Caregiving as a risk factor for mortality - The caregiver health effects study
Caregiving as a risk factor for mortality - The caregiver health effects study
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DOI：
10.1001/jama.282.23.2215
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发表时间：
1999-12-15
影响因子：
120.7
通讯作者：
Beach, SR
中科院分区：
文献类型：
--
作者：
Schulz, R;Beach, SR
背景
人们普遍认为，照顾残疾老年人对许多家庭成员来说是沉重的负担且压力巨大，并会导致精神疾病的发生。研究人员还指出，失落感、长期的痛苦、照顾的体力要求以及老年照顾者自身的生理脆弱性相结合，可能会损害他们的生理机能，增加他们出现身体健康问题的风险，进而导致死亡率上升。
目的
在控制社会人口统计学因素、基线时的临床疾病和亚临床疾病的情况下，研究老年配偶照顾者的照顾需求与4年全因死亡率之间的关系。
设计
基于人群的前瞻性队列研究，从1993年到1998年，平均随访4.5年。
地点
美国的四个社区。
参与者
共有392名照顾者和427名非照顾者，年龄在66岁到96岁之间，且与配偶共同生活。
主要观察指标
基于照顾水平的4年死亡率：（1）配偶无残疾；（2）配偶残疾但未提供帮助；（3）配偶残疾且提供帮助但未报告有压力；（4）配偶残疾且提供帮助并报告有精神或情感压力。
结果
经过4年的随访，103名参与者（12.6%）死亡。在对社会人口统计学因素、常见疾病和亚临床心血管疾病进行调整后，提供照顾且经历照顾者压力的参与者的死亡风险比非照顾对照组高63%（相对风险[RR]，1.63；95%置信区间[CI]，1.00 - 2.65）。提供照顾但未经历压力的参与者（RR，1.08；95%CI，0.61 - 1.90）以及配偶残疾但未提供照顾的参与者（RR，1.37；95%CI，0.73 - 2.58）相对于非照顾对照组，调整后的死亡率没有升高。
结论
我们的研究表明，作为一名经历精神或情感压力的照顾者是老年配偶照顾者死亡的一个独立风险因素。报告与照顾相关压力的照顾者比非照顾对照组更有可能死亡。
Context There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality.Objective To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline.Design Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up. Setting Four US communities. Participants A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses.Main Outcome Measure Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported.Results After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95% CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls.Conclusions Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.