家庭会议对延缓痴呆患者入住养老院时间的效果：一项随机试验。

Effectiveness of family meetings for family caregivers on delaying time to nursing home placement of dementia patients: a randomized trial.

机构信息

Department of General Practice and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.

出版信息

PLoS One. 2012;7(8):e42145. doi: 10.1371/journal.pone.0042145. Epub 2012 Aug 2.

DOI:10.1371/journal.pone.0042145

PMID:22876304

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3410917/

Abstract

BACKGROUND

Interventions relieving the burden of caregiving may postpone or prevent patient institutionalization. The objective of this study was to determine whether a family meetings intervention was superior to usual care in postponing nursing home placement of patients with dementia.

METHODS

A randomized multicenter trial was conducted among 192 patients with a clinical diagnosis of dementia living at home at enrolment and their primary family caregiver. Dyads of caregivers and patients were randomized to the family meetings intervention (n = 96) or usual care (n = 96) condition. The intervention consisted of two individual sessions with the primary caregiver and four family counseling sessions that included family members and friends. The primary outcome measure was the time until institutionalization of the patient. Intention-to-treat as well as per protocol analyses were performed. Survival analyses were carried out to evaluate the effectiveness of the intervention.

RESULTS

During 18 months follow-up 23 of 96 relatives with dementia of caregivers in the intervention group and 18 of 96 relatives with dementia of caregivers in the usual care group were institutionalized. No significant difference between the intervention and the usual care group was found in time until institutionalization (adjusted hazard ratio (HR) 1.46, 95% confidence interval (CI) 0.78 to 2.74). The per-protocol analysis revealed no significant effect either (adjusted HR 0.57, 95% CI 0.21 to 1.57), although the number of placements among the adherers was relatively low (9.4%). A subgroup effect was found for patients' age, with a significantly higher risk of institutionalization for 'younger' patients in the intervention group compared with the usual care group (adjusted HR = 4.94, 95% CI 1.10 to 22.13).

CONCLUSION

This family meetings intervention for primary caregivers of patients with dementia did not postpone patient institutionalization more than usual care.

TRIAL REGISTRATION

CONTROLLED-TRIALS.COM ISRCTN90163486.

摘要

背景

减轻护理负担的干预措施可能会延迟或防止患者住院。本研究的目的是确定家庭会议干预是否优于常规护理，以延迟痴呆患者入住养老院。

方法

在纳入时居住在家中的 192 名有临床诊断为痴呆的患者及其主要家庭照顾者中进行了一项随机多中心试验。照顾者和患者的对被随机分配到家庭会议干预组（n=96）或常规护理组（n=96）。干预包括与主要照顾者进行两次个体会议和四次家庭咨询会议，包括家庭成员和朋友。主要结局指标是患者的住院时间。进行意向治疗和方案分析。进行生存分析以评估干预的效果。

结果

在 18 个月的随访期间，干预组的 96 名有痴呆症的照顾者中的 23 名和常规护理组的 96 名有痴呆症的照顾者中的 18 名患者被安置在养老院。在安置时间方面，干预组与常规护理组之间没有发现显著差异（调整后的危险比（HR）1.46，95%置信区间（CI）0.78 至 2.74）。方案分析也没有显示出显著效果（调整后的 HR 0.57，95% CI 0.21 至 1.57），尽管遵守者的安置人数相对较低（9.4%）。对于患者的年龄，发现了亚组效应，干预组中“较年轻”患者的住院风险明显高于常规护理组（调整后的 HR=4.94，95% CI 1.10 至 22.13）。