A family intervention to delay nursing home placement of patients with Alzheimer disease - A randomized controlled trial
A family intervention to delay nursing home placement of patients with Alzheimer disease - A randomized controlled trial
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DOI：
10.1001/jama.1996.03540210033030
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发表时间：
1996-12-04
影响因子：
120.7
通讯作者：
Levin, B
中科院分区：
文献类型：
--
作者：
Mittelman, MS;Ferris, SH;Levin, B
目标。目的：确定配偶、照顾者和家庭在推迟或防止老年痴呆症（AD）患者入住养老院方面的综合支持和咨询的长期有效性。-随机对照干预研究。-纽约市区门诊研究诊所。-在31年半的时间里，206名AD患者的配偶照顾者参与了这项研究。所有患者基线时均住在家中，且至少有1名亲属住在该地区。治疗组的护理人员在入组后的4个月内接受了6次个人和家庭咨询，并被要求加入支持小组。此外，咨询师随时可以提供进一步的咨询。主要结果测量。从研究中招募护理人员到将AD患者安置在养老院的时间。-使用Kaplan-Meier生存分析，我们估计治疗组AD患者从基线到养老院安置的中位时间（男性和女性护理人员估计的加权平均值）比对照组长329天（z=2.29； P= 0.02）。在调整了护理人员性别、患者年龄和患者收入后，养老院安置的Cox比例风险模型（意向治疗估计值）的相对风险（RR）为0.65(95%置信区间[CI]， 0.45至0.94；P= 0.02)，表明护理人员在任何时间点将其配偶安置在养老院的可能性大约是对照组的三分之二。治疗对轻度痴呆（RR, 0.18; 95% CI， 0.04至0.77）或中度痴呆（RR, 0.38; 95% CI， 0.17至0.82）患者的安置风险影响最大。-咨询和支持计划可以大大增加配偶照顾者能够在家照顾阿尔茨海默病患者的时间，特别是在痴呆症的早期到中期，当养老院安置通常是最不合适的。
Objective.-To determine the long-term effectiveness of comprehensive support and counseling for spouse-caregivers and families in postponing or preventing nursing home placement of patients with Alzheimer disease (AD).Design.-Randomized controlled intervention study.Setting.-Outpatient research clinic in the New York City metropolitan area.Participants.-Referred, volunteer sample of 206 spouse-caregivers of AD patients who enrolled in the study during a 31/2-year period. All patients were living at home at baseline and had at least 1 relative living in the area.Intervention.-Caregivers in the treatment group were provided with 6 sessions of individual and family counseling within 4 months of enrollment in the study and were required to join support groups. In addition, counselors were available for further counseling at any time.Main Outcome Measure.-Time from enrollment of caregivers in the study to placement of the AD patients in a nursing home.Results.-Using Kaplan-Meier survival analysis, we estimated that the median time (weighted average of estimates for male and female caregivers) from baseline to nursing home placement of AD patients was 329 days longer in the treatment group than in the control group (z=2.29; P=.02). The relative risk (RR) from a Cox proportional hazard model of nursing home placement (intent-to-treat estimate) after adjusting for caregiver sex, patient age, and patient income was 0.65 (95% confidence interval [CI], 0.45 to 0.94; P=.02), indicating that caregivers were approximately two thirds as likely to place their spouses in nursing homes at any point in time if they were in the treatment group than if they were in the control group. Treatment had the greatest effect on risk of placement for patients who were mildly demented (RR, 0.18; 95% CI, 0.04 to 0.77) or moderately demented (RR, 0.38; 95% CI, 0.17 to 0.82).Conclusions.-A program of counseling and support can substantially increase the time spouse-caregivers are able to care for AD patients at home, particularly during the early to middle stages of dementia when nursing home placement is generally least appropriate.