Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts.
The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
JAMA Surg. 2023 Sep 1;158(9):945-952. doi: 10.1001/jamasurg.2023.2500.
Caregiver burden, characterized by psychological distress and physical morbidity, affects more than 50 million family caregivers of older adults in the United States. Risk factors for caregiver burden among caregivers of older trauma patients have not been well characterized.
To characterize postdischarge caregiver burden among caregivers of older trauma patients and identify targets that can inform interventions to improve their experience.
DESIGN, SETTING, AND PARTICIPANTS: This study used a repeated cross-sectional design. Participants were family caregivers for adults 65 years or older with traumatic injury who were discharged from 1 of 2 level I trauma centers. Telephone interviews were conducted at 1 month and 3 months postdischarge with family caregivers (identified by the patient as family or friends who provided unpaid care). Admissions occurred between December 2019 and May 2021, and data were analyzed from June 2021 to May 2022.
Hospital admission for geriatric trauma.
High caregiver burden was defined by a score of 17 or higher on the 12-item Zarit Burden Interview. Caregiver self-efficacy and preparedness for caregiving were assessed via the Revised Scale for Caregiving Self-Efficacy and Preparedness for Caregiving Scale, respectively. Associations between caregiver self-efficacy, preparedness for caregiving, and caregiver burden were tested via mixed-effect logistic regression.
There were 154 family caregivers enrolled in the study. Their mean (SD) age was 60.6 (13.0) years (range, 18-92 years), 108 of 154 were female (70.6%). The proportion of caregivers experiencing high burden (Zarit Burden Interview score ≥17) was unchanged over time (1 month, 38 caregivers [30.9%]; 3 months, 37 caregivers [31.4%]). Participants with lower caregiver self-efficacy and preparedness for caregiving were more likely to experience greater caregiver burden (odds ratio [OR], 7.79; 95% CI, 2.54-23.82; P < .001; and OR, 5.76; 95% CI, 1.86-17.88; P = .003, respectively).
This study found that nearly a third of family caregivers of older trauma patients experience high caregiver burden up to 3 months after the patients' discharge. Targeted interventions to increase caregiver self-efficacy and preparedness may reduce caregiver burden in geriatric trauma.
在美国，有超过 5000 万老年人的家庭护理人员承受着 caregiver 负担，其特征是心理困扰和身体发病。尚未充分描述老年创伤患者的 caregiver 负担的危险因素。
描述老年创伤患者 caregiver在出院后的 caregiver 负担，并确定可以为改善其体验提供信息的干预目标。
设计、地点和参与者：本研究采用重复横断面设计。参与者是从 2 个一级创伤中心之一出院的年龄在 65 岁或以上的成年创伤患者的家庭护理人员（由患者确定为提供无偿护理的家庭或朋友）。在出院后 1 个月和 3 个月通过电话对家庭护理人员进行了访谈（2019 年 12 月至 2021 年 5 月期间发生住院，数据分析于 2021 年 6 月至 2022 年 5 月进行）。
老年创伤住院。
高 caregiver 负担的定义是 Zarit 负担访谈的 12 项中有 17 项或更多项得分较高。通过修订后的护理自我效能量表和护理准备度量表分别评估 caregiver 自我效能和护理准备度。通过混合效应逻辑回归测试 caregiver 自我效能、护理准备度与 caregiver 负担之间的关联。
共有 154 名家庭护理人员参加了这项研究。他们的平均（SD）年龄为 60.6（13.0）岁（范围，18-92 岁），154 名参与者中，有 108 名（70.6%）为女性。 caregiver 负担（Zarit 负担访谈得分≥17）的比例在时间上没有变化（1 个月时，38 名 caregiver [30.9%]；3 个月时，37 名 caregiver [31.4%]）。自我效能感和护理准备度较低的护理人员更有可能经历更大的 caregiver 负担（比值比 [OR]，7.79；95%CI，2.54-23.82；P<0.001；和 OR，5.76；95%CI，1.86-17.88；P=0.003）。
这项研究发现，老年创伤患者的家庭护理人员中，近三分之一在患者出院后 3 个月内仍经历着较高的 caregiver 负担。针对增加 caregiver 自我效能感和准备度的靶向干预措施可能会减轻老年创伤患者的 caregiver 负担。
