Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland.
Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
BMC Geriatr. 2019 Jan 22;19(1):18. doi: 10.1186/s12877-019-1033-2.
Caregivers of a family member with a chronic disability or illness such as dementia are at increased risk for chronic disease. There are many factors that contribute to dementia caregiver vulnerability and these factors can be challenging to assess in clinical settings. Self-rated health (SRH) is an independent measure of survival and physical health in the elderly. As an inclusive measure of health, SRH has been proposed as a reliable way to assess a patient's general health in primary care. Therefore, we sought to identify determinants of poor/fair SRH versus categories of at least good SRH in informal caregivers.
In a cross-sectional study, we examined 134 elderly (≥55 years) providing in-home care for a spouse with dementia who rated their own health with a single-item question: "In general, would you say your health is excellent, very good, good, fair or poor?". In a multivariable model, we compared caregivers with poor/fair SRH to those with good, very good, or excellent SRH on demographics, health characteristics (health behaviors, physical health indicators, psychosocial factors) and caregiving-specific stress (a composite index/total of four caregiving-specific stressors: years of caregiving, dementia severity, care recipient functional impairment and perceived caregiver burden).
Compared with caregivers who rated their own health as either good (31.3%), very good (38.8%) or excellent (14.2%), caregivers with poor/fair SRH (15.7%) were more likely to have lower physical function and total greater caregiving-specific stress. More years of caregiving, severe dementia and care recipient functional impairment, but not perceived caregiver burden, were also more likely among caregivers with poor/fair SRH. Additionally, high negative affect and low positive affect were more likely in caregivers with poor/fair vs. good or excellent and very good or excellent SRH, respectively.
Caregivers with poor/fair SRH were characterized by higher levels of medical comorbidity, low physical function, high negative, but low positive affect and longer duration of caregiving, as well as more severe dementia and greater functional impairment of the care recipient. These findings suggest that caregivers need to be more closely evaluated and targeted for preventive interventions in clinical practice.
ClinicalTrials.gov registration number: NCT02317523 .
照顾患有慢性残疾或疾病（如痴呆症）的家庭成员的照护者患慢性病的风险增加。有许多因素导致痴呆症照护者易受伤害，这些因素在临床环境中难以评估。自我评估健康（SRH）是老年人生存和身体健康的独立衡量标准。作为健康的综合衡量标准，SRH 已被提议作为评估初级保健中患者一般健康的可靠方法。因此，我们试图确定影响非正式照护者 SRH 差/一般与至少良好 SRH 分类的因素。
在一项横断面研究中，我们检查了 134 名年龄在 55 岁以上的老年人，他们为患有痴呆症的配偶提供家庭护理，并使用单项问题评估自己的健康状况：“总的来说，您会说自己的健康状况极好、非常好、好、一般还是差？”。在多变量模型中，我们将 SRH 差/一般的照护者与 SRH 好、非常好或极好的照护者进行比较，比较因素包括人口统计学、健康特征（健康行为、身体健康指标、心理社会因素）和照护特定压力（一个综合指数/总共四个照护特定压力源：照护年限、痴呆症严重程度、照护对象功能障碍和感知照护者负担）。
与自评健康状况为好（31.3%）、非常好（38.8%）或极好（14.2%）的照护者相比，自评健康状况差/一般（15.7%）的照护者更有可能身体功能较低，照护特定压力更大。更多的照护年限、严重的痴呆症和照护对象的功能障碍，而不是感知到的照护者负担，也更有可能发生在自评健康状况差/一般的照护者中。此外，与自评健康状况好或极好以及非常好或极好的照护者相比，自评健康状况差/一般的照护者更有可能表现出较高的负性情绪和较低的正性情绪。
自评健康状况差/一般的照护者具有更高的合并症水平、较低的身体功能、较高的负性情绪、较低的正性情绪以及更长的照护年限、更严重的痴呆症和更大的照护对象功能障碍。这些发现表明，在临床实践中，需要更密切地评估和针对这些照护者进行预防性干预。
ClinicalTrials.gov 注册号：NCT02317523。
