Schulz Richard, Belle Steven H, Czaja Sara J, McGinnis Kathleen A, Stevens Alan, Zhang Song
Department of Psychiatry, University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pa 15260, USA.
JAMA. 2004 Aug 25;292(8):961-7. doi: 10.1001/jama.292.8.961.
Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described.
To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being.
DESIGN, SETTING, AND PARTICIPANTS: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers.
Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety.
Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P =.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P =.21). These effects were most pronounced among caregivers who were married to the patient (P =.02 for depression), visited more frequently (P =.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P =.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P =.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P =.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative.
The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.
对于照顾者而言，将患有痴呆症的亲属安置到长期护理机构是常见做法。安置过渡以及患者安置后影响照顾者健康和幸福感的因素尚未得到充分描述。
评估将患有痴呆症的亲属安置到长期护理机构对照顾者健康和幸福感的影响。
设计、地点和参与者：1996年至2000年的一项前瞻性研究，对从美国6个地点招募的1222对照顾者 - 患者二元组样本的安置过渡情况进行研究。在18个月的随访期内，共有180名患者被安置到长期护理机构。对安置前后收集的数据进行分析，以确定与安置相关的因素、安置后照顾者与其在机构中的亲属之间的接触性质，以及这两个因素与痴呆症照顾者健康结果的关系。
照顾者的抑郁（流行病学研究中心抑郁量表[CES - D]上的症状；范围为0 - 60）、焦虑（状态 - 特质焦虑量表；范围为10 - 40）以及用于抑郁和焦虑的处方药使用情况。
将亲属安置到机构的照顾者报告的抑郁症状和焦虑程度与居家照顾者时一样高。安置前后抑郁的总体CES - D评分没有变化（中位数[四分位间距]，安置前为15.0[8 - 24.5]，安置后为15.0[7.7 - 28]；P = 0.64）。状态 - 特质焦虑量表上的总体焦虑评分也没有显著变化（中位数[四分位间距]，安置前为22.0[19 - 27]，安置后为21.1[18 - 27]；P = 0.21）。这些影响在与患者结婚的照顾者中最为明显（抑郁方面P = 0.02）、探访更频繁的照顾者中（抑郁方面P = 0.01，焦虑方面P<0.001）以及对从他人那里获得的帮助不太满意的照顾者中（抑郁方面P = 0.003，焦虑方面P<0.001）。安置前（占21.1%）至安置后（占17.9%）抗抑郁药的使用没有显著变化（P = 0.16）。安置前至安置后抗焦虑药的使用从14.6%增加到19%（P = 0.02），并且近一半的照顾者（48.3%）在其亲属安置后有临床抑郁风险。
向机构护理的过渡对配偶来说尤其困难，其中几乎一半人每天探访患者并在探访期间继续提供身体护理方面的帮助。能够更好地让照顾者为安置过渡做好准备并在安置后治疗其抑郁和焦虑的临床干预措施可能对这些人有很大益处。
