Verbeek Hilde, Meyer Gabriele, Challis David, Zabalegui Adelaida, Soto Maria E, Saks Kai, Leino-Kilpi Helena, Karlsson Staffan, Hamers Jan P H
Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands.
School of Nursing Science, Faculty of Health, Witten/Herdecke University, Germany.
J Adv Nurs. 2015 Jun;71(6):1338-50. doi: 10.1111/jan.12663. Epub 2015 Apr 14.
To explore inter-country variation of factors associated with institutionalization of people with dementia.
There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific.
A prospective cohort study.
Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied.
Considerable differences were found between the eight countries in characteristics of people with dementia who had been recently admitted to ILTC. However, caregiver burden appeared the most consistent factor associated with institutionalization in all analyses. Indications for the importance of independence in activities of daily life were found as well, although country differences may be more prominent for this factor.
Evidence was found for two common factors, crucial in the process of institutionalization across countries: caregiver burden and independency in activities of daily life. However, this study also suggests that admission to institutional dementia care is context-specific, as wide variation exists in factors associated with institutionalization across countries. Tailored best-practice strategies are needed to reflect variations in response to these needs.
探讨与痴呆症患者机构化相关因素在不同国家间的差异。
迫切需要证据来证明与机构化痴呆症护理入院相关的因素是否适用于所有医疗保健系统，因为越来越多的证据表明这些因素可能因国家而异。
一项前瞻性队列研究。
在八个欧洲国家收集了基线数据以及3个月随访后的数据（2010年11月至2012年4月）。样本包括2014对痴呆症患者及其非正式照料者；791名患者最近被送入机构，1223名患者居家且有被送入机构的风险。研究了护理环境（机构与家庭）与已证明会影响机构化的因素（如认知、日常生活活动独立性、行为）之间的关联。
在最近入住长期照护机构的痴呆症患者特征方面，八个国家之间存在相当大的差异。然而，在所有分析中，照料者负担似乎是与机构化最一致相关的因素。也发现了日常生活活动独立性重要性的迹象，尽管该因素的国家差异可能更为突出。
发现了两个在各国机构化过程中至关重要的共同因素：照料者负担和日常生活活动独立性。然而，本研究也表明，机构化痴呆症护理的入院情况因具体情况而异，因为各国与机构化相关的因素存在很大差异。需要量身定制最佳实践策略以反映对这些需求的不同反应。
