阿尔茨海默病性痴呆患者的照料者负担及其影响因素调查

摘要

Objective To assess care burdens and related factors of caregivers of patients with Alzheimer′s disease. Methods A total of 192 patients clinically diagnosed with Alzheimer's disease and their primary caregivers from Chongqing Mental Health Center,outpatients and nursing institutions from January 2013 to December 2013,who were divided into three groups including the hospitalization group with 63 cases(the caregivers of the Alzheimer′s disease in hospital),the family group with 64 cases(the caregivers of the Alzheimer′s disease at home)and the nursing institutions with 65 cases(the caregivers of the Alzheimer′s disease in the nursing institutions). The caregivers of patients with Alzheimer′s disease were assessed with Zarit Caregiver Burden Interview(ZBI),Symptom Checklist-90(SCL-90),World Health Organization(WHO) of Quality of Life Scale-Brief Form Questionnaire (QOL-BREF) and Social Support Rating Scale (SSRS). The patients were assessed with Simple Mental State Examination(MMSE),Activities Of Daily Living Scale(ADL),Neuropsychiatry Questionnaire(NPI). And then the relevant factors were investigated and analyzed. Results (1)The total scores of ZBI in caregivers of Alzheimer′s disease were significant ly lower than the national normal,the difference had statistical significance(t=-13.059,P<0.01);There were statistically significant difference between the three groups in the total score of ZBI and each factor score (P<0.01);The total score in the family group was significantly higher than that in the hospitalization group(P<0.01)and the total score in the hospitalization group was signifi-cantly higher than it in nursing institutions group(P<0.01).(2)The ZBI score was significantly positive correlation with the ages of caregivers,care time,family members or not,physical illness,ADL scoring,NPI scoring and SCL-90 scoring(r=0.244,0.347,0.444, 0.209,0.299,0.323,0.605,P<0.01)and positive correlation with caregivers′income and disease duration of patients(r=0.151, 0.179,P<0.05),and significantly negatively correlated with MMSE score and QOL score (r=-0.282,-0.236,P<0.01),and nega-tively correlated with SSRS score(r=-0.157,P<0.05).(3)It took NPI score,care time,whether family members or not and physical illness into the regression equation,R2=0.324. It found that care time,physical illness,the ages of the patients were the main pre-dictor respectively to the hospitalized,family and agency group. Conclusion The burden to care patients with Alzheimer′s disease for family caregivers was so heavy that it impacted the mental health and quality of life of caregivers and reduce the time for care and improve the symptoms of patients,which could help them release caregiver burden.%目的对阿尔茨海默病（AD）性痴呆患者的照料者的照料负担及其相关影响因素进行评估。方法选取2013年1～12月在重庆市精神卫生中心住院、门诊及同地区养老机构中经临床确诊的192例AD性痴呆患者及其主要照料者为研究对象，按患者不同将照料者分为三组：住院组（住院痴呆患者的照料者）63例、家庭组（居家痴呆患者的照料者）64例、机构组（养老机构痴呆患者的照料者）65例。采用扎瑞特照料负担量表（ZBI）、症状自评量表（SCL-90）、WHO生活质量测定简表（QOL-BREF）、社会支持评定量表（SSRS）评定照料者；采用简易智力状态检查（MMSE）、日常生活活动能力量表（ADL）、神经精神科问卷（NPI）评定患者，并对有关影响因素进行调查和统计学分析。结果（1）AD性痴呆患者的照料者ZBI总分得分显著低于中国常模，差异有统计学意义（t=-13.059，P<0.01）；不同组别ZBI总分及各因子得分比较，差异均有统计学意义（P<0.01）；住院组ZBI总分及责任负担得分明显低于家庭组，机构组ZBI总分及各因子得分明显低于家庭组，住院组ZBI总分及个人负担得分显著高于机构组，差异均有统计学意义（P<0.01）。（2）照料者ZBI总分得分与照料者年龄、照料时间、是否家属、躯体疾病、ADL评分、NPI评分、SCL-90评分呈显著正相关（r=0.244、0.347、0.444、0.209、0.299、0.323、0.605，P<0.01），与照料者人均月收入、患者病程呈正相关（r=0.151、0.179，P<0.05），与 MMSE 评分、QOL-BREF 评分呈显著负相关（r=-0.282、-0.236，P<0.01），与SSRS 评分呈负相关（r=-0.157，P<0.05）。（3）将是否家属、NPI评分、照料时间、躯体疾病等因素进入总体回归方程，R2=0.324；照料时间、躯体疾病、患者年龄分别是住院组、家庭组、机构组的主要预测因子。结论家庭照料者的照料负担较重，并且影响照料者的心理健康及生活质量；减少照料时间和改善患者精神症状有助于减轻照料者负担。