国外居家失能老年人主要照护者照护负担影响因素研究现状

<正>随着老龄化人口快速的增长,与之相适应的依赖性照护也在增长〔1〕。目前居家失能老年人的照护者主要为配偶和子女,他们被看作是长期照护、以家庭为基础和以社区为基础照护系统的中流砥柱〔2〕。研究发现:63%的照护人员出现严重的照护负担,47%的人出现精神障碍〔3〕。由于照护角色的社会化、照护负担加重、照护导致的经济和健康问题下滑,联合国千年发展目标的总成就着重强调了全球非正式照护者的重要意义〔4〕。     

国外居家失能老年人主要照护者照护负担干预研究进展

<正>目前,世界已进入一个老龄化的时代,联合国人口署预测,到2050年,80岁及以上人口比例将增高4倍〔1〕,65岁以上的世界人口将从7.6%上升到16.2%,即增加10亿老龄人口〔2〕。随着老龄化人口快速的增长,与之相适应的依赖性照护也在增长〔3〕。家庭是老年人安享晚年的最佳地方,当老年人生理机能下降,逐渐出现功能性依赖,这就需要家庭成员给予相应的照护。因此居家照护作为传统的照护模式被许多国家失能老年     

维吾尔族、哈萨克族居家主要照护者照护需要与照护负担相关性

目的探讨维、哈两民族失能老年人居家主要照护者照护需要与照护负担之间的关系。方法应用照护负担量表和照护需要问卷对621例维、哈民族主要照护者进行研究。结果维、哈民族失能老年人居家主要照护者对照护的总需要得分为(87.45±11.99)分,处于高需要水平,其中对经济协助的需要最高,条目均分为(4.15±0.62)分,选择需要和非常需要的照护者占到93.8%;照护需要总得分与照护负担得分存在正相关,相关系数r=0.324。结论满足维、哈照护者的照护需要可以减轻其照护负担。     

维、哈失能老年人居家照护者知识态度行为相关性

目的探讨维、哈失能老年人居家主要照护者知识态度行为相关性。方法应用问卷对621名少数民族失能老年人居家照护者进行知信行相关性研究。结果维、哈失能老年人居家照护者的知识、态度、行为两两之间存在正相关(P0.05)。结论在提高失能老年人生活质量并对其照护者进行干预前,应注重居家主要照护者知识、态度、行为三者之间的相关性。     

居家非正式照护者与失能老年人生活满意度比较

目的 探讨居家非正式照护者及失能老人的生活满意度和影响因素.方法 应用生活满意度指数B量表对750对照护者及失能老人的生活满意度进行研究.结果 居家非正式照护者的生活满意度总体上低于被照护的失能老人,也低于国内常模.其中两者都处于高水平满意度者20.5％,两者都处于低水平满意度者37.5％,两者不一致者42.0％.多元回归分析显示,影响照护者生活满意度的因素为照护者的文化程度、就业状况、家庭月收入、每天照护时间、有无其他家人参与照护以及被照护老人的生活满意度;影响失能老人生活满意度的因素为老人的性别、失能程度、医保类型及照护者的生活满意度.结论 照护者以及失能老人的生活状况值得关注,提高二者的生活满意度可以把两者作为整体进行干预.     

新疆维哈失能老年人生活满意度与照护者照护负担、社会支持交互作用

目的探讨新疆维哈失能老年人生活满意度与其照护者照护负担、社会支持交互作用。方法应用生活满意度指数B量(LSIB)表、主要照护者负担量表(ZBI)和社会支持量表(SSRS)等对621对维哈失能老年人/照护者进行研究。结果 (1)维哈少数民族失能老年人生活满意度得分为(13.15±3.744)分,低于新疆汉族失能老年人,也低于国内常模;(2)交互作用表明:照护者有照护负担及低社会支持、高龄失能老年女性、重度失能、失能老年人文化程度低、患2种以上疾病、子女经济差是影响维哈失能老年人生活满意度的危险因素。结论照护者有照护负担且社会支持低是影响新疆维哈失能老年人生活满意度的主要危险因素,因素间交互作用大大降低了失能老年人生活满意度。     

失能老人家庭照护质量与照顾者负担的相关性

目的探讨失能老人家庭护理质量及其与照顾者负担的关系。方法采用问卷对316对失能老年人及其照顾者进行调查,内容涵盖失能老人照顾者一般资料、失能老人家庭照护质量、照顾者负担状况。结果失能老人家庭照护质量评分为(47.32±6.11)分。72名失能老人照顾者为轻度负担,189名为中度负担,55名为重度负担。照顾者个人负担、角色负担、总负担与家庭照护质量中的失能老人部分、照顾者部分呈显著负相关(P0.05)。结论通过给予照顾者照顾技能和知识支持,关注照顾者的心理状态及情绪反应,为其提供相应帮助。建立失能老人的长期照护体系,构建符合中国国情的长期照护保险制度,根据失能老人的失能程度为照顾者发放照顾津贴,提供多种形式的经济支持和帮助。大力发展专业化服务养老机构,为失能老人提供照顾,缓解照顾者及整个家庭的负担,提高照护质量。     

失能老年人长期照护需求及影响因素

目的了解新疆石河子市失能老年人长期照护的需求,分析其影响因素。方法采用日常生活能力(ADL)量表对石河子市老年人进行失能筛查,对符合失能标准的298名老年人采用以Maslow需求论为理论框架,自行设计的长期照护需求调查表进行问卷调查。结果石河子市失能老年人对长期照护的需求水平低,经多元线性回归分析,影响其长期照护需求的因素为失能原因和失能程度。结论以石河子市失能老年人的需求为向导,结合影响需求的因素,开展适合该人群的居家长期照护服务。     

失能老年人机构长期照护需求及影响因素

目的了解重庆市失能老年人机构长期照护需求及影响因素。方法基于日常生活能力(ADL)量表对机构照护的老年人进行失能判定,并设计机构长期照护需求调查表进行问卷调研。结果重庆市机构照护的失能老年人对日常生活必需且服务频次多的项目需求率较高,影响照护需求最为显著的因素是失能程度、失能时间及月收入。结论重庆市长期照护服务内容制定应首先解决需求率较高的照护项目。     

失能老人家庭照护者的照护感受及影响因素

目的探查家庭照护者的照护感受及影响因素。方法对305位失能老人的家庭照护者进行问卷调查。结果照护者的消极感受比较明显。年龄、投入时间、积极体验、照护自评、失能老人需要的照护多、经济压力大是影响消极感受的主要因素。结论建议制定家庭支持政策,加强社区老年照护设施建设,提高机构照护的质量。     

新疆维吾尔族、哈萨克族失能老年人生活质量现状及影响因素

目的探讨维、哈失能老年人生活质量现状及影响因素。方法应用SF-36生活质量问卷对621例维、哈失能老年人进行研究。结果维、哈失能老年人生活质量得分为(91.25±11.96)分;Logistic回归分析显示:照护者照护负担、失能程度、失能老年人性别、失能老年人年龄、失能年限及认知情况、家庭人口数是影响被照护者生活质量的重要因素,其中照护者照护负担为主要影响因素。结论提高维、哈失能老年人生活质量应从减轻照护者负担着手,同时考虑失能程度的影响。     

Life worth living for caregiving and caregiver burden among Japanese caregivers of the disabled elderly in Japan

The aim of this study is to determine the relationship between life worth living and caregiver burden among caregivers in Japan. We used 111 caregivers of frail elders who completed a self-administered questionnaire including the 8 items developed by Arai et al. (J-ZBI) used as a scale to measure subjective burdens and psychological factors used as covariates other than life worth living. Total score (0-32) of the J-ZBI was dichotomized into "high burden" (> or =21 points) and "low burden" (<21 points). Multivariate logistic regression analysis revealed that only life worth living was significantly associated with caregiver burden. The direct effect of life worth living on caregiver burden (92.9%) was much greater than the indirect effect (7.1%). Our findings suggest that the increase of the sense of life worth living may play an important role in the prevention of the development of caregiver burden.     

Frontal function, disability and caregiver burden in elderly patients with major depressive disorder

Caregivers of patients with late-life major depressive disorder experience a significant level of general caregiver burden. Disability in patients is possibly one of the origins of caregiver burden. Frontal lobe dysfunction might be the source of disability. This study investigated if frontal lobe dysfunction (body level) of patients with late-life major depressive disorder was associated with their disability (individual level), and if it led to a high level of caregiver burden (societal level). Thirty-four unselected pairs of caregivers and their family members with late-life major depressive disorder were recruited. Frontal Assessment Battery and Timed Instrumental Activities of Daily Living (TIADL) were used to assess patients' frontal function and disability, and Caregiver Burden Inventory was used to measure caregiver burden. Frontal Assessment Battery correlated with TIADL (r= -0.47; p<0.006). TIADL score was also associated with two subscales of the Caregiver Burden Inventory: social (r = 0.38, p=0.026) and time-dependent (r= 0.37, p= 0.033). This study supported the hypothesis that frontal lobe dysfunction in elderly patients with depression is associated with their disability in instrumental activities of daily living. Disability is related to social and time-dependent aspects of caregiver burden. Further studies to examine proposed cognitive interventions are suggested to reduce patient disability and caregiver burden.     

Social support and caregiving circumstances as predictors of caregiver burden in Taiwan

Previous research has failed to consider the importance of caregiving circumstances and their impact on social support and caregiver burden. Hence, this study aimed to investigate the association between perceived and received social support and caregiver burden. This cross-sectional study was carried out on 301 family caregivers. Data was collected using structured questionnaires which included a Social Support Scale, Family APGAR (adaptation, partnership, growth, affection, resolve), and Caregiver Burden Scale. Findings showed that the caregiver burden was best predicted by two perceived and one received social support variables. Caregiver burden was likely to be higher when the caregivers had lower levels of family function and social support. Perceived social support was better at predicting caregiver burden than received social support. Our study indicates that family function has an important influence on caregiver burden. Further studies on family based interventions are needed to determine approaches for effectively reducing caregiver burden. The role of perceived social support in the health of caregivers should be further investigated as a possible protective determinant in the caring process.     

Family caregiving to elderly African Americans: caregiver types and structures

OBJECTIVES: This study identified different types of caregivers who provide care to older African Americans, the types of caregiving structures created to provide care, and the factors that help predict caregiving structures. METHODS: A community sample of 330 caregivers caring for 202 elderly African Americans was used. Multinomial logistic regression predicted what type of caregiving structure was created by families to provide care to older relatives. RESULTS: Three types of caregivers were identified: 187 primary caregivers, who were connected to 79 secondary caregivers and 49 tertiary caregivers. Fifteen tertiary-only caregivers who were not connected to other caregivers were identified. Five caregiving structures were found: (i) primary, secondary, and tertiary, (ii) primary and secondary, (iii) primary and tertiary, (iv) primary only, and (v) tertiary-only. Characteristics of care recipients were predictive of caregiving structures. DISCUSSION: Different types of caregivers with distinct roles and responsibilities provided care within defined caregiving structures to older African American family members. Caregiving structures may be individualistic (only one caregiver) or collectivist (two or more caregivers). Caregiving structure is predicted by the care recipients' conditions and situations, but not those of the primary caregiver.     

Caregiver role appraisal and caregiver tasks as factors in ending caregiving

This study focuses on factors related to why people with primary responsibility for providing care to ADL-impaired elderly persons ended their caregiving roles. Data are from the 1982 National Long-Term Care Survey and the Informal Caregiver Survey. Variables reflecting characteristics of care recipients and caregivers, caregiver role responsibilities, and appraisal of the caregiver role are investigated. Of particular interest is the influence of role responsibilities, such as number of ADL tasks, relative to appraisal of the caregiving role. The results indicate that factors other than role responsibilities are important in understanding who ends caregiving, and that risk factor profiles may prove a useful means of targeting caregivers at greatest risk of ending caregiving.     

Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis

In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.