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Yıl:2008; Cilt: 16; Sayı: 2>> Özet
TAM METİN
Kriz Dergisi; 2008;16(2):11-24
Alzheimer Hastalarının Yakınlarında Bakımevi Tercihini Belirleyen Faktörler
A Yılmaz, E Turan
Ankara Üniversitesi, Tıp Fakültesi, Psikiyatri Anabilim Dalı, Konsültasyon Liyezon Psikiyatri Bilim Dalı
Amaç; Bu çalışmanın amacı, Alzheimer hastalığı tanısı alan hastalara bakım veren yakınlarının bakımevi tercihlerini belirleyen faktörleri incelemektir. Yöntem ve Gereçler; Araştırmanın örneklemi, Ankara Üniversitesi Tıp Fakültesi Psikiyatri AD geropsikiyatri polikliniğine başvuran ve diğer tanılar ekarte edilerek Alzheimer hastalığı tanısı konmuş bireyler ve onlara primer bakım veren yakınları arasından seçilmiştir. Hasta ve yakınlarının yapılandırılmış birer anket formu uygulanarak demografik verilerinin sorgulanmasının ardından, Alzheimer hastalarına Mini Mental Durum Değerlendirme (MMDD) Testi, Kısa Psikiyatrik Derecelendirme Ölçeği (KPDÖ), Fiziksel Özbakım Ölçeği (FÖB) ve Geriatri Depresyon Ölçeği (GDÖ) uygulanırken, bakım verenlere ise Maslach Tükenmişlik Ölçeği (MBI), Hamilton Anksiyete (HAÖ) ve

Depresyon Ölçeği (HDÖ) uygulanmıştır. Bulgular; Çalışmaya 44 hasta ve yakını alınmıştır. 44 bakım verenin 37'si (%84) hastalarının evde bakılmasını tercih ederken, 7'sinin tercihi bakımevleri (%16) olmuştur. Alzheimer hastalarına bakım veren yakınlarının bakımevi tercihi ile hastaların kognitif durumları (MMDD), davranışsal ve psikolojik semptomları (KPDÖ), fiziksel özbakımları (FÖB), uyku düzeni ve bakımveren-lerin Maslach duygusal tükenme puanları arasında anlamlı ilişkili olduğu (p<0.05) saptanmıştır. Alzheimer hastalarının depresyon puanları ve bakımverenin maslach duyarsızlaşma ve kişisel başarı alt ölçekleri, depresyon ve anksiyete puanları ile bakımevinin tercih edilmesi arasında ise anlamlı ilişki saptanmamıştır (p>0.05). Tartışma; Alzheimer hastalarına ba-kımveren yakınlarının bakımevi tercihlerini etkileyen faktörler arasında en çok kognitif fonksiyonlar, fiziksel özbakım, psikolojik ve davranışsal semptomlar, ayrı bir antite olarak uyku düzensizliği ve bakımverenin duygusal tükenmişliği dikkati çekmektedir. Bu faktörlerden özellikle psikolojik ve davranışsal semptomların ve uyku düzensizliğinin tedavi ile düzeltilebilir ve kontrol altına alınabilir faktörler olması önemlidir. Daha önce yapılan çalışmalarda, bu konuda yapılacak uygun müdahaleler ile bakı m verenlerin bakımevlerini daha geç tercih ettikleri bildirilmiştir.
Factors That Determine Nursing Home Preference Among Alzheimer Diseases' Relatives
Aim; The aim of this study is to determine factors which predicate nursing home preference of the Alzheimer diseases' caregivers. Material-Method; Sample of the study has been elected from subjects who had Alzheimer disease diagnosis and their primary caregiver relatives, who refered to Ankara University School of Medicine Psychiatry Department, Geropsychiatry Policlinic. After constructed questionnaire and demographic data were collected, Alzheimer patients were evaluated by using Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS), Personal Self-Maintaining Scale (PSMS) and Geriatric Depression Scale (GDS), while caregivers were administrated Maslach Burn-Out Inventory (MBI), Hamilton Anxiety (HAS) and Hamilton Depression Scale (HDS). Results; 44 Alzheimer disease patients and their relatives were included in the study. 37 caregiver (84%) preferred nursing their patients at home and 7 (16%) caregiver preferred nursing homes. Caregivers of Alzheimer patients' preference of nursing home is significantly correlated with cognitive states (MMSE), behavioral and psychological symptoms (BPRS), personal self-maintaining (PSMS), sleep deprivation of patients and maslach emotional exhaustion subscale of caregivers (p<0.05). Not any significant relationship was observed between nursing home preference and patients' depression levels and caregivers' maslach depersonalization and personal accomplishment subscale scores and depression and anxiety levels

(p>0.05). Discussion; Factors which predicate nursing home preference among caregivers, cognitive functions, personal self maintaining, psychological and behavioral symptoms, as a symptom sleep disorder, and emotional exhaustion of caregiver were the most saliency factors. Psychological and behavioral symptoms' and sleep deprivations' being amendable and mane-gable factors were important. In previous studies, it was signified that with appropriate interventions, caregivers would rather prefer nursing home later.

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