School of Nursing, Center on Aging, University of Minnesota, Minneapolis 55455, USA.
Nurs Res. 2011 May-Jun;60(3 Suppl):S28-37. doi: 10.1097/NNR.0b013e318216007d.
Current research fails to capture the temporal dynamics of chronic disease in favor of cross-sectional snapshots of symptoms and outcomes.
The aim of this study was to estimate the effects of comprehensive psychosocial support on trajectories of spouse caregivers' well-being related to the nursing home placement transition.
Data from the New York University Caregiver Intervention, a randomized controlled trial of a comprehensive support program for spouse caregivers of persons with Alzheimer's disease, were utilized. A convenience sample of 406 spouse caregivers of community-dwelling persons with Alzheimer's disease was enrolled over a 9.5-year period in an Alzheimer's disease research center in New York City. Outcome measures, including the Zarit Burden Inventory and Geriatric Depression Scale, were used to assess the differential effects of nursing home placement and of the intervention on spouse caregivers. In-person interviews of spouse caregivers took place every 4 months during the first year of participation and every 6 months thereafter for up to 16 years; 385 caregivers provided sufficient follow-up data for all analyses.
Longitudinal models found that wives were more likely than husbands to indicate reductions in burden in the months after placement in an institution. Wives also reported greater decreases in depressive symptoms after placement in an institution when compared with husbands.
The inclusion of transitions and health trajectories in a randomized controlled trial offers an intriguing picture of how comprehensive psychosocial interventions can help families navigate the challenges of chronic disease care. The results also indicate how advances in nursing science can facilitate future research in the modeling of trajectories and transitions in the dementia care context.
目前的研究未能捕捉到慢性病的时间动态，而是倾向于对症状和结果进行横断面快照分析。
本研究旨在估计综合心理社会支持对配偶照顾者在疗养院安置过渡期间与护理相关的幸福感轨迹的影响。
利用纽约大学护理员干预（New York University Caregiver Intervention）的数据，这是一项针对阿尔茨海默病患者配偶护理员的综合支持计划的随机对照试验。在纽约市一家阿尔茨海默病研究中心，在 9.5 年的时间里，对 406 名居住在社区的阿尔茨海默病患者的配偶护理员进行了便利抽样。使用 Zarit 负担量表（Zarit Burden Inventory）和老年抑郁量表（Geriatric Depression Scale）等评估工具，评估疗养院安置和干预对配偶护理员的影响。在第一年的参与期间，配偶护理员每 4 个月接受一次面对面访谈，此后每 6 个月接受一次访谈，最多进行 16 年；385 名护理员提供了所有分析所需的足够随访数据。
纵向模型发现，在配偶被安置到疗养院后，妻子比丈夫更有可能在几个月内表示负担减轻。与丈夫相比，妻子在被安置到疗养院后报告的抑郁症状也有更大的减轻。
将过渡和健康轨迹纳入随机对照试验提供了一个有趣的画面，说明综合心理社会干预如何帮助家庭应对慢性疾病护理的挑战。研究结果还表明，护理科学的进步如何能够促进未来在痴呆症护理背景下轨迹和过渡建模的研究。
