Courtney H. Van Houtven PhD, Karen M. Stechuchak MS, Paul A. Dennis PhD, MSA, Kasey Decosimo MPH, Chelsea L. Whitfield MPH, Nina R. Sperber PhD, S. Nicole Hastings MD, MHS, Megan Shepherd-Banigan PhD, MPH, Brystana G. Kaufman PhD, Valerie A. Smith DrPH
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Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted “days not at home” variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%–3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (−0.1%). An IP day had a slight protective effect (−0.2 to −0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. 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引用次数: 0
摘要
背景：在医疗机构的时间与患者生活质量（QoL）的下降有关，但对家庭护理者生活质量的影响尚不清楚。我们评估了护理对象不在家的天数--在急诊科（ED）、住院（IP）护理和急性期后护理（PAC）的天数--以了解护理对象不在家的天数与家庭护理者 QoL 的对应关系：方法：将二级数据与接受护理者的使用数据联系起来。我们使用弹性网机器学习模型来评估在每种环境中使用一天护理服务对二元 QoL 结果的影响。我们还比较了综合加权和非加权 "不在家天数 "变量。我们使用 6 个月和 18 个月这两个时间段来预测三种照顾者 QoL 指标（自评健康、抑郁症状和主观负担）：结果：在 6 个月的时间框架内，单日使用急诊室与所有三个评估结果的 QoL 较差可能性增加有关（范围：1.4%-3.2%）。一天的 PAC 与护理负担（0.2%）和抑郁症状（0.1%）的增加有一定程度的相关性，但对自评健康有轻微的保护作用（-0.1%）。IP 日也有轻微的保护作用（-0.2% 到 -0.1%）。在 18 个月时，ED 和 IP 与照顾者负担和抑郁症状的关系相似，但较为平淡。PAC 对照顾者的负担有轻微的保护作用（-0.1%）。在所有环境中的累计天数一般与护理者的 QoL 无关：虽然接受照护者离开家庭的总时间对家庭照护者有一些负面溢出效应，但独特环境对照护者 QoL 的反作用可能会掩盖 QoL 的净效应。这一发现限制了单一的受照护者在家时间测量作为以照护者为中心的有效测量方法的实用性。要揭示对照顾者 QoL 的真正净影响，可能需要单独考虑个别环境中照顾者的累计时间。
Is more care recipient time at home also a family caregiver-centered quality of life measure?
Background
Time in healthcare facilities is associated with worse patient quality of life (QoL); however, impact on family caregiver QoL is unknown. We evaluate care recipient days not at home—days in the emergency department (ED), inpatient (IP) care, and post-acute care (PAC)—to understand how care recipient days not at home correspond to family caregiver QoL.
Methods
Secondary data were linked to care recipient utilization data. Elastic net machine learning models were used to evaluate the impact of a single day of utilization in each setting on binary QoL outcomes. We also compared composite weighted and unweighted “days not at home” variables. Two time periods, 6 and 18 months, were used to predict three caregiver QoL measures (self-rated health, depressive symptoms, and subjective burden).
Results
In the 6-month timeframe, a single day of ED utilization was associated with increased likelihood of poor QoL for all three assessed outcomes (range: 1.4%–3.2%). A day of PAC was associated to a modest degree with increased likelihood of caregiver burden (0.2%) and depressive symptoms (0.1%), with a slight protective effect for self-rated health (−0.1%). An IP day had a slight protective effect (−0.2 to −0.1%). At 18 months, ED and IP had similar, albeit more muted, relationships with caregiver burden and depressive symptoms. PAC had a slight protective effect for caregiver burden (−0.1%). Cumulative days in all settings combined generally was not associated with caregiver QoL.
Conclusion
Whereas total care recipient time away from home had some negative spillovers to family caregivers, the countervailing effects of unique settings on caregiver QoL may mask net QoL effects. This finding limits the utility of a single care recipient home time measure as a valid caregiver-centered measure. Considering cumulative care recipient time in individual settings separately may be needed to reveal the true net effects on caregiver QoL.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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