本文選題：阿爾茨海默病 + 疾病負(fù)擔(dān)　； 參考：《山西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：阿爾茨海默病即老年癡呆癥，是一種進(jìn)行性發(fā)展的致死性神經(jīng)退行性疾病，臨床表現(xiàn)為認(rèn)知和記憶功能不斷惡化，日常生活能力進(jìn)行性減退，并有各種神經(jīng)精神癥狀和行為障礙。由于AD對老年人更是重要的死亡或致殘原因，在世界與我國人口老齡化趨勢日益加速的情況下，AD對人類所造成的疾病負(fù)擔(dān)還將日漸加重。因此，全面了解AD所造成的疾病負(fù)擔(dān)，具有現(xiàn)實意義。本研究以疾病負(fù)擔(dān)現(xiàn)狀與預(yù)測兩個方面研究為基礎(chǔ)，對AD患者的疾病負(fù)擔(dān)進(jìn)行了較為全面的研究，為促進(jìn)我國AD疾病負(fù)擔(dān)的研究及今后衛(wèi)生資源的合理配置提供了參考。 本研究對AD患者的疾病負(fù)擔(dān)現(xiàn)狀進(jìn)行了評價，分別從患者群體負(fù)擔(dān)、經(jīng)濟(jì)負(fù)擔(dān)、照料者負(fù)擔(dān)以及家庭負(fù)擔(dān)四個方面出發(fā)，對AD導(dǎo)致的疾病負(fù)擔(dān)進(jìn)行了全面的研究。患者群體負(fù)擔(dān)研究采用全國死因監(jiān)測系統(tǒng)數(shù)據(jù)；經(jīng)濟(jì)負(fù)擔(dān)研究對象為采用整群抽樣方法選取的太原市兩所醫(yī)院和三個社區(qū)共168名AD患者；照料者負(fù)擔(dān)調(diào)查對象為168名AD患者的照料者；家庭負(fù)擔(dān)調(diào)查對象為168名AD患者的主要家庭成員。 AD患者群體負(fù)擔(dān)研究傷殘調(diào)整生命年（DALY）評價AD患者的負(fù)擔(dān)大小。首先利用死亡數(shù)據(jù)計算YLL，其次利用疾病負(fù)擔(dān)模型擬合數(shù)據(jù)，產(chǎn)生YLD所需數(shù)據(jù)，從而計算YLD。結(jié)果顯示AD患者DALY值大于國內(nèi)相關(guān)研究結(jié)果，且以YLD為主。60歲上男性每千人DALYs為6.46，女性每千人DALYs為8.65，總?cè)巳好壳薉ALYs為7.59。YLL方面：男性的每千人YLLs和死亡率均高于女性。不論男性還是女性，基本隨著年齡的增長而增長。同一年齡段每千人YLLs比較：60歲以上人群基本上是男性高于女性。YLD方面：女性的每千人YLDs和死亡率均高于男性。不論男性還是女性，YLD均隨著年齡的增長而增長。同一年齡段每千人YLDs比較：60歲以上人群基本上是女性高于男性。 經(jīng)濟(jì)負(fù)擔(dān)采用自編的經(jīng)濟(jì)負(fù)擔(dān)問卷，包括直接醫(yī)療費(fèi)用、直接非醫(yī)療費(fèi)用、間接費(fèi)用。直接醫(yī)療費(fèi)用包括掛號費(fèi)、診療費(fèi)、化驗費(fèi)、檢查費(fèi)、治療費(fèi)、藥品費(fèi)等；直接非醫(yī)療費(fèi)用包括交通費(fèi)、住宿費(fèi)、伙食費(fèi)、營養(yǎng)保健品費(fèi)用、雇傭照顧者費(fèi)用、商業(yè)醫(yī)療保險費(fèi)用等；間接費(fèi)用包括患者由于疾病或身體不適導(dǎo)致的不能正常生活以及家屬提供無償照料所導(dǎo)致的損失。結(jié)果顯示：AD患者直接醫(yī)療費(fèi)用均值為7708元/年，直接非醫(yī)療費(fèi)用為1525元/年，間接費(fèi)用為6516元/年。醫(yī)療總費(fèi)用為15749元/年。多因素分析結(jié)果顯示影響經(jīng)濟(jì)負(fù)擔(dān)總費(fèi)用的因素包括患者性別、年齡以及認(rèn)知功能。 照料者負(fù)擔(dān)采用照料者負(fù)擔(dān)問卷（CBI）進(jìn)行評價照料者的負(fù)擔(dān)嚴(yán)重程度。并利用路徑分析構(gòu)建患者因素，照料者因素對最終負(fù)擔(dān)的影響。結(jié)果表明：照料者得分為47.54±17.61，處于中等水平�；颊哒J(rèn)知水平低、照料時間長加重照料者的負(fù)擔(dān)；社會支持度高、家庭關(guān)懷度高、感受越積極，，照料者的負(fù)擔(dān)會越低。照料時間、社會支持及家庭關(guān)懷度不僅與患者的認(rèn)知水平有直接關(guān)系，而且均是患者認(rèn)知水平與照料者負(fù)擔(dān)的中間調(diào)節(jié)因素。同理，社會支持是患者日常行為能力與照料者負(fù)擔(dān)的中間調(diào)節(jié)變量；照料時間與積極感受是患者精神行為癥狀與照料者負(fù)擔(dān)的中間調(diào)節(jié)變量。 AD家庭負(fù)擔(dān)研究以家庭負(fù)擔(dān)量表(FBS)為測評工具，評價患者家庭負(fù)擔(dān)各方面的嚴(yán)重程度。首先對FBS應(yīng)用于AD家庭負(fù)擔(dān)的信度和效度進(jìn)行測試，隨后對各維度家庭負(fù)擔(dān)得分進(jìn)行分析，最后用逐步回歸對FBS總分進(jìn)行多因素分析。結(jié)果顯示：FBS具有良好的分半信度(分半信度系數(shù)為0.930 )和內(nèi)部一致性信度(各維度Cronbach a系數(shù)范圍為0.691-0.734 )，內(nèi)容效度、結(jié)構(gòu)效度以及反應(yīng)度也較好。FBS得分分析結(jié)果表明：AD患者家庭負(fù)擔(dān)各維度均存在不同程度的負(fù)擔(dān)，家庭日常生活和家庭娛樂活動兩方面負(fù)擔(dān)相比其它維度則更為顯著；多因素分析結(jié)果顯示影響FBS總得分的因素包括患者性別、認(rèn)知功能以及日常生活能力。 本研究采用預(yù)測模型對2010年-2030年中國AD患病數(shù)進(jìn)行預(yù)測�；A(chǔ)模型是一個多狀態(tài)時間離散Markov模型。個體可以從健康狀態(tài)，進(jìn)展到疾病早期階段，然后到疾病晚期階段。個體在每一個階段都有一定的死亡危險。結(jié)果顯示：模型估計2010年大約有6621268人患有AD，男性患者2920486（44.1%），女性患者3700782（55.9%）；疾病的早期階段3730547（56.3%），晚期階段2890721（43.7％），并且患病率會隨著年齡的增長而增長。以患病數(shù)預(yù)測為例，到2030年由于人口因素，AD的患病數(shù)可能增加為原來的2.42倍，男性患者與女性患者比值約44.2：55.8，早期與晚期的比例穩(wěn)定（55.9：44.1）；根據(jù)方案P（2012年實施預(yù)防干預(yù)措施導(dǎo)致了疾病的發(fā)病延遲2年）2030年增加患病數(shù)僅僅1.85倍，男性患者與女性患者比值約44.2：55.8，早期與晚期的比例穩(wěn)定（56.0：44.0）；方案T（2012年實施治療干預(yù)導(dǎo)致了疾病的進(jìn)展延緩2年），患病數(shù)增長為2.54略高于方案D（基本方案），男性患者與女性患者比值約44.2：55.8；早期：晚期比例為64.1：35.9；方案C（綜合干預(yù)）很好的表示了以上兩個干預(yù)措施，總體患病數(shù)增長為1.94倍；并且階段比例發(fā)生轉(zhuǎn)變，約為64.2：35.8。男性患者與女性患者比值沒有改變，約44.2：55.8。 結(jié)論：（1）監(jiān)測區(qū)老年人平均傷殘調(diào)整生命年為7.59/千人，說明AD帶來的患者群體負(fù)擔(dān)較嚴(yán)重，影響患者的生存質(zhì)量。 （2）AD患者經(jīng)濟(jì)負(fù)擔(dān)較重，相對其他相關(guān)研究結(jié)果一致�；颊哚t(yī)療費(fèi)用占48.9%，直接非醫(yī)療費(fèi)用占9.7%，間接費(fèi)用占41.4%，說明患者帶來的醫(yī)療費(fèi)用較高，患者損失的時間以及照料者由于照料患者帶來的時間損失所占比重也較大。 （3）AD患者照料者研究中，AD患者認(rèn)知水平、日常行為能力、精神行為癥狀嚴(yán)重程度與照料者負(fù)擔(dān)呈密切關(guān)系，照料者獲得的社會支持、家庭關(guān)懷度以及自我積極感受也與其自身負(fù)擔(dān)密切相關(guān)，關(guān)注患者的相關(guān)問題，積極促進(jìn)照料者的人文關(guān)懷，有助于減輕照料者的負(fù)擔(dān)。 （4）AD患者家庭負(fù)擔(dān)中，相比較其他研究，家庭負(fù)擔(dān)較重，AD患者帶給家庭成員日常生活以及娛樂方面很大的影響。 （5）預(yù)測研究顯示：2030年我國將有16032655人患AD。開展積極的預(yù)防控制措施將有效降低AD患病數(shù)，緩解家庭和社會負(fù)擔(dān)。
[Abstract]:Alzheimer's disease, known as Alzheimer's disease, is a progressive progressive neurodegenerative disease, characterized by worsening cognitive and memory functions, progressive impairment of daily living capacity, and various neuropsychiatric symptoms and behavioral disorders. Because AD is more important for death or disability in the elderly, it is in the world and in China With the increasing trend of population aging, the burden of disease caused by AD will be more and more serious. Therefore, it is of practical significance to fully understand the burden of disease caused by AD. Based on the two aspects of the status and prediction of the disease burden, this study has carried out a more comprehensive study on the disease burden of the patients of AD, in order to promote the disease burden. The study of AD disease burden in China and the rational allocation of health resources in the future provide a reference.
In this study, the status of the disease burden of AD patients was evaluated. From the four aspects of the group burden, the economic burden, the burden of the caregivers and the family burden, the disease burden caused by AD was comprehensively studied. The study of the population burden of the patients adopted the data of the national death cause monitoring system; the object of economic burden study was to adopt the study. A total of 168 AD patients were selected from 2 hospitals in Taiyuan and three communities in a cluster sampling method. The caregivers' burden of investigation was the caregivers of 168 AD patients, and the family burden survey was the main family members of 168 AD patients.
AD patients' population burden study on disability adjusted life year (DALY) to evaluate the burden of AD patients. First, YLL is calculated by using death data, and then data can be obtained by using the disease burden model to generate the data required for YLD, thus the results of YLD. show that the DALY value of AD patients is greater than that of domestic related research results, and YLD is the main male per thousand DALY on.60 years old. S was 6.46, women per 1000 people DALYs was 8.65, and the total population was DALYs per 1000 people 7.59.YLL: male per thousand YLLs and mortality were higher than women. No matter male or female, it increased basically with age. Comparison of each thousand people at the same age group YLLs: men over 60 years older than women.YLD aspect: Female The YLDs and mortality rate of every 1000 people were higher than that of men. Both male and female, YLD increased with age. YLDs compared to each thousand people in the same age group: the population over 60 years old was basically higher than that of the male.
The economic burden adopts the self compiled economic burden questionnaire, including direct medical expenses, direct non medical expenses and indirect costs. Direct medical expenses include registration fee, diagnosis and treatment fee, laboratory fee, inspection fee, treatment fee, drug fee and so on. Direct non medical expenses include transportation, lodging, food, nutrition and health care expenses, and hiring caregivers' expenses. The indirect cost includes the loss of the patient's unnormal life due to disease or physical discomfort and the free care provided by the family members. The result shows that the average cost of direct medical treatment for AD patients is 7708 yuan per year, the direct non medical cost is 1525 yuan per year, the indirect cost is 6516 yuan per year. The total medical cost is 15. 749 yuan / year. Multivariate analysis showed that the factors affecting the total cost of the economic burden included gender, age and cognitive function.
The caregiver burden of caregiver burden questionnaire (CBI) was used to evaluate the burden of the caregivers. The effect of the patient factor and the caregiver factors on the ultimate burden was constructed by means of path analysis. The results showed that the caregivers were 47.54 + 17.61, at the middle level. The patients' cognitive level was low and the care time was longer for the burden of the caregivers. High social support, high family care, more positive feelings, the lower the burden of caregivers. Care time, social support and family care are not only directly related to the cognitive level of the patients, but also the middle adjustment factors of the patient's cognitive level and the burden of the caregivers. The mediating variables of burden are caregiver time and positive feeling.
AD family burden study used family burden scale (FBS) as an assessment tool to evaluate the seriousness of the family burden. First, the reliability and validity of FBS applied to AD family burden were tested, and then the family burden scores of each dimension were analyzed. Finally, the multifactor analysis of the total score of FBS was carried out by stepwise regression. The results showed that: FBS With good semi reliability (half reliability coefficient 0.930) and internal consistency reliability (the range of Cronbach a coefficient of each dimension is 0.691-0.734), content validity, structure validity and response degree also better.FBS score analysis results show that all dimensions of family burden of AD patients have different degrees of burden, family daily life and family entertainment The two aspects of the music activity were more significant than those of other dimensions. The results of multiple factors analysis showed that the factors affecting the total score of FBS included the gender, cognitive function and daily living ability.
The prediction model is used to predict the number of Chinese AD diseases in -2030 2010. The basic model is a multi state time discrete Markov model. The individual can move from healthy state to early stage of the disease and then to the late stage of the disease. The individual has a certain risk of death at each stage. The results show that the model is estimated to be 2010 About 6621268 people in the year were AD, 2920486 (44.1%) for men, 3700782 (55.9%) for women, 3730547 (56.3%) at the early stage of the disease, 2890721 (43.7%) in the late stage, and the prevalence rate increased with age. For example, the number of AD may increase to 2.42 by 2030 due to population factors. The ratio of male and female patients was about 44.2:55.8, and the proportion of early and late period was stable (55.9:44.1). According to program P (2 years of disease delay in 2012), the number of diseases increased by only 1.85 times in 2030, and the ratio between male and female patients was about 44.2:55.8, and the proportion of early and late period was stable (56). 44): (44); program T (2012 implementation treatment intervention led to a delay of 2 years of disease progression), the number of diseases increased by 2.54 slightly higher than that of program D (basic scheme), the ratio of male to female patients was about 44.2:55.8; early stage ratio was 64.1:35.9; program C (comprehensive intervention) was a good indication of the above two interventions and overall illness. The number increased by 1.94 times, and the proportion of stages changed, about 64.2:35.8.. The ratio of male to female patients did not change, about 44.2:55.8.
Conclusion: (1) the average disability adjusted life years of the elderly in the monitoring area is 7.59/, which indicates that the burden of AD patients is more serious, which affects the quality of life of the patients.
(2) the economic burden of AD patients was more serious than other related research results. The medical expenses accounted for 48.9%, the direct non medical expenses accounted for 9.7% and the indirect cost accounted for 41.4%. It indicated that the medical expenses of the patients were higher, the time of the loss of the patients and the time loss of the caregivers due to the care of the patients were also larger.
(3) in the study of AD patient caregivers, the cognitive level, the daily behavior ability, the severity of the mental behavior symptoms are closely related to the burden of the caregivers, the social support obtained by the caregivers, the degree of family care and the self positive feelings are closely related to their own burden, and the related problems of the patients are concerned and the humane customs of the caregivers are actively promoted. It helps to lighten the burden of the caregivers.
(4) family burden of AD patients, compared with other studies, family burden is heavier, and AD patients have great influence on family members' daily life and entertainment.
(5) prediction studies show that in 2030, 16032655 people will be infected with AD. in China. Active prevention and control measures will effectively reduce the number of AD cases and relieve family and social burdens.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R749.16

【引證文獻(xiàn)】

相關(guān)博士學(xué)位論文 前1條

1 呂繁;疾病家庭負(fù)擔(dān)和社會負(fù)擔(dān)研究[D];中國協(xié)和醫(yī)科大學(xué);2000年

本文編號：2073423