影响老年痴呆患者及其照顾者幸福感因素的横断面研究

A cross-sectional study of the effects of well-being of dementia patients and their caregivers

目的研究影响痴呆患者及其照顾者幸福感的因素,为提高其幸福感提供指导。方法选取2015年4月至2016年4月入住北京协和医院神经内科确诊为痴呆的患者及其照顾者共94对,记录每例患者及其照顾者的人口统计学资料,记录痴呆患者的简易智力状态检查(MMSE)评分,照顾者的角色负荷量表(ROS)评分,两者的二元压力量表(DRS)评分,两者的痴呆患者生命质量量表评分(QOL-D)及抑郁自评量表(CES-D)评分。用分层线性模型做各个层面的影响因子与痴呆患者-照顾者的QOL-D及CES-D评分回归分析。结果固定效应模型中未控制变量多层线性模型分析:QOL-D的结果提示,痴呆患者的评分为β1j=(31.01±0.77)分,照顾者的评分为β_(2j)=(35.15±0.88)分,CES-D的结果提示,痴呆患者和照顾者的评分分别为β1j=(14.55±1.03)分和β_(2j)=(13.11±1.44)分。随机效应模型提示对于痴呆患者及照顾者的QOL-D评分及CES-D评分方差成分的异质性差异有统计学意义(χ^(2)值为98.94~168.06,P<0.01)。调整2级模型,调整后回归分析中最终结果提示:照顾者的关系压力(DRS),痴呆患者的自我意识评估(MMSE),照顾者护理相关的压力(ROS),痴呆患者关系压力(DRS)显著影响二者幸福感中的生命质量评分(QOL-D)(β值为-3.22~0.43,P<0.05)。痴呆患者关系压力(DRS),照顾者护理相关的压力(ROS),照顾者关系压力(DRS)显著影响二者幸福感中的抑郁症状(β值为5.34、3.26、1.62,P<0.05)。结论需要对痴呆患者及照顾者进行全面评估,合并家庭关系紧张,照顾者护理相关的压力大需进行必要的心理疏导。

Objective To study the factors influencing the happiness of dementia patients and their caregivers,provide guidance for improving their well-being.Methods A total of 94 pairs of patients and their caregivers who were admitted to the neurology department of Peking Union Medical College Hospital from April 2015 to April 2016 were selected,the demographics of each patient and their caregivers were recorded.The Mini-Mental State Examination(MMSE)of patients with dementia,Role of Overload Scale(ROS)of caregivers,Dyadic Relationship Strain(DRS),Quality of Life for Dementia(QOL-D),Self-Evaluation Scale-Depression(CES-D)were recorded.Layered linear model was used to make regression analysis between the influencing factors and the scores of QOL-D and CES-D.Results The results of the multi-layer linear model of uncontrolled variables in the fixed effect model:the results of QOL-D suggested that the score of patients with dementia wasβ1j=31.01±0.77,and the score of caregivers wasβ_(2j)=35.15±0.88;the results of CES-D suggested that the scores of dementia patients and caregivers wereβ1j=14.55±1.03 andβ_(2j)=13.11±1.44,respectively.The random effects model suggested that there were statistical differences in the heterogeneity of the QOL-D score and the CES-D score variance component for dementia patients and caregivers(χ^(2) values were 98.94-168.06,P<0.01).It indicated that the data was heterogeneous,adjusting the level 2 model,and the final results in the adjusted regression analysis suggested:caregiver relationship pressure(DRS),dementia patient self-awareness assessment(MMSE),caregiver care-related stress(ROS),dementia patient relationship stress(DRS)significantly affected the quality of life score(QOL-D)in both well-being(βvalues were-3.22-0.43,P<0.05).Dementia patient relationship stress(DRS),caregiver-related stress(ROS),and caregiver relationship stress(DRS)significantly affected depressive symptoms in both well-being(βvalues were 5.34,3.26,1.62,P<0.05).Conclusions A comprehensive assessment of dementia patients and caregivers is needed.The combined family relationship is tense and the pressure associated with caregivers needs to be psychologically counseled.