Long K, Sudha S, Mutran E J
Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill 27599, USA.
J Am Geriatr Soc. 1998 Sep;46(9):1103-11. doi: 10.1111/j.1532-5415.1998.tb06648.x.
To examine the influence of caregiver burden and depressive symptomatology on elder-proxy response concordance regarding the older person's functional status and medical history.
Cross-sectional study via telephone interviews.
Community-dwelling older people and caregivers in North Carolina.
340 matched pairs of frail persons aged 65 and older and their respective caregivers.
Multidimensional Functional Assessment: The OARS methodology
Percent agreement on the ADL items ranged from 97.6% on personal hygiene to 99.7% for toileting, with moderate kappa coefficients. IADL percent agreement ranged from 71.5 to 93.7%, with fair to moderate kappa coefficients. Agreement among the medical history items ranged from 76.3 to 98.5% (kappa = .138-.831). Response bias for the IADL composite measure is influenced marginally by caregiver burden (F[259] = 1.751, P = .098). Five of the individual IADL bias items are influenced significantly by burden, such that an increase in burden results in a greater likelihood that the caregiver will overstate disability compared with the rating by the older person. Response bias on the ADL scale was increased among persons who experienced more caregiver burden (OR = 1.096, 95% CI = 1.000, 1.192) and those who spent more hours providing care (OR = 1.012, 95% CI = 1.001, 1.024). Additionally, black caregivers were more likely than white caregivers to disagree with the older people on the ADL scale (OR = 2.73, 95% CI = 1.642, 3.809). A composite of the medical history items is influenced by the relationship of the caregiver to the older person; bias is more likely among adult children ((F[227] = 1.56, P = .081).
Elder-proxy concordance is highest among ADL items, followed by medical history items and IADL items. Caregiver depressive symptomotology had no significant impact on elder-proxy response concordance on any of the three outcomes of interest: IADL and medical history bias and ADL disagreement. However, caregiver burden was marginally predictive of bias on the total ADL and IADL scales. Additionally, increased burden was significantly predictive of bias on five of the seven individual items of the IADL scale, suggesting that the more burden a caregiver feels, the greater likelihood that s/he will overstate the older person's disability compared with self-report. These findings suggest that clinicians and researchers who use proxy reports to determine treatment regimens and complete data collection efforts may do so with confidence on ADL individual items and medical history items when the older person's frailty is marginal. However, caregiver burden may result in misleading representation of the older person's functional status, specifically in regard to IADL items.
探讨照顾者负担和抑郁症状对老年人功能状态及病史的老年人代理报告一致性的影响。
通过电话访谈进行的横断面研究。
北卡罗来纳州居家的老年人及其照顾者。
340对匹配的65岁及以上体弱老年人及其各自的照顾者。
多维功能评估：OARS方法
日常生活活动（ADL）项目的一致率从个人卫生方面的97.6%到如厕方面的99.7%不等，kappa系数为中等。工具性日常生活活动（IADL）的一致率在71.5%至93.7%之间，kappa系数为一般到中等。病史项目的一致率在76.3%至98.5%之间（kappa = 0.138 - 0.831）。IADL综合测量的反应偏差受照顾者负担的影响较小（F[259] = 1.75, P = 0.098）。五个单独的IADL偏差项目受负担影响显著，即负担增加会使照顾者比老年人自评更有可能高估残疾程度。经历更多照顾者负担的人（优势比[OR] = 1.096, 95%置信区间[CI] = 1.000, 1.192）以及提供照顾时间更长的人（OR = 1.012, 95% CI = 1.001, 1.024）在ADL量表上的反应偏差增加。此外，黑人照顾者在ADL量表上比白人照顾者更有可能与老年人意见不一致（OR = 2.73, 95% CI = 1.642, 3.809）。病史项目的综合情况受照顾者与老年人关系的影响；成年子女中偏差更有可能出现（F[227] = 1.56, P = 0.081）。
老年人代理报告一致性在ADL项目中最高，其次是病史项目和IADL项目。照顾者的抑郁症状对感兴趣的三个结果（IADL和病史偏差以及ADL不一致）中的老年人代理报告一致性没有显著影响。然而，照顾者负担对ADL和IADL总量表的偏差有一定预测作用。此外，负担增加对IADL量表七个单独项目中的五个项目的偏差有显著预测作用，这表明照顾者负担感越强，与自我报告相比，其高估老年人残疾程度的可能性就越大。这些发现表明，当老年人虚弱程度较轻时，使用代理报告来确定治疗方案和完成数据收集工作的临床医生和研究人员在ADL单独项目和病史项目上可以放心使用。然而，照顾者负担可能导致对老年人功能状态的误导性描述，特别是在IADL项目方面。
