本文選題：阿爾茨海默病 + 照料者負(fù)擔(dān)��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本文探討社會(huì)支持是否調(diào)節(jié)了社區(qū)居住的輕度阿爾茨海默病(Alzheimer’s disease,AD)患者因素與照料者負(fù)擔(dān)的關(guān)系,以及照料者積極感受是否是患者因素影響照料者負(fù)擔(dān)的中介變量。方法:采用橫斷面研究,研究對(duì)象為太原市2所醫(yī)院和3個(gè)社區(qū)確診的AD患者及其照料者,210對(duì)輕度AD患者及其照料者完成問卷調(diào)查。照料者主觀負(fù)擔(dān)評(píng)價(jià)包括照料者負(fù)擔(dān)量表(Caregiver Burden Inventory,CBI)、焦慮自評(píng)量表(Self-Rating Anxiety Scale,SAS)和抑郁自評(píng)量表(Self-Rating Depression Scale,SDS),照料者同時(shí)完成了社會(huì)支持評(píng)定量表(Social Support Rating Scale,SSRS)和照料者積極感受量表(Positive Aspects of Caregiving,PAC)。采用蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment,MoCA)和老年抑郁量表(the Geriatric Depression Scale,GDS)評(píng)估AD患者認(rèn)知功能和抑郁水平。分別采用潛調(diào)節(jié)結(jié)構(gòu)方程(Latent Moderated Structure Equations,LMS)方法和偏差校正的非參數(shù)百分位Bootstrap(Bias-Corrected Percentile Bootstrap)方法分析阿爾茨海默病照料者社會(huì)支持、積極感受的調(diào)節(jié)效應(yīng)和中介效應(yīng)。結(jié)果:LMS研究結(jié)果顯示:照料者社會(huì)支持與患者認(rèn)知(γa11=0.147,P0.001)和患者抑郁(γa12=-0.146,P=0.001)的交互項(xiàng)對(duì)照料者負(fù)擔(dān)的效應(yīng)均有統(tǒng)計(jì)學(xué)意義,低社會(huì)支持時(shí),關(guān)系均最強(qiáng),高社會(huì)支持時(shí),關(guān)系均最弱,說明照料者社會(huì)支持調(diào)節(jié)并緩和了患者認(rèn)知、患者抑郁與照料者負(fù)擔(dān)的關(guān)系;偏差校正的非參數(shù)百分位Bootstrap法分析結(jié)果顯示,照料者積極感受對(duì)患者抑郁與照料者負(fù)擔(dān)(=0.197,P=0.006)、照料者焦慮(=0.225,P=0.007)、照料者抑郁(=0.178,P=0.034)的完全中介效應(yīng)有統(tǒng)計(jì)學(xué)意義,但照料者積極感受不是患者認(rèn)知和照料者負(fù)擔(dān)的中介變量;混合效應(yīng)分析結(jié)果顯示社會(huì)支持對(duì)以上中介效應(yīng)模型前后路徑均無調(diào)節(jié)效應(yīng)(P 0.05)。結(jié)論:本研究初步揭示了阿爾茨海默病患者因素“怎樣”以及“何時(shí)”作用于照料者負(fù)擔(dān);由于在高社會(huì)支持水平時(shí),阿爾茨海默病患者認(rèn)知、抑郁與照料者負(fù)擔(dān)的關(guān)系均最弱,所以,應(yīng)該給予低社會(huì)支持水平的照料者更多關(guān)注,為其提供所需的社會(huì)支持,從而降低其負(fù)擔(dān);另外,患者抑郁減少照料者的積極感受,進(jìn)而加重照料者負(fù)擔(dān),因此,需要意識(shí)到這些關(guān)系監(jiān)控和管理患者抑郁、照料者積極感受的變化從而減緩照料者負(fù)擔(dān)。
[Abstract]:Objective: to investigate whether social support regulates the relationship between the factors of mild Alzheimer's disease (AD) in community and the burden of carers, and whether the positive feelings of carers are the mediating variables that affect the burden of carers. Methods: a cross-sectional study was carried out in two hospitals and three communities in Taiyuan. A questionnaire survey was carried out among the patients with mild AD and their caregivers. The subjective burden assessment included Caregiver burden scale (CBI), Self-Rating Anxiety scale (SAS) and Self-Rating Depression scale (SDS). The carers also completed the Social support rating scale (SSRS) and the positive Aspects of carers (PAC). The cognitive function and depression level of AD patients were evaluated with the Montreal Cognitive Assessment scale (MCA) and the Depression scale (the). The methods of latent moderated structure equation (LMS) and bias-corrected percentile bootstrap (Bootstrap) were used to analyze the effects of social support, positive perception and mediation of Alzheimer's disease carers. Results the results of the study showed that the interaction between social support and patient cognition (緯 a110.147 P0.001) and depression (緯 a12-0.146 P0. 001) had significant effects on the burden of carers. When the social support was low, the relationship was the strongest, and the relationship between the patients with high social support was the weakest. The results showed that the social support of carers regulated and alleviated the cognition of patients, the relationship between depression and burden of carers, and the nonparametric bootstrap analysis of bias correction showed that, The total mediating effects of depression and carer burden (0.197 P0. 006), carer anxiety (0. 225 P0. 007) and carer depression (0. 178 P0. 034) were positively felt by carers, but positive feelings of carers were not mediating variables of patients' cognition and carers' burden. The results of mixed effect analysis showed that social support had no regulating effect on the path before and after the intermediary effect model (P 0.05). Conclusion: this study preliminarily revealed how and when the factors of Alzheimer's disease affected the burden of carers, because at the high level of social support, the patients with Alzheimer's disease were cognized. The relationship between depression and carers' burden is the weakest, so more attention should be given to caregivers with low level of social support to reduce their burden by providing them with the necessary social support. In addition, depression in patients reduces the positive feelings of carers. Therefore, it is necessary to realize that these relationships monitor and manage the depression of the patient, and the change of positive feelings of the carer reduces the burden of the carer.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.16

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本文編號(hào)：2113546