【作者】 柳琳琳；

【导师】 胡慧；

【作者基本信息】 湖北中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的：(1)探讨社区老年痴呆患者的照顾者在生理、心理、社会关系、环境四大领域的生活质量以及社会支持对于个体行为转变的影响；以了解社区护理服务利用和需求的情况；(2)探讨在社区范围内,有效利用社区护理服务的程度,以期通过护理干预,提高患者家庭照顾者社会支持水平,增进健康的可行性。方法：本研究选择武汉市已建立居民健康档案的10个居委会作为研究地点,分为实验区和对照区,调查对象为武汉市的老年痴呆患者的家庭照顾者；调查的内容包括：调查对象的一般情况(人口学特征及照料史等),及通过世界卫生组织生活质量测定量表简表(WHOQOL-BREF)中文版对其照顾者生活质量进行测评以了解其生理、心理、社会关系、环境四大领域的基本情况及需求状况。遵循方便取样原则,将实验区和对照区的家庭照顾者作为调查对象,进行有关生理、心理、社会关系、环境四大领域以及社区护理服务利用和需求的问卷调查。具体方式由调查人员上门发放问卷,或通过居委会发放的形式发给调查对象,问卷由调查对象自己填写。结果运用统计描述与分析,相关回归分析的方法,对家庭照料过程中的日常生活、医疗、护理、社会等有偿服务的需求状况及其影响因素进行分析。根据调查结果,制定相应的社区护理干预方案,实验组每两周一次,每次30-40分钟,并实施连续6个月的护理干预,以调查了解其生活质量的改善情况,评价干预效果。所得的资料全部采用量化专项数据库进行整理分析,采用均值与标准差值(x士s)表示。实验组与对照组的指标比较采用t检验。结果：本次调查共发放问卷150份,完成调查问卷149份,回收率为99.3%,去除回答不完整或不合格问卷后,共获得有效问卷132份,其中男性71例,女性61例,年龄范围为34-78岁。分析结果显示：1.家庭照顾组94.2%的老年痴呆患者的家庭照顾者存在不同的生活质量问题。主要包括以下几个方面：(1)生理上的压力：照顾老年痴呆患者的工作多而琐碎,患者起居常存在日夜颠倒的问题,有时还会猜忌甚至攻击家人,照顾者往往长期拖着疲累之躯而操劳,久而久之,会影响到照顾者的身体健康。(2)照顾者的心理压力大：由于老年痴呆患者的言行举止发生了很大的变化,与以往相比,在沟通、智力及自理方面都出现了很大的障碍,这些都会对照顾者造成巨大的压力。而且由于家庭照顾者是非正式的护理者,对疾病的病因、发展过程,结局等知识的不了解,在漫长而琐碎的照料中,往往会产生无奈、挫折等消极情绪。(3)缺乏社交生活：因本病的特殊性使照顾者的个人时间减少、社交生活圈缩小、娱乐缺乏,无法满足人际需求或培养兴趣爱好。2.养老机构的老年痴呆家庭照顾者大多具有较好的经济基础,其社会关系领域得分明显优于居家养老照顾者,说明养老机构有一定的优越性,不失为一种切实可行的养老方式,有利于改善照顾者的生活质量,提升其社会职能。但现有养老设施大多是在无城市总体规划的情况下逐步兴建起来的,且受中国传统伦理文化“养儿防老”的影响,大部分家庭没有选择入住养老机构。3.照顾者对社区护理均有较高需要,除个别条目的需要在50%以下外,大部分条目均在50%以上。4.照顾者的生活质量与护理需要呈负性相关,生活质量越差,对社区护理的需要也越高。结论：现阶段,我国城区养老设施少于需求量、条件差、收费高,故大部分家庭选择居家照顾,而老年痴呆患者在许多方面给家庭照顾者造成很大的负担,直接导致照顾者生活质量下降,从而影响其对老年痴呆患者的照顾质量。所以,加快发展、完善我国老年痴呆患者的护理服务体系,建立完善社区老年服务网络,完善医疗体制,对家庭照顾者给予相应的协助并加强对其的引导与教导,以减轻其照顾压力,从而改善其生活质量,并最终提高其照顾质量。更多还原

【Abstract】 Objective:(1) To study and explore the quality of life for family caregivers of Alzheimer patients from physical, psychological, social relations, environment, as well as how social support would affect individual behavior; understanding of community care service utilization and demand; (2) To explore how much is the feasibility of improve the recovery status of patients within the community by offering more social support to family caregivers from effective community care services and intervening from professional nursing.Methods:The purpose of this study has established the health of residents in Wuhan file 10 neighborhood as an experimental community, the survey of Wuhan City Patients with Alzheimer’s Family Caregivers; survey include:the survey of the general situation (demographic characteristics, health status, care history), and the quality of life measured by the World Health Organization (WHOQOL-BREF) Chinese version of the quality of life of their caregivers evaluation in order to understand their physical, psychological, social relations, environment, four major areas of the basic conditions and demand conditions. To follow the principle of convenience sampling, from the intervention area and control area, respectively, of family caregivers an object of investigation to carry out the physical, psychological, social relations, environment and community care services in four major fields of and demand for the use of questionnaires. Concrete way by the investigating officers will be issuing questionnaires over the door, and through the neighborhood of two forms of payment payable to the survey, the questionnaire completed by the survey itself. Apply the results of statistical description and analysis, Logistic regression analysis, the method of combining, for family caregivers in the process of everyday life, medical, nursing, and social service needs have paid and their influencing factors were analyzed. According to the survey, formulate corresponding community care intervention programs, the intervention group to intervene every two weeks, once 30-40 minutes, and the implementation of 6 consecutive months of care and intervention, to investigate about their quality of life improvements, evaluate intervention effect. Used in all the information available to quantify the specific database and analyzed using mean and standard deviation (x±s) indicated. Intervention group and control group was used to compare each index t test.Results:This survey was completed a total of 149 copies of the questionnaire response rate was 99.3%, removal of incomplete or failed to answer the questionnaire, a total of 132 valid questionnaires were received, of which 71 cases of male, female 61 cases, age range of 34-78 years. Analysis showed that:1. 94.2% of elderly caregivers of dementia there are different degrees of quality of life issues. (1) Those physical pressure of the caregivers:to take care of AD is an onerous task trivial, their patients often living day and night reversed, abnormal behavior, and sometimes suspicion, attack family members, caregivers are often tired day after day, dragging the footer, long-term physical exertion, affect the health of caregivers. (2) Those psychological pressure of the caregivers:As the AD patients with the demeanor of the great changes have taken place, than in the past, communication skills, intelligence and self-care ability of the larger obstacles have emerged, which will take care of those enormous pressure. Because it is informal caregivers, the disease etiology, the development process, the knowledge of the outcome of lack of understanding of the care of a long and arduous, of ten occur helplessness, frustration, loss of confidence in the other negative emotions, thereby affecting the quality of care. (3) The caregivers basically did not own their social life: Because of the particularity of the Alzheimer’s disease that the caregivers’ personal time was reduced, and making friends the opportunity to reduce the lack of recreational activities, this time will not be able to meet the personal or interpersonal needs or develop interests and hobbies.2. Endowment institution dementia family caregivers mostly has good economic base, its social relation area score significantly better than family endowment caregivers, has certain advantages of endowment institution, can yet be regarded as a viable way, to improve the endowment of quality of life, and to promote their social functions. But the existing facilities are mostly in aged under the condition of urban planning, and gradually build up by Chinese traditional ethical culture, most families have no choice in endowment.3. The caregivers have a high need for community care, in addition to the needs of the individual entries of 50% or less, the majority of entries were more than 50%.4. The quality of life and care needs was negatively relevance, the poorer quality of life, the faster the community care needs increased.Conclusions:At present, our city endowment facilities are far away from our demand, poor living condition and overcharging, most families choose caring for patients with senile dementia in the community and in their own homes. Senile patients with dementia in many respects to the family caregiver burden caused by a lot of pressure, resulting in a decline in quality of life of caregivers, thereby affecting their quality of care in patients with senile dementia. Therefore, Accelerate development and perfect our country’s dementia patient care service system, establishing and perfecting the community elderly service network, we should change the traditional model of medical care, improve the health care system, for family caregivers, to give appropriate assistance and to strengthen its guidance and teachings in order to alleviate the pressure of their care, thus improving their quality of life, and ultimately improve their quality of care.更多还原