Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.
Mental Health Promotion Unit, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan.
Front Public Health. 2023 Mar 30;11:915387. doi: 10.3389/fpubh.2023.915387. eCollection 2023.
Advance care planning (ACP) is an increasing priority for people with dementia during the COVID-19 pandemic. This study evaluated the association between ACP initiation and depressive symptoms among home-dwelling people living with dementia.
An internet-based questionnaire survey was conducted with Japanese family caregivers of home-dwelling persons with dementia in June 2021. Family caregivers evaluated the level of depressive symptoms in persons with dementia using the Neuropsychiatric Inventory (NPI). Caregivers also rated the quality of life of persons with dementia using the EQ-5D-5L.
A total of 379 family caregivers participated in the survey. Depressive symptoms were reported in 143 persons with dementia (37.7%). A total of 155 persons with dementia (40.9%) had initiated ACP, of which 88 (56.8%) had care professionals involved in ACP conversation. After adjusting for the characteristics of persons with dementia and caregivers, persons with professional involvement showed significantly more severe depressive symptoms compared to those who did not initiate ACP. There was no significant difference in the quality of life of persons with dementia according to ACP initiation.
Many home-dwelling persons with dementia experienced depressive symptoms during the COVID-19 pandemic, especially in cases where care professionals were involved in ACP conversations. Optimal and proactive ACP approaches need to be developed to prevent depressive symptoms in newly diagnosed persons.
在 COVID-19 大流行期间，预先医疗指示（ACP）成为痴呆症患者日益关注的重点。本研究评估了痴呆症患者居家照护者中 ACP 启动与抑郁症状之间的关联。
于 2021 年 6 月，采用基于互联网的问卷调查方式，对痴呆症居家患者的日本家属照护者进行调查。家属照护者使用神经精神问卷（NPI）评估痴呆症患者的抑郁症状水平。照护者还使用 EQ-5D-5L 评估痴呆症患者的生活质量。
共有 379 名家属照护者参与了调查。143 名痴呆症患者（37.7%）报告存在抑郁症状。共有 155 名痴呆症患者（40.9%）启动了 ACP，其中 88 名（56.8%）有专业人员参与 ACP 对话。在调整了痴呆症患者和照护者的特征后，有专业人员参与的患者表现出更严重的抑郁症状，与未启动 ACP 的患者相比差异具有统计学意义。根据 ACP 启动情况，痴呆症患者的生活质量无显著差异。
在 COVID-19 大流行期间，许多痴呆症居家患者出现抑郁症状，尤其是在有专业人员参与 ACP 对话的情况下。需要制定最佳和积极主动的 ACP 方法，以预防新诊断患者出现抑郁症状。
