Acute Care Utilization by Dementia Caregivers Within Urban Primary Care Practices
Acute Care Utilization by Dementia Caregivers Within Urban Primary Care Practices
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DOI：
10.1007/s11606-008-0711-0
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发表时间：
2008-11-01
影响因子：
5.7
通讯作者：
Hendrie, Hugh C.
中科院分区：
文献类型：
--
作者：
Schubert, Cathy C.;Boustani, Malaz;Hendrie, Hugh C.
背景：照顾阿尔茨海默氏痴呆症 (AD) 患者会带来压力，研究表明这种压力会对照顾者的身心健康产生影响。然而，关于 AD 患者及其护理人员的特征导致这种压力以及它如何影响护理人员对医疗资源的使用，仍然存在许多问题。 目的：研究压力对护理人员身心健康的影响。设计：患者接受了广泛的测试，以描述他们的认知障碍程度、行为和心理症状、医疗合并症和功能能力。对护理人员的抑郁症状以及过去六个月内急诊室 (ED) 使用情况和住院情况进行了评估。使用多变量逻辑回归来评估患者的痴呆症症状对护理人员急性医疗保健利用的影响。 参与者：参加两个大型城市大学附属初级保健机构的 153 名 AD 患者及其护理人员参加了一项横断面研究，以检查痴呆症护理的各个方面影响护理人员急性医疗保健利用的情况。 结果：24% 的护理人员在紧急医疗护理期间至少接受过一次急诊就诊或住院治疗。入学前六个月。在调整护理人员的年龄、性别和教育程度后，我们的逻辑回归模型发现，护理人员的急性护理利用率与他们的抑郁症（通过 PHQ-9 测量）（OR 1.09，95% CI 1.00-1.18）、患者的行为和心理症状（通过 NPI 测量）（OR 1.04，95% CI 1.01-1.08）以及患者的功能状态（通过 NPI 测量）相关。 ADCS-ADL（OR 1.05，95% CI 1.01-1.09）。结论：为了改善 AD 护理人员的健康，初级护理系统需要重新分配资源来管理与 AD 护理接受者相关的功能、行为和心理症状。
BACKGROUND: Caring for an individual with Alzheimer's dementia (AD) is stressful, and studies show that this stress has an impact on both the physical and mental health of the caregiver. However, many questions remain about the characteristics of AD patients and their caregivers that contribute to this stress and how it impacts caregivers' use of healthcare resources.OBJECTIVE: To study the impact of stress on the physical and mental health of the caregiver.DESIGN: Patients underwent extensive testing to allow description of their degree of cognitive impairment, behavioral and psychological symptoms, medical comorbidities, and functional abilities. Caregivers were assessed for depressive symptoms and also for emergency department (ED) use and hospitalizations in the previous six months. Multivariate logistic regression was used to evaluate impact of patients' dementia symptoms on caregivers' acute care utilization.PARTICIPANTS: One hundred and fifty-three AD patients and their caregivers attending two large, urban, university-affiliated primary care practices were enrolled in a cross-sectional study to examine the facets of dementia caregiving that impact caregiver acute health care utilization.RESULTS: Twenty-four percent of the caregivers had at least one ED visit or hospitalization in the six months prior to enrollment. After adjusting for caregiver age, gender, and education, our logistic regression model found that the caregivers' acute care utilization was associated with their depression as measured by the PHQ-9 (OR 1.09, 95% CI 1.00-1.18), the patients' behavioral and psychological symptoms as measured by the NPI (OR 1.04, 95% CI 1.01-1.08), and the patients' functional status as measured by the ADCS-ADL (OR 1.05, 95% CI 1.01-1.09).CONCLUSION: To improve the health of AD caregivers, a primary care system needs to reallocate resources to manage the functional, behavioral, and psychological symptoms related to the care-recipients suffering from AD.