全国老年人队列中接受护理与精神健康使用的关系

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry Pub Date : 2024-07-03 DOI:10.1016/j.jagp.2024.06.010

Mary F. Wyman Ph.D. , Josephine Jacobs Ph.D. , Lily Stalter M.S. , Manasa Venkatesh M.S. , Corrine I. Voils Ph.D. , Ranak B. Trivedi Ph.D. , Carey E. Gleason Ph.D. , Amy L. Byers Ph.D., M.P.H.

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引用次数: 0

摘要

目标在心理健康（MH）的使用方面存在着明显的年龄差异，因此包括老年退伍军人在内的老年人使用心理健康服务的可能性要低得多。居家护理人员是提高适当使用率的一个新途径，但对其研究不足。我们试图在老年退伍军人样本中研究接受护理援助与医疗服务利用率之间的关系，并测试认知状况和抑郁严重程度的调节作用。方法采用跨部门混合效应逻辑回归与调节作用分析，并将 2000-2012 年美国健康与退休研究（U.S. Health and Retirement Study）的调查数据与退伍军人事务部（VA）的医疗保健管理记录相结合，形成独特的数据资源。分析样本包括 1957 名居住在社区的退伍军人（平均年龄 68.2 [9.7]），主要为男性（96.5%）和非西班牙裔白人（77.0%）。测量指标包括从退伍军人事务部记录或自我报告中提取的医疗服务使用情况；CESD-8抑郁症状；以及使用修改后的TICS进行的Langa-Weir认知状态分类。结果在考虑了人口统计学、配偶照顾者的可用性、健康因素和社会经济状况后，与未接受任何援助相比，接受照顾与两倍的医疗服务使用几率相关（8839人年观察值；OR = 2.02；95% CI 1.54-2.65），并且在退伍军人事务部为提高医疗服务的可及性而改变政策后仍然相似。探索性分析表明，认知类别和抑郁症状可能会缓和这种关联。护理人员可能是一种未被充分利用的资源，可以减少与年龄相关的心理健康就医差异。

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Association of Caregiving Receipt With Mental Health Utilization in a National Cohort of Older Adults

Objective

There exist significant age disparities in mental health (MH) utilization, such that older adults, including older veterans, are much less likely to use MH services. In-home caregivers represent a novel, yet understudied, pathway to increase appropriate utilization. We sought to examine the association between receiving caregiving assistance and MH utilization and test moderation effects of cognitive status and depression severity in a sample of older veterans.

Methods

Cross-sectional, mixed effects logistic regression with moderation analyses was used with a unique data resource combining survey data from the 2000–2012 U.S. Health and Retirement Study with Veterans Affairs (VA) healthcare administrative records. The analytic sample included N=1,957 Community-dwelling veterans (mean age 68.2 [9.7]), primarily male (96.5%) and non-Hispanic white (77.0%). Measures included MH utilization extracted from VA records or self-report; CESD-8 for depressive symptoms; and the Langa-Weir cognitive status classification using the modified TICS.

Results

After accounting for demographics, spousal caregiver availability, health factors, and socioeconomic status, caregiving receipt was associated with two-fold odds of MH utilization, compared to receiving no assistance (8,839 person-year observations; OR = 2.02; 95% CI 1.54–2.65) and remained similar following VA policy changes to enhance MH access. Exploratory analyses revealed that categories of cognition and depressive symptoms may moderate the association.

Conclusion

Receipt of any in-home caregiving is associated with increased likelihood of MH use by older adults. Caregivers may represent an underutilized resource to reduce age-related mental health access disparities.

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来源期刊

American Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

13.00

自引率

4.20%

发文量

381

审稿时长

26 days

期刊介绍： The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.