居家痴呆患者疾病症状与其照顾者负担相关性的纵向研究

Longitudinal Study on the Relationship Between Dementia-related Symptoms and Burden of Caregivers of Homebound Patients

目的了解痴呆患者疾病症状中影响照顾者负担的因素,为制订减轻照顾者负担的有效护理措施提供依据。方法应用简易智能状态量表(MMSE)、痴呆临床分级量表(CDR)、阿尔茨海默病病理行为问卷(BEHAVE-AD)、痴呆患者日常生活能力问卷(ADCS-ADL)以及照顾者负担问卷(CBI)对15对居家痴呆患者及其照顾者进行为期2年的追踪调查,分别于基线、12个月、24个月时进行资料收集。结果痴呆患者的疾病呈逐渐加重的趋势,与基线相比,24个月时患者的MMSE、ADCS-ADL评分显著下降,CDR评分显著升高(均P<0.05)。照顾者负担在2年期间保持稳定,负担总分在基线、12个月、24个月时差异无统计学意义(均P>0.05)。患者疾病症状中精神行为症状与照顾者负担在基线、12个月时呈显著正相关(r=0.689、0.543,均P<0.01)。结论居家痴呆患者的疾病逐渐加重,照顾者负担在患者的疾病进程中持续存在,精神行为症状对照顾者的负担有影响。应采取有效的措施减少患者的精神行为症状,进而减轻照顾者的负担。

Objective To explore the dementia-related symptoms that are associated with earegivers＇ burden and to provide information for nursing intervention. Methods Totally, 15 homebound dementia patients and their caregivers were followed up over a period of 2 years. They were evaluated by filling out Mini-mental State Examination（MMSE）, Clinical Dementia Rating （CDR）, Behavioral Pathology in Alzheimer＇s Disease （BEHAVE-AD）, the Alzheimer＇s Disease Co-operative Study-Activities of Daily Living Inventory（ADCS-ADL） and Care Burden Inventory（CBI） at the baseline, 12th, 24th month respectively. Results The disease exacer-bated during observation period. Compared to the results at the baseline, scores of MMSE and ADCS-ADL decreased at the 24th month（P〈0.05 for both）, while the score of CDR increased at the 24th month（P〈0.05）. Caregivers＇ burden remained stable during observation period; the scores of CBI at baseline, 12th,24th month didn＇t have significant differences （P〉0.05 for all）. There was significant relationship between patients＇ score of BEHAVE-AD and caregivers＇ burden, and the correlation coefficients were significant at baseline（r=0. 689, P〈0.01 ） and at 12th month（r=0.543, P〈0.01）. Conclusion The symptoms of homebound dementia patients aggravate as time goes on. Caregivers＇ burden remained outstanding along with the persistency of disease. A-mong the symptoms, behavioral psychiatric symptoms have significant impact on caregivers＇ burden.