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

Burden of family caregivers and health service status of dementia patients in Guangzhou

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。

Objective To investigate burden status of family caregivers for outpatients with dementia disease and its influencing factors in Guangzhou,and analyze demands and utilization of health services.Methods All outpatients with dementia,who were diagnosed in the outpatient department of a hospital in Guangzhou,met inclusive criteria,and obtained informed consents of their caregivers,together with their family caregivers were recruited from March to September 2017.Caregiver Burden Inventory(CBI)was used to assess caregiver burden.The general information of the participants,and the health demands and utilization of the health services were collected.Student′s t test,ANOVA,and multiple linear regression were used to determine factors influencing the caregiver burden.Results A total of 97 pairs of dementia outpatients and their caregivers were enrolled.The average age of the caregivers was(55±12)years.The total CBI score of dementia caregivers was(40.43±20.05),and time-dependent burden was the heaviest.The main influencing factors were subjective economic burden(standard coefficient[SC]:0.24,0.43),weekly care time≥61 hours(SC:0.22),and undertaking the housework apart from the caregiving work(SC:0.21).The health services demanded most for dementia patients were nursing home,special care,and home treatment.However,physical examination and outpatient medical treatment were the actually utilized health services.Conclusion The economic burden and time cost were the factors affecting the caregiver burden.The health service demand and utilization for dementia patients are imbalance.It is suggested to establish specialized care facilities and senior activity centers for dementia patients.