老年失智症之照顧者的負荷及憂鬱的相關因素探討

The Associative Factors of the Burden and Depression in Caregivers of Patients with Dementia

黃斯聖(Si-Sheng Huang)

指導教授 ： 賴德仁

中山醫學大學/醫學院/醫學研究所/碩士(2008年)

https://doi.org/10.6834/CSMU.2008.00025

摘要

目的：本研究之目的在探究老年失智症照顧者之負荷及憂鬱的相關因素。
方法：本研究採橫斷式相關性研究設計。研究對象為西元2007年1月至12月，至中部某醫學中心精神科記憶門診就診，根據美國精神醫學會出版之第四版精神疾病診斷與統計手冊診斷為老年失智症之病患及其家庭照顧者。使用「神經精神問卷照顧者負荷量表」(NPI-D)評估照顧者的負荷，使用美國流行病學研究中心憂鬱量表(CES-D)評估照顧者的憂鬱，並收集失智病患之基本資料、失智病患之認知功能、臨床失智嚴重度、行為精神症狀、及照顧者之基本資料。使用線性椱迴歸分析並結合路徑分析去探究負荷及憂鬱的相關因素。
結果：共88位失智病患及其照顧者被納入研究。失智老人之照顧者有76%有不等程度的負荷感；42%的照顧者有憂鬱的問題。照顧者負荷的相關影響因素為：工具性日常生活功能依賴他人的項目越少(p=0.045)、簡短式智能評估分數越低(p=0.046)、臨床失智程度越輕(p=0.014)、及病患之整體行為精神症狀越明顯(神經精神病徵調查表總分越高)(p<0.001)；照顧者憂鬱的相關影響因素為：照顧者的負荷(p=0.001)。路徑分析中對於照顧者憂鬱有直接效果的因素為：照顧者負荷；有間接效果的因素為：工具性日常功能、簡短式智能評估分數、臨床失智程度、及病患之整體行為精神症狀。
結論：失智症的早期診斷及對家庭照顧者的早期介入應是減輕照顧負荷的努力方向，而減輕照顧負荷也應可減輕照顧者的憂鬱。另外，患者的行為精神症狀也須積極治療以減輕照顧負荷及憂鬱。

關鍵字

負荷 ； 憂鬱 ； 失智症 ； 照顧者

並列摘要

Objective: To investigate the associative factors of burden and depression in caregivers of patients with dementia.
Methods: The study is a cross-sectional correlational research design. The patients with dementia and their caregivers who visited the memory clinic of a medical center in central Taiwan from January 2007 to December 2007 were recruited. The diagnostic criteria for dementia was according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.(DSM-IV). The caregiver burden was evaluated by Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D), and caregiver depression was evaluated by the Center for Epidemiologic Studies Depression Scale (CES-D). The demographic data of patients and their caregivers, patients’ cognitive functions, patients’ clinical dementia ratings, and patients’ behavioral and psychological symptoms were collected. The associative factors of burden and depression were determined using multiple linear regression analysis and path analysis.
Results: Eighty-eight demented patients and their caregivers were recruited. Seventy-six percent of the caregivers have burden, and 42% of the caregivers have“at risk”of depression. The associative factors of caregiver burden included less dependence in instrumental activities of daily living (IADL) (p=0.045), lower Mini-Mental State Examination (MMSE) scores (p=0.046), less severity of clinical dementia rating (CDR)(p=0.014), and more obvious behavioral and psychological symptoms of dementia (BPSD) (higher total scores for Neuropsychiatric Inventory)(p<0.001). The associative factors of caregiver depression included only level of caregiver burden (p=0.001). In path analyses, the direct effect for caregiver depression included caregiver burden, and the indirect effect included IADL dependence, MMSE, CDR, and BPSD.
Conclusion: Early diagnosis for dementia and early intervention for caregivers are important for reducing caregiving burden. To reduce burden could also lessen the caregiver depression. Besides, caregiver burden and depression could be attenuated by treating patients’BPSD.

並列關鍵字

burden ； depression ； dementia ； caregiver

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