Icahn School of Medicine at Mount Sinai (H.M., H.K., E.B.L.), Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA.
Icahn School of Medicine at Mount Sinai (H.M., H.K., E.B.L.), Brookdale Department of Geriatrics and Palliative Medicine, New York, New York, USA.
J Pain Symptom Manage. 2022 Dec;64(6):513-520. doi: 10.1016/j.jpainsymman.2022.07.017. Epub 2022 Aug 6.
In the United States, 30% of all deaths occur at home. Effective symptom management is integral to quality end-of-life (EOL) care. Family caregivers play a major role in EOL symptom management. Recent federal policies emphasize the need to improve training and support for family caregivers.
In a nationally representative sample: 1) Characterize the population of caregivers assisting with and reporting difficulty in symptom management at the end of life; and 2) Assess caregiver and care recipient characteristics associated with caregiver report of difficulty.
Cross-sectional analysis of data from the National Health and Aging Trends Study and National Study of Caregiving. Multivariable logistic regression to assess association between care recipient and caregiver characteristics and caregiver report of difficulty.
Caregivers (n = 214) were mean age 57.1 years, 74% female, and 86% white non-Hispanic. Over 2 million family caregivers provided assistance with symptom management in the last month of life in 2017; 78% reported difficulty. Non-Hispanic Black caregivers (aOR 0.24, 95% CI 0.08-0.75), Hispanic caregivers (0.13, 0.03-0.56), and caregivers with lower than high school education (0.26, 0.11-0.63) were less likely to report difficulty. Caregivers of care recipients who received paid care (3.37, 1.30-8.69) were more likely to report difficulty. Receipt of training and support services (1.80, 0.83-3.93) and hospice (1.83, 0.82-4.07) were not associated with caregiver report of difficulty.
These findings underscore the need to improve training and support for family caregivers in EOL symptom management.
在美国，30%的死亡发生在家庭中。有效的症状管理是高质量临终关怀（EOL）的关键。家庭照顾者在 EOL 症状管理中起着重要作用。最近的联邦政策强调需要改善对家庭照顾者的培训和支持。
在全国代表性样本中：1）描述协助和报告临终生命末期症状管理困难的照顾者人群；2）评估与照顾者报告困难相关的照顾者和照顾对象特征。
横断面分析来自国家健康与老龄化趋势研究和国家护理研究的数据。多变量逻辑回归评估照顾对象和照顾者特征与照顾者报告困难之间的关联。
照顾者（n=214）平均年龄为 57.1 岁，74%为女性，86%为白人非西班牙裔。2017 年，超过 200 万名家庭照顾者在生命的最后一个月提供症状管理协助；78%报告有困难。非西班牙裔黑人照顾者（aOR 0.24，95%CI 0.08-0.75）、西班牙裔照顾者（0.13，0.03-0.56）和受教育程度低于高中的照顾者（0.26，0.11-0.63）报告困难的可能性较低。照顾接受付费护理的照顾对象的照顾者（3.37，1.30-8.69）更有可能报告困难。接受培训和支持服务（1.80，0.83-3.93）和临终关怀（1.83，0.82-4.07）与照顾者报告困难无关。
这些发现强调需要改善家庭照顾者在 EOL 症状管理方面的培训和支持。
