脑卒中后遗症患者养老方式对陪护者生活质量的影响研究
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摘要
研究目的
探讨脑卒中后遗症患者居家养老、福利院养老和医疗机构养老3种养老方式对陪护者生活质量的影响。
研究方法
2008年7月至2009年12月,在山东省泰安市中医院、山东省泰安荣军医院、泰安市泰山区两家老年护理院、泰山区5个社区,根据纳入标准选取187例脑卒中后遗症患者的陪护者作为研究对象。根据脑卒中后遗症患者的养老方式将陪护者分为三组:1医疗机构养老陪护者;2福利院养老陪护者;3居家养老陪护者。应用《照顾者应对方式问卷》、《脑血管病后遗症病人陪护者的生活质量调查表》、《照顾者社会支持评定量表》、《照顾者生活满意度调查问卷》、《照顾者幸福度调查问卷》和《照顾者生活质量综合评定问卷》为测量工具,通过临床对照研究,探讨这3种养老方式对陪护者生活质量的影响。将收集的资料用EXCEL建立数据库,采用SPSS17.0软件进行统计分析。三组数据的分析用t检验和F检验,比较探讨3种养老方式对陪护者生理、心理及社会状况的影响。
研究结果
1.陪护者生活质量的比较:居家组、福利院组和医疗机构组的陪护者在生理功能、生理职能和机体疼痛方面无显著差异;而在总体健康、精力、社会职能、情感职能和心理健康方面,三组陪护者有显著差异:医疗机构养老方式的陪护者在这五方面均优于福利院组和居家组,而福利院组优于居家组。其中情感职能、心理健康和社会职能的差异性更明显。提示脑卒中后遗症患者的陪护工作对心理方面的影响较生理方面的影响更显著。
2.陪护者生活满意度的比较:三组陪护者对生活的满意度有明显差异。三组陪护者对生活满意度得分,医疗机构组、福利院组、居家组得分依次降低,分别为:24.15±2.56、22.3±3.14、17.7±2.63。医疗机构内养老的陪护者比福利院内养老的陪护者满意度高(P<0.05);福利院内养老的陪护者比居家养老的陪护者满意度高(P<0.01);医疗机构内养老的陪护者比居家养老的陪护者的满意程度明显的高(P<0.01)。
3.三组陪护者得到社会支持的比较:在得到的社会支持方面(来自配偶、子女、子女的配偶、父母、兄弟姐妹、其他有亲属关系的人、周围的邻居、工作单位、社区或其他机构),居家组与福利院组得到的社会支持无明显差别(P=0.11) ;福利院组与医疗机构组比较,两组得到的社会支持无显著差异(P=0.43),福利院组和医疗机构组得到的社会帮助相差不大;而医疗机构养老方式的陪护者得到的社会支持比居家养老方式的陪护者多(P<0.01)。
4.三组陪护者应对挫折困难方式的比较:当陪护者在生活中经受到挫折打击或遇到困难时可能采取的态度和做法。在积极的应对方式方面:医疗机构组得分大于福利院组,大于居家组,三组有显著差异;医疗机构组较福利院组积极(p<0.05);福利院组较居家组积极(p<0.05);居家组与医疗机构组得分相比,医疗机构组在应对方式上比居家组的陪护者更容易采取积极的态度(P<0.01)。相反,在消极的应对方式方面:居家组得分大于福利院组,大于医疗机构组,有统计学显著差异;居家组的陪护者要比福利院组的陪护者在处理挫折困难时要消极(p<0.05);居家组的陪护者比医疗机构组的陪护者在应对方式上要更消极(P<0.01);福利院组与医疗机构组相比(P=0.10),无显著统计学意义,福利院组的陪护者与医疗机构组的陪护者在处理挫折困难时消极态度相差不大。
研究结论
1.医疗机构养老的陪护者虽然在生理上与居家组和福利院组相差不大,但是在心理和社会职能上优于居家组和福利院组,对生活的满意度相对较高,得到的社会支持也相对多,遇到挫折和困难更容易积极应对,而福利院组优于居家组。提示医疗机构养老是一种使陪护者生活质量相对较高的养老方式,福利院养老方式的陪护者生活质量次之,但目前医疗机构内养老有一定的局限性。
2.医疗机构养老及福利院养老的陪护者较多获得社会及家庭的帮助和支持,且病人每天进行康复训练较多,提示应加强对居家养老陪护者的社会支持及帮助,加强对居家养老CACS病人的康复功能锻炼。
研究意义
该研究为脑卒中后遗症患者养老方式对陪护者生活质量的影响提供了大量、详实的临床资料,对于制定脑卒中后遗症患者养老方式提供了理论依据和循证医学证据。
Objective:
To survey the influence on the main caregivers quality of life between three aged living in hospital, in welfare and at home among the CACS patients.
Methods
187 caregivers of CACS patients living in Taian Traditional Chinese Medicine Hospital, Taian Invalides Hospital, two TaiShanQu elderly nursing and five TaiShanQu communities from July 2008 to December 2009, were selected. There are three endowment ways for CACS patients, and the caregivers of CACS were divided into three groups: caregivers in medical agency, caregivers in welfare hospital and caregivers in household. By using the clinical control study method, to survey and analysis of these 3 kinds of endowment way the influence on the quality of the escort resorted to life through six questionnaires. The original data were put into database to be statistically analysed with EXCEL and the tool SPSS17.0. Three sets of data were compared with t-test and F-inspection to calculate respectively and compare the influence of physiology, psychology and social conditions of the three kinds of endowments for the caregivers.
Results
1.Comparison in the quality of the caregivers’life: No significant difference on PF, RP and BP were not found, but significant differences on GH, VT, SF, RE and MH were shown: The caregivers of hospital endowment way are superior to welfare endowment way and home endowment way in the five aspects, and welfare endowment way are superior to home endowment way. There were more obvious differences for caregivers in emotional functions, in mental health and in social functions. The influence of the psychological aspect is more significant than that of the physiological aspect.
2.Comparison in the life satisfaction of the caregivers: There were marked differences among the three groups. Life satifaction of hospital group, welfare group and home group fell in turn, 24.15±2.56、22.3±3.14、17.7±2.63 respectively. The life satisfaction of hospital group is higher than welfare group(P<0.05), but the life satisfaction of home group is lower than hospital group(P<0.01) and welfare group(P<0.01).
3.Comparison in the social support of three groups: There are not obvious difference between home group and welfare group(P=0.11);The caregivers of hospital group get more social support than home group(P<0.01);there is no obvious difference between welfare group and hospital group.
4.Comparison in cope with setbacks among the three groups: When the caregivers encounters the setback in the life or frustrations, they can take the attitude or response. In a positive manner: Hospital group is more active than welfare group (p < 0.05); Welfare group is more active than home group (p < 0.05); hospital group is more active than home group (p < 0.01). In contrast, home group is easier than welfare group in a negative way (p<0.05); Compared with home group and hospital group(p < 0.01), the caregivers are more negtive than that of hospita; Compared with welfare group and hospital group(P=0.10), there is no difference between them.
Conclusion
1.There showed little difference in physiology between the three groups, but hospital group is superior, in psychology and in social function and with higher life satisfaction, to welfare group and home group. Moreover, hospital group can receive more social support and is tend to take more actively when meet setbacks and difficulties. Hospital endowment is an endowment that can have the caregivers get higher quality of life. The caregivers’life quality of the welfare pension way takes second place. But medical institutions have some limitations in endowment.
2.Not only the caregivers in hospital and in welfare can get more supports and help from society and family, but also patients can get more training. So more social support and help should be given to the caregivers, and more function exercise should be entitled CACS patients.
Significance
The research provides the clinical data on the influence of the life quality for the CACS’caregivers , and is will help to provide theory basis and evidence-based medical evidence for decide aged living Patterns for CACS Patients.
探讨脑卒中后遗症患者居家养老、福利院养老和医疗机构养老3种养老方式对陪护者生活质量的影响。
研究方法
2008年7月至2009年12月,在山东省泰安市中医院、山东省泰安荣军医院、泰安市泰山区两家老年护理院、泰山区5个社区,根据纳入标准选取187例脑卒中后遗症患者的陪护者作为研究对象。根据脑卒中后遗症患者的养老方式将陪护者分为三组:1医疗机构养老陪护者;2福利院养老陪护者;3居家养老陪护者。应用《照顾者应对方式问卷》、《脑血管病后遗症病人陪护者的生活质量调查表》、《照顾者社会支持评定量表》、《照顾者生活满意度调查问卷》、《照顾者幸福度调查问卷》和《照顾者生活质量综合评定问卷》为测量工具,通过临床对照研究,探讨这3种养老方式对陪护者生活质量的影响。将收集的资料用EXCEL建立数据库,采用SPSS17.0软件进行统计分析。三组数据的分析用t检验和F检验,比较探讨3种养老方式对陪护者生理、心理及社会状况的影响。
研究结果
1.陪护者生活质量的比较:居家组、福利院组和医疗机构组的陪护者在生理功能、生理职能和机体疼痛方面无显著差异;而在总体健康、精力、社会职能、情感职能和心理健康方面,三组陪护者有显著差异:医疗机构养老方式的陪护者在这五方面均优于福利院组和居家组,而福利院组优于居家组。其中情感职能、心理健康和社会职能的差异性更明显。提示脑卒中后遗症患者的陪护工作对心理方面的影响较生理方面的影响更显著。
2.陪护者生活满意度的比较:三组陪护者对生活的满意度有明显差异。三组陪护者对生活满意度得分,医疗机构组、福利院组、居家组得分依次降低,分别为:24.15±2.56、22.3±3.14、17.7±2.63。医疗机构内养老的陪护者比福利院内养老的陪护者满意度高(P<0.05);福利院内养老的陪护者比居家养老的陪护者满意度高(P<0.01);医疗机构内养老的陪护者比居家养老的陪护者的满意程度明显的高(P<0.01)。
3.三组陪护者得到社会支持的比较:在得到的社会支持方面(来自配偶、子女、子女的配偶、父母、兄弟姐妹、其他有亲属关系的人、周围的邻居、工作单位、社区或其他机构),居家组与福利院组得到的社会支持无明显差别(P=0.11) ;福利院组与医疗机构组比较,两组得到的社会支持无显著差异(P=0.43),福利院组和医疗机构组得到的社会帮助相差不大;而医疗机构养老方式的陪护者得到的社会支持比居家养老方式的陪护者多(P<0.01)。
4.三组陪护者应对挫折困难方式的比较:当陪护者在生活中经受到挫折打击或遇到困难时可能采取的态度和做法。在积极的应对方式方面:医疗机构组得分大于福利院组,大于居家组,三组有显著差异;医疗机构组较福利院组积极(p<0.05);福利院组较居家组积极(p<0.05);居家组与医疗机构组得分相比,医疗机构组在应对方式上比居家组的陪护者更容易采取积极的态度(P<0.01)。相反,在消极的应对方式方面:居家组得分大于福利院组,大于医疗机构组,有统计学显著差异;居家组的陪护者要比福利院组的陪护者在处理挫折困难时要消极(p<0.05);居家组的陪护者比医疗机构组的陪护者在应对方式上要更消极(P<0.01);福利院组与医疗机构组相比(P=0.10),无显著统计学意义,福利院组的陪护者与医疗机构组的陪护者在处理挫折困难时消极态度相差不大。
研究结论
1.医疗机构养老的陪护者虽然在生理上与居家组和福利院组相差不大,但是在心理和社会职能上优于居家组和福利院组,对生活的满意度相对较高,得到的社会支持也相对多,遇到挫折和困难更容易积极应对,而福利院组优于居家组。提示医疗机构养老是一种使陪护者生活质量相对较高的养老方式,福利院养老方式的陪护者生活质量次之,但目前医疗机构内养老有一定的局限性。
2.医疗机构养老及福利院养老的陪护者较多获得社会及家庭的帮助和支持,且病人每天进行康复训练较多,提示应加强对居家养老陪护者的社会支持及帮助,加强对居家养老CACS病人的康复功能锻炼。
研究意义
该研究为脑卒中后遗症患者养老方式对陪护者生活质量的影响提供了大量、详实的临床资料,对于制定脑卒中后遗症患者养老方式提供了理论依据和循证医学证据。
Objective:
To survey the influence on the main caregivers quality of life between three aged living in hospital, in welfare and at home among the CACS patients.
Methods
187 caregivers of CACS patients living in Taian Traditional Chinese Medicine Hospital, Taian Invalides Hospital, two TaiShanQu elderly nursing and five TaiShanQu communities from July 2008 to December 2009, were selected. There are three endowment ways for CACS patients, and the caregivers of CACS were divided into three groups: caregivers in medical agency, caregivers in welfare hospital and caregivers in household. By using the clinical control study method, to survey and analysis of these 3 kinds of endowment way the influence on the quality of the escort resorted to life through six questionnaires. The original data were put into database to be statistically analysed with EXCEL and the tool SPSS17.0. Three sets of data were compared with t-test and F-inspection to calculate respectively and compare the influence of physiology, psychology and social conditions of the three kinds of endowments for the caregivers.
Results
1.Comparison in the quality of the caregivers’life: No significant difference on PF, RP and BP were not found, but significant differences on GH, VT, SF, RE and MH were shown: The caregivers of hospital endowment way are superior to welfare endowment way and home endowment way in the five aspects, and welfare endowment way are superior to home endowment way. There were more obvious differences for caregivers in emotional functions, in mental health and in social functions. The influence of the psychological aspect is more significant than that of the physiological aspect.
2.Comparison in the life satisfaction of the caregivers: There were marked differences among the three groups. Life satifaction of hospital group, welfare group and home group fell in turn, 24.15±2.56、22.3±3.14、17.7±2.63 respectively. The life satisfaction of hospital group is higher than welfare group(P<0.05), but the life satisfaction of home group is lower than hospital group(P<0.01) and welfare group(P<0.01).
3.Comparison in the social support of three groups: There are not obvious difference between home group and welfare group(P=0.11);The caregivers of hospital group get more social support than home group(P<0.01);there is no obvious difference between welfare group and hospital group.
4.Comparison in cope with setbacks among the three groups: When the caregivers encounters the setback in the life or frustrations, they can take the attitude or response. In a positive manner: Hospital group is more active than welfare group (p < 0.05); Welfare group is more active than home group (p < 0.05); hospital group is more active than home group (p < 0.01). In contrast, home group is easier than welfare group in a negative way (p<0.05); Compared with home group and hospital group(p < 0.01), the caregivers are more negtive than that of hospita; Compared with welfare group and hospital group(P=0.10), there is no difference between them.
Conclusion
1.There showed little difference in physiology between the three groups, but hospital group is superior, in psychology and in social function and with higher life satisfaction, to welfare group and home group. Moreover, hospital group can receive more social support and is tend to take more actively when meet setbacks and difficulties. Hospital endowment is an endowment that can have the caregivers get higher quality of life. The caregivers’life quality of the welfare pension way takes second place. But medical institutions have some limitations in endowment.
2.Not only the caregivers in hospital and in welfare can get more supports and help from society and family, but also patients can get more training. So more social support and help should be given to the caregivers, and more function exercise should be entitled CACS patients.
Significance
The research provides the clinical data on the influence of the life quality for the CACS’caregivers , and is will help to provide theory basis and evidence-based medical evidence for decide aged living Patterns for CACS Patients.
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[4]徐持华,张卫东.川穹嗪对大鼠心肌缺血再灌注心肌预适应保护与一氧化氮的关系[J].中国临床康复,2006,10(3):74-76.
[5]程桂荣,易胜中.黄芪预处理大鼠心肌保护效应的实验研究[J].高血压杂志,2001,9(4):316-318.
[6]Tritto IRC, Koutos MC, loesser KE, etal. Oxygen tadicals can induce preconditioning in rabbit hearts[J]. Cir Res,1997,80(5):734-738.
[7]孔羽,徐峰,余振球.刺五加苷预适应对大鼠心肌缺血再灌注损伤的保护作用[J].中国全科医学,2009,12(2B):292-294.
[8]张玉华,韩丛成,曲绍春,等.刺五加叶皂苷对大鼠实验性心肌梗死的保护作用[J].中国新药杂志,2002,11(9):695-697.
[9]赵国安,刘三强,陈志刚,等.灯盏花素对家兔缺血预适应心肌保护作用的影响[J].中国康复理论与实践,2006,12(6):467-468.
[10]赵国安,丁明伟,陈丹.灯盏花素联合预适应对家兔心肌缺血再灌注细胞凋亡的影响[J].华南国防医学杂志,2009,23(1):4-7.
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[1]梁国庆,孙霞,亢晓东,等.丹参联合缺血预适应对缺血性心肌的保护作用[J].中国现代应用药学杂志,2002,19(5):370-372.
[2]高秀梅,张伯礼,商洪才,等.复发丹参对缺血预适应大鼠心肌蛋白激酶C表达的影响[J].中草药,2003,34(10):933-935.
[3]梁日欣,廖福龙,李文,等.川穹嗪的药理性预处理对麻醉大鼠心肌缺血再灌注损伤的保护作用.中药药理与临床,1999,15(5):13-14.
[4]徐持华,张卫东.川穹嗪对大鼠心肌缺血再灌注心肌预适应保护与一氧化氮的关系[J].中国临床康复,2006,10(3):74-76.
[5]程桂荣,易胜中.黄芪预处理大鼠心肌保护效应的实验研究[J].高血压杂志,2001,9(4):316-318.
[6]Tritto IRC, Koutos MC, loesser KE, etal. Oxygen tadicals can induce preconditioning in rabbit hearts[J]. Cir Res,1997,80(5):734-738.
[7]孔羽,徐峰,余振球.刺五加苷预适应对大鼠心肌缺血再灌注损伤的保护作用[J].中国全科医学,2009,12(2B):292-294.
[8]张玉华,韩丛成,曲绍春,等.刺五加叶皂苷对大鼠实验性心肌梗死的保护作用[J].中国新药杂志,2002,11(9):695-697.
[9]赵国安,刘三强,陈志刚,等.灯盏花素对家兔缺血预适应心肌保护作用的影响[J].中国康复理论与实践,2006,12(6):467-468.
[10]赵国安,丁明伟,陈丹.灯盏花素联合预适应对家兔心肌缺血再灌注细胞凋亡的影响[J].华南国防医学杂志,2009,23(1):4-7.
[11]郭佳,刘小康,武文,等.人参皂苷Rb1预适应对肥厚乳鼠心肌细胞缺氧复氧损伤的保护作用[J].中国临床药理学和治疗学,2005,10(9):1010-1014
[12]宋清,张晓文,徐志伟,等.人参茎叶皂苷预适应对自发性高血压大鼠心肌缺血再灌注损伤的保护作用[J]. 2008,22(1):42-48.
[13]马英,刘文利,朱飞奇.地奥心血康防治心肌缺血再灌注损伤的实验研究[J].中华医学丛刊杂志,2002,2(7):27-28.
[14]楼兰花,丁志山,高承贤.血府逐瘀汤对大鼠心肌缺血再灌注损伤的保护作用[J].中药药理与临床,2002,18(5):5-6.