Document Detail


The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers.
MedLine Citation:
PMID:  21556040     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Cirrhosis and hepatic encephalopathy (HE) can adversely affect survival, but their effect on socioeconomic and emotional burden on the family is not clear. The aim was to study the emotional and socioeconomic burden of cirrhosis and HE on patients and informal caregivers.
METHODS: A cross-sectional study in two transplant centers (Veterans and University) of cirrhotic patients and their informal caregivers was performed. Demographics for patient/caregivers, model-for-end-stage liver disease (MELD) score, and cirrhosis complications were recorded. Patients underwent a cognitive battery, sociodemographic, and financial questionnaires. Caregivers were given the perceived caregiver burden (PCB; maximum=155) and Zarit Burden Interview (ZBI)-Short Form (maximum=48) and questionnaires for depression, anxiety, and social support.
RESULTS: A total of 104 cirrhotics (70% men, 44% previous HE, median MELD 12, 49% veterans) and their caregivers (66% women, 77% married, relationship duration 32±14 years) were included. Cirrhosis severely impacted the family unit with respect to work (only 56% employed), finances, and adherence. Those with previous HE had worse unemployment (87.5 vs. 19%, P=0.0001) and financial status (85 vs. 61%, P=0.019) and posed a higher caregiver burden; PCB (75 vs. 65, P=0.019) and ZBI (16 vs. 11, P=0.015) compared with others. Cognitive performance and MELD score were significantly correlated with employment and caregiver burden. Veterans and non-veterans were equally affected. On regression, depression score, MELD, and cognitive tests predicted both PCB and ZBI score.
CONCLUSIONS: Previous HE and cognitive dysfunction are associated with worse employment, financial status, and caregiver burden. Cirrhosis-related expenses impact the family unit's daily functioning and medical adherence. A multidisciplinary approach to address this burden is required.
Authors:
Jasmohan S Bajaj; James B Wade; Douglas P Gibson; Douglas M Heuman; Leroy R Thacker; Richard K Sterling; R Todd Stravitz; Velimir Luketic; Michael Fuchs; Melanie B White; Debulon E Bell; HoChong Gilles; Katherine Morton; Nicole Noble; Puneet Puri; Arun J Sanyal
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-05-10
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  106     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-07     Completed Date:  2011-10-31     Revised Date:  2014-09-15    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1646-53     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anxiety / psychology
Caregivers / economics,  psychology*
Cognition Disorders / economics,  psychology*
Cost of Illness*
Cross-Sectional Studies
Depression / psychology
Employment / economics,  psychology
Female
Hepatic Encephalopathy / complications,  economics,  psychology*
Humans
Liver Cirrhosis / complications,  economics,  psychology*
Male
Middle Aged
Patient Compliance / psychology
Quality of Life / psychology
Questionnaires
Regression Analysis
Veterans / psychology
Grant Support
ID/Acronym/Agency:
R01 DK087913/DK/NIDDK NIH HHS; U01 AT004428/AT/NCCAM NIH HHS; U01 AT004428/AT/NCCAM NIH HHS; UL1 RR031990/RR/NCRR NIH HHS; UL1RR031990/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
Am J Gastroenterol. 2012 Mar;107(3):486; author reply 486-7   [PMID:  22388031 ]

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