驻京部队干休所居家痴呆照料者负担调查研究

目的 调查驻京部队干休所居家痴呆照料者负担及心理状况.方法 2009年1月～2009年4月,以驻京部队干休所81例临床诊断痴呆患者和76例非痴呆患者的主要照料者为调查对象,采用照料者负担问卷、抑郁和焦虑自评量表等进行评估,所有数据使用SPSS 13.0分析.结果 调查发现痴呆患者照料者较非痴呆患者照料者的负担更重,负担...     

驻京部队干休所居家痴呆照料者需求与身心负担的相关性研究

目的 探讨驻京部队干休所痴呆照料者需求现况及与其身心负担的相关性.方法 采用问卷调查方法,调查者通过发放问卷,对81位痴呆患者的主要照料者进行调查.结果 照料者总体需求呈中等程度,标化得分为(56.08±20.79)分;知识技能需求标化得分为(58.63±21.63)分;社会支持需求得分为(49.66±26.28)分.焦虑(32.47±8.25)分、抑郁(35.04±9.47)分、负担总分(18.91±11.47)分,其中社会支持需求得分与身心负担呈正相关.结论 驻京部队干休所痴呆照料者广泛存在中等程度的需求,满足照料者的需求,有助于减轻其身心负担.     

照料者负性情绪与痴呆患者的认知和精神行为症状的相关性研究

目的探讨痴呆患者的认知和精神行为症状对其照料者负性情绪的影响,为更好地提供卫生服务提供依据。方法调查101例痴呆伴精神行为症状(BPSD)的患者及其照料者,采用蒙特卡利认知评估量表(MoCA)和神经精神评估量表(NPI)对痴呆患者评估,同时对照料者使用抑郁自评量表(SDS)和焦虑自评量表(SAS)进行评估,并作相关性分析。结果照料者的抑郁情绪和焦虑情绪与痴呆患者的精神行为症状总分呈正相关(P0.05)。其中,照料者的抑郁情绪与痴呆患者的焦虑症状呈正相关(P0.05),照料者的焦虑情绪与痴呆患者的妄想症状、异常运动行为、睡眠/夜间行为呈正相关(P0.05)。多重线性回归分析显示,痴呆患者的焦虑情绪以及异常行为是照料者抑郁情绪的影响因素(P0.01);照料者的年龄、痴呆患者的异常运动行为、睡眠异常是照料者焦虑情绪的影响因素(P0.05)。结论痴呆患者的焦虑情绪会影响照料者的抑郁情绪;痴呆患者的异常运动行为和睡眠异常可影响照料者的焦虑情绪。识别并且对痴呆患者的焦虑和异常行为等症状重点干预,有利于照料者对痴呆患者的长期照护。     

阿尔茨海默病照料者心理压力及影响因素分析

目的探讨引起阿尔茨海默病患者主要照料者心理压力包括负担、焦虑及抑郁的影响因素。方法采用神经精神科问卷、简易精神状态量表、蒙特利尔认知评估量表、画钟测验、Zarit护理者负担量表、广泛性焦虑障碍-7量表及患者健康问卷抑郁量表对天津市环湖医院痴呆门诊的200例AD患者及他们的主要照料者进行调查、评估。结果照料者负担(11.52±13.02)与NPI(P0.01)、护理患者年限(P0.01)存在高度相关性;照料者焦虑(2.15±3.56)与NPI(P0.01)、护理患者年限(P0.01)存在显著相关性;照料者抑郁(3.52±3.37)与NPI(P0.01)、增加照料者人数(P0.05)存在相关性。结论 AD主要照料者大部分存在负担、焦虑及抑郁情况及风险,通过了解这些心理状态的影响因素,能够帮助医护人员快速、有效的发现和治疗照料者的心理健康问题。     

老年痴呆病人照料者心理健康和生活质量分析

[目的]分析保定市社区老年痴呆病人照料者的心理健康状况和生活质量. [方法]利用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、世界卫生组织生活质量测定简表(WHOQO-BREF) (中文版),对保定市社区确诊的113例老年痴呆患者的家庭主要照料者(研究组)进行调查,并同非痴呆老年病人照料者(对照组)进行对比. [结果]保定社区老年痴呆照料者抑郁情绪和焦虑情绪患病率分别为49.55%和54.95%,均显著高于对照组,HAMD、HAMA得分显著高于对照组;生活质量得分低于对照组. [结论]老年痴呆病人照料者心理健康水平显著低于非痴呆病人照料者,而且生活质量显著降低.     

军队干休所离退休干部抑郁情绪现状调查

目的:了解部队干休所老年人抑郁情绪现状。方法:用老年抑郁自评量表(GDS),对某部离退休干部及部分家属340人进行调查,并对相关因素进行分析。结果:340人中,存在轻度抑郁者52人,占15%;比较严重抑郁者9人,占3%。住院患者总分显著高于机关大院(P<0.05)和干休所人群(F=3.336,P<0.01),高中学历者总分显著高于大学学历者(F=2.390,P<0.05),性别、年龄差异不显著性差异。结论:部队离退休人员存在一定程度的抑郁倾向,住院患者由于患有各种较严重的疾病,抑郁情绪较正常健康人群更为显著,且高中学历者较大学学历者更为严重。     

老年痴呆病人照料者负担及相关因素分析

目的揭示老年痴呆患者照料者的负担程度,为养老制度的改革提供参考。方法对233例老年患者的家庭照料者进行调查,采用方差分析的方法比较不同类型患者间的负担差异。结果老年痴呆组照料者在护理负担Zarit平均得分为71.04,血管性痴呆组平均得分为55.76,混合性痴呆组平均得分为66.61,非痴呆组为32.96;混合性痴呆组照料者每月花费1490元为最高,其次是老年痴呆组的照料者。照料花费的时间,混合性痴呆组最高,为7.96小时,其次是老年痴呆组。结论痴呆患者家庭照料者的负担高于非痴呆患者照料。     

心力衰竭患者配偶照顾者焦虑抑郁状况及其影响因素

目的了解心力衰竭(简称心衰)患者配偶照顾者的焦虑抑郁状况,分析其影响因素。方法采用一般资料问卷及ZUNG焦虑自评量表(SAS)、抑郁自评量表(SDS)对150例心衰患者配偶照顾者进行问卷调查。结果心衰患者配偶照顾者焦虑、抑郁评分分别为(48.82±7.64)分和(46.79±6.85)分,均高于国内常模(P0.01)。多元回归分析结果显示,配偶照顾者年龄、医疗费用负担、有无照顾经验、累计照顾时间是影响其焦虑情绪的主要因素(均P0.05);抑郁情绪的主要影响因素是配偶照顾者性别、医疗费用负担及患者心功能(均P0.05)。结论心衰患者配偶照顾者焦虑抑郁水平较高,其焦虑情绪受配偶照顾者年龄、医疗费用负担、有无照顾经验、累计照顾时间影响,其抑郁情绪受配偶照顾者性别、医疗费用负担及患者心功能影响。医护人员需重视对这一特殊人群的心理干预,以减轻其焦虑抑郁。     

首次住院儿童精神分裂症患者父母情绪状况调查

目的调查首次住院儿童精神分裂症患者父母的情绪状况。方法采用焦虑自评量表、抑郁自评量表对83例首次住院儿童精神分裂症患者父母的情绪状况进行调查,并以同期早期干预首次住院的60例成人精神分裂症患者父母60例为对照。结果首次住院儿童精神分裂症患者父母的焦虑、抑郁发生率分别为44.58%和48.19%,对照组分别为16.67%和18.33%两组比较差异均有非常显著性(焦虑χ2=12.30,抑郁χ2=13.53,均P<0.01)。焦虑、抑郁评分调查组分别为(48.3±9.3)和(44.3±10.9)分,对照组分别为(43.8±7.3)和(39.3±10.6)分,两组比较t值分别为3.09和4.59,均P<0.01。结论精神分裂症患儿父母的焦虑、抑郁水平高于对照组,提示在患儿治疗的同时,还应做好患儿父母的心理疏导,以减轻他们的焦虑、抑郁程度。     

慢性阻塞性肺疾病患者焦虑和抑郁情绪调查分析

目的探讨慢性阻塞性肺疾病(COPD)患者合并抑郁焦虑情绪的特点,完善康复治疗方法。方法选择145例COPD患者(观察组)和145例同期呼吸科门诊或住院患者(对照组),进行医院焦虑抑郁量表问卷调查,了解抑郁焦虑情绪发生的比例和相关因素。结果 COPD组的抑郁(10. 70±4. 57)和焦虑(11. 69±4. 55)量表得分均显著高于对照组。145例COPD患者有抑郁情绪的患者有50人(34. 5%),达到抑郁症状肯定存在标准者62人(42. 8%)。有焦虑情绪者46例(31. 7%),达到焦虑症状肯定存在标准者71人(49. 0%)。重度和极重度COPD比轻中度患者抑郁和焦虑情况更严重,文化程度高、经济情况好的人群产生抑郁和焦虑程度低。结论 COPD患者中抑郁焦虑情绪发生率较高,良好的社会支持、家属参与的健康教育可以促进COPD康复,临床中需要实行药物以及社会、心理方面的综合治疗。     

Coordination between formal providers and informal caregivers

BACKGROUND: The increased "outsourcing" of care-related tasks to patients and their informal caregivers is part of a broader trend in service industries toward engaging customers as "coproducers" of service outcomes. As both quasi-patients and quasi-providers, caregivers may play a critical role in successful coproduction, but they require coordination with care providers to play this role effectively. When tasks are highly interdependent, uncertain, and time constrained, as they often are in health care, relational forms of coordination are expected to be most effective. PURPOSES: This study explores the effects of coordination between formal providers and informal caregivers on caregiver preparation to provide care at home and the effect of caregiver preparation on patient outcomes. Gittell's theory of relational coordination posits that effective coordination occurs through frequent, high-quality communication that is supported by relationships of shared goals, shared knowledge, and mutual respect. We extend the relational coordination model, previously used to examine coordination between formal providers, to encompass coordination of care between formal providers and informal caregivers. METHODOLOGY: We surveyed patients before and 12 weeks after knee replacement surgery to assess outcomes. At 6 weeks postsurgery, we surveyed their caregivers regarding coordination with providers and preparation to provide care. FINDINGS: We found that relational coordination between formal providers and caregivers improves caregiver preparation to provide care, which, in turn, is positively associated with patients' freedom from pain, functional status, and mental health. IMPLICATIONS: Providers should be encouraged to attend to the interpersonal aspects of their interactions with caregivers to promote relational coordination, which may ultimately benefit the patient's health. It is not enough, however, to urge providers to build shared goals, shared knowledge, and mutual respect with patients and caregivers. Dedicated resources and support are needed, given the context of constrained resources and brief encounters in which providers deliver care.     

Understanding factors that influence the demand for dialysis among elderly in a multi-ethnic Asian society

BackgroundDespite literature suggesting conservative management (CM) is a viable option for elderly comorbid ESRD patients, the vast majority in Singapore receive dialysis. We hypothesized that the high demand for dialysis is driven by 1) lack of knowledge of CM and relative benefits of dialysis to CM, 2) adherence to physician recommendations which favour dialysis, and 3) high subsidies for haemodialysis (HD).MethodsWe tested these hypotheses via a survey, including a discrete choice experiment (DCE), administered to 151 elderly pre-dialysis kidney patients and their family caregivers.ResultsResults are consistent with the hypotheses: 40% (95% Confidence Interval (CI) 32–48) of patients and 46% (CI 38–55) of caregivers reported not being aware of CM, and 43% (CI 35–51) of patients and 24% (CI 17–31) of caregivers could not provide information on expected survival for dialysis or CM. Yet, once aware of CM as an option, 54% of patients and 42% of caregivers chose CM. However, if their physician recommended dialysis, 49% (CI 40–58) of patients and 68% (CI 59–77) of caregivers switched their choice. Subsidies on HD further reduced demand for CM by 6 percentage points.ConclusionsThese results reveal that the high demand for dialysis is driven mostly by lack of awareness of CM as an option and by physician recommendations for dialysis over CM.     

A comparison of the well-being of family caregivers of elderly patients hospitalized with physical impairments versus the caregivers of patients hospitalized with dementia

OBJECTIVES: This study investigated the differences between the level of well-being of caregivers of older patients hospitalized with dementia and the well-being of caregivers of older patients hospitalized with physical impairments. It also explored the relationships between social roles, religious faith, and well-being. SETTING: Two groups were constructed to compare caregivers' well-being levels: caregivers of patients with dementia and caregivers of patients with physical impairments. The groups were caregivers of patients of two geriatric hospitals in central Israel. Patients were categorized by their medical files according to their medical diagnosis. PARTICIPANTS: A total of 107 caregivers participated in this research. Of that number, 46% were caregivers of patients with physical impairments while the other 54% were caregivers of patients with dementia. The patients with physical impairments suffered from stroke, hip fractures, Parkinson's disease, diabetes, and heart and lung diseases. The patients with dementia suffered from Alzheimer's disease or related dementia. Of the total number of patients, 67% were males and 33% were females. INTERVENTION: The caregivers were asked to fill out a questionnaire that included 90 questions. Some of the questionnaires were given to the caregivers to be filled out at home. MEASUREMENTS: The questionnaire integrated three subcategories: well-being, identity accumulation, and religious faith. RESULTS: Differences were found only in the dimensions of social activity. Caregivers of the patients with physical impairments were found to attend synagogues and clubs more than caregivers of the patients with dementia did. The number of the caregivers' social roles were found to have been significantly related to caregivers' mental health. A negative correlation was found between the intensity of religious faith and the level of the caregivers' spouses' self-rated physical and mental health: those of stronger faith rated their physical health lower and were reported to have more symptoms of stress. CONCLUSION: There are no significant differences between the level of well-being of caregivers of patients with dementia and caregivers of patients with physical impairments. Both groups of caregivers are at great risk of compromised physical and mental health, of decreased social activity, and of financial distresses. Various social roles and religious faith may enhance the caregiver's well-being. However, the spouse's religious faith has negative effects on their own well-being. These results call for welfare services and religious organizations to form support groups for family caregivers. They also make clear that all caregivers should benefit from the same social support if their older relatives are hospitalized.     

Women's work at end of life: The intersecting gendered vulnerabilities of patients and caregivers in rural Malawi

ABSTRACT

Gender inequality in the form of gender-based violence manifests throughout the course of women's lives but has a particularly unique impact at end of life. We sampled 26 patients and 14 caregivers for this qualitative critical ethnographic study. The study purpose was to describe the lived experience of female palliative care patients in rural Malawi and their caregivers. The specific aims were to (i) analyse physical, spiritual and mental health needs and (ii) guide best healthcare practice. The study was informed by feminist epistemology, which drew us to an analysis focused on how gender inequality and gender-based violence affect the care of those with terminal illness. In this article, based on our findings, we demonstrate how gender inequality manifests through the intersecting gendered vulnerabilities of patients and their caregivers in rural Malawi. The findings specifically provide insight into the gendered nature of care work and how the gendered life trajectories of both patients and caregivers intersect to impact the health and well-being of both groups. Our findings have implications on how palliative care can be scaled up in rural Malawi in support of women who are experiencing intimate partner violence at end of life, and the caregivers responsible for their well-being.     

Satisfaction with care as a quality-of-life predictor for stroke patients and their caregivers

Purpose

We sought to identify indicators associated with the quality of life (QoL) of stroke patients and caregivers.

Methods

The cross-sectional study was conducted at nine Dutch stroke service facilities involving 251 stroke patients and their caregivers. We used the EuroQol (EQ-5D) and Satisfaction with Stroke Care questionnaires, and included the variables (1) disability at hospital admission, (2) length of hospital stay, (3) demographic data, and (4) caregivers?? relationship with stroke patients. The Actor?CPartner (patient?Ccaregiver) Interdependence Model (APIM) was used to examine dependence between patients?? and caregivers?? QoL scores through dyad membership.

Results

Patients?? age was significantly related to their QoL, and caregivers?? age and educational level were significantly related to their QoL. Patients?? disability on hospital admission and length of stay were associated with patients?? QoL, and their disability on admission was related to caregivers?? QoL. No relationship was found between length of stay and caregivers?? QoL. Satisfaction with care was associated with both patients?? and caregivers?? QoL.

Conclusions

The APIM distinguished the different roles of patients and caregivers while acknowledging the interdependence of their QoL scores. Satisfaction with care was identified as important indicator of stroke patients?? and caregivers?? QoL.     

胃癌复发患者家庭照顾者死亡焦虑现状及影响因素分析

目的 了解胃癌复发患者家庭照顾者死亡焦虑现状并分析其影响因素。方法 便利抽取205例胃癌复发患者及其家庭照顾者,使用死亡焦虑量表（T - DAS）,并结合一般资料问卷、自我调节疲劳量表（SRF - S）、照顾者积极感受量表（PAC）对其进行调查。结果 胃癌复发患者家庭照顾者死亡焦虑得分为（37.94±6.92）分。回归分析结果显示,患者的日常生活能力指数,照顾者的健康自评、年龄、自我调节疲劳和积极感受影响照顾者死亡焦虑,可解释总体变异度的63.7%。结论 胃癌复发患者家庭照顾者死亡焦虑呈较高水平,患者的日常生活能力指数,照顾者的健康自评、年龄、自我调节疲劳和积极感受是其影响因素。医护人员应针对以上因素制定有效的护理措施,减轻照顾者死亡焦虑。     

Caregiving Experiences and Health Conditions of Women Veteran and Non-Veteran Caregivers

BackgroundUnique experiences, for example, trauma, of women veteran caregivers may create differences in the caregiving experience and may be associated with health concerns. We examined caregiving factors and health concerns in women veteran caregivers compared to non-veteran women (civilian) caregivers, and identified variables associated with being a woman veteran caregiver.MethodsWe conducted secondary data analyses using data from a multistate survey to examine sociodemographics, the caregiver experience (relationship to recipient, duration as caregiver, hours of care provided, area help is needed, and greatest difficulty faced as a caregiver); emotional support; life satisfaction; lifestyle behaviors; general, physical, and mental health; and chronic conditions in women informal caregivers.FindingsOf women caregivers, more veteran caregivers provided activities of daily living (ADL) help (33%) than non-veteran caregivers (21%; p = .02). There were no differences in years as a caregiver, hours of care provided, or the relationship to the recipient. Poor sleep and poor mental health were experienced by more women veteran caregivers (vs. non-veteran), but physical health, general health, and chronic condition prevalence did not differ. Women veteran caregivers had twofold greater odds of being Black, never married, college educated, and providing ADL assistance. Odds of obesity were lower for women veteran caregivers relative to other women caregivers.ConclusionsWomen veteran caregivers experience health concerns, including sleeplessness, poor mental health, and some chronic conditions. Our cohort were young women, yet had concerns that may be exacerbated by being a veteran and assuming a caregiver role. Comprehensive services to support their needs as veteran patients and as caregivers are needed.     

Study on the effects of telephone counseling for family caregivers of demented patients

PURPOSE: The purposes of this study were to clarify the impact of telephone counseling on the actual state of family caregivers of demented patients, and to investigate strategies of public health care for such caregivers. METHODS: We classified 206 counseling cases, including 103 cases in 1999 and 103 cases through mid-2000, using several checklists, and analyzed date with the chi 2 test. RESULTS: 1) The most common symptom of demented patients was "forgetfulness." (106 cases) 2) 87 caregivers (42.2%) lived separately from demented patients, and in 60 cases the caregivers were daughters. 3) 104 caregivers suffered from stress because of caregiving difficulties, 89 (43.2%) having "emotional difficulties in caregiving," 33 (16.0%) "social difficulties with caregiving," 28 (13.6%) "physical difficulties with caregiving," and 8 (3.9%) "financial difficulties." While 102 caregivers (49.5%) reported no caregiving difficulties. 42 (40.4%) belonged to more than two of the listed categories. 4) The greatest concern of caregivers was "how to care for senile patients' mental symptoms." followed by "whether suffering from dementia" in 36 cases, "how to use welfare services" in 35, "whether the doctor should be consulted" in 30, and "expression of emotion" in 30 cases. The caregivers for whom "expression of emotion was an issue" had emotional, social and physical caregiving difficulties, prompting the contact for telephone counseling. 5) Public health nurses who had been working for more than 10 years tended to deal with the caregivers' "emotional caregiving difficulties" (P = 0.05). There were no differences regarding other items. CONCLUSIONS: 1) The results suggest that living apart, especially for daughters, has an effect on caregiving with senile patients if the number of family caregivers is reduced. In the future, we should consider ways to support families living apart from senile patients. 2) The results also reveal that caregivers of senile patients have emotional, social and physical caregiving difficulties. Therefore, a necessity for support of caregivers' emotional and physical health maintenance, and provision of community education is indicated. 3) Caregivers can talk more freely on the telephone than face-to-face, and get help when senile patients' symptoms are in the early stages. Therefore, it is possible to mitigate caregiving difficulties by intervening in their problems before these become serious and entrenched. 4) Telephone counseling gives caregivers the opportunity to express their emotions. Therefore, it can be expected to mitigate caregiving difficulties through appropriate targets of their expressed concerns.     

Prayer,Medicine, and Science: The New Dialogue

SUMMARY

We discuss the various stages of Alzheimer's disease and related disorders (ADRD) and present a psychosocial model which spiritual caregivers can use in their ministry, the Progressively Lowered Stress Threshold (PLST) model. We argue that religious activities are very important to these patients and that spiritual caregivers can make an important contribution.     

Young adult caregivers: a first look at an unstudied population

OBJECTIVES: We examined the prevalence, characteristics, and responsibilities of young adults aged 18 to 25 years who are caregivers for ill, elderly, or disabled family members or friends. METHODS: We analyzed 2 previously published national studies (from 1998 and 2004) of adult caregivers. RESULTS: Young adult caregivers make up between 12% and 18% of the total number of adult caregivers. Over half are male, and the average age is 21. Most young adults are caring for a female relative, most often a grandmother. Young adult caregivers identified a variety of unmet needs, including obtaining medical help, information, and help making end-of-life decisions. CONCLUSIONS: Analysis of these 2 surveys broadens our understanding of the spectrum of family caregivers by focusing on caregivers between the ages of 18 and 25 years. The high proportion of young men raises questions about the appropriateness of current support services, which are typically used by older women. Concerted efforts are essential to ensure that young adults who become caregivers are not deterred from pursuing educational and career goals.