Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8553, Japan.
Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
BMC Geriatr. 2022 Aug 15;22(1):671. doi: 10.1186/s12877-022-03371-2.
A prolonged COVID-19 pandemic could exacerbate the risk of infection and undesirable effects associated with infection control measures of older people with dementia (PWD), and the care burden of families. In this study, we examined the efficacy of care manager-led information provision and practical support for families of older PWD who need care, regarding appropriate infection prevention, prevention of deterioration of cognitive and physical functions, and preparedness in cases of infection spread or infection during the pandemic.
Fifty-three family members (aged ≥20 years) who were primary caregivers living with older PWD using public long-term care services were enrolled in an one-month randomized controlled trial. This duration was set based on behavior modification theory and with consideration of ethical issue that the most vulnerable people not benefiting from the intervention. The intervention group (IG) received care manager-led information provision and practical support, and the control group (CG) received usual care. Care burden (primary outcome) was measured using the Zarit Caregiver Burden Interview, and secondary outcomes were analyzed using Patient Health Questionnaire-9 (PHQ9), the Fear of COVID-19 Scale, and salivary α-amylase activity. Data were collected at baseline and after 1 month. Multiple regression analysis was conducted to examine the efficacy of the intervention. The participants evaluated the care managers' support.
The participants were randomly divided into IG (n = 27) and CG (n = 26) groups. After the intervention, compared with the CG, there was a decrease in PHQ-9 (β = -.202, p = 0.044) and α-amylase activity in saliva (β = -.265, p = 0.050) in IG. IG also showed an increased fear of COVID-19 after the intervention (β = .261, p = 0.003). With the care managers' support, 57.2% of the participants felt secure in their daily lives and 53.1% agreed that they were able to practice infection prevention suitable for older PWD.
Our findings suggest that the care manager-led intervention may be useful for families of older PWD to enhance behavioral changes in preventing COVID-19 infection and improve their psychological outcomes in the COVID-19 era.
This study was registered on April 2, 2021 (No. UMIN000043820).
COVID-19 大流行时间延长可能会加剧感染风险，以及与感染控制措施相关的不良影响，这对于患有痴呆症（PWD）的老年人及其家庭来说更是如此。在这项研究中，我们研究了以护理经理为指导的信息提供和实际支持，对需要护理的老年 PWD 家庭的作用，包括适当的感染预防、预防认知和身体功能下降，以及在大流行期间感染传播或感染时的准备情况。
我们招募了 53 名（年龄≥20 岁）主要照顾者，他们与使用公共长期护理服务的老年 PWD 一起居住，参与了一项为期一个月的随机对照试验。之所以选择一个月的时间，是基于行为改变理论，并考虑到了一个伦理问题，即最脆弱的人群无法从干预中受益。干预组（IG）接受了护理经理主导的信息提供和实际支持，而对照组（CG）则接受了常规护理。使用 Zarit 护理人员负担量表来衡量护理负担（主要结局），并使用患者健康问卷-9（PHQ9）、新冠恐惧量表和唾液α-淀粉酶活性来分析次要结局。在基线和 1 个月后收集数据。采用多元回归分析来检验干预的效果。参与者评估了护理经理的支持情况。
参与者被随机分为 IG（n=27）和 CG（n=26）组。干预后，与 CG 相比，IG 组的 PHQ-9（β=-0.202，p=0.044）和唾液α-淀粉酶活性（β=-0.265，p=0.050）降低。IG 组对新冠的恐惧也增加了（β=0.261，p=0.003）。在护理经理的支持下，57.2%的参与者感到日常生活有保障，53.1%的参与者认为他们能够为老年 PWD 实施适当的感染预防措施。
我们的研究结果表明，护理经理主导的干预措施可能有助于老年 PWD 家庭增强预防 COVID-19 感染的行为改变，并改善他们在 COVID-19 时代的心理结局。
本研究于 2021 年 4 月 2 日注册（注册号：UMIN000043820）。
