使用居民评估工具家庭护理版对社区环境中照顾者困扰的预测因素

Predictors of Caregiver Distress in the Community Setting Using the Home Care Version of the Resident Assessment Instrument.

作者信息

Pauley Tim, Chang Byung Wook, Wojtak Anne, Seddon Gayle, Hirdes John

机构信息

Tim Pauley, MSc, is the Manager, Research & Knowledge Mobilization at the Toronto Central Community Care Access Center. Winner of two international research awards (ISPRM; ISPO) and author of numerous journal articles, his work includes support of informal caregivers, community-based diabetes management, engagement of clients/caregivers in knowledge mobilization, amputee, and stroke rehabilitation. Byung Wook Chang, PhD, is a Senior Analyst at University Health Network. He graduated from the Aging, Health, and Well-being program supervised by Dr John Hirdes. His areas of research include home care quality indicators, minority health, and inpatient rehabilitation. Anne Wojtak, DrPH, MHSc, BSc, is the Chief Performance Officer at the Toronto Central Community Care Access Centre and is an Adjunct Faculty member at the University of Toronto, in the Institute of Health Policy, Management and Evaluation. Her research focuses on public reporting on health care performance and quality, and she has published numerous articles on home care, with a particular focus on patient experience Gayle Seddon, BScN, MHSc, is the Director of Community Programs at the Toronto Central Community Care Access Centre. She has extensive experience with delivery of community-based person-centered care programs and services. John Hirdes, PhD, FCAHS, is a professor in the School of Public Health and Health Systems at the University of Waterloo. He is a board member of interRAI, and chairs both the interRAI Network of Excellence in Mental Health (iNEMH) and the interRAI Network of Canada.

出版信息

Prof Case Manag. 2018 Mar/Apr;23(2):60-69. doi: 10.1097/NCM.0000000000000245.

DOI:10.1097/NCM.0000000000000245

PMID:29381670

Abstract

PURPOSE OF STUDY

The purpose of this study was to identify factors predictive of new onset and improved caregiver distress among informal caregivers providing assistance for clients receiving home care.

PRIMARY PRACTICE SETTINGS

Home care.

METHODOLOGY AND SAMPLE

The sample included 323,409 clients receiving home care from a Community Care Access Centre between March 2002 and March 2015 for whom data were available from two subsequent Resident Assessment Instrument-Home Care (RAI-HC) assessments. Separate multivariate logistic regression models were created for onset of and improvement in caregiver distress.

RESULTS

Variables that increase the odds in onset of caregiver distress included primary caregiver is not satisfied with support received from family and friends; client lives with primary caregiver; 65 years and older; has Alzheimer and other related dementia; has condition or disease that makes cognition, activities of daily living, mood, or behavior patterns unstable; took sedatives in the last 7 days; Method for Assigning Priority Levels (MAPLe) score 4 or more; demonstrates persistent anger; has difficulty using the telephone; is married; requires 20 hr or more of informal help weekly; and Clinical Risk Scale score 4 or more. Variables that increased the odds of improved caregiver distress include client now lives with other persons (as compared with 90 days ago); demonstrates good prospects for recovery; treatment changes in last 30 days; surgical wound; female; one or more hospital visits in last 90 days; greater number of months between RAI-HC assessments; and two or more hours of physical activities in the last 3 days. Variables that decreased the odds of improved caregiver distress (i.e., persistent distress) include MAPLe score 4 or more; persistent anger; difficulty using telephone; Alzheimer, related dementia; requires interpreter; and lives with primary caregiver.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Informal caregivers provide essential support for home care clients. Factors predictive of new onset and improved caregiver distress can be used by case managers for comprehensive care planning that addresses the collective needs of the client-caregiver dyad.

摘要

研究目的

本研究旨在确定为接受家庭护理的客户提供帮助的非正式护理人员中新发和改善的护理人员困扰的预测因素。

主要实践环境

家庭护理。

方法与样本

样本包括2002年3月至2015年3月期间从社区护理接入中心接受家庭护理的323,409名客户，可从随后的两次居家护理居民评估工具（RAI-HC）评估中获得数据。针对护理人员困扰的发生和改善情况分别建立了多变量逻辑回归模型。

结果

增加护理人员困扰发生几率的变量包括：主要护理人员对从家人和朋友那里获得的支持不满意；客户与主要护理人员同住；65岁及以上；患有阿尔茨海默病和其他相关痴呆症；患有使认知、日常生活活动、情绪或行为模式不稳定的疾病；在过去7天内服用过镇静剂；优先级别分配方法（MAPLe）得分4或更高；表现出持续愤怒；使用电话有困难；已婚；每周需要20小时或更多的非正式帮助；以及临床风险量表得分4或更高。增加护理人员困扰改善几率的变量包括：客户现在与其他人同住（与90天前相比）；显示出良好的康复前景；在过去30天内治疗有变化；手术伤口；女性；在过去90天内有一次或多次住院；RAI-HC评估之间的月数更多；以及在过去3天内有两个或更多小时的体育活动。降低护理人员困扰改善几率（即持续困扰）的变量包括：MAPLe得分4或更高；持续愤怒；使用电话困难；阿尔茨海默病、相关痴呆症；需要口译员；以及与主要护理人员同住。