家庭护理的利用及其在中国痴呆症护理强度和护理者负担之间的缓冲作用。
Utilization of home-based care and its buffering effects between dementia caregiving intensity and caregiver burden in China.
机构信息
Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No.200, Xiaolingwei District, Nanjing, Jiangsu Province, 210094, China.
Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, NE1 8QH, UK.
出版信息
BMC Geriatr. 2024 Nov 5;24(1):913. doi: 10.1186/s12877-024-05501-4.
BACKGROUND
Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited.
METHODS
Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden.
RESULTS
A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (β = 0.26, p < .001; β = 0.16, p < .01). However, attendance and time of supervision tasks were not significant predictors of burden. HBC services in China comprised four dimensions: Referral service, Household care, Skilled care, and Mental health service. While these did not directly predict caregiver burden, they moderated the associations between ADL-based tasks and caregiver burden (β=-0.25, p < .001; β=-0.24, p < .001; β=-0.23, p < .001; β=-0.20, p < .001), between time of ADL-based tasks and caregiver burden (β=-0.17, p < .001; β=-0.18, p < .001; β=-0.17, p < .001; β=-0.15, p < .01), and between the attendance at supervision tasks and caregiver burden (β=-0.11, p < .05; β=-0.20, p < .001; β=-0.17, p < .001; β=-0.17, p < .001). Only Referral service buffered the relationship between supervision time and caregiver burden (β = -0.13, p < .01).
CONCLUSION
Informal caregivers of PwDs face high caregiving intensity and burden. HBC services may moderate this relationship, with different services playing varying roles. Further research is essential to explore the impact of supervision levels and develop effective strategies to enhance HBC services for dementia caregiving in China.
背景
家庭护理服务因其降低痴呆症患者（PwD）非正式照顾者的照顾者负担的潜力而受到全球关注，这些照顾者经历着高强度的照顾。然而，中国关于家庭护理服务及其对痴呆症照顾影响的研究仍然有限。
方法
数据来自江苏省的 PwD 的主要照顾者。使用自我开发的工具测量照顾强度和家庭护理服务的使用情况。使用照顾者负担量表-短表评估照顾者负担。因子分析用于分解家庭护理服务。分层多元回归分析家庭护理服务对照顾强度与负担之间关系的调节作用。
结果
纳入了 318 对照顾者和 PwD 二人组的社区样本。照顾者平均年龄为 62.16 岁，61%为女性，84%未就业，66.2%收入低。PwD 的平均年龄为 77.45 岁，52.8%为女性，行为问题平均得分为 42.27。照顾者的平均得分是 15.19。ADL 为基础的任务数量和时间与照顾者负担呈正相关（β=0.26，p<0.001；β=0.16，p<0.01）。然而，监督任务的出席和时间并不是负担的显著预测因素。中国的家庭护理服务包括四个方面：转介服务、家庭护理、技能护理和心理健康服务。虽然这些服务并没有直接预测照顾者的负担，但它们调节了 ADL 为基础的任务与照顾者负担之间的关系（β=-0.25，p<0.001；β=-0.24，p<0.001；β=-0.23，p<0.001；β=-0.20，p<0.001），ADL 为基础的任务时间与照顾者负担之间的关系（β=-0.17，p<0.001；β=-0.18，p<0.001；β=-0.17，p<0.001；β=-0.15，p<0.01），以及监督任务的出席与照顾者负担之间的关系（β=-0.11，p<0.05；β=-0.20，p<0.001；β=-0.17，p<0.001；β=-0.17，p<0.001）。只有转介服务缓冲了监督时间与照顾者负担之间的关系（β=-0.13，p<0.01）。
结论
PwD 的非正式照顾者面临着高强度的照顾负担。家庭护理服务可能调节这种关系，不同的服务发挥不同的作用。进一步的研究对于探索监督水平的影响并制定有效的策略来加强中国的家庭护理服务以满足痴呆症照顾的需求至关重要。
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