在疾病与健康中：孤独、抑郁以及痴呆患者配偶的婚姻质量所扮演的角色。
In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia.
机构信息
Division of General Internal Medicine, University of California, San Francisco, California, USA.
Division of Geriatrics, University of California, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2023 Nov;71(11):3538-3545. doi: 10.1111/jgs.18520. Epub 2023 Aug 4.
BACKGROUND
Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.
METHODS
We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.
RESULTS
The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).
CONCLUSIONS
One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.
背景
与患有痴呆症的人（PLwD）生活在一起的老年配偶可能面临孤独和抑郁的风险。我们评估了配偶为 PLwD 或认知障碍但非痴呆症（CIND）患者、以及婚姻质量在这些结果中的中介作用的配偶中孤独和抑郁症状的患病率。
方法
我们使用了一项基于美国人群的样本，其中包括参加健康与退休研究（2014 年和 2016 年）的 4071 对夫妇。我们纳入了配偶为 PLwD（n=227）、配偶为 CIND 患者（n=885）或配偶无认知障碍（NCI）（n=2959）的老年人。我们使用多变量逻辑回归调整了社会人口统计学和健康相关特征，确定了孤独感（UCLA 3 项量表）、抑郁症状（CESD-8 量表）以及两者的患病率。然后，我们测试了婚姻质量（4 项量表）和配偶认知障碍程度之间的交互项对于孤独和抑郁症状的每种结果。
结果
样本中 55%为女性，平均年龄为 67 岁（范围：50-97 岁）。调整后，认知障碍患者的配偶更有可能感到孤独（NCI：20%，CIND：23%，PLwD：29%；p=0.04）、抑郁（NCI：8%，CIND：15%，PLwD：14%；p<0.01）以及两者（NCI：4%，CIND：9%，PLwD：7%；p<0.01）。认知与孤独之间的关联，但与抑郁无关，这取决于婚姻质量（交互 p 值=0.03）。在婚姻质量高的夫妇中，配偶的认知障碍与更高的孤独感相关（p<0.05）。相比之下，在婚姻质量较低的夫妇中，配偶认知与孤独感之间没有关联（p=0.37）。
结论
六分之一的 CIND 或更严重疾病（PLwD）患者的配偶患有抑郁症状，而 PLwD 患者的配偶中孤独感的发生率则为两倍。通过识别和管理这些问题，并促进促进高质量社交联系的干预措施，临床团队可能会改善面临痴呆症的老年夫妇的生活。
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