Burgdorf Julia G, Arbaje Alicia I, Wolff Jennifer L
Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Am Med Dir Assoc. 2020 Dec;21(12):1914-1919. doi: 10.1016/j.jamda.2020.05.032. Epub 2020 Jul 5.
To estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs.
Nationally representative retrospective cohort study.
1758 (weighted n = 8,477,990) Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016.
Older adult and caregiving network characteristics before home health (sociodemographic factors, caregiver assistance, older adult health and function) were drawn from NHATS; characteristics during home health (family caregiver training needs, older adult health and function) were drawn from home health patient assessments. Weighted proportions of family caregivers with an identified need for activity-specific training were estimated. Weighted, multivariable logistic regressions modeled associations between older adult/caregiving network characteristics and family caregivers' identified activity-specific training needs during home health.
More than 1 in 3 (35.7%) family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Rates of need for training varied widely, from 8.6% among caregivers helping with advocacy to 48.2% among caregivers helping with medical procedures. In weighted analyses that adjusted for older adults' health and function, family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission.
Findings highlight the pervasiveness of family caregivers' training needs, particularly with medically oriented activities, and indicate that escalations in older adults' care needs are linked to caregiver training needs. Therefore, transitions of care may present critical opportunities to connect family caregivers with training resources.
评估在医疗保险家庭健康护理期间协助老年人的家庭护理人员中，确定有特定活动培训需求的比例，并确定与护理人员培训需求相关的特征。
具有全国代表性的回顾性队列研究。
1758名（加权n = 8,477,990）医疗保险受益人，他们参与了国家健康与老龄化趋势研究（NHATS），并在2011年至2016年期间接受了医疗保险资助的家庭健康护理。
家庭健康护理之前的老年人及护理网络特征（社会人口统计学因素、护理人员协助、老年人健康与功能）来自NHATS；家庭健康护理期间的特征（家庭护理人员培训需求、老年人健康与功能）来自家庭健康护理患者评估。估计有特定活动培训需求的家庭护理人员的加权比例。加权多变量逻辑回归模型分析了老年人/护理网络特征与家庭健康护理期间家庭护理人员确定的特定活动培训需求之间的关联。
在医疗保险家庭健康护理期间协助老年人的家庭护理人员中，超过三分之一（35.7%）确定至少有一项护理活动的培训需求。培训需求率差异很大，从协助维权的护理人员中的8.6%到协助医疗程序的护理人员中的48.2%不等。在对老年人的健康和功能进行调整的加权分析中，当协助有持续残疾的老年人或在家庭健康护理入院前接受护理人员协助的老年人时，家庭护理人员确定有培训需求的可能性较小。
研究结果凸显了家庭护理人员培训需求的普遍性，尤其是在医疗相关活动方面，并表明老年人护理需求的增加与护理人员培训需求相关。因此，护理过渡可能为将家庭护理人员与培训资源联系起来提供关键机会。
