轻度认知障碍照顾者的整合干预成效研究--以上海市长征医院为例

Research on the Effectiveness of Integrated Social Work Intervention on Caregivers for Patients Mild Cognitive Impairment:A Case Study Based in Shanghai Changzheng Hospital

轻度认知障碍(MCI)是老年痴呆的前期症状,因疾病特殊性,其照顾者表现出与压力相关的负面情绪和照顾负担等问题。课题组成员尝试在认知障碍初期阶段对家庭照顾者进行整合干预,从而缓解照顾者的照顾负担。采用准实验设计,对干预组进行社会工作整合干预,并使用照顾者负担量表、社会支持评定量表、简易自我效能量表和一般应对方式量表对参与者进行干预前和干预后测量,并和对照组进行描述性统计、T检验等统计分析。在干预结束后,对6名照顾者进行了跟进访谈,以更深入地了解和分析照顾者各维度变化原因。研究发现,照顾者的照顾负担没有显著性差异,但照顾负担的情感负担维度显著降低,发展负担维度却有显著提升。照顾者的社会支持有显著提升,自我效能感和应对方式无显著变化。总体而言,对MCI照顾者进行为期8周的整合干预可以增加MCI照顾者的社会支持。但对其自我效能感和应对方式没有显著影响,这与干预对象的样本量和干预的时间有关。同时,结合文献和访谈可知,照顾者的发展负担增加主要受照顾者对疾病认知的增加、客观照顾时间的增加,以及患者的病觉缺失和精神行为症状的增加的影响。

Mild Cognitive Impairment(MCI)is an early stage of memory disorder.Caregivers of MCI patients have shown strong stress-related negative emotions and caregiving burden.This study aims to conduct integrated social work interventions among informal caregivers for MCI patients.Quasi-experimental design was employed to evaluate the effects of integrated social work intervention among the intervention group(N=38).The effectiveness of the intervention was evaluated by general information questionnaires,caregiver burden inventory,social support scale and general self-efficacy scale,and simplified coping style scale before and after the intervention.The comparison between the experiment group and the control group(N=32)was conducted by descriptive statistics and T-test.After the intervention,six caregivers were interviewed to further understand the caregivers’changes in each dimension of caregiving burden.Overall,there was no significant difference between the caregiver’s care burden(P>0.05).As to the sub-dimentions of care burden,there were statistically significant differences on the emotional burden(P<0.05)and the development-restricted burden(P<0.05).There was significant improvement in social support(P<0.05)for caregivers after intervention,and there was no significant change in self-efficacy and coping style of caregivers(P>0.05).The 8-week integrated intervention for MCI caregivers increased the social support of MCI caregivers and strengthened their social support network.However,integrated intervention had no significant effect on self-efficacy and coping strategies,which was mainly attributed to the limited sample size and the duration of the intervention.Although there was no statistically significant alleviation on the overall caregiving burden,the emotional burden of caregivers has decreased significantly with the strengthened social support.On the contrary,the caregiver’s development restriction increased,which was impacted by the further understanding of the multiple caregiving tasks for mild cognition impairment,the increase of objective caregiving time,the patients’anosognosia and the increase of the behavioral and psychological symptoms.