加拿大安大略省 COVID-19 大流行期间居家护理接受者的社会参与和困扰：一项回顾性队列研究。
Social Engagement and Distress Among Home Care Recipients During the COVID-19 Pandemic in Ontario, Canada: A Retrospective Cohort Study.
机构信息
Dalhousie University, Halifax, Nova Scotia, Canada.
University of Waterloo, Waterloo, Ontario, Canada.
出版信息
J Am Med Dir Assoc. 2022 Jul;23(7):1101-1108. doi: 10.1016/j.jamda.2022.04.005. Epub 2022 Apr 18.
OBJECTIVES
To examine factors associated with distressing social decline and withdrawal during the COVID-19 pandemic for home care recipients.
DESIGN
Retrospective cohort.
SETTING AND PARTICIPANTS
Home care recipients age 18 years or older in Ontario, Canada without severe cognitive impairment with an assessment and follow-up between September 1, 2018 and August 31, 2020.
METHODS
Data were collected using the interRAI home care. Outcomes of interest were distressing decline in social participation and social withdrawal. Independent variables were entered into multivariable longitudinal generalized estimating equations. Interaction terms with the pandemic were tested. Those significant at P < .01 were retained in final models and reported as odds ratios (ORs), 95% confidence intervals (CIs).
RESULTS
We compared 26,492 and 19,126 home care recipients before and during the pandemic, respectively. The pandemic was associated with greater odds of experiencing distressing social decline (OR 1.28, 95% CI 1.22‒1.34) and withdrawal (OR 1.09, 95% CI 1.04‒1.15). Living alone (OR 1.13, 95% CI 1.05‒1.22), frailty (OR 3.21, 95% CI 2.76‒3.73), health instability (OR 2.22, 95% CI 2.02‒2.44), and depression (OR 2.14, 95% CI 2.01‒2.29) increased the odds of distressing social decline. Older age (OR 0.71, 95% CI 0.65‒0.77), functional impairment (OR 0.58, 95% CI 0.51‒0.67), and receiving caregiving (OR 0.73, 95% CI 0.67‒0.79) decreased the odds. Home care recipients with mild/moderate dementia were less likely to experience distressing social decline during the pandemic. Those who lived alone were more likely. Frailty (OR 9.49, 95% CI 7.69‒11.71) and depression (OR 2.76, 95% CI 2.55‒3.00) increased the odds of social withdrawal. Functional impairment (OR 0.32, 95% CI 0.27‒0.39), congestive heart failure (OR 0.77, 95% CI 0.70‒0.84), and receiving caregiving (OR 0.50, 95% CI 0.46‒0.55) decreased the odds. Home care recipients age 18‒64 years and older than 75 years were less likely to experience social withdrawal during the pandemic.
CONCLUSIONS AND IMPLICATIONS
Social support interventions should focus on supporting those living alone, with frailty, health instability, or depression.
目的
调查与 COVID-19 大流行期间居家护理接受者令人痛苦的社会衰退和退出相关的因素。
设计
回顾性队列研究。
地点和参与者
在加拿大安大略省，18 岁或以上、无严重认知障碍的居家护理接受者，在 2018 年 9 月 1 日至 2020 年 8 月 31 日期间进行评估和随访。
方法
使用 interRAI 居家护理收集数据。感兴趣的结果是社交参与和社会退出方面令人痛苦的下降。将自变量纳入多变量纵向广义估计方程。测试了与大流行的交互项。那些 P<.01 的被保留在最终模型中，并报告为比值比（OR）、95%置信区间（CI）。
结果
我们分别比较了大流行前的 26492 名和大流行期间的 19126 名居家护理接受者。大流行与经历令人痛苦的社会衰退（OR 1.28，95%CI 1.22-1.34）和退出（OR 1.09，95%CI 1.04-1.15）的几率增加有关。独居（OR 1.13，95%CI 1.05-1.22）、虚弱（OR 3.21，95%CI 2.76-3.73）、健康不稳定（OR 2.22，95%CI 2.02-2.44）和抑郁（OR 2.14，95%CI 2.01-2.29）增加了令人痛苦的社会衰退的几率。年龄较大（OR 0.71，95%CI 0.65-0.77）、功能障碍（OR 0.58，95%CI 0.51-0.67）和接受护理（OR 0.73，95%CI 0.67-0.79）降低了几率。轻度/中度痴呆的居家护理接受者在大流行期间不太可能经历令人痛苦的社会衰退。独居的人更有可能。虚弱（OR 9.49，95%CI 7.69-11.71）和抑郁（OR 2.76，95%CI 2.55-3.00）增加了社会退出的几率。功能障碍（OR 0.32，95%CI 0.27-0.39）、充血性心力衰竭（OR 0.77，95%CI 0.70-0.84）和接受护理（OR 0.50，95%CI 0.46-0.55）降低了几率。18-64 岁和 75 岁以上的居家护理接受者在大流行期间不太可能经历社会退出。
结论和意义
社会支持干预措施应侧重于支持那些独居、身体虚弱、健康不稳定或抑郁的人。
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