Vernooij-Dassen M, Felling A, Persoon J
Department of General Practice and Social Medicine/Centre for Quality of Care Research, University of Nijmegen, The Netherlands.
Int J Geriatr Psychiatry. 1997 Jun;12(6):671-7. doi: 10.1002/(sici)1099-1166(199706)12:6<671::aid-gps599>3.0.co;2-g.
To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients.
A prospective longitudinal study with a follow-up period of 10 months.
Dementia patients living in the community selected by Dutch general practitioners.
Pairs of demented patients and their primary caregivers (N = 138).
Sense of competence: a 27-item scale (alpha = 0.79) based on issues derived from the family crisis model and the Burden Interview. Continuity in home care is determined by the number of patient's admissions to a nursing or retirement home.
Regression analysis revealed that a change in the caregiver's sense of competence was independently predicted by characteristics of the patient, the primary caregiver and the professional social network. A decreased sense of competence was associated with a longer duration of dementia and the patient's more agitated behaviour, the caregiver's higher initial sense of competence and being a female caregiver sharing a household with the demented patient. A positive influence on the change in the sense of competence was found when these females received a professional intervention consisting of support for the caregiver. Reporting to be a Catholic or a Protestant compared with not being religiously involved positively influenced the change in sense of competence. Logistic regression analysis identified that continuity in home care was predicted by characteristics of the demented patient and the professional social network of the patient. Predictors of continuation of home care were: lower severity of dementia, patient's higher ADL impairment, the intervention and involvement of regular home help. Institutionalization was more likely when the patient's behaviour was more apathetic and a district nurse was involved in the care.
Caregiver characteristics influenced the change in sense of competence but did not influence the risk for institutionalization. Findings suggest that health professionals should pay attention to the negative consequences of agitated behaviour and to the most vulnerable group, females sharing a household with the demented patient.
探讨老年痴呆患者家庭主要照料者能力感变化及家庭护理连续性的预测因素。
一项为期10个月的前瞻性纵向研究。
由荷兰全科医生挑选的社区老年痴呆患者。
老年痴呆患者及其主要照料者配对（N = 138）。
能力感：基于家庭危机模型和负担访谈得出的问题编制的27项量表（α = 0.79）。家庭护理的连续性由患者入住疗养院或养老院的次数决定。
回归分析显示，患者、主要照料者及专业社会网络的特征可独立预测照料者能力感的变化。能力感降低与痴呆病程较长、患者更易激惹行为、照料者较高的初始能力感以及与痴呆患者同住一户的女性照料者有关。当这些女性照料者接受包括照料者支持在内的专业干预时，对能力感变化有积极影响。与无宗教信仰相比，报告为天主教徒或新教徒对能力感变化有积极影响。逻辑回归分析表明，痴呆患者的特征及患者的专业社会网络可预测家庭护理的连续性。家庭护理持续的预测因素为：痴呆严重程度较低、患者日常生活活动能力损害较高、定期上门护理的干预和参与。当患者行为更淡漠且有 district nurse 参与护理时，更有可能入住机构。
照料者特征影响能力感变化，但不影响入住机构的风险。研究结果表明，卫生专业人员应关注激惹行为的负面后果以及与痴呆患者同住一户的最脆弱群体女性。
