Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia.
Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia.
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共同关怀：为痴呆症社区居民提供有偿和家庭护理支持的轨迹。
DOI：
10.1093/geronb/gbac006
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Ornstein,KatherineA
中科院分区：
文献类型：
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作者：
Reckrey,JenniferM;Li,Lihua;Zhan,Serena;Wolff,Jennifer;Yee,Cynthia;Ornstein,KatherineA
目的照顾者(例如，家庭健康助手)经常与家庭照顾者合作，支持家中的痴呆症患者。我们确定了(A)有高度护理需求的痴呆症患者中付费和家庭护理支持的独特轨迹以及(B)与这些轨迹相关的因素。方法我们使用基于组的多轨迹建模来确定死亡或搬到养老院的痴呆症患者(n=334，平均随访5.5年)的付费和家庭护理时间的不同轨迹。结果3组模型最符合我们的数据：(A)“低/稳定护理”(61.3%的受访者)，包括稳定、低/无报酬护理和中等家庭护理；(B)“增加付费护理”，包括增加、中等报酬和家庭护理；(C)“高家庭护理”，包括增加、高家庭护理和稳定、低报酬护理。虽然“增加付费护理”和“高家庭护理”组比“低/稳定护理”组的功能受损更严重，但“高家庭护理”组也更有可能是非白人，并经历了多种医疗并发症、抑郁症和社会孤立。讨论研究结果强调了在痴呆症护理中考虑独特安排的重要性。是否接受付费护理不仅取决于病人的护理需求。随着护理需求的增长，建立平等获得付费护理的机会可能是支持痴呆症患者及其家庭照顾者的一种特别重要的方式。
ObjectivesPaid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify (a) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and (b) factors associated with these trajectories.MethodsWe used group-based multiple trajectory modeling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study respondents with dementia who died or moved to a nursing home (n= 334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modeling.ResultsA 3-group model best fit our data: (a) “low/stable care” (61.3% of respondents) with stable, low/no paid care and moderate family care, (b) “increasing paid care” with increasing, moderate paid and family care, and (c) “high family care” with increasing, high family care and stable, low paid care. While both the “increasing paid care” and “high family care” groups were more functionally impaired than the “low/stable care” group, the “high family care” group was also more likely to be non-White and experience multiple medical comorbidities, depression, and social isolation.DiscussionStudy findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.