O'Caoimh R, Cornally N, Svendrovski A, Weathers E, FitzGerald C, Healy E, O'Connell E, O'Keeffe G, O'Herlihy E, Gao Y, O'Donnell R, O'Sullivan R, Leahy-Warren P, Orfila F, Paúl C, Clarnette R, Molloy D W
Dr Rónán O'Caoimh, Email:
J Frailty Aging. 2016;5(2):104-10. doi: 10.14283/jfa.2016.86.
Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown.
To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one ("can manage") to five ("absent/liability"). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death.
Observational cohort study.
Community-dwelling adults, aged >65, attending health centres in Ireland, (n=779). PROCEDURE AND MEASUREMENTS: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five).
The majority of patients had a primary caregiver (582/779; 75%), most often their child (200/582; 34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%, p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation.
This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.
尽管照护者在体弱的社区老年人管理中很重要，但不同照护者网络类型对不良医疗结局风险的影响尚不清楚。
研究照护者类型与社区筛查风险工具（RISC）的照护者网络子测试之间的关联，该测试采用五点李克特量表，从1分（“能够自理”）到5分（“无人照护/负担”）进行评分。测量照护者网络得分与机构化、住院和死亡的一年发生率之间的关联。
观察性队列研究。
居住在爱尔兰社区、年龄>65岁、在健康中心就诊的成年人（n=779）。程序和测量：RISC的照护者网络子测试由公共卫生护士评分。照护者被二分法分为低风险（得分为1）或高风险（得分为2至5）。
大多数患者有主要照护者（582/779；75%），最常见的是他们的子女（200/582；34%）。当患者没有公认的主要照护者时，照护者网络得分最高，表明风险最大；当只有配偶或子女时，得分最低。尽管如此，有照护者的患者比那些不需要或未确定照护者的患者更有可能被机构化（11.5%对6.5%，p=0.047）。当国家提供的照护是唯一支持时，不良结局的一年发生率最高；当私人照护是唯一支持时，发生率最低。照护者网络得分高风险的患者比低风险网络的患者需要机构化的比例显著更高；这种关联在感知到的医疗领域问题管理困难方面最为强烈，优势比（OR）为3.87：（2.22-6.76）。只有感知到的日常生活活动管理困难与死亡显著相关，OR为1.72：（1.06-2.79）。照护者网络得分与住院风险之间没有关联。
本研究实施了一种评估照护者网络的简单方法。由亲密家庭成员（配偶/子女）组成的网络以及反映更高社会经济特权的网络（私人支持）与较低的不良结局发生率相关。照护者网络得分比住院或死亡更能预测机构化。
