Predictors of caregiver unawareness and nontreatment of dementia among residents of assisted living facilities: the Maryland Assisted Living Study.
Predictors of caregiver unawareness and nontreatment of dementia among residents of assisted living facilities: the Maryland Assisted Living Study.
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DOI：
10.1097/01.jgp.0000209214.28172.45
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发表时间：
2006-08
期刊：
影响因子：
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通讯作者：
D. Maust;C. Onyike;Jeannie-Marie E. Sheppard;L. Mayer;Quincy M. Samus;J. Brandt;P. Rabins;C. Lyketsos;A. Rosenblatt
中科院分区：
文献类型：
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作者：
D. Maust;C. Onyike;Jeannie-Marie E. Sheppard;L. Mayer;Quincy M. Samus;J. Brandt;P. Rabins;C. Lyketsos;A. Rosenblatt
辅助生活（AL）是一种快速发展的老年人居住选择。随着使用率的提高，了解在这种情况下痴呆症的检测和治疗变得非常重要，但目前所知甚少。本研究的目的是识别和评估与护理人员对阿尔茨海默氏症不知情和未能治疗阿尔茨海默氏症相关的因素。方法：该研究是对马里兰州中部阿尔茨海默氏症设施的随机样本进行横断面研究（马里兰州辅助生活研究）。老年精神病学家评估了198名参与者，并对134名居民（67.7%）进行了痴呆诊断。痴呆症在这些设施中被识别和治疗的程度是根据护理人员访谈和图表回顾数据估计的。使用逻辑回归模型，人口统计学、认知和功能测量被评估为护理人员不知情和不治疗痴呆症的预测因素。结果认知和功能障碍的严重程度、神经精神症状的数量和男性性别都是护理者对痴呆不知情的独立预测因素。家庭和照顾者对痴呆症的不了解以及女性性别是痴呆症治疗失败的预测因素。检测和治疗与种族、年龄或整体医疗健康状况无关。结论：在没有严重认知障碍或明显的行为和功能问题的居民中，护理人员更有可能不知道痴呆症。照顾者和家人的不知情反过来又与不治疗有关。在检测和治疗方面观察到的性别差异将需要复制和进一步研究。这些观察结果表明，对护理人员和家庭进行系统的教育干预可能会提高对AL环境的发现和治疗。
OBJECTIVE Assisted living (AL) is a rapidly expanding residential option for the senior population. With increased utilization, it becomes important to understand the detection and treatment of dementia in this setting, but little is known. The objective of this study was to identify and evaluate factors associated with caregiver unawareness of dementia and failure to treat dementia in AL. METHODS The setting was a cross-sectional study of a random sample of AL facilities in central Maryland (The Maryland Assisted Living Study). Geriatric psychiatrists evaluated 198 participants and assigned dementia diagnoses to 134 residents (67.7%). The extent to which dementia was recognized and treated in these facilities was estimated on the basis of caregiver interview and chart review data. Using logistic regression models, demographic, cognitive, and functional measures were evaluated as predictors of caregiver unawareness and nontreatment of dementia. RESULTS Severity of cognitive and functional impairment, number of neuropsychiatric symptoms, and male gender were all independent predictors of caregiver unawareness of dementia. Family and caregiver unawareness of dementia and female gender were predictors of failure to treat dementia. Detection and treatment were not associated with race, age, or overall medical health. CONCLUSIONS Caregivers were more likely to be unaware of dementia in residents who did not have severe cognitive impairment or obvious behavioral and functional problems. Caregiver and family unawareness were in turn associated with nontreatment. Observed gender differences in detection and treatment will require replication and further study. These observations suggest that systematic educational interventions for caregivers and families may improve detection and hence treatment in the AL setting.