护理者负担量表中文版的应用与评价

目的 对译制的中文版的“Zarit护理者负担量表（ZBI）”在中国人群中的适用性和修订效果进行评价。方法 应用译制的量表对陪护人员的护理负担进行测量。通过对测定结果进行信度和效度分析以及Logisti。回归分析护理负担的影响因素并评价量表的修订效果。结果 护理者文化程度、患者的日常生活能力（ADL）分值、护理人数是影响护理负担的主要因素。中文版量表的信度和效度达到量表译制的技术要求。结论 增加护理人数可降低护理者的负担。扩大中文版ZARIT护理者负担量表的测量人群范围，可以提高量表的适用性。     

阿尔茨海默病患者精神症状对其照护者的影响

目的探讨阿尔茨海默病(AD)患者的神经精神症状对其照护者负担的影响。方法选取天津市环湖医院痴呆门诊150例伴有神经精神障碍的AD患者及其主要照护者作为研究对象,采用神经精神科问卷(NPI)、Zarit护理者负担量表(ZBI)对AD患者及其照护者进行调查和评估。结果(1)患者NPI得分与照护者负担存在明显相关性(r=0.474,P0.01)。(2)NPI中12种神经精神症状的出现除脱抑制外均与照护者负担存在相关性(P0.05)。(3)照护者负担ZBI得分与患者情感淡漠/漠不关心(r=0.346,P0.01)、易激惹/情绪不稳(r=0.330,P0.01)、异常运动行为(r=0.321,P0.01)的发病频率明显相关。结论 NPI量表显示AD患者几乎所有神经精神症状的出现都与照护者负担有关,尤其是情感淡漠、激惹及异常运动行为的发生频率的增加更加重照护者的心理负担。     

老年痴呆患者照料者Zarit回归分析

目的揭示老年痴呆患者照料者的负担程度,发现其影响因素。方法 2012年3月—2013年3月,利用自制基础资料调查表、Zarit护理负担量表(ZBI)对辽宁省沈阳市4家三级甲等医院住院的233例老年痴呆病人的家庭照料者进行调查,采用多元线性逐步回归分析探讨影响老年痴呆患者照料者负担的因素。结果 233例病人照料者中男性105人(45.06%),女性128(54.94%),照料者在护理负担ZBI平均得分为(57.56±13.45)分;多元线性回归分析结果表明,夜间觉醒次数、疾病类型、每周护理频次、是否与病人居住在一起及年龄与Zarit平均得分存在线性回归关系(P0.05)。结论多数老年痴呆照料者承受轻中度照顾负担。夜间觉醒次数、疾病类型、每周护理频次、是否与病人居住在一起等是影响痴呆照料者负担的因素。     

白血病患者照料者护理负担的影响因素研究

目的通过测量白血病患者照料者的护理负担,以了解照料者的照顾负担及心理健康状况,探讨照料者护理负担的影响因素,为改善其心理健康状况提供依据。方法以Zarit护理负担量表为测量工具,采用横断面调查方便抽样的方法,面对面结构化访谈收集调查问卷,对白血病患者家属的主要照料者的护理负担进行测量。结果照料者护理负担得分为(33.2±17.6)。照料者的慢性病对护理负担有显著性影响,经济影响是护理负担的危险因素,而睡眠时间,自尊和心理一致感是护理负担的保护性因素。结论白血病患者照料者护理负担的改善措施应当围绕改善照料者自身的健康状况以及增强照料者应对能力等措施来缓解护理负担的发生。     

家庭负担量表应用于血吸虫病调查的信度、效度及敏感性评价

目的 评价家庭负担量表(FBS)应用于血吸虫病患者家庭负担调查的信度、效度及敏感性.方法 用FBS对224例血吸虫病患者进行现场调查.采用Cronbach's α和折半信度评价量表的信度,因子分析法评价量表的效度,用方差分析比较不同收入水平患者的评分以评价量表的敏感性.结果 量表的内容一致性较高,整个量表的Cronbach's α和折半信度分别为0.874和0.939;量表各个维度的Cronbach's α和折半信度大多在0.70以上;采用冈子分析法,共提取6个公因子,累计贡献率为66.76%,基本证实了其结构效度;该量表能够区分不同收入水平患者家庭负担之间的差异(P<0.001),证实其敏感性较好.结论 FBS具有较好的信度、效度及敏感性,可用于血吸虫病患者的家庭负担调查.     

维吾尔族、哈萨克族失能老年人居家主要照护者照护负担研究

目的探讨维、哈少数民族失能老年人居家主要照护者照护负担现状。方法应用ADL量表对少数民族失能老年人进行筛查并应用ZBI照护负担量表对621例少数民族主要照护者进行照护负担的研究。结果少数民族有照护负担者311人(50.1%);照护负担四个维度中经济负担最重,其中哈萨克族的经济负担得分最高,为(1.76±0.9660)分。结论减轻维、哈少数民族居家照护者的照护负担应从经济方面着手。     

老年患者冠脉搭桥术后自我感受负担及影响因素研究

目的 调查老年患者冠状动脉搭桥术（CABG）术后自我感受负担水平及其影响因素。方法 采用一般资料调查问卷、自我感受负担量表（SPBS）、社会支持评定量表（SSRS）、Zarit护理负担量表（ZBI）对86例CABG术后老年患者和主要照顾者进行问卷调查。结果 老年CABG患者的自我感受负担得分为（27.54±7.93）分,处于轻中度水平。单因素和多元线性回归分析显示老年患者的主要照顾者、心功能分级、照顾者负担水平是老年患者CABG术后自我感受负担的主要影响因素(P<0.05)。结论 老年患者CABG术后普遍经历轻度至中度的自我感受负担,护理人员应针对相关因素给予及时有效的个性化护理干预,降低患者的自我感受负担及减少负性情绪。     

慢性阻塞性肺疾病患者照顾者负担及影响因素分析

目的了解慢性阻塞性肺疾病(COPD)患者照顾者负担及影响因素,为减轻COPD患者照顾者负担提供依据。方法选取2017年—2019年1月攀钢集团总医院呼吸内科住院COPD患者的照顾者为研究对象,采用一般资料调查表、《照顾者负担量表》(ZBI)、《医院焦虑抑郁量表》、《疲劳评定量表》和《社会支持评定量表》进行问卷调查,分析一般情况、心理状态和社会支持情况与COPD患者照顾者负担的相关性。COPD患者照顾者负担的影响因素采用多重线性回归分析。结果发放问卷248份,收回有效问卷236份,问卷有效率为95.16%。COPD患者照顾者ZBI得分(39.76±8.27)分,其中个人负担维度得分(17.54±7.33)分,责任负担维度得分(9.17±3.81)分。COPD患者照顾者的焦虑、抑郁、疲劳和社会支持得分分别为(10.26±3.19)分、(9.03±3.18)分、(96.77±15.91)分和(36.74±6.37)分。多重线性回归分析结果显示,学历、职业、COPD患者严重程度、日均照顾时间、病程、焦虑、疲劳和社会支持均是COPD患者照顾者负担的影响因素(P0.05)。结论 COPD患者照顾者负担处于较高水平,有中度以上负担者占51.27%;照顾者负担与学历、职业、COPD患者严重程度、病程、日均照顾时间、焦虑、疲劳和社会支持度均有关。     

评判性思维能力题表信度和效度评价

目的 通过测量高职护理专业护生评判性思维能力,探讨评判性思维能力量表用于高职护生的可行性.为进一步评价高职护理专业人才培养模式、课程设置及教学方式提供参考依据.方法 采用评判性思维能力测量表(CTDI-CV),对全国5所高职院校护理专业学生进行问卷调查.结果 评判性思维能力测量表的信度系数为0.8975,除开放思想维度外,其他6个维度变化范围为0.7101～0.7787,可满足群组比较的要求.因为分析产生的7个公因子与理论结构基本一致,累积方差贡献率为66.03%.结论 CTDI-CV量表的信度和效度较好,可用于高职护理专业学生评价.     

疾病家庭负担量表在HIV感染者/病人中的信度和效度评价

目的 将疾病家庭负担量表（Family Burden Scale of Diseases,FBSD）在HIV感染者/病人中进行应用，验证FBSD自评表的信度和效度。方法 2021年12月至2022年2月对四川省某3个县区共计597名HIV感染者/病人进行现场调查，使用疾病家庭负担量表为调查工具，全程质控，运用克隆巴赫系数、分半系数、验证性因子分析、相关性研究等验证FBSD的信度与效度。结果 FBSD整体克隆巴赫系数为0.940，分半系数为0.842；模型拟合结果 GFI=0.874,CFI=0.901,RMSEA=0.080,RMR=0.014;6个维度对应的AVE值全部均大于0.5，且CR值均高于0.7;6个维度的AVE平方根值均大于因子间相关系数绝对值的最大值；标化后总分与各维度得分的Pearson相关系数介于0.722～0.849之间，均大于各维度间的Pearson相关系数。结论 FBSD量表在HIV感染者/病人中运用具有较好的信度和效度，可以考虑在临床以及科研中用于研究HIV感染者/病人的疾病家庭负担。     

Caregivers Burden of Older Adults with Chronic Illnesses in the Community: A Cross-Sectional Study

A chronic physical/mental disease not only has direct consequences for the chronically-ill older adults but can also alter the caregiver’s life. The objectives of this study were to identify burdens of community-dwelling older adults, characteristics of caregivers, severity of caregiver burden, and to develop supportive strategies. Caregivers of community-dwelling older adults were randomly interviewed between February and March 2012. Information on baseline characteristics and caregiver burden using Zarit Burden Inventory (ZBI) was collected. One hundred-fifty caregivers were interviewed. The mean ZBI was 20.8 + 11.3 [95 % CI 19.0, 22.7]. The majority of caregiver burden was classified as no burden (52 %). The age of caregivers, self-reported health status and duration of care had a positive relationship with ZBI scores while self-reported income had a negative one. Caregiver burden among Thai community-dwelling elder persons was small as most of those cared for had uncomplicated illness but this might be underestimated. Caregiver-dependent factors were more strongly associated with high burden than patient characteristics. Healthcare providers should consider these factors for interventions to alleviate burden.     

Factors Associated With Family Caregiver Burden of Home-Dwelling Patients With Advanced Dementia

ObjectivesTo realize patients’ preferences for home death, this study aimed to identify factors associated with family caregiver burden of home-dwelling patients with advanced dementia and examine its relationship with end-of-life care treatment decisions.DesignA prospective cohort study.Setting and ParticipantsPatient-family caregiver dyads enrolled in a home-based palliative care program for patients with advanced dementia, with family caregiver burden assessed using the Zarit Burden Interview (ZBI) on enrolment, were included.MethodsIndependent variables included sociodemographic data, patients’ clinical phase, symptom severity, quality of life, informal paid help availability, and community resources utilized. Dependent variable was continuous ZBI scores and ZBI scores dichotomized into <24 and ≥24 for predicting depression risk. Place of death and interventions received 2 weeks before death were also collected. Data were analyzed using multivariate linear and logistic regression.ResultsFrom October 2014 to December 2020, a total of 377 family caregivers were assessed with ZBI. Median score was 25 (IQR 15-36), and 54.4% of them were at risk of depression. Younger family caregivers had higher ZBI scores (β = ?0.22, 95% CI –0.38, ?0.07), with the depression risk doubling for family caregivers aged <60 years (OR 2.13, 95% CI 1.33, 3.43). Absence of informal paid help also increased the ZBI scores (β = ?9.04, 95% CI –14.86, ?3.22) and depression risk (OR 2.50, 95% CI 1.03, 6.09). In addition, caregivers’ ZBI scores increased with patients’ neuropsychiatric symptom severity (β = 0.49, 95% CI 0.08, 0.89), and caregivers of clinically unstable patients had a higher depression risk (OR 1.80, 95% CI 1.03, 3.12). Baseline caregiver burden was not associated with treatment decisions made at the end of life.Conclusions and ImplicationsYounger family caregivers caring for clinically unstable patients with severe neuropsychiatric symptoms experienced greater burden without informal paid help. For end-of-life care at home in advanced dementia to be tenable, relevant national agencies and stakeholders are recommended to work collectively to support family caregivers holistically.     

照顾者的照顾负担、应对方式与焦虑抑郁情绪 相关性分析

摘要:目的　探讨肠癌化疗病人主要照顾者焦虑抑郁情绪、照顾负担、应对方式现况及其相关性。方法　采用自编的一般资料问卷、医院焦虑抑郁量表（HAD）、照顾负担量表（ZBI）、简易应对方式量表（SCSQ）对319例肠癌化疗主要照顾者进行问卷调查。结果　有焦虑情绪者138例（43.3%）,有抑郁情绪者86例（27.3%）,66例（20.7%）处于焦虑抑郁共存状态;照顾负担总分为（28.7±11.3）分,83例（26.0%）处于轻度负担,182例（57.1%）处于中度负担,54例（17.54％）处于重度负担;消极应对维度均分为（1.22±0.58）分,低于国内常模,差异有统计学意义（P＜0.01）;照顾负担得分、消极应对方式得分与照顾者焦虑得分呈正相关（r＝0.50,0.19）;照顾负担得分、消极应对方式得分与照顾者抑郁得分呈正相关（r＝0.41,0.16）;积极应对方式得分与照顾者抑郁得分呈负相关（r＝-0.24）。结论　肠癌化疗病人主要照顾者存在不同程度的焦虑抑郁情绪,照顾负担以中度为主,应对方式良好,三者之间存在一定的相关性。     

Economic cost and quality of life of family caregivers of schizophrenic patients attending psychiatric hospitals in Ghana

Background

Low and middle income countries face many challenges in meeting their populations’ mental health care needs. Though family caregiving is crucial to the management of severe mental health disabilities, such as schizophrenia, the economic costs borne by family caregivers often go unnoticed. In this study, we estimated the household economic costs of schizophrenia and quality of life of family caregivers in Ghana.

Methods

We used a cost of illness analysis approach. Quality of life (QoL) was assessed using the abridged WHO Quality of Life (WHOQOL-BREF) tool. Cross-sectional data were collected from 442 caregivers of patients diagnosed with schizophrenia at least six months prior to the study and who received consultation in any of the three psychiatric hospitals in Ghana. Economic costs were categorized as direct costs (including medical and non-medical costs of seeking care), indirect costs (productivity losses to caregivers) and intangible costs (non-monetary costs such as stigma and pain). Direct costs included costs of medical supplies, consultations, and travel. Indirect costs were estimated as value of productive time lost (in hours) to primary caregivers. Intangible costs were assessed using the Zarit Burden Interview (ZBI). We employed multiple regression models to assess the covariates of costs, caregiver burden, and QoL.

Results

Total monthly cost to caregivers was US$ 273.28, on average. Key drivers of direct costs were medications (50%) and transportation (27%). Direct costs per caregiver represented 31% of the reported monthly earnings. Mean caregiver burden (measured by the ZBI) was 16.95 on a scale of 0–48, with 49% of caregivers reporting high burden. Mean QoL of caregivers was 28.2 (range: 19.6–34.8) out of 100. Better educated caregivers reported lower indirect costs and better QoL. Caregivers with higher severity of depression, anxiety and stress reported higher caregiver burden and lower QoL. Males reported better QoL.

Conclusions

These findings highlight the high household burden of caregiving for people living with schizophrenia in low income settings. Results underscore the need for policies and programs to support caregivers.

     

高血压合并冠心病患者家属照顾者社会支持、压力及应对方式研究

目的分析社区高血压合并冠心病患者家属照顾者社会支持情况及其与压力、应对方式的相关性,为制定具体可行的压力应对干预模式提供参考依据。方法对福州市25个社区196例中有压力的高血压合并冠心病患者家属照顾者66例进行社会支持、压力及应对方式的测量。结果66例家属照顾者社会支持总分为（36．50±5．67）分,国内常模为（34．56±3．73）分,差异有统计学意义（t=2．782,P=0．007）,且60．6％的家属照顾者表示社会支持度一般。Spearman相关分析结果显示,社会支持水平、客观支持、主观支持、社会支持利用度与家属照顾者ZBI压力总分及ZBI等级、个人负担、角色负担均呈负相关（P〈0．01）;积极应对方式与家属照顾者社会支持总分、社会支持水平、客观支持、社会支持利用度呈正相关（P〈0．05或〈0．01）;积极应对方式与家属照顾者ZBI压力总分及ZBI等级、个人负担、角色负担呈负相关（P〈0．05）。结论高血压合并冠心病患者家属照顾者社会支持情况有待提高,且其社会支持、压力及应对方式存在一定的相关性。     

A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview

ObjectivesBrief screening scales for caregiver burden are much needed in routine dementia services to efficiently identify caregivers of persons with dementia (PWD) for further intervention. Although the 22-item Zarit Burden Interview (ZBI) is often used, its available screening versions have not performed as well as the full version in distinguishing significant burden. We developed a brief screening scale that is valid and comparable to ZBI in distinguishing caregiver burden.Design and settingBaseline data of an ongoing cohort study.ParticipantsFamily careivers of community-dwelling PWD (n = 394).MeasuresParticipants completed questionnaires containing ZBI and other caregiving scales. Initially, we split the study samples into 2—the derivation sample (n = 215) was used to develop a brief scale that best distinguishes significant burden (using the best-subset approach with 10-fold cross-validation), whereas the validation sample (n = 179) verified its actual performance in distinguishing significant burden. We then evaluated the derived scale in its internal consistency reliability, factorial validity, known group validity, and construct validity, and mapped the scores between the brief scale and ZBI using the equipercentile equating method.ResultsWe derived a 3-item scale which had comparable performance to ZBI in distinguishing significant burden (area under the receiver operating characteristic curve 0.86, 95% confidence interval 0.81-0.92). It had a single dimension in exploratory factor analysis and maintained good psychometric properties similar to those of ZBI. It also explained 77.8% of the variability in ZBI, and had scores that could be mapped to ZBI with reasonable precision.Conclusions and ImplicationsWe have derived a highly accessible tool to screen for caregiver burden, which can have a wider health system effect of expanding the reach of caregiver-focused interventions to services involved in the care of PWD. Notably, this screening tool was developed using rigorous methods and demonstrated comparability to ZBI in its validity, reliability, and total scores.     

Burden and depression among informal caregivers of visually impaired patients in Mexico

BackgroundThe needs of informal caregivers who provide care to family relatives with visual impairment are often neglected, resulting in burden and depression.ObjectiveTo determine the degree of burden and the prevalence of major depression experienced by caregivers, defined as non-paid family relatives, of legally blind individuals in a Mexican population.MethodsObservational, single-center, cross-sectional study in adults providing care to their family relatives with visual impairment (visual acuity ≤ 20/200 in the best eye for at least 3 months). According to visual impairment degree, care provided included activities of daily living (ADL) and instrumental ADL. Burden of care was evaluated with the Zarit burden interview (ZBI)-22 and the prevalence of major depression was determined by the patient health questionnaire (PHQ)-9.Results115 patients and 115 caregivers were included. Male caregivers had significantly higher ZBI-22 (28.7 ± 15.5 vs. 19.2 ± 12.6, p = 0.001) and PHQ-9 (10.0 ± 5.5 vs. 5.3 ± 5.1, p < 0.001) scores than females. Likewise, parent caregivers of adult children and the hours of daily care were significantly associated with higher burden and depression scores. A significant linear correlation between ZBI-22 and PHQ-9 scores in caregivers was also found (r = 0.649, p < 0.001).ConclusionsMale caregivers, parent caregivers of adult children, and caregivers providing greater hours of care were at higher risk of burden and depression. Upon diagnosis of visual impairment, adults providing care to visually impaired family relatives should be screened for burden and depression and referred to a mental health specialist when necessary. Tailored interventions targeting the caregivers’ needs are required to reduce burden and depression.     

Analysis of burden in caregivers of people with Alzheimer’s disease using self-report and supervision hours

Objectives

This study aimed to describe the baseline characteristics of informal carers of community-living Alzheimer’s disease (AD) patients by AD severity group and to identify factors associated with two measures of caregiver burden.

Design and setting

GERAS is a prospective observational study in France, Germany, and the UK, designed to assess costs and resource use associated with AD, for patients and their caregivers, stratified by disease severity.

Participants

1497 community-dwelling AD patients and their primary caregivers.

Measurements

Subjective caregiver burden assessed using the Zarit Burden Interview [ZBI] and time spent supervising patients (an objective measure of burden recorded using the Resource Utilization in Dementia instrument) during the month before the baseline visit were recorded. Separate multiple linear regression analyses using ZBI total score and caregiver supervision time as dependent variables were performed to identify patient and caregiver factors independently associated with caregiver burden.

Results

Increasing AD severity was associated with both subjective caregiver burden (ZBI total score) and overall caregiver time, which includes supervision time (both p<0.001, ANOVA). Better patient functioning (on instrumental activities of daily living) was independently associated with both a lower ZBI total score and less supervision time, whereas higher levels of caregiver distress due to patient behavior were associated with greater caregiver burden. Other factors independently associated with an increased ZBI total score included younger caregiver age, caregiver self-reported depression, caring for a male patient, and longer time since AD diagnosis. Caregivers living with the patient, being a male caregiver, patient living in a rural location, higher patient behavioral problem subdomain scores for apathy and psychosis, more patient emergency room visits, not receiving food delivery and receiving financial support for caregiving were all associated with greater caregiver supervision time.

Conclusion

Our results show that subjective caregiver burden and caregiver time are influenced by different factors, reinforcing the need to consider both aspects of caregiving when trying to minimize the burden of AD. However, interventions that minimize caregiver distress and improve patient functioning may impact on both subjective and objective burden.     

Social support and burden among caregivers of patients with dementia in Malaysia

This study aims to examine selected factors of dementia patients and their caregivers that were associated with the burden of family caregivers. This cross sectional study involves face-to-face interview with family caregivers of patients with dementia. Participants were recruited through convenient sampling from geriatric and psychiatry outpatient clinics from three government hospitals, one university hospital, one rural health centre and Alzheimer Disease caregivers' support groups. 70 caregivers took part in the study. Measures included patient and caregiver demographic variables and caregiver burden using the Zarit Burden Interview (ZBI). Caregiver burden was found to be significantly associated with both ethnicity and informal support. Chinese caregivers were found to have a higher level of burden compared to Indians and Malays. Informal support, in particular assistance from family members, was significantly associated with a lower burden perceived by the caregivers. However, the study shows that formal support such as assistance from maids and private nurses did not alleviate the burden of caregivers. Results highlighted the importance of improving the coping skills in burdened caregivers particularly among family members with dementia relatives. Interventions should be designed for specific needs of caregivers of different ethnicities.