老年痴呆照顾者虐待倾向风险评估模型的构建与评价

Development and validation of risk assessment model of abuse tendency among caregivers of elders with dementia in long-term care facilities

目的分析长期护理机构老年痴呆照顾者虐待倾向相关因素,构建风险评估模型,为机构早期识别虐待高危人群及制订干预措施提供依据。方法 2018年7月—12月便利抽样8所长期护理机构中307名老年痴呆照顾者,采用一般资料调查表、照顾者虐待评估表、大五人格问卷、简易应对方式问卷、照顾者积极感受问卷、一般健康问卷12项进行调查。结果自评照顾难度困难、照顾对象有精神行为症状是照顾者虐待倾向的危险因素(OR=8.668、4.412),照顾者宜人性、开放性是其虐待倾向的保护因素(OR=0.888、0.940)。得出风险评估模型为Y=15×X1+10×X2-8×X3-4×X4(X1:自评照顾难度困难;X2:照顾对象存在精神行为症状;X3:宜人性;X4:开放性);模型受试者操作特征曲线下面积为0.856,灵敏度为81.0%,特异度为68.2%,总符合率为74.6%,Hosmer-Lemeshow拟合优度检验显示P=0.515,模型拟合尚佳。结论多种相关因素参与照顾者虐待倾向的发生过程,构建的风险评估模型预测效能尚佳,有一定的临床应用价值。

Objective To analyze the related factors of abuse tendency among caregivers of elders with dementia in long-term care facilities,and to construct a risk assessment model,so as to provide evidence for early identification of abusive population in high-risk and formulation of intervention measures to prevent elder abuse.Methods A total of 307 caregivers of elders with dementia in 8 long-term care facilities were conveniently sampled and investigated from July to December 2018 by general information survey questionnaire,the Caregiver Abuse Screen for the Elderly(CASE),Neuroticism Extraversion Openness Five-Factor Inventory(NEO-FFI),Simplified Coping Style Questionnaire(SCSQ),Positive Aspects of Caregiver(PAC),General Health Questionnaire(GHQ-12).Results Self-rated difficulty of care and care recipients’ psycho-behavioral symptoms were the risk factors of abuse tendency among caregivers(OR=8.668,4.412). The protective factors of abuse tendency among caregivers were their agreeableness and openness(OR=0.888,0.940). The risk assessment model was Y=15 × X1+10 × X2-8 × X3-4 × X4(X1:self-rated difficulty of care;X2:psycho-behavioral symptoms;X3:agreeableness;X4:openness). The area under ROC curve was 0.856,the sensitivity was 81.0%,the specificity was 68.2%,the total coincidence rate was 74.6%. Hosmer-Lemeshow goodness of fit test showed that P=0.515 and the model fit was good.Conclusion Various related factors are involved in the occurrence of caregivers’ abuse tendency. The risk assessment model is effective in predicting caregivers’ abuse tendency,and has certain clinical application value.