McClendon McKee J, Smyth Kathleen A
a Department of Neurology, School of Medicine , Case Western Reserve University , Cleveland , OH , USA.
Aging Ment Health. 2015;19(12):1093-102. doi: 10.1080/13607863.2014.1003284. Epub 2015 Jan 29.
Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival.
We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival.
Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival.
It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.
在家中照料痴呆患者的照护者会采用多种质量参差不齐的照护方式。现已确定了三种高质量照护方式和低质量照护方式。然而，不同照护方式的结果尚不清楚。我们的目的是研究照护质量与长期护理安置及生存之间的联系。
我们选取了148名在家中照料因记忆或思维问题而需要帮助的亲属的主要照护者作为样本。我们使用了四个现有量表中的条目以及五个新条目来构建高质量和低质量照护的测量指标。通过两次随访确定长期护理情况和生存情况。使用Cox比例风险回归来估计照护质量与长期护理安置及生存之间的关系。
正如预期的那样，低质量照护增加了长期护理安置的风险，但高质量照护与安置无关。令人惊讶的是，高质量照护增加了死亡风险，而低质量照护降低了死亡风险。次要结果为：如意/内心应对（一种功能失调的以情绪为中心的应对方式）和长期护理安置缩短了生存期；而照护者的神经质和宜人性人格特质延长了生存期。
基于我们意外的研究结果推荐照护者干预措施还为时过早。进一步的研究至关重要，并且应将受照护者的损伤以及痴呆患者的生活质量作为额外的结果纳入研究。
