Zhu Carolyn W, Scarmeas Nikolaos, Ornstein Katherine, Albert Marilyn, Brandt Jason, Blacker Deborah, Sano Mary, Stern Yaakov
Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain; Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Alzheimers Dement. 2015 Apr;11(4):444-54. doi: 10.1016/j.jalz.2013.12.018. Epub 2014 Mar 15.
To examine the effects of caregiver and patient characteristics on caregivers' medical care use and cost.
One hundred forty-seven caregiver/patient dyads were followed annually for 6 years in three academic Alzheimer's disease centers in the United States. Logistic, negative binomial, and generalized linear mixed models were used to examine overall effects of caregiver/patient characteristics on caregivers' hospitalizations, doctor visits, outpatient tests and procedures, and prescription and over-the-counter medications.
Patients' comorbid conditions and dependence were associated with increased health-care use and costs of caregivers. Increases in caregiver depressive symptoms are associated with increases in multiple domains of caregivers' health-care use and costs.
Findings suggest expanding our focus on dementia patients to include family caregivers to obtain a fuller picture of effects of caregiving. Primary care providers should integrate caregivers' needs in health-care planning and delivery. Clinical interventions that treat patients and caregivers as a whole will likely achieve the greatest beneficial effects.
研究照顾者及患者特征对照顾者医疗服务利用及费用的影响。
在美国三个学术性阿尔茨海默病中心,对147对照顾者/患者组合进行了为期6年的年度随访。采用逻辑回归、负二项回归和广义线性混合模型,研究照顾者/患者特征对照顾者住院、看医生、门诊检查与治疗以及处方药和非处方药使用情况的总体影响。
患者的共病情况和依赖程度与照顾者医疗服务利用及费用的增加相关。照顾者抑郁症状的加重与照顾者医疗服务利用及费用多个领域的增加相关。
研究结果表明,应扩大对痴呆患者的关注范围,将家庭照顾者纳入其中,以便更全面地了解照顾的影响。初级保健提供者应将照顾者的需求纳入医疗保健规划和服务中。将患者和照顾者作为一个整体进行治疗的临床干预措施可能会取得最大的有益效果。