测试一项旨在改善痴呆症患者及其家庭护理伙伴出院后结局的干预措施。

Testing an Intervention to Improve Posthospital Outcomes in Persons Living With Dementia and Their Family Care Partners.

作者信息

Boltz Marie, Mogle Jacqueline, Kuzmik Ashley, BeLue Rhonda, Leslie Douglas, Galvin James E, Resnick Barbara

机构信息

Ross and Carol Nese College of Nursing, The Pennsylvania State University, State College, Pennsylvania, USA.

College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, South Carolina, USA.

出版信息

Innov Aging. 2023 Aug 16;7(7):igad083. doi: 10.1093/geroni/igad083. eCollection 2023.

DOI:10.1093/geroni/igad083

PMID:37841214

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10573730/

Abstract

BACKGROUND AND OBJECTIVES

Hospitalized persons living with dementia are at risk for functional decline, behavioral symptoms of distress, and delirium, all persisting in the postacute period. In turn, family care partners (FCPs) experience increased anxiety and lack of preparedness for caregiving, compounding existing strain and burden. Family-centered Function-focused Care (Fam-FFC) purposefully engages FCPs in assessment, decision-making, care delivery, and evaluation of function-focused care during and after hospitalization (within 48 hours of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months). The objective of this study was to test the efficacy of Fam-FFC.

RESEARCH DESIGN AND METHODS

A cluster randomized controlled trial included 455 dyads of persons living with dementia and FCPs in 6 medical units in 3 hospitals. Patient outcomes included return to baseline physical function, behavioral symptoms of distress, depressive symptoms, and delirium severity. Family care partner measures included preparedness for caregiving, anxiety, strain, and burden.

RESULTS

Multilevel level modeling demonstrated that the likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.4, = .01, 95% CI 1.2-4.7). Family-centered Function-focused Care was also associated with fewer symptoms of distress ( = -1.1, = 0.56, = .05) but no differences in the amount of moderate physical activity, depressive symptoms, and delirium severity. Preparedness for caregiving increased significantly only from 2 to 6 months ( = 0.89, = 0.45, = 0.21, overall = .02) in the intervention group, with no group differences in anxiety, strain, and burden.

DISCUSSION AND IMPLICATIONS

Family-centered Function-focused Care may help prevent some of the postacute functional decline and behavioral symptoms in hospitalized persons living with dementia. Further research is needed to promote sustained improvements in these symptoms with more attention to the postacute needs of the care partner.

摘要

背景与目的

住院的痴呆症患者有功能衰退、痛苦行为症状和谵妄的风险，这些在急性后期都会持续存在。相应地，家庭护理伙伴（FCP）会经历焦虑增加和缺乏护理准备的情况，这加剧了现有的压力和负担。以家庭为中心的功能聚焦护理（Fam-FFC）有目的地让FCP参与住院期间及出院后（出院后48小时内、随后7周每周进行电话随访、再接下来4个月每月进行电话随访）功能聚焦护理的评估、决策、护理提供和评价。本研究的目的是检验Fam-FFC的疗效。

研究设计与方法

一项整群随机对照试验纳入了3家医院6个医疗单元中的455对痴呆症患者和FCP。患者结局包括恢复到基线身体功能、痛苦行为症状、抑郁症状和谵妄严重程度。家庭护理伙伴的测量指标包括护理准备、焦虑、压力和负担。

结果

多水平模型显示，到6个月末，Fam-FFC参与者随时间恢复到基线功能的可能性是对照组的两倍（OR = 2.4，P = 0.01，95%CI 1.2 - 4.7）。以家庭为中心的功能聚焦护理还与较少的痛苦症状相关（P = -1.1，β = 0.56，P = 0.05），但在中等强度身体活动量、抑郁症状和谵妄严重程度方面没有差异。干预组中，仅在2至6个月期间护理准备显著增加（P = 0.89，β = 0.45，P = 0.21，总体P = 0.02），在焦虑、压力和负担方面没有组间差异。