Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States of America.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America.
J Geriatr Oncol. 2024 Nov;15(8):102060. doi: 10.1016/j.jgo.2024.102060. Epub 2024 Sep 7.
Few studies have evaluated the potential effects of aging-related conditions like frailty in older adults with cancer on informal caregivers. Our objective was to evaluate the association between the sum total of the aging-related conditions of older adults with non-muscle-invasive bladder cancer (NMIBC) and the strain reported by their informal caregivers.
We conducted an explanatory sequential mixed methods cross-sectional survey study that recruited 81 dyads of older adults with NMIBC (age ≥ 65 at diagnosis) and their informal caregivers. Our outcome was measured by the Caregiver Strain Index (CSI), a self-reported measure of informal caregivers. Our exposure was the patient's deficit accumulation index (DAI), a validated composite measure of frailty derived from a geriatric assessment. A multivariable negative binomial regression was conducted to model CSI. We conducted qualitative thematic content analysis of responses to open-ended survey questions to understand specific types of caregiver strain and to identify coping strategies.
Mean ages of patients and caregivers were 79.4 years and 72.5 years, respectively. Most caregivers were spouses (75.3 %) and lived with the patient (80.2 %). Of patients, 54.3 % were robust, 29.6 % were pre-frail, and 16.1 % were frail. In the multivariable model, we found that patient DAI was significantly associated with CSI (adjusted incidence rate ratio 1.05, 95 % CI 1.02-1.09). The top three sources of strain identified by caregivers were emotional adjustments, medical management, and family adjustments. Coping strategies for each included self-management of emotions, self-education about bladder cancer, and social support, respectively.
In this cross-sectional study, we found that worsening frailty in an older adult with NMIBC was associated with greater informal caregiver strain. Informal caregivers reported challenges with emotional management, family dynamics, and medical tasks. These findings may inform longitudinal research and interventions to support informal caregivers who provide care for older adults with NMIBC.
很少有研究评估与衰老相关的状况（如衰弱）对老年癌症患者的非肌肉浸润性膀胱癌（NMIBC）患者及其非正式照顾者的潜在影响。我们的目的是评估老年 NMIBC 患者的与衰老相关的状况的总和与他们的非正式照顾者报告的压力之间的关联。
我们进行了一项解释性序贯混合方法的横断面调查研究，招募了 81 对患有 NMIBC（诊断时年龄≥65 岁）的老年患者及其非正式照顾者。我们的结果是通过照顾者压力指数（CSI）来衡量的，这是一种自我报告的非正式照顾者压力测量工具。我们的暴露是患者的缺陷积累指数（DAI），这是一种源自老年评估的衰弱综合测量的验证复合指标。采用多变量负二项回归模型来模拟 CSI。我们对开放式调查问题的回答进行了定性主题内容分析，以了解特定类型的照顾者压力，并确定应对策略。
患者和照顾者的平均年龄分别为 79.4 岁和 72.5 岁。大多数照顾者是配偶（75.3%），与患者同住（80.2%）。患者中，54.3%为健壮，29.6%为前期衰弱，16.1%为衰弱。在多变量模型中，我们发现患者的 DAI 与 CSI 显著相关（调整后的发病率比 1.05，95%CI 1.02-1.09）。照顾者报告的前三名压力源是情绪调整、医疗管理和家庭调整。针对每种压力源的应对策略分别是自我情绪管理、膀胱癌自我教育和社会支持。
在这项横断面研究中，我们发现老年 NMIBC 患者衰弱程度的恶化与非正式照顾者的压力增加有关。非正式照顾者报告在情绪管理、家庭动态和医疗任务方面存在挑战。这些发现可能为支持为老年 NMIBC 患者提供护理的非正式照顾者的纵向研究和干预措施提供信息。
