Impact of caring for persons with Alzheimer's disease or dementia on caregivers' health outcomes: findings from a community based survey in Japan.
Impact of caring for persons with Alzheimer's disease or dementia on caregivers' health outcomes: findings from a community based survey in Japan.
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DOI：
10.1186/s12877-016-0298-y
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发表时间：
2016-06-10
期刊：
影响因子：
4.1
通讯作者：
Ueda K
中科院分区：
文献类型：
--
作者：
Goren A;Montgomery W;Kahle-Wrobleski K;Nakamura T;Ueda K
本研究评估了日本阿尔茨海默病（AD）或痴呆症患者的家庭照顾者与非照顾者在特征和健康结果（即合并症、与健康相关的生活质量[HRQoL]、生产力和资源利用）方面的差异。假设照顾者的结果明显比非照顾者差。数据来自2012年和2013年日本全国健康和保健调查（n = 60000）。研究人员对患有AD或痴呆的成年亲属的照顾者与无照顾者在以下方面进行了比较：合并症（包括患者健康问卷（PHQ-9）显示是否存在重度抑郁症（MDD）的截止分数）、工作效率和活动障碍（WPAI）、基于sf -36v2的HRQoL和医疗资源利用。各组间比较社会人口学特征、健康特征和行为以及Charlson共病指数（CCI）得分。倾向匹配，基于预测护理的逻辑回归产生的分数，用于匹配照顾者与非照顾者，他们成为照顾者的可能性相似。配对组间的双变量比较用于估计由于护理引起的结果差异。在55060名受访者中，与非照顾者（n = 53758）相比，照顾者（n = 1302）年龄较大（52.6岁对47.5岁），女性更频繁（53%对49%），已婚/有伴侣，经常饮酒，目前吸烟，锻炼，没有工作，他们的平均CCI得分更高（0.37比0.14），均p < 0.05。倾向得分包括性别、年龄、身体质量指数（BMI）、运动、饮酒、吸烟、婚姻状况、CCI、保险状况、教育、就业、收入和家庭子女。贪婪匹配算法产生了1297个精确匹配，排除了5个不匹配的看护者。护理者的健康效用得分（0.724）明显低于非护理者（0.764），SF-36v2身心成分总结得分也是如此。在过去的六个月里，照顾者与非照顾者相比，缺勤率、出勤相关障碍、整体工作障碍（分别为25.8%对20.4%）和活动障碍（25.4%对21.8%）明显更高，急诊室和传统提供者就诊次数（7.70对5.35）更多，MDD（14%对9%）、抑郁、失眠、焦虑和疼痛更频繁。在日本，那些为阿尔茨海默氏症或痴呆症患者提供护理的人的HRQoL明显较差，合并症风险、生产力损害和资源使用更高。这些发现表明需要对护理人员及其患者提供更多支持。
This study assessed how family caregivers for patients with Alzheimer’s disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes (i.e., comorbidities, health-related quality of life [HRQoL], productivity, and resource use). Caregivers were hypothesized to experience significantly poorer outcomes than non-caregivers. Data were combined from the 2012 and 2013 National Health and Wellness Survey in Japan (n = 60000). Caregivers for adult relatives with AD or dementia were compared with non-caregivers on: comorbidities (including Patient Health Questionnaire (PHQ-9) cutoff scores suggesting presence/absence of major depressive disorder (MDD)), Work Productivity and Activity Impairment (WPAI), SF-36v2-based HRQoL, and healthcare resource utilization. Sociodemographic characteristics, health characteristics and behaviors, and Charlson comorbidity index (CCI) scores were compared across groups. Propensity matching, based on scores generated from a logistic regression predicting caregiving, was used to match caregivers with non-caregivers with similar likelihood of being caregivers. Bivariate comparisons across matched groups served to estimate outcomes differences due to caregiving. Among 55060 respondents, compared with non-caregivers (n = 53758), caregivers (n = 1302) were older (52.6 vs. 47.5 years), more frequently female (53 % vs. 49 %), married/partnered, frequent alcohol drinkers, current smokers, exercisers, and not employed, and they averaged higher CCI scores (0.37 vs. 0.14), all p < 0.05. Propensity scores incorporated sex, age, body mass index (BMI), exercise, alcohol, smoking, marital status, CCI, insured status, education, employment, income, and children in household. A greedy matching algorithm produced 1297 exact matches, excluding 5 non-matched caregivers. Health utilities scores were significantly lower among caregivers (0.724) vs. non-caregivers (0.764), as were SF-36v2 Physical and Mental Component Summary scores. Caregivers vs. non-caregivers had significantly higher absenteeism, presenteeism-related impairment, overall work impairment (25.8 % vs. 20.4 %, respectively), and activity impairment (25.4 % vs. 21.8 %), more emergency room and traditional provider visits (7.70 vs. 5.35) in the past six months, and more frequent MDD (14 % vs. 9 %), depression, insomnia, anxiety, and pain. Those providing care for patients with AD or dementia in Japan experienced significantly poorer HRQoL and greater comorbid risk, productivity impairment, and resource use. These findings inform the need for greater support for caregivers and their patients.