城市基层医疗实践中痴呆症护理人员的急性护理利用情况。
Acute care utilization by dementia caregivers within urban primary care practices.
作者信息
Schubert Cathy C, Boustani Malaz, Callahan Christopher M, Perkins Anthony J, Hui Siu, Hendrie Hugh C
机构信息
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
出版信息
J Gen Intern Med. 2008 Nov;23(11):1736-40. doi: 10.1007/s11606-008-0711-0. Epub 2008 Aug 9.
BACKGROUND
Caring for an individual with Alzheimer's dementia (AD) is stressful, and studies show that this stress has an impact on both the physical and mental health of the caregiver. However, many questions remain about the characteristics of AD patients and their caregivers that contribute to this stress and how it impacts caregivers' use of healthcare resources.
OBJECTIVE
To study the impact of stress on the physical and mental health of the caregiver.
DESIGN
Patients underwent extensive testing to allow description of their degree of cognitive impairment, behavioral and psychological symptoms, medical comorbidities, and functional abilities. Caregivers were assessed for depressive symptoms and also for emergency department (ED) use and hospitalizations in the previous six months. Multivariate logistic regression was used to evaluate impact of patients' dementia symptoms on caregivers' acute care utilization.
PARTICIPANTS
One hundred and fifty-three AD patients and their caregivers attending two large, urban, university-affiliated primary care practices were enrolled in a cross-sectional study to examine the facets of dementia caregiving that impact caregiver acute health care utilization.
RESULTS
Twenty-four percent of the caregivers had at least one ED visit or hospitalization in the six months prior to enrollment. After adjusting for caregiver age, gender, and education, our logistic regression model found that the caregivers' acute care utilization was associated with their depression as measured by the PHQ-9 (OR 1.09, 95% CI 1.00-1.18), the patients' behavioral and psychological symptoms as measured by the NPI (OR 1.04, 95% CI 1.01-1.08), and the patients' functional status as measured by the ADCS-ADL (OR 1.05, 95% CI 1.01-1.09).
CONCLUSION
To improve the health of AD caregivers, a primary care system needs to reallocate resources to manage the functional, behavioral, and psychological symptoms related to the care-recipients suffering from AD.
背景
照顾阿尔茨海默病（AD）患者压力很大，研究表明这种压力会对照顾者的身心健康产生影响。然而，关于AD患者及其照顾者的哪些特征会导致这种压力以及它如何影响照顾者对医疗资源的使用，仍有许多问题。
目的
研究压力对照顾者身心健康的影响。
设计
对患者进行了广泛测试，以描述其认知障碍程度、行为和心理症状、合并症以及功能能力。对照顾者进行了抑郁症状评估，并评估了他们在过去六个月内使用急诊科（ED）的情况和住院情况。采用多因素逻辑回归来评估患者痴呆症状对照顾者急性护理利用的影响。
参与者
153名AD患者及其照顾者参与了一项横断面研究，这些患者和照顾者来自两家大型城市大学附属初级保健机构，该研究旨在考察痴呆症护理中影响照顾者急性医疗利用的各个方面。
结果
24%的照顾者在入组前六个月内至少有一次急诊就诊或住院。在调整了照顾者的年龄、性别和教育程度后，我们的逻辑回归模型发现，照顾者的急性护理利用与他们通过PHQ-9测量的抑郁情况相关（比值比1.09，95%置信区间1.00-1.18），与通过NPI测量的患者行为和心理症状相关（比值比1.04，95%置信区间1.０1-1.08），以及与通过ADCS-ADL测量的患者功能状态相关（比值比1.05，95%置信区间1.01-1.09）。
结论
为改善AD照顾者的健康状况，初级保健系统需要重新分配资源，以管理与AD患者护理相关的功能、行为和心理症状。
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