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远程医疗在 COVID-19 大流行期间对痴呆症患者及其照护者的保护作用。

The Protective Impact of Telemedicine on Persons With Dementia and Their Caregivers During the COVID-19 Pandemic.

机构信息

Department of Rehabilitation Sciences (FHYL, DTHC), The Hong Kong Polytechnic University, Hong Kong, China.

Occupational Therapy Department (EWHY), Kowloon Hospital, Hong Kong, China.

出版信息

Am J Geriatr Psychiatry. 2020 Nov;28(11):1175-1184. doi: 10.1016/j.jagp.2020.07.019. Epub 2020 Aug 8.

Abstract

OBJECTIVES

Social distancing under the COVID-19 pandemic has restricted access to community services for older adults with neurocognitive disorder (NCD) and their caregivers. Telehealth is a viable alternative to face-to-face service delivery. Telephone calls alone, however, may be insufficient. Here, we evaluated whether supplementary telehealth via video-conferencing platforms could bring additional benefits to care-recipient with NCD and their spousal caregivers at home.

PARTICIPANTS

Sixty older adults NCD-and-caregiver dyads were recruited through an activity center.

DESIGN, INTERVENTION: The impact of additional services delivered to both care-recipient and caregiver through video conference (n = 30) was compared with telehealth targeted at caregivers by telephone only (n = 30), over 4 weeks in a pretest-post-test design. Interviews and questionnaires were conducted at baseline and study's end.

MEASUREMENTS, RESULTS: Supplementary telemedicine had averted the deterioration in the Montreal Cognitive Assessment evident in the telephone-only group (η = 0.50). It also reversed the falling trend in quality of life observed in the telephone only group (QoL-AD, η = 0.23). Varying degrees of improvements in physical and mental health (Short-Form 36 v2), perceived burden (Zarit Burden Interview Scale) and self-efficacy (Revised Caregiving Self-Efficacy Scale) were observed among caregivers in the video-conferencing group, which were absent in the telephone-only group (η = 0.23-0.51).

CONCLUSION

Telemedicine by video conference was associated with improved resilience and wellbeing to both people with NCD and their caregivers at home. The benefits were visible already after 4 weeks and unmatched by telephone alone. Video conference as the modus operandi of telehmedicine beyond the context of pandemic-related social distancing should be considered.

摘要

目的

在 COVID-19 大流行期间,社交距离限制了患有神经认知障碍 (NCD) 的老年人及其照顾者获得社区服务的机会。远程医疗是面对面服务提供的可行替代方案。然而,仅通过电话进行沟通可能还不够。在这里,我们评估了通过视频会议平台提供的补充远程医疗是否可以为在家中患有 NCD 的护理接受者及其配偶照顾者带来额外的好处。

参与者

通过活动中心招募了 60 对患有 NCD 的老年人及其照顾者。

设计、干预:通过视频会议向护理接受者和照顾者提供额外服务(n=30)的效果与仅通过电话向照顾者提供远程医疗(n=30)的效果进行了比较,采用预测试-后测试设计进行了 4 周的研究。在基线和研究结束时进行了访谈和问卷调查。

测量结果

补充远程医疗避免了仅通过电话组中明显的蒙特利尔认知评估恶化(η=0.50)。它还扭转了仅通过电话组中观察到的生活质量下降趋势(QoL-AD,η=0.23)。在视频会议组中,照顾者的身心健康(Short-Form 36 v2)、感知负担(Zarit 负担访谈量表)和自我效能感(修订后的照顾自我效能量表)都有不同程度的改善,而仅通过电话组则没有(η=0.23-0.51)。

结论

视频会议远程医疗与提高患有 NCD 的人和他们在家中的照顾者的弹性和幸福感有关。这些好处在 4 周后就显现出来,并且是通过电话单独提供的无法比拟的。在与大流行相关的社交距离限制之外,应考虑将视频会议作为远程医疗的操作模式。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e10a/7413846/4679f4360aec/gr1_lrg.jpg

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