Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA.
Clin Ther. 2021 Jun;43(6):930-941. doi: 10.1016/j.clinthera.2021.03.022. Epub 2021 May 8.
Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience.
Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving).
About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (-0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33).
The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.
患有痴呆症的老年人通常依赖于付费护理人员（即家庭健康助手、个人护理服务员、其他直接护理人员）和家庭护理人员（即配偶、子女、其他无薪人员）来留在社区中。本研究将付费护理人员视为协作式痴呆症护理团队的一部分，并研究接受付费护理与主要家庭护理人员经验之间的关联。
使用来自 3 个时间点（2011 年、2015 年和 2017 年）的国家健康与老龄化趋势研究（National Health and Aging Trends Study）与国家护理研究（National Study of Caregiving）的数据，确定了 338 例居住在社区的年龄≥67 岁、患有晚期痴呆症的医疗保险受益人的观察值。比较了无、兼职（<40 小时/周）和全职（≥40 小时/周）付费护理人员的主要家庭护理人员的经验，并使用多变量模型评估了全职付费护理与家庭护理人员压力（例如，因护理而不堪重负）和活动限制（例如，因护理而无法工作获得报酬）之间的关联。
大约一半患有晚期痴呆症的社区居住老年人接受了付费护理：30%的人接受兼职付费护理，18%的人接受全职付费护理。接受兼职和无付费护理的家庭护理人员的经验没有显著差异。在调整了家庭护理人员和护理接受者的特征后，接受全职付费护理与因护理而导致活动受限的几率降低近 70%（优势比，0.31；P=0.01），并且护理人员的压力评分降低了 0.73（P=0.04）。在高护理人员压力（评分≥5）的几率与接受付费护理之间，没有统计学上的显著关联（优势比，0.65；P=0.33）。
为社区中的痴呆症患者提供付费护理可能使家庭护理人员受益。未来的工作应承认付费护理人员对协作式痴呆症护理团队所有成员的结果的重要贡献方式。
