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照料阿尔茨海默病患者配偶并送其入住养老院及患者死亡对照料者的心血代谢影响。

Cardiometabolic effects in caregivers of nursing home placement and death of their spouse with Alzheimer's disease.

机构信息

Department of General Internal Medicine, University of Bern, Switzerland.

出版信息

J Am Geriatr Soc. 2011 Nov;59(11):2037-44. doi: 10.1111/j.1532-5415.2011.03634.x. Epub 2011 Sep 21.

Abstract

OBJECTIVES

To test the hypothesis that cardiometabolic risk is attenuated when caregivers are relieved of caregiving stress when the caregiving recipient transitions out of the home.

DESIGN

Longitudinal.

SETTING

Participants' homes.

PARTICIPANTS

One hundred nineteen spousal caregivers of a patient with Alzheimer's disease (AD) and 55 noncaregiving controls (mean age of entire sample 75 ± 8, 68% women).

MEASUREMENTS

Participants underwent up to three yearly assessments of metabolic syndrome (MetS) factors related to adiposity, dyslipidemia, hypertension, and hyperglycemia. Changes in the total number of MetS factors (range: 0-5) 3 months after caregiver transitions were evaluated using random regression models with fixed and time-variant effects for sociodemographic and health-related covariates.

RESULTS

Caregivers had a greater number of MetS factors over time than noncaregivers (1.78 ± 0.13 vs 1.36 ± 0.18, P = .008), which, after the death of the spouse, dropped by 0.46 ± 0.16 (P = .003) being no longer different from those of noncaregivers; this effect was most prominently related to decreases in triglycerides (-22.2 ± 11.0 mg/dL, P = .03), systolic blood pressure (-6.2 ± 2.6 mmHg, P = .02), and diastolic blood pressure (-3.4 ± 1.5 mmHg, P = .03). Placement of the spouse decreased the number of MetS factors only in caregivers with lower levels of depressive symptoms (-0.48 ± 0.18, P = .01) and sleeping difficulties (-0.42 ± 0.18, P = .02) but not in caregivers with higher levels in these measures at postplacement.

CONCLUSION

High cardiometabolic risk in caregivers decreased to the level of that of noncaregivers within 3 months of death of the spouse with AD, although placement, a transition in the course of dementia caregiving, did not benefit cardiovascular health in highly distressed caregivers.

摘要

目的

检验当照顾者的被照顾者离开家庭时,照顾者的照护压力得到缓解,那么其心血管代谢风险是否会降低这一假说。

设计

纵向研究。

地点

参与者的家中。

参与者

119 名阿尔茨海默病(AD)患者的配偶照顾者和 55 名非照顾者对照(整个样本的平均年龄为 75±8 岁,68%为女性)。

测量方法

参与者接受了多达三次的代谢综合征(MetS)因素评估,包括与肥胖、血脂异常、高血压和高血糖相关的因素。使用随机回归模型,通过固定和时间变化的影响,评估照顾者过渡后 3 个月内 MetS 因素总数(范围:0-5)的变化,同时考虑社会人口统计学和健康相关的协变量。

结果

与非照顾者相比,照顾者的 MetS 因素随着时间的推移而增加(1.78±0.13 与 1.36±0.18,P=0.008),在配偶去世后,MetS 因素减少了 0.46±0.16(P=0.003),与非照顾者不再有差异;这种效应主要与甘油三酯下降(-22.2±11.0mg/dL,P=0.03)、收缩压下降(-6.2±2.6mmHg,P=0.02)和舒张压下降(-3.4±1.5mmHg,P=0.03)有关。配偶的安置仅降低了抑郁症状(-0.48±0.18,P=0.01)和睡眠困难(-0.42±0.18,P=0.02)水平较低的照顾者的 MetS 因素数量,但在安置后这些措施水平较高的照顾者中,心血管健康并没有得到改善。

结论

AD 配偶去世后 3 个月内,照顾者的心血管代谢风险降低到非照顾者的水平,尽管安置是痴呆症照护过程中的一个过渡,对高度困扰的照顾者的心血管健康并没有益处。

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