Iacob Eli, Hollingshaus Mike, Utz Rebecca L, Tay Djin L, Ornstein Katherine A, Alexander Rachael, Barrientos Pamela, Ellington Lee, Newman Mike, Belnap Tom, Cizik Amy M, Smith Ken R, Meeks Huong D, Stephens Caroline E
College of Nursing, University of Utah, Salt Lake City, Utah, USA.
Kem C. Gardner Policy Institute, University of Utah, Salt Lake City, Utah, USA.
Alzheimers Dement. 2025 Jun;21(6):e14590. doi: 10.1002/alz.14590.
End-of-life (EOL) caregiving is associated with stress and burden, especially for persons with dementia. Little is known, however, about how dementia diagnosis, family structure, and co-residence influence the prevalence of antidepressants and anxiolytics (psychiatric prescriptions) among spouses and adult children during EOL caregiving.
This was a retrospective cohort study of spouses (n = 82,321) and adult children (n = 367,888) linked to decedents with (n = 35,482) and without dementia (n = 121,548) between 1998 and 2016. Multivariable logistic regression analyses examined differences in prescription rates by decedent dementia status and family characteristics.
Decedents' dementia status was associated with increased odds of psychiatric prescription for all family members (wives: odds ratio [OR] = 1.22 [1.13-1.31]; husbands: OR = 1.15 [1.00-1.32]; sons: OR = 1.01 [1.01-1.14]; daughters: OR = 1.05 [1.01-1.10]). Co-residence with the decedent reduced odds of prescriptions for daughters (OR = 0.78 [0.72-0.84]) and sons (OR = 0.73 [0.66-0.81]).
Dementia status, family structure, and co-residence may serve as useful indicators for assessing psychosocial needs, allowing health-care professionals to better identify and support families during EOL caregiving.
Antidepressant and anxiolytic prescriptions may be influenced by the availability, proximity, and structure of family associated with persons with dementia; therefore, assessing family dynamics is essential in holistic dementia care. Family caregivers of individuals with dementia were more likely than non-dementia caregivers to have a psychiatric prescription in the year leading up to the decedent's death. Findings underscore the added stress of dementia end-of-life (EOL) care and the need for greater support during this critical pre-death period. Families in which children co-resided with the decedent and those with more available members generally had lower odds of receiving psychiatric prescriptions. This suggests that family structure, living arrangements, and availability may serve as useful indicators for assessing psychosocial needs, allowing health-care professionals to better identify and support families requiring assistance during EOL dementia caregiving.
临终关怀与压力和负担相关，尤其是对患有痴呆症的患者而言。然而，关于痴呆症诊断、家庭结构和同住情况如何影响配偶和成年子女在临终关怀期间使用抗抑郁药和抗焦虑药（精神科处方）的情况，我们知之甚少。
这是一项回顾性队列研究，研究对象为1998年至2016年间与患有痴呆症（n = 35,482）和未患痴呆症（n = 121,548）的死者相关的配偶（n = 82,321）和成年子女（n = 367,888）。多变量逻辑回归分析研究了死者痴呆症状态和家庭特征对处方率的差异。
死者的痴呆症状态与所有家庭成员使用精神科处方的几率增加相关（妻子：优势比[OR]=1.22[1.13 - 1.31]；丈夫：OR = 1.15[1.00 - 1.32]；儿子：OR = 1.01[1.01 - 1.14]；女儿：OR = 1.05[1.01 - 1.10]）。与死者同住会降低女儿（OR = 0.78[0.72 - 0.84]）和儿子（OR = 0.73[0.66 - 0.81]）的处方几率。
痴呆症状态、家庭结构和同住情况可能是评估心理社会需求的有用指标，使医疗保健专业人员能够在临终关怀期间更好地识别并支持家庭。
抗抑郁药和抗焦虑药的处方可能受到与痴呆症患者相关的家庭的可及性、亲近程度和结构的影响；因此，评估家庭动态对于全面的痴呆症护理至关重要。在死者去世前一年，痴呆症患者的家庭护理人员比非痴呆症患者的护理人员更有可能开具精神科处方。研究结果强调了痴呆症临终关怀的额外压力以及在此关键的死亡前时期提供更多支持的必要性。子女与死者同住的家庭以及家庭成员更多的家庭通常获得精神科处方的几率较低。这表明家庭结构、生活安排和可及性可能是评估心理社会需求的有用指标，使医疗保健专业人员能够在痴呆症临终关怀期间更好地识别并支持需要帮助的家庭。
