摘要
目的比较阿尔茨海默病（AD）患者不同照料模式下照料者的生活质量及其影响因素。方法选择2013年1~12月在重庆市精神卫生中心住院、门诊及渝北区龙塔老年公寓中临床确诊的192例AD患者及其192名照料者为研究对象,按照环境不同,将192名照料者分为三组：住院组（住院AD患者的照料者）63名、家庭组（居家AD患者的照料者）64名、机构组（养老机构AD患者的照料者）65名。采用世界卫生组织生活质量测定简表（WHOQOL-BREF）进行评定,并对有关影响因素进行调查和统计学分析。结果三组照料者WHOQOL-BREF总分及社会、环境领域得分比较,差异有统计学意义（H=8.005、11.352、14.067,P=0.018、0.003、0.001）;住院组的WHOQOL-BREF总分显著高于机构组,差异有统计学意义（Z=-2.774,P=0.006）,住院组与家庭组、机构组与家庭组WHOQOL-BREF总分比较,差异均无统计学意义（t=1.230、1.525,P=0.221、0.130）;住院组的社会领域得分显著高于家庭组和机构组,差异均有统计学意义（Z=2.703、-3.186,P=0.008、0.001）;机构组的环境领域得分显著低于住院组和家庭组,差异均有统计学意义（Z=-3.615、2.759,P=0.000、0.000）。住院组照料者的生活质量总得分与慢性躯体疾病、医疗费支付方式及与患者关系呈负相关（r=-0.296、-0.274、-0.258,P=0.019、0.030、0.041）,与社会支持评定量表（SSRS）得分呈显著正相关（r=0.367,P=0.003）;家庭组的生活质量总得分与年龄、Zarit照料者负担量表（ZBI）得分呈显著负相关（r=-0.340、-0.433;P=0.006、0.000）,与经济收入、SSRS得分呈显著正相关（r=0.341、0.346,P=0.006、0.005）。机构组的生活质量总得分与教育年限呈正相关（r=0.245,P=0.049）、与经济收入、SSRS得分呈显著正相关（r=0.387、0.681,P=0.001、0.000）,与慢性躯体疾病、医疗费支付方式、ZBI得分呈显著负相关（r=-0.338、-0.416、-0.364,P=0.006、0.001、0.003）;三组社会支持得分与生活质量总分呈显著正相关（P〈0.01）。医疗费支付方式、ZBI、SSRS分别是住院组、家庭组、机构组生活质量的主要影响因素。结论 AD照料者的生活质量与照料环境密切相关;加强医疗卫生服务,提升社会支持水平,有利于改善其生活质量。
Objective To compare the quality of life under different care modes in caregivers of Alzheimer′s disease（AD）and its influencing factors. Methods 192 inpatients and outpatients of AD in the Chongqing Municipal Mental Health Center and Yubei District Longta Elderly Apartment and their caregivers were taken as the study subjects from January to December of2013. 192 caregivers were divided into the hospitalization group（caregivers of AD inpatients,63 cases）,family group（caregivers of AD patients living in home,64 cases） and institution group（caregivers of AD patients in the retirement institutions,65 cases）. The quality of life of the AD caregivers was assessed by the WHO Quality of Life（WHOQOL-BREF）,and the relevant influential factors were investigated and statistically analyzed. Results The total scores of WHOQOL-BREF,social domain and environmental domain scores had significant significant differences among the three groups（H=8.005,11.352,14.067,P=0.018,0.003,0.001）;the total score of life quality in the hospitalization group was significantly higher than that in the institution group with statistical difference（Z=-2.774,P=0.006）;the total score of life quality had no statistical difference between the hospitalization group and the family group and between the institution group and the family group（t=1.230,1.525,P=0.221,0.130）;the social domain score in the hospitalization group was significantly higher than that in the family group and the institution group,the differences were statistically significant（Z=2.703,-3.186,P=0.008,0.001）;the environment domain score in the institution group was significantly lower than that in the hospitalization group and the family group,the differences were statistically significant（Z =-3.615,2.759,P =0.000,0.000）. The total score of life quality in the hospitalization group was negatively correlated with the chronic somatic diseases,medical fee payment ways and relation with the patients（r=-0.296,-0.274,-0.258,P=0.019,0.030,0.041）,significantly positively correlated with the SSRS score（r=0.367,P=0.003）;the total score of life quality in the family group was significantly negatively correlated with the age and ZBI score（r=-0.340,-0.433,P=0.006,0.000）,and significantly positively correlated with the economic income and SSRS score（r=0.341,0.346,P=0.006,0.005）. The total score of life quality in the institution group was positively corre lated with the education years（r=0.245,P=0.049）,significantly positively correlated with the economic income and SSRS score（r =0.387,0.681,P=0.001,0.000）,and significantly negatively correlated with the chronic somatic disease,medical fee payment ways and ZBI score（r=-0.338,-0.416,-0.364,P=0.006,0.001,0.003）;the social support score in the three groups showed the significantly positive correlation with the total score of life quality（P〈0.01）. The medical fee payment ways,ZBI and SSRS were the main influencing factors of life quality in the 3 groups. Conclusion The life quality of the AD caregivers is closely correlated with the care environment;strengthening the medical and health services and promoting the level of social support conduce to improve their overall quality of life.
出处
《现代医药卫生》
2015年第14期2089-2092,共4页
Journal of Modern Medicine & Health
基金
重庆市卫生局医学科研计划项目(2012-2-247)
关键词
阿尔茨海默病
痴呆
问卷调查
生活质量
照料者
对比研究
Alzheimer Disease
Dementia
Questionnaires
Quality of life
Caregiver
Comparative study
