Factors associated with long-term institutionalization of older people with dementia: Data from the Canadian study of health and aging
Factors associated with long-term institutionalization of older people with dementia: Data from the Canadian study of health and aging
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DOI：
10.1093/gerona/56.11.m693
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发表时间：
2001-11-01
影响因子：
5.1
通讯作者：
Cohen, C
中科院分区：
文献类型：
--
作者：
Hébert, R;Dubois, MF;Cohen, C
背景在加拿大，一半的痴呆症患者生活在机构中。与机构化相关的因素应确定与实施战略的目标，不仅允许那些与痴呆症留在自己的家，只要是可行的，但也要确保采取措施，及时机构化时适当的。作为加拿大健康与老龄化研究（CSHA）的一部分，我们对居住在社区的326名痴呆症患者的非正式护理人员进行了鉴定和采访。在基线访谈后2.5年和5年再次联系这些受试者，以收集有关其护理接受者状况的信息。采用考克斯比例风险模型估计风险比（HR），对痴呆患者的临床资料和与其非正式照顾者的访谈资料进行生存分析。在5年的时间里，166名痴呆症患者（50.9%）被机构化，入院的中位时间为41个月。从多变量分析中，与机构化显著相关的因素是：痴呆类型（阿尔茨海默病：HR = 1.83），残疾的严重程度（轻度：1.51;中度：2.34;总损伤：4.02），照顾者的年龄超过60岁（1.83），照顾者不是配偶或子女（1.55），严重的照顾者负担（1.71）。照顾者的负担与被照顾者的行为障碍（部分r = 0.55）和照顾者的抑郁情绪（r = 0.55）相关。筛选照顾者的负担和抑郁，并设计干预措施，以减少行为障碍对照顾者的后果将是探索减少痴呆症患者的机构化的相关途径。
Background. In Canada, half the people with dementia live in institutions. Factors associated with institutionalization should be identified with the goal of implementing strategies not only to permit those with dementia to stay in their homes as long as is feasible but also to ensure that steps are taken for timely institutionalization when appropriate.Methods. Informal caregivers of 326 individuals with dementia living in the community were identified and interviewed as part of the Canadian Study of Health and Aging (CSHA). These subjects were contacted again 2.5 and 5 years after the baseline interview to collect information on the status of their care recipients. Survival analyses using clinical data for the individuals with dementia and data from the interviews with their informal caregivers were carried out using Cox proportional hazard modeling to estimate the hazard ratio (HR).Results. Over the 5-year period, 166 individuals with dementia (50.9%) were institutionalized and the median time to admission was 41 months. From the multivariate analysis, the factors significantly associated with institutionalization were: type of dementia (Alzheimer's disease: HR = 1.83), severity of disability (mild: 1.51; moderate: 2.34; total impairment: 4.02), caregiver's age over 60 (1.83), caregiver not a spouse or child (1.55), and severe caregiver burden (1.71). Caregiver's burden was associated with the care-receiver's behavioral disturbance (partial r = .55) and the caregiver's depressive mood (r = .55).Conclusions. Screening caregivers for burden and depression and designing interventions to decrease the consequences of behavioral disturbance on caregivers would be relevant avenues to explore to decrease institutionalization of people with dementia.