Garre-Olmo J, Vilalta-Franch J, Calvó-Perxas L, Turró-Garriga O, Conde-Sala L, López-Pousa S
Girona Biomedical Research Institute [IDIBGI],C/ Dr. Castany s/n,17190 Salt,GironaSpain.
Department of Developmental Psychology,University of Barcelona,Barcelona,Spain.
Int Psychogeriatr. 2016 Jul;28(7):1133-41. doi: 10.1017/S1041610216000223. Epub 2016 Mar 1.
The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants.
Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence.
The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress.
Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.
依赖概念已被提出作为评估阿尔茨海默病（AD）进展的综合指标。本研究旨在探讨在一个包含其他既定决定因素的一般理论模型中，患者依赖水平与照料者负担之间的关联。
观察性横断面多中心研究。样本由通过便利抽样程序在门诊咨询办公室招募的AD患者组成，按痴呆严重程度分层。使用标准化工具评估认知和功能状态、行为障碍、依赖水平、合并症和照料者负担。采用路径分析来检验照料者负担与其决定因素（包括依赖水平）之间的假设关系。
样本包括306例患者（轻度33.3%，中度35.9%，重度30.7%），平均年龄78.5岁（标准差=7.8），66.2%为女性。模型拟合度可接受，解释了照料者负担方差的29%。主要压力源是依赖水平和与行为障碍相关的痛苦。照料者的年龄、性别以及与患者共同居住是与照料者负担相关的背景因素。照料者的工作状态是一个重要的次要压力源，功能残疾通过依赖与照料者负担间接相关，行为障碍的频率通过痛苦与照料者负担间接相关。
除行为障碍外，依赖是与照料者负担直接相关的最重要的主要压力源，与疾病严重程度无关。
