将照料者支持嵌入成人日间服务中：一项多地点试验的结果。
Embedding Caregiver Support Within Adult Day Services: Outcomes of a Multisite Trial.
机构信息
AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
Center on Aging and Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
出版信息
Gerontologist. 2024 Apr 1;64(4). doi: 10.1093/geront/gnad107.
BACKGROUND AND OBJECTIVES
Adult day services (ADS) provide quality-of-life benefits to people with dementia, but few provide systematic caregiver support. We report outcomes of a multisite, national trial testing a staff-delivered caregiver program, ADS Plus.
RESEARCH DESIGN AND METHODS
Cluster-randomized trial involving 34 ADS: 18 sites provided ADS (controls) and 16 provided ADS and ADS Plus (intervention). Trained staff met with caregivers to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12 months. Main outcomes included depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and well-being at 6 and 12 months, and client attendance over 12 months.
RESULTS
Of 203 caregivers (Intervention = 102; Control = 101), 5.9% at 3 months, 12.8% at 6 months, and 22.7% at 12 months were lost to follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as White/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had ≥college education and were 65.0 years old (SD = 13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (≥16 CES-D) at baseline. By 6 months, 43.6% control versus 34.2% ADS Plus caregivers had ≥16 scores (odds ratio = 0.38, p = .072). By 12 months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p = .013) and lower depressed affect scores (p = .015). Of 18 sites providing 12-month client attendance data, 9 intervention sites reported 126.05 days attended versus 78.49 days for 9 control sites (p = .079).
DISCUSSION AND IMPLICATIONS
Compared with ADS alone, by 12 months, ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance ADS benefits.
CLINICAL TRIAL REGISTRATION
NCT02927821.
背景与目的
成人日间服务（ADS）为痴呆患者提供生活质量方面的益处，但很少有服务提供系统的护理人员支持。我们报告了一项多地点、全国性试验的结果，该试验测试了一种由员工提供的护理人员计划，即 ADS Plus。
研究设计和方法
这是一项涉及 34 个 ADS 的聚类随机试验：18 个站点提供 ADS（对照组），16 个站点提供 ADS 和 ADS Plus（干预组）。经过培训的工作人员与护理人员会面，提供有关痴呆症的教育、支持/验证、转介/联系，以及应对护理挑战和自我护理的策略，为期 12 个月。主要结果包括在 6 个月和 12 个月时的抑郁症状（流行病学研究中心抑郁量表 [CES-D]）和幸福感，以及在 12 个月时的客户出勤率。
结果
在 203 名护理人员中（干预组=102 名；对照组=101 名），3 个月时有 5.9%、6 个月时有 12.8%、12 个月时有 22.7%的护理人员失访。护理人员主要是女性（80.3%），其中 76.4%为白种人/高加索人，14.8%为黑人/非裔美国人，12.3%为西班牙裔/拉丁裔。大多数（88.2%）具有大学及以上学历，年龄为 65.0 岁（标准差=13.46）。对于那些有 6 个月数据的人，40.4%的对照组和 40.2%的 ADS Plus 护理人员在基线时就有抑郁症状（CES-D≥16）。到 6 个月时，对照组有 43.6%的护理人员和 ADS Plus 护理人员的 CES-D 评分≥16（优势比=0.38，p=0.072）。到 12 个月时，经过协变量调整后，ADS Plus 护理人员报告的总抑郁评分低于对照组（p=0.013），抑郁情绪评分也较低（p=0.015）。在提供 12 个月客户出勤率数据的 18 个站点中，9 个干预站点报告了 126.05 天的出勤，而 9 个对照站点为 78.49 天（p=0.079）。
讨论与意义
与单独的 ADS 相比，到 12 个月时，ADS Plus 改善了护理人员的情绪，并将 ADS 的利用率提高了 60.6%。结果支持 ADS 工作人员提供基于证据的护理人员支持，以增强 ADS 的益处。
临床试验注册
NCT02927821。
Zotero 插件