Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain and the G.H. Sergievsky Center, Columbia University Medical Center.
Department of Clinical and Health Psychology, University of Florida, FL.
Alzheimer Dis Assoc Disord. 2019 Jan-Mar;33(1):62-67. doi: 10.1097/WAD.0000000000000287.
The objective of this study was to examine whether reduced awareness of memory deficits in individuals with dementia is associated with more frequent need for Medicare home health care services.
Cross-sectional analyses were conducted in a multicenter, clinic-based cohort. In total, 192 participants diagnosed with dementia and their informants were independently asked whether or not the participant demonstrated cognitive symptoms of dementia related to memory and word-finding. Participant self-awareness was measured as the discrepancy between participant and caregiver report of these symptoms. Annual Medicare home health benefit use data was obtained from Medicare claims matched by year to the Predictors study visit.
Participants that used home health services had lower awareness scores than those who did not. Awareness remained independently associated with home health use in a logistic regression adjusted for age, gender, education, caregiver relationship, global cognition, dementia subtype, and medical comorbidities.
Reduced self-awareness of memory deficits in individuals with dementia is associated with more frequent use of Medicare home health services. The disproportionate use of in-home assistance as a function of awareness level may reflect dangers faced by patients, and challenges faced by caregivers, when patients have limited awareness of their memory deficits. Current results have implications for clinical care, caregiver education, and models of health care utilization.
本研究旨在探讨痴呆患者对记忆缺陷的认知程度降低是否与更频繁地需要医疗保险家庭保健服务相关。
在一项多中心、基于诊所的队列研究中进行了横断面分析。共有 192 名被诊断为痴呆的参与者及其知情人分别被独立询问该参与者是否表现出与记忆和找词相关的痴呆认知症状。参与者的自我意识被衡量为参与者和护理人员对这些症状的报告之间的差异。从医疗保险索赔中获得了年度医疗保险家庭健康福利使用数据，并按年份与预测研究就诊进行了匹配。
使用家庭保健服务的参与者的意识得分低于未使用的参与者。在调整了年龄、性别、教育程度、护理人员关系、整体认知、痴呆亚型和合并症后，意识状态仍与家庭保健服务的使用独立相关。
痴呆患者对记忆缺陷的自我意识降低与更频繁地使用医疗保险家庭保健服务相关。意识水平差异导致家庭护理服务的使用不成比例，这可能反映了患者意识有限时所面临的危险，以及护理人员面临的挑战。目前的结果对临床护理、护理人员教育和医疗保健利用模式具有重要意义。
