Change Over Time in Caregiving Networks for Older Adults With and Without Dementia
Change Over Time in Caregiving Networks for Older Adults With and Without Dementia
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DOI：
10.1093/geronb/gbz065
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发表时间：
2020-09-01
影响因子：
6.2
通讯作者：
Wolff, Jennifer L.
中科院分区：
文献类型：
--
作者：
Spillman, Brenda C.;Freedman, Vicki A.;Wolff, Jennifer L.
目的：我们提供了全国性的估计，老年人与老年痴呆症和非老年痴呆症的网络，并检查这些网络如何随着时间的推移发展。大多数以前的研究都集中在主要照顾者，很少对随着时间的推移而变化。方法：我们确定了一个队列的老年人不断遵循的国家健康和老龄化趋势研究在2011年和2015年之间，并在2015年接受家庭成员或无偿照顾者的帮助（n = 1，288）。我们研究了网络规模，类型的援助和任务分担，以及组成区分“专家”和“通才”照顾者帮助在一个与多个活动域的痴呆状态的差异。多项回归是用来估计随着时间的推移网络任务共享和composition.Results的变化：在2015年，老年痴呆症患者有较大的网络，涉及更多的任务共享比那些没有痴呆症，更经常依赖于通才照顾者，特别是子集协助医疗，家庭，流动性或自我护理活动。随着时间的推移，这些更强烈的参与通才照顾者主要占较大的dementia networks.Discussion：研究结果提供支持，需要照顾者培训管理多个任务域和痴呆症照顾者，特别是任务分享技能。更一般地说，设计新的方法，以更好地支持老年人和他们的照顾者应该考虑的复杂性，异质性，并随着时间的推移在网络中的变化。
Objectives: We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time.Method: We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288). We examine differences by dementia status in network size, types of assistance and task sharing, and composition-differentiating between "specialist" and "generalist" caregivers helping in one versus multiple activity domains. Multinomial regression is used to estimate change over time in network task sharing and composition.Results: In 2015, older adults with dementia had larger caregiving networks involving more task sharing than those without dementia and more often relied on generalist caregivers, especially the subset assisting with medical, household, and mobility or self-care activities. Uniformly greater reliance over time on these more intensely engaged generalist caregivers chiefly accounts for larger dementia networks.Discussion: Findings lend support to the need for caregiver training on managing multiple task domains and-for dementia caregivers in particular-task-sharing skills. More generally, the design of new approaches to better support older adults and their caregivers should consider the complexity, heterogeneity, and change over time in caregiving networks.