Department of Psychiatry, Singapore General Hospital, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
J Am Geriatr Soc. 2020 Oct;68(10):2348-2353. doi: 10.1111/jgs.16717. Epub 2020 Jul 23.
Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the PWD, with such caregiver grief postulated to affect the well-being of the PWD-caregiver dyads. However, the longitudinal effects of caregiver grief and the moderating effects of social services are not yet clear.
We investigated the longitudinal effects of caregiver grief on caregiver depression, caregivers' quality of life (QoL), and caregivers' perceived positive aspects of caregiving (PAC); and examined potential effect modification of social service utilization (dementia care services, caregiver programs, and paid caregivers).
A prospective cohort study with three time points of assessments (at 0, 6, and 12 months).
Family caregivers of community-dwelling PWD (n = 178).
At time point 1 (baseline), participants completed questionnaires that captured caregiver grief, burden, and social service utilization. Outcomes that were captured over time were: depression (time points 1-3), QoL (time point 2), and PAC (time point 3). Caregiver grief as well as interaction terms with social service utilization were included in Tobit regression to examine the association with outcomes.
After accounting for the effect of caregiver burden, caregiver grief remained associated with depressive symptoms (P < .001) and poorer QoL (P < .001). However, compared with burden, grief contributed to larger magnitudes of the adverse effects. Grief, not burden, was associated with less PAC (P = .006 and P = .746, respectively). In contrast, burden, not grief, was associated with poorer physical health (P = .010 and P = .110, respectively). Dementia care services attenuated the effect of burden but not grief; caregiver programs did not affect burden but appeared to aggravate the effect of grief; and paid caregivers attenuated the effect of burden, and partially attenuated the effect of grief.
Caregiver grief has an impact on dementia caregivers, likely through a distinct mechanism from that of caregiver burden. However, prevailing social services may not be sufficient to address grief, highlighting the need to further train care workers in this respect. J Am Geriatr Soc 68:2348-2353, 2020.
痴呆症患者（PWD）的照顾者在 PWD 去世之前可能会经历失落和悲伤，据推测，这种照顾者的悲伤会影响 PWD-照顾者的幸福感。然而，照顾者悲伤的纵向影响以及社会服务的调节作用尚不清楚。
我们研究了照顾者悲伤对照顾者抑郁、照顾者生活质量（QoL）和照顾者对照顾的积极感知（PAC）的纵向影响；并探讨了社会服务利用（痴呆症护理服务、照顾者计划和付费照顾者）的潜在效应修饰作用。
一项前瞻性队列研究，共进行了三次评估（0、6 和 12 个月）。
社区居住的 PWD 的家庭照顾者（n = 178）。
在第 1 时间点（基线），参与者完成了问卷调查，其中包括照顾者悲伤、负担和社会服务利用情况。随着时间推移而捕获的结果是：抑郁（时间点 1-3）、QoL（时间点 2）和 PAC（时间点 3）。在 Tobit 回归中，将照顾者悲伤及其与社会服务利用的交互项纳入其中，以检查与结果的关联。
在考虑到照顾者负担的影响后，照顾者悲伤仍然与抑郁症状相关（P < 0.001），且与较差的 QoL 相关（P < 0.001）。然而，与负担相比，悲伤对不良影响的贡献更大。悲伤而不是负担与较少的 PAC 相关（P = 0.006 和 P = 0.746，分别）。相比之下，负担而不是悲伤与较差的身体健康相关（P = 0.010 和 P = 0.110，分别）。痴呆症护理服务减轻了负担的影响，但没有减轻悲伤的影响；照顾者计划对负担没有影响，但似乎加重了悲伤的影响；付费照顾者减轻了负担的影响，并部分减轻了悲伤的影响。
照顾者悲伤对痴呆症照顾者有影响，可能通过与照顾者负担不同的机制产生影响。然而，现有的社会服务可能不足以解决悲伤问题，这突出表明需要在这方面进一步培训护理人员。美国老年学会杂志 68：2348-2353，2020 年。
