连带病耻感对照顾阿尔茨海默病患者的照顾负担影响

doi:10.3760/cma.j.issn.1007-1245.2023.04.033

摘要/Abstract

摘要：

目的　探讨阿尔茨海默病患者家庭主要照顾者连带病耻感、照顾负担、社会支持现状，并分析三者之间的相关性。方法　采用方便抽样法，选取2020年1月至2021年1月收治于南阳医学高等专科学校第一附属医院、南阳市中心医院的老年早期阿尔茨海默病患者172例为研究对象进行横断面调查。入组阿尔茨海默病患者均为已婚，且家庭结构完整。采用一般资料调查表、贬低-歧视感知量表、照顾负担量表、社会支持评定量表进行调查。采用SPSS 20.0、AMOS 20.0统计软件处理相关数据。计数资料采用百分率、频数表示。符合正态分布的计量资料组间比较采用独立样本t检验及方差分析。Pearson相关分析照顾者的连带病耻感、社会支持与照顾负担之间的相关性。建立路径关系模型，对照顾者连带病耻感、社会支持、照顾负担三者之间的关系进行路径分析，并采用最大似然估计法进行模型拟合。P<0.05为差异有统计学意义。结果　患者年龄（68.34±10.40）岁，男84例（48.84%），女88例（51.16%）。照顾者的连带病耻感、社会支持、照顾负担总分分别为（49.15±7.90）分、（35.97±7.89）分、（52.04±8.68）分；连带病耻感对照顾者负担具有明显的正向预测效应（B=1.586，P<0.001）。连带病耻感对社会支持具有明显的负向预测效应（B=-1.497，P<0.001）。连带病耻感影响照顾负担时，社会支持亦具有中介作用，其95%置信区间不包括0（95%CI 0.451～1.059），社会支持的中介效应占总效应的47.3%。结论　阿尔茨海默病患者家庭主要照顾者的连带病耻感水平较高，社会支持水平较低，照顾负担较重，其连带病耻感能直接预测社会支持、照顾负担，并通过社会支持对照顾负担发挥间接预测效应。医护人员应重视家庭主要照顾者连带病耻感对照顾负担的影响路径，积极构建相关干预方案，强化对照顾者的经济帮助、情感支持及社会支持利用度，减轻照顾者连带病耻感，从而最大限度地降低照顾者的照顾负担，促进患者预后。

关键词:

阿尔茨海默病, 主要照顾者, 连带病耻感, 照顾负担, 社会支持

Abstract:

Objective　To explore the current status of stigma, care burden, and social support in the family caregivers of patients with Alzheimer's disease, and to analyze the correlation between them. Methods　From January 2020 to January 2021, convenience sampling was used to select 172 elderly patients with early Alzheimer's disease treated in The First Affiliated Hospital of Nanyang Medical College and Nanyang City Central Hospital as the research objects for the cross-sectional investigation. All the patients with Alzheimer's disease were married and had intact family structure. The General Information Questionnaire, Perceived Demeaning-Discrimination Scale, Caring Burden Scale, and Social Support Rating Scale were used for the investigation. The SPSS 20.0 and AMOS 20.0 statistical softwares were used to process the relevant data. The enumeration data were expressed as percentage and frequency. The measurement data of normal distribution were compared between the groups by independent sample t test and analysis of variance. Pearson correlation was used to analyze the correlation between stigma, social support, and care burden of the caregivers. The path relationship model was established to analyze the relationship between stigma, social support, and care burden of the caregivers; the maximum likelihood estimation method was used to fit the model. When P<0.05, there is a statistical difference. Results　The patients were (68.34±10.40) years old; there were 84 males (48.84%) and 88 females (51.16%). The total scores of stigma, social support, and caring burden of the caregivers was (49.15±7.90), (35.97±7.89), and (52.04±8.68), respectively. Stigma had a significant positive predictive effect on the caregivers' burden (B=1.586, P<0.001). Stigma had a negative predictive effect on social support (B=-1.497, P<0.001). When stigma affected care burden, social support also had a mediating effect. The 95% confidence interval did not include 0 (95%CI 0.451-1.059); the mediating effect of social support accounted for 47.3% of the total effect. Conclusions　Primary family caregivers of patients with Alzheimer's disease have a high level of stigma, a low level of social support, and heavy care burden. Stigma can directly predict social support and care burden, and plays an indirect predictive effect on care burden through social support. Primary health care workers should attach importance to the paths influencing the care burden by the family caregivers' stigma, actively build related intervention plans, strengthening the caregivers' economy help, emotional support, and social support to reduce the caregivers' stigma and burden, so as to promote the patients' prognosis.

Key words:

Alzheimer's disease, Primary caregivers, Attached stigma, Care burden, Social support

张珺周静.

连带病耻感对照顾阿尔茨海默病患者的照顾负担影响 [J]. 国际医药卫生导报, 2023, 29(4): 581-587.

Zhang Jun, Zhou Jing.

Effect of stigma on caregivers' burden of patients with Alzheimer's disease [J]. International Medicine and Health Guidance News, 2023, 29(4): 581-587.

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