Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
J Am Med Dir Assoc. 2024 Jul;25(7):104981. doi: 10.1016/j.jamda.2024.03.001. Epub 2024 Apr 7.
To assess the bidirectional association of caregivers' burden and anticipatory grief with acute health care use (inpatient or emergency admission) among older adults with severe dementia.
Prospective cohort.
A total of 215 family caregivers of older adults with severe dementia in Singapore were surveyed every 4 months for 3 years (up to 10 surveys). We measured caregiver burden using the Caregiver Reaction Assessment scale and anticipatory grief using the Marwit Meuser Caregiver Grief Inventory-Short Form.
Using separate multivariable mixed-effects logistic regressions, controlling for relevant confounders, we assessed the association of caregiver burden and anticipatory grief (independent variables measured at time t) with older adults' acute health care use in the next 4 months (outcome measured at time t + 1). We also performed separate multivariable mixed-effects linear regressions to assess the association of older adults' acute health care use in the past 4 months (independent variable measured at time t) with caregiver burden and anticipatory grief (outcomes measured at time t).
At baseline, 33% of the older adults had an inpatient or emergency admission in the past 4 months. Regression results showed that higher caregiver burden [odds ratio (OR), 1.58; 95% CI, 1.15-2.16] and anticipatory grief (OR, 1.02; 95% CI, 1.00-1.04) significantly increased the likelihood of older adults experiencing acute health care use in the next 4 months. However, older adults' acute health care use in the past 4 months did not significantly change their caregivers' burden or anticipatory grief.
Higher caregiver burden and anticipatory grief increase the likelihood of older adults having acute health care use. Addressing caregivers' well-being has implications for reducing acute health care use in older adults and the economic burden of severe dementia.
评估照顾者负担和预期悲伤与严重痴呆老年人急性医疗保健使用（住院或急诊入院）之间的双向关联。
前瞻性队列研究。
共对新加坡 215 名严重痴呆老年人的家庭照顾者进行了调查，每 4 个月调查一次，为期 3 年（最多 10 次调查）。我们使用照顾者反应评估量表来衡量照顾者负担，使用 Marwit Meuser 照顾者悲伤量表-短式来衡量预期悲伤。
使用单独的多变量混合效应逻辑回归，控制相关混杂因素，我们评估了照顾者负担和预期悲伤（在时间 t 测量的自变量）与老年人在接下来的 4 个月内急性医疗保健使用之间的关联（在时间 t + 1 测量的结果）。我们还进行了单独的多变量混合效应线性回归，以评估老年人在过去的 4 个月内急性医疗保健使用（在时间 t 测量的自变量）与照顾者负担和预期悲伤之间的关联（在时间 t 测量的结果）。
在基线时，33%的老年人在过去的 4 个月内有住院或急诊入院。回归结果表明，较高的照顾者负担[比值比（OR），1.58；95%置信区间，1.15-2.16]和预期悲伤（OR，1.02；95%置信区间，1.00-1.04）显著增加了老年人在接下来的 4 个月内经历急性医疗保健使用的可能性。然而，老年人在过去的 4 个月内的急性医疗保健使用并没有显著改变他们的照顾者的负担或预期悲伤。
较高的照顾者负担和预期悲伤增加了老年人接受急性医疗保健的可能性。关注照顾者的福祉对于减少严重痴呆老年人的急性医疗保健使用和经济负担具有重要意义。
