Department of Gerontology and Gerontology Institute, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA.
Int J Geriatr Psychiatry. 2012 Apr;27(4):382-93. doi: 10.1002/gps.2730. Epub 2011 May 10.
This study examined the moderating effect of caregiver burden on the relationship between the health status of Alzheimer's disease (AD) patients and their use of institutional services (i.e., hospitalization, nursing home, and residential care).
Data were obtained at baseline and at 3, 6, and 9 months following study entry on 421 community-dwelling patients with AD in the Clinical Antipsychotic Trials of Intervention Effectiveness for AD. The outcome variable includes use of any institutional services. Logistic regression was employed to estimate the interaction between Health Utility Index Mark III score (a general health status measure) and four concurrent caregiver burden measures at outcome. Marginal effects were calculated and plotted using random effects models for observations at multiple time points per individual. Average effects were calculated across all observations using models without random effects.
Random effects results suggest that caregiver burden weakens the inverse relationship between health utilities and institutional service use, leading to greater likelihood of institutional use than would be expected at a given level of health. This is indicated by positive and significant signs on the Health Utility Index Mark III*caregiver burden interaction when burden is measured using the Caregiver Distress Scale, Beck Depression Inventory, and Caregiver Assessment Survey (all p < 0.05). It is reinforced by positive and significant average effects deriving from Caregiver Distress and Beck Depression Inventory models without random effects (both p < 0.10). Results derived from the Burden Interview Scale, although positive, were non-significant and weak by comparison.
Caregiver support interventions should be offered to individuals caring for less-advanced AD patients. Otherwise, healthy patients may be at increased risk for institutionalization when caregivers experience high levels of burden.
本研究检验了照顾者负担对阿尔茨海默病（AD）患者健康状况与机构服务使用（即住院、养老院和住宿护理）之间关系的调节作用。
数据来自于临床抗精神病药物干预 AD 有效性试验中 421 名居住在社区的 AD 患者，在研究入组后 3、6 和 9 个月时进行了基线和随访。因变量包括使用任何机构服务。采用逻辑回归估计健康效用指数 Mark III 评分（一般健康状况衡量指标）与四种并发照顾者负担衡量指标在结局时的交互作用。采用随机效应模型计算和绘制个体多次观察的边际效应。使用无随机效应模型计算所有观察的平均效应。
随机效应结果表明，照顾者负担削弱了健康效用与机构服务使用之间的反比关系，导致在给定健康水平下，机构使用的可能性增加。这表明，当使用照顾者困扰量表、贝克抑郁量表和照顾者评估量表衡量负担时，健康效用指数 Mark III*照顾者负担交互作用的符号为正且显著（均 p<0.05）。这一结果通过无随机效应的照顾者困扰和贝克抑郁量表模型的正且显著的平均效应得到加强（均 p<0.10）。虽然来自负担访谈量表的结果为正，但与其他结果相比，其结果较弱且不显著。
应向照顾轻度 AD 患者的个体提供照顾者支持干预措施。否则，当照顾者负担较高时，健康患者可能面临更高的机构化风险。
