Does Caregiving Strain Increase as Patients With and Without Dementia Approach the End of Life?
Does Caregiving Strain Increase as Patients With and Without Dementia Approach the End of Life?
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DOI：
10.1016/j.jpainsymman.2018.11.004
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发表时间：
2019-02-01
影响因子：
4.7
通讯作者：
Wolff, Jennifer L.
中科院分区：
文献类型：
--
作者：
Vick, Judith B.;Ornstein, Katherine A.;Wolff, Jennifer L.
上下文家庭照顾者在老年痴呆症患者的临终关怀中扮演着重要而苛刻的角色。本研究的目的是确定老年人接近生命的尽头时，痴呆症照顾者的工作压力是否会增加，其次，这种关联是否与非痴呆症患者不同。参与者包括一个具有全国代表性的样本，社区生活的老年人接受帮助自我照顾或室内移动和他们的主要照顾者（3422对）。老年人在调查后12个月内的死亡情况是根据相关的医疗保险登记文件进行评估的。在综合调整其他老年人和照顾者因素后，使用多变量logistic回归评估痴呆和临终状态之间的关联，并使用一个综合衡量标准来衡量老年人的压力（范围：0-9，使用5的临界点来定义“高”压力）。在我们的样本中，痴呆症的患病率为30.1%; 13.2%的样本在12个月内死亡。经历高压力的照顾者的比例范围从非痴呆、非临终照顾者的13.5%到12个月内死亡的老年人的痴呆照顾者的35.0%。在痴呆症照顾者中，那些帮助接近生命尽头的老年人的人，高生活压力的几率几乎是他们的两倍（aOR = 1.94，95%CI：1.10-3.45）。在非痴呆的照顾者中，在生命的最后阶段提供照顾与高压力无关。对于痴呆症照顾者来说，生命结束时的压力增加尤其明显。需要采取干预措施来满足这一人群的需求。(C)2018年美国临终关怀和姑息医学学会。爱思唯尔公司出版All rights reserved.
Context. Family caregivers play critical and demanding roles in the care of persons with dementia through the end of life.Objectives. The objective of this study was to determine whether caregiving strain increases for dementia caregivers as older adults approach the end of life, and secondarily, whether this association differs for nondementia caregivers.Methods. Participants included a nationally representative sample of community-living older adults receiving help with self-care or indoor mobility and their primary caregivers (3422 dyads). Older adults' death within 12 months of survey was assessed from linked Medicare enrollment files. Multivariable logistic regression was used to assess the association between dementia and end-of-life status and a composite measure of caregiving strain (range: 0-9, using a cut point of 5 to define "high" strain) after comprehensively adjusting for other older adult and caregiver factors.Results. The prevalence of dementia in our sample was 30.1%; 13.2% of the sample died within 12 months. The proportion of caregivers who experienced high strain ranged from a low of 13.5% among nondementia, noneend-of-life caregivers to a high of 35.0% among dementia caregivers of older adults who died within 12 months. Among dementia caregivers, the odds of high caregiving strain were nearly twice as high (aOR = 1.94, 95% CI: 1.10-3.45) for those who were assisting older adults nearing end of life. Among nondementia caregivers, providing care near the end of life was not associated with high strain.Conclusion. Increased strain toward the end of life is particularly notable for dementia caregivers. Interventions are needed to address the needs of this population. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.