心脏病患者照料者抑郁症状的影响因素

目的测量心脏病患者照料者抑郁症状水平,并探索使照料者产生抑郁症状的影响因素,为改善心脏病患者照料者的心理健康状况提供依据。方法以抑郁自评CES-D量表为测量工具,采用横断面调查方便抽样的方法,对心脏病患者照料者的抑郁状况进行测量。结果 52.5%的心脏病患者照料者有抑郁症状,其中患者日常活动能力(ADL)和照料者的护理负担对抑郁症状有显著影响。结论需要通过改善患者的日常活动能力和降低照料者的护理负担来降低抑郁症状的发生率。     

103例癌症患者照料者抑郁症状的影响因素研究

目的通过测量癌症患者照料者的抑郁症状水平,以了解照料者的心理健康状况,探讨照料者抑郁症状的影响因素,为改善其心理健康状况提供依据。方法以流调用抑郁自评CES-D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,对癌症患者家属的主要照料者的抑郁症状进行测量。结果癌症患者照料者中抑郁症状的发生率为47.57%。年龄、婚姻状况和照料者的关系对抑郁症状有显著性影响,健康影响是抑郁症状的危险因素,而睡眠时间和心理一致感是抑郁症状的保护性因素。结论癌症患者照料者抑郁症状的发生率较高,改善措施应当针对减轻护理工作量建立轮流护理的补偿机制以及增强照料者应对能力等措施。     

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。     

阿尔茨海默病照料者现状及护理干预研究进展

阿尔茨海默病是一种神经细胞退行性疾病,患者进行性记忆力减退,日常生活能力也逐渐下降,给家庭和社会带来沉重的负担,是一个严重的社会和医疗卫生问题。另外,患者神经精神行为的出现更会加重照料者的负担。照料者的生理和心理健康状况不容忽视,本文对目前阿尔茨海默病照料者现状及护理干预措施进行了综述,针对照料者存在的心理问题、经济负担、体力疲乏、缺乏与外界交流时间及家庭和社会支持等状况进行原因分析和措施干预的总结,为提高照料者的生活质量提供依据。     

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。     

无锡市阿尔茨海默病患病现状和家属照料者心理状况调查研究

目的了解无锡市阿尔茨海默病(Alzheimer′s disease,AD)患病率和家属照料者心理健康状况,并分析其影响因素,为社区制定AD的早期干预措施及提高照料者心理健康水平提供参考依据。方法采用分层整群随机抽样方法,对无锡市4 195名60岁及以上老年人进行AD筛查和临床诊断,同时对诊断为AD的居家患者家属照料者进行心理状况调查。计算并比较不同人口学特征AD患病率及家属照料者心理问题的阳性检出率,分析其影响因素。结果无锡市60岁及以上老年人AD患病率为4.89%,居家患者的家属照料者心理问题阳性检出率为55.06%。Logistic回归分析显示,低文化程度、非在婚状态、负性生活事件是AD的危险因素;男性、相对低龄、参加娱乐活动是AD的保护因素。影响家属照料者心理健康的危险因素为被照顾患者男性、伴有精神行为症状、照料者处于在岗状态、与患者配偶关系;保护因素为被照顾患者有多个子女(≥3个)、参加职工医保、照料者家庭支持良好、每日照顾患者6h。结论无锡市老年人AD患病率较高,家属照料者心理问题存在较普遍,社区应在培养老年人健康的生活方式、提高对AD患者及照料者的家庭和社会支持等方面加强关注和投入。     

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SPSS13.0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,负担总分18.91±11.47vs8.50±8.56(P<0.001),压力更大,焦虑(20.98%vs7.98%)、抑郁(23.46%vs13.16%)情绪更明显,但情况好于普通社区(P<0.0001)。结论痴呆照料者无论在照料负担还是负性情绪方面都不容乐观。部队干休所较好的管理机制和健全的医疗服务体系有助于减轻痴呆照料者的负担。     

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。     

老年性痴呆患者亲属照料负担与心理健康的相关性分析

目的 了解老年性痴呆患者的家庭照料者的照料负担和心理健康状况.方法 采用照料负担量表(BCS)及照料者生活变化问卷、90项症状清单量表(SCL-90)对216位家庭照料老年性痴呆患者亲属进行问卷调查.结果 BCS及照料者生活变化问卷测评依次为经济负担[(2.52±2.40)分]＞心理健康＞[(2.11±2.2)分]家庭生活[(2.02±2.11)分]＞家庭关系[(1.62±0.68)分]＞躯体健康[(1.12±0.33)分]＞家庭活动[(0.92±0.95)分].SCL-90测评显示,焦虑、抑郁、躯体化、强迫等因子分均升高,与常模比较,差别有统计学意义(P＜0.05).且照料负担与SCL-90总分呈现正相关性.经干预后躯体化、强迫、抑郁、焦虑、人际敏感等因子分均下降(P＜0.05).结论 家庭照料负担越重,对患者亲属的心理健康影响越大.     

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.     

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.     

精神分裂症患者照护负担现状及其影响因素分析

目的:了解缓解期精神分裂症患者照护负担现状及其影响因素,为针对性采取干预措施提供科学依据。方法:采用Zarit负担量表、家庭关怀度量表、社会功能量表对湖北省201名缓解期精神分裂症患者及其主要照顾者进行一对一访谈调查。结果:照顾者中163例(81.1%)存在负担,其中轻、中、重度负担分别66、72、25例,分别占比32.8%、35.9%、12.4%。照顾者家庭关怀和患者社会功能都普遍较差。多重线性回归分析结果显示照顾者年龄、照顾者文化程度、照顾者所受家庭关怀、患者医疗费用、患者社会功能是缓解期精神分裂症患者照护负担的影响因素(P<0.05)。结论:政府、精神卫生中心和家属应了解缓解期精神分裂症患者的照护负担水平及其影响因素,并提供有针对性的措施以减轻照护负担。     

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.     

ZBI用于精神疾患护理者的信度和效度评价

目的通过测量精神疾患护理者的护理负担水平,探讨Zarit护理者负担量表(ZBI)用于精神疾患护理者负担调查的可行性,为进一步评价护理人员身心健康提供相关依据。方法以ZBI为测量工具,对精神疾患护理者的护理负担进行测量。结果个人维度和责任维度信度系数分别为0.847 8和0.857 5,满足群组比较的要求。因子分析所得2个公因子与理论结构基本一致,累积方差贡献率为63.60%。结论 ZBI的信度和效度较好,可用于精神疾患护理者负担的调查。     

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.     

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。     

非酒精性脂肪肝病住院患者照顾者负担的潜在类别分析

目的 分析非酒精性脂肪肝病住院患者主要的照顾者负担的潜在类别及影响因素。方法 选取非酒精性脂肪肝病住院患者主要照顾者145名,采用照料者负担量表(ZBI)调查照顾者负担现状,用潜在类别分析和无序多分类logistic回归分析探讨照顾者负担的潜在类分别分布特征及其影响因素。结果 根据每个类别的条件概率,可将非酒精性脂肪肝病住院患者主要照料者照顾者负担分为低负担组(29.86%)、高个人负担组(38.19%)、个人负担合并责任负担组(31.94%)三个潜类别。无序多分类logistic回归分析结果显示,照顾者月经济收入≤1 000(OR=0.05,95%CI=0.01～0.62)、1 001～3 000(OR=0.07,95%CI=0.02～0.86)、单独照顾患者(OR=0.01,95%CI=0.01～0.07)、无娱乐活动(OR=0.16,95%CI=0.03～4.72)是高个人负担组的危险因素; 照顾者是女性(OR=2.68,95%CI=0.86～8.38)是合并个人及责任负担组的保护因素、月经济收入≤1 000(OR=0.05,95%CI=0.01～0.55)、1 001～3 000(OR=0.08,95%CI=0.01～0.87)、单独照顾患者(OR=0.02,95%CI=0.02～0.247)是合并个人及责任负担组的危险因素。结论 非酒精性脂肪肝病住院患者主要照料者的照顾者负担存在明显的群体差异性,月经济收入水平低、单独照顾患者、缺乏娱乐活动的照顾者存在较高的个人负担, 除上述三个因素外,男性照顾者更易同时存在个人负担和角色负担,这两类照顾者是重点干预对象。     

广州市老年痴呆症患者家庭照顾者负担及卫生服务现状分析

目的 了解广州市老年痴呆症门诊患者家庭照顾者负担现状及其影响因素,分析其卫生服务需求与利用情况。方法 选取2017年3—9月在广州市某医院门诊确诊、符合纳入排除标准且照顾者知情同意的全部老年痴呆症患者及其家庭照顾者,采用照顾者负担评估量表（CBI）评估照顾者负担情况,收集一般资料及卫生服务需求与利用。采用t检验、方差分析、多元线性回归分析照顾者负担的影响因素。结果 本研究中老年痴呆症患者及其照顾者97对,照顾者平均年龄为（55 ± 12）岁。照顾者CBI总分为（40.43 ± 20.05）分,时间依赖性维度的负担最重,主要影响因素为主观感觉的经济负担（标准系数：0.24、0.43）、每周照顾时长≥61 h（标准系数：0.22）和承担除照顾外的家务（标准系数：0.21）。照顾者认为患者最需要的卫生服务分别为护理院照顾、特别看护和上门治疗,而实际利用的卫生服务则以体格检查与门诊医疗为主。结论 影响照顾者负担的主要因素是经济状况和照顾时长。广州市老年痴呆症患者卫生服务需求与利用不平衡。建议增设老年痴呆护理机构和老人活动中心等。     

Predictors of caregiver burden across the home‐based palliative care trajectory in Ontario,Canada

Family caregivers of patients enrolled in home‐based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non‐modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home‐based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi‐weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home‐care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non‐linear fashion from study admission to patient death. Increased monthly unpaid care‐giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non‐modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have benefits such as improved caregiver health outcomes, and enhancing their ability to meet care‐giving demands, thereby potentially allowing for longer patient care in the home setting.