对管理。我们假设增加压力应对部分会改善照料者的结局。
对167对照料者-受照料者二元组进行了一项随机临床试验，其中76对在没有丧亲或安置情况的条件下完成了研究。
在24个月期间，仅接受患者行为管理部分的照料者与同时接受压力应对部分的照料者相比，总体幸福感的结局显著更差，且有抑郁风险增加的趋势（即流行病学研究中心抑郁量表得分>16）。在与受照料者行为相关的困扰方面（根据修订后的记忆与行为问题清单），整个研究中有改善。
我们的数据表明，简短的初级保健干预措施可能在痴呆症患者的长期管理中有效减轻照料者的困扰和负担。数据还表明，仅关注受照料者行为而不解决照料问题的干预措施，可能不足以减轻照料者的困扰。
