Einmanakennd aldraðra sem njóta heimaþjónustu

Abstract

Tilgangur: Markmið þessarar rannsóknar var að skoða tengsl einmanakenndar við andlega, líkamlega og félagslega þætti aldraðra sem nutu heimaþjónustu heilsugæslunnar árið 1997 Efniviður og aðferð: 257 einstaklingar sem nutu heimaþjónustu heilsugæslunnar á Reykjavíkursvæðinu haustið 1997 voru metnir með MDS-RAI HC (Minimum Data Set- Resident Assessment Instrument for Home Care) mælitækinu. Tengsl við einmanakennd eru skoðuð með ein og fjölþáttagreiningu. Leitað var staðfestingar á algengi einmanakenndar í sambærilegri könnun 5 árum síðar. Niðurstöður: Af heildarhóp þeirra sem nutu heimahjúkrunar upplifðu 20,3% einmanakennd, 18,3% karla, 20,9% kvenna. Ekkjufólk var marktækt líklegra til að vera einmana en fólk í hjúskap, p=0,013. Ekki var munur á milli kynja með tilliti til einmanakenndar og færni til frumathafna daglegs lífs (ADL) en hins vegar höfðu eimana karlar marktækt meiri líkur á erfiðleikum í almennum athöfnum daglegs lífs (IADL). Konur með vitræna skerðingu voru marktækt líklegri til að finna fyrir einmanakennd, p=0,022. Konur, en ekki karlar, sem voru með einmanakennd voru líklegri til að hafa jafnframt depurðareinkenni, p=0,025. Konur með fleiri lyf en sex voru marktækt líklegri til þess að vera einmana, (79,2% vs. 20,8%, p=0,018) og þær voru líklegri til að taka sterk geðlyf ( p=0,007) en einmana karlar voru líklegri til að taka svefnlyf (p=0,046). Þeir sem mátu eigið heilsufar lélegt voru líklegri til að vera einmana, p=0,042. Þeir sem fóru aldrei út fyrir hússins dyr á einum mánuði voru ekki líklegri til að vera einmana og ekki kom fram munur á tíma formlegrar þjónustu milli þeirra sem voru einmana og ekki einmana. Þegar spurt er um hvort einstaklingur telji sig betur kominn annars staðar, svöruðu 43,5% kvenna með einmanakennd játandi á móti 12,7% kvenna án einmanakenndar, p<0,0001. Sambærilegar tölur fyrir karla eru ómarktækar, 18,2% á móti 14,3%. ADHOC rannsóknin fimm árum síðar sýnir að algengi einmanakenndar er 18,4% í algerlega sambærilegum hópi. Ályktanir: Einmanakennd greindist hjá fimmta hluta þeirra einstaklinga sem njóta heimaþjónustu heilsugæslunnar, og það algengi er staðfest fimm árum síðar. Einmanakennd sást oftar hjá ekkjufólki og konum með vitræna skerðingu. Þeir sem mátu heilsufar sitt lélegt voru líklegri til að vera einmana. Kynjamunur kom fram með tilliti til andlegrar líðanar og lyfjainntöku. Skoða þyrfti nánar hvernig þörfum þessara einstaklinga verði best mætt.

Objective: The purpose of this study was to explore the association between loneliness and affective, cognitive, physical and social factors for older persons in home care in 1997 in Reykjavík. Materials and method: 257 individuals who received home care in the Reykjavik area in autumn of 1997 were assessed with the MDS-RAI HC (Minimum Data Set – Resident Assessment Instrument for Home Care) instrument. Association of loneliness was evaluated in uni- and multivariate analysis. Prevalence of loneliness was reassessed 5 years later with the same methodology. Results: Of the total group that received home care, 20.3% expressed loneliness, 18.3 of males and 20.9% of females. Widowed persons were significantly more likely to be lonely than married persons, p=0.013. There was no sex difference with regards to loneliness and primary ADL, but lonely males were significantly more likely to have IADL difficulties. Females with cognitive impairment were more likely to be lonely, p=0.022. Females, but not males, who were lonely were more likely to have depressive symptoms, p=0.025. Females who took more than six medications were significantly more likely to be lonely (79.2% vs. 20.8%, p=0.018) and were more likely to take neuroleptic medications (p=0.007). Lonely males were more likely to take sleeping medications (p=0.046). Those who assessed their health as poor were more likely to be lonely, p=0.042. Those who never went out of their home in one month were not more likely to be lonely and there was no difference in the use of formal care services with regards to loneliness. When females were asked if she thought she would be better of elsewhere, 43.5% of the females with loneliness agreed with the statement versus 12.7% of women without loneliness, p<0.0001. Similar numbers for males were non significant, 18.2% and 14.3%, respectively. In the ADHOC study, 5 years later, the prevalence of loneliness was 81.4%. Conclusion: Loneliness was identified in one fifth of persons in home care and that prevalence was confirmed 5 years later. Loneliness was more often seen among widowed persons and females with cognitive impairment. Those who assessed their health as being poor were more likely to be lonely. Sex difference was seen with regards to affective symptoms and medication use. Further studies are needed to understand how the needs of lonely persons in home care can be best met.