痴呆症患者的配偶在其伴侣去世前后的心理社会困扰。
Psychosocial distress among spouses of persons with dementia before and after their partner's death.
机构信息
Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2024 Aug;72(8):2336-2346. doi: 10.1111/jgs.19030. Epub 2024 Jun 1.
BACKGROUND
Spouses of persons living with dementia may face heightened psychosocial distress in the years immediately before and after their partner's death. We compared the psychosocial needs of spouses of partners with dementia with spouses of partners with non-impaired cognition nearing and after the end of life, focusing on loneliness, depression, life satisfaction, and social isolation.
METHODS
We used nationally representative Health and Retirement Study married couples data (2006-2018), restricting to spouses 50+ years old. We included 2098 spouses with data on loneliness and depressive symptoms 2 years before and after the partner's death. We additionally examined a subset of spouses (N = 1113) with available data on life satisfaction and social isolation 2 years before their partner's death. Cognitive status of partners was classified as non-impaired cognition, cognitive impairment not dementia (cognitive impairment), and dementia. We used multivariable logistic regression to determine: 1) the change in loneliness and depression for spouses pre- and post-partner's death, and 2) life satisfaction and social isolation 2 years before the partner's death.
RESULTS
Spouses were on average 73 years old (SD: 10), 66% women, 7% Black, 7% Hispanic non-White, 24% married to persons with cognitive impairment, and 19% married to partners with dementia. Before their partner's death, spouses married to partners with dementia experienced more loneliness (non-impaired cognition: 8%, cognitive impairment: 16%, dementia: 21%, p-value = 0.002) and depressive symptoms (non-impaired cognition: 20%, cognitive impairment: 27%, dementia: 31%, p-value < 0.001), and after death a similar prevalence of loneliness and depression across cognitive status. Before their partner's death, spouses of partners with dementia reported less life satisfaction (non-impaired cognition: 74%, cognitive impairment: 68%; dementia: 64%, p-value = 0.02) but were not more socially isolated.
CONCLUSION
Results emphasize a need for clinical and policy approaches to expand support for the psychosocial needs of spouses of partners with dementia in the years before their partner's death rather than only bereavement.
背景
痴呆症患者的配偶在伴侣去世前后的几年中可能面临更高的心理社会困扰。我们比较了痴呆症患者的配偶和认知功能正常的临终配偶的配偶的心理社会需求，重点关注孤独感、抑郁、生活满意度和社会隔离。
方法
我们使用具有全国代表性的健康与退休研究已婚夫妇数据（2006-2018 年），限制在 50 岁以上的配偶。我们包括了 2098 名在伴侣去世前 2 年有孤独感和抑郁症状数据的配偶。我们还检查了一部分有伴侣去世前 2 年生活满意度和社会隔离数据的配偶（N=1113）。伴侣的认知状态分为认知功能正常、认知障碍非痴呆（认知障碍）和痴呆。我们使用多变量逻辑回归来确定：1）配偶在伴侣去世前后孤独感和抑郁感的变化，以及 2）伴侣去世前 2 年的生活满意度和社会隔离。
结果
配偶的平均年龄为 73 岁（标准差：10），66%为女性，7%为黑人，7%为西班牙裔非白人，24%与认知障碍者结婚，19%与痴呆症患者结婚。在他们的伴侣去世之前，与痴呆症患者结婚的配偶感到更孤独（认知功能正常：8%，认知障碍：16%，痴呆症：21%，p 值=0.002）和抑郁症状（认知功能正常：20%，认知障碍：27%，痴呆症：31%，p 值<0.001），而在死亡后，不同认知状态的配偶的孤独感和抑郁症状的患病率相似。在他们的伴侣去世之前，痴呆症患者的配偶报告的生活满意度较低（认知功能正常：74%，认知障碍：68%；痴呆症：64%，p 值=0.02），但社会隔离程度不高。
结论
研究结果强调需要采取临床和政策措施，在伴侣去世前扩大对痴呆症患者配偶的心理社会需求的支持，而不仅仅是在丧亲之后。
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