The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study
The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study
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DOI：
10.1177/2050312116661877
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发表时间：
2016-01-01
影响因子：
2.3
通讯作者：
Kahle-Wrobleski, Kristin
中科院分区：
文献类型：
--
作者：
Porter, Candace N.;Miller, Margaret C.;Kahle-Wrobleski, Kristin
目的：阿尔茨海默病患者痴呆的行为和心理症状以及照顾者的特征可能会影响在家中或在养老院提供护理的决定，尽管很少有研究在实际安置养老院时检查这种联系。使用配对病例对照设计，本研究调查了(1)神经精神病学总分，(2)神经精神病量表-4(激越/攻击性子量表)和(3)神经精神病量表的个别领域和养老院安置之间的关系。方法：来自南卡罗来纳州阿尔茨海默病登记处的数据提供了一个机会，通过查看疗养院护理资格/安置时的病例并允许进行倾向分数匹配的对照来扩展文献。病例(n=352)在研究开始后6个月内进入疗养院；对照(n=289)留在社区。登记数据与护理者调查数据相结合，包括神经精神病学问卷。结果：神经精神病学问卷得分增加10%意味着有已婚或男性照顾者预测养老院安置的人入住养老院的几率增加30%(优势比：1.30；95%可信区间：1.14-1.50)。在疗养院入院前1个月，患者与对照组相比更容易出现与激越/攻击有关的痴呆行为和心理症状。结论：针对痴呆的行为和心理症状的干预措施对阿尔茨海默病患者没有有效的干预措施和照顾者支持服务是必要的，以防止或推迟疗养院的入院。
Objectives: Behavioral and psychological symptoms of dementia in individuals with Alzheimer's disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case-control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement.Methods: Data from the South Carolina Alzheimer's disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied.Results: A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14-1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission.Conclusion: Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer's disease and caregiver support services are necessary to prevent or delay nursing home admission.