Clinical characteristics and longitudinal changes of informal cost of Alzheimer's disease in the community
Clinical characteristics and longitudinal changes of informal cost of Alzheimer's disease in the community
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DOI：
10.1111/j.1532-5415.2006.00871.x
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发表时间：
2006-10-01
影响因子：
6.3
通讯作者：
Stern, Yaakov
中科院分区：
文献类型：
--
作者：
Zhu, Carolyn W.;Scarmeas, Nikolaos;Stern, Yaakov
对阿尔茨海默病(AD)患者非正式护理成本的大多数估计仍然是横截面的。对非正式护理时间和费用的纵向估计较少，而且是根据只涵盖较短时间的评估得出的。这项研究的目的是评估AD患者非正式护理的使用和成本的长期轨迹，以及患者特征对非正式护理的使用和成本的影响。样本来自Predictors研究，这是一个可能患有AD的大型多中心队列，在美国三个以大学为基础的AD中心(n=170)每年进行长达7年的前瞻性跟踪调查。广义线性混合模型被用来估计患者特征对非正式护理的使用和成本的影响。患者的临床特征包括认知状态(简易智力状态检查)、功能能力(幸福痴呆评定量表(BDR))、合并症、精神症状、行为问题、抑郁症状和锥体外系体征。结果表明，随着时间的推移，非正式护理使用率和护理时间(和费用)大幅增加，但与患者特征的关系不同。非正式护理的使用与认知较差、功能较差和较高的合并症显著相关。在接受非正式护理的条件下，非正式护理时间(和费用)主要与较差的功能有关。BDR每增加一分，非正式护理成本就会增加5.4%。平均每年非正式费用估计为每名患者25,381美元，从基线的20,589美元增加到第4年的43,030美元。
Most estimates of the cost of informal caregiving in patients with Alzheimer's disease (AD) remain cross-sectional. Longitudinal estimates of informal caregiving hours and costs are less frequent and are from assessments covering only short periods of time. The objectives of this study were to estimate long-term trajectories of the use and cost of informal caregiving for patients with AD and the effects of patient characteristics on the use and cost of informal caregiving. The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers in the United States (n = 170). Generalized linear mixed models were used to estimate the effects of patient characteristics on use and cost of informal caregiving. Patients' clinical characteristics included cognitive status (Mini-Mental State Examination), functional capacity (Blessed Dementia Rating Scale (BDRS)), comorbidities, psychotic symptoms, behavioral problems, depressive symptoms, and extrapyramidal signs. Results show that rates of informal care use and caregiving hours (and costs) increased substantially over time but were related differently to patients' characteristics. Use of informal care was significantly associated with worse cognition, worse function, and higher comorbidities. Conditional on receiving informal care, informal caregiving hours (and costs) were mainly associated with worse function. Each additional point on the BDRS increased informal caregiving costs 5.4%. Average annual informal cost was estimated at $25,381 per patient, increasing from $20,589 at baseline to $43,030 in Year 4.