不同养老模式下老年人生命质量研究 ——以乌鲁木齐市为例

[目的]了解乌鲁木齐市不同养老模式下老年人健康相关生命质量(HRQOL),并分析不同养老模式及一般人口学因素对老年人生命质量的影响.[方法]采用欧洲五维健康量表(EQ-5D-3L)对社区居家、机构养老、医养结合养老老年人进行生命质量调查,并分析其影响因素.[结果]单因素分析显示:子女经济支持是影响老年人生命质量的重要因...     

Should age limit admission to the intensive care unit?

People who are older than 65 years of age are the fastest growing segment of the United States population. With the projected exponential increase in the number of elderly patients and the increasing burden of chronic disease, the number of elderly patients who will require treatment in an intensive care unit is expected to increase. Owing to the elderly patient's reduced life expectancy and higher intensive care unit and hospital mortality, it could be argued that elderly patients should not be admitted to the intensive care unit. However, an analysis of available data suggests that functional elderly patients have a favorable "long-term" outcome after intensive care unit admission. This suggests that age alone should not be used in making intensive care unit triage decisions.     

Defining roles, relationships, boundaries and participation between elderly people and nurses within the home: an ethnographic study

Recently there has been a marked shift in the location of nursing care in the UK from the hospital setting to the community and more particularly the home, with elderly people identified as key recipients of care in this setting. A number of commentators have highlighted the particular situation of elderly people with regard to care provision, illuminating the often disempowering nature of care interactions between nurses and elderly people. However, although there is clear evidence from a number of settings that care for elderly people has been less than optimal, to date there is little comparable evidence available regarding elderly people's experiences of nursing care within the home environment. Utilising an ethnographic approach, incorporating participant observation and semistructured interviews with nurses and elderly people (aged 65 years and over), the aim of this study was to explore the nature of the care relationship within the home setting. Thirteen elderly people who were receiving nursing care within the home and 16 community nurses within one Primary Care Trust in the UK took part in the study and data were collected over a period of 1 year. Three themes emerged from the data: the location of care; the nature of nurse–patient relationships; and the meaning of health and illness. These offer an account of the ways in which roles and relationships are constructed, negotiated and experienced by nurses and elderly people in the home, illuminating the centrality of relationships between nurses and elderly people in defining the experiences and perceptions of both groups of the quality of care overall. As the location of care continues to move closer to home, it is crucial that the implicit qualities that are valued within nurse–patient relationships in this context are recognised and made more explicit at both the organisational and policy level.     

Nursing home and nursing home physician: the Dutch experience

Dutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community.     

社区居家养老服务高质量发展评价指标体系的构建研究

目的：社区居家养老服务对于缓解养老压力和提升老人生活质量具有重要作用,本文结合新时代养老服务高质量发展需求,基于SERVPERF模型,构建社区居家养老服务高质量发展评价指标体系,为社区居家养老服务高质量发展的评价和改进提供参考。方法：通过梳理社区居家养老服务相关政策及文献,结合专家访谈,确定初步指标池;开展两轮德尔菲专家咨询,确定评价指标体系。结果：两轮咨询专家积极系数均为100%,专家权威系数分别为0.79、0.82,专家协调程度逐轮提升;最终确定的评价指标体系包括6个一级指标和36个二级指标。结论：本研究构建的社区居家养老服务高质量发展评价指标体系具有一定科学性和可靠性,可为社区居家养老服务高质量发展的评价、建设和改进提供依据。     

适合社区的“医养结合”新养老模式探索

人口老龄化进程的加速,老年患病比例的增加,就医质量需求的增长,让如何养老成为了当今重要的热点社会问题。传统的养老方式无法满足现有的养老需求,促使新型养老模式应运而生。新养老模式“医养结合”的提出,已经得到各方面的积极响应。但养老机构医疗服务能力较弱、专业人才短缺,医养服务质量低、社区卫生服务中心的利用率不高、政策细则不完善、法律法规不健全等问题仍是医养结合养老模式发展面临的巨大问题和困难。该文在此基础上提出建议,构建多层次的“医养结合”服务体系、多层次专业人员培养模式,加快养老服务护理人才队伍建设、改革医疗保险方式,健全护理保险体系、完善相关法律规范,提高政策执行效率,以促进“医养结合”养老模式的迅速发展。     

Long term care: the case of the elderly

Health care for the elderly in industrialized countries has been characterized by a variety of persistent myths, nurtured by an amazing blindness for facts, and pertaining to their number, the related morbidity, the models of care, the unbearable costs and the financial situation of the elderly. Today a more optimistic perspective about the elderly is emerging emphasizing an older person with a remarkable physical and mental fitness and living in satisfying housing and income conditions. There is a less alarming prognosis about the increase of the elderly population and the share of elderly in the increase of health care budgets seems to be incremental. A wide spectrum of models of care has unfolded over Europe and the plausible explanations for the differences relate to the North-South gradient, the cultural patterns, the history of the health care system and the level of economic development. Europe is focusing on community care: in northern Europe to substitute for institutional care and in southern Europe as a response to changing family patterns. There is a danger of overshooting with policies for the aged, but more than special attention is to be given to the vulnerable risk groups which are the octogenarians, suffering from dementia and poor in housing assets.     

Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions

Aspiration pneumonia is a leading cause of morbidity and mortality of elderly residents in long-term care facilities. The microflora present in the oral cavity because of poor oral hygiene has been associated with aspiration pneumonia. There is evidence that improved oral care can reduce the risk of developing aspiration pneumonia in the elderly. The purpose of this paper is to review aspiration pneumonia and provide oral health care guidelines in an effort to help reduce the risk of aspiration pneumonia in the elderly residing in long-term care facilities.     

The mortality effects of changing public funding for home health care: An empirical analysis of Medicare home health care in the United States

In light of population aging, it is important to understand whether limiting public in‐kind transfers to the elderly affects elderly mortality. I focus on home health care—a popular in‐kind transfer—and I exploit variation in the Medicare home health care reimbursement that arose in 1997 in the United States to study whether cuts to government coverage of home health care affected elderly mortality. Under the identifying assumptions of the DID model, I find that the cuts affected total mortality for some men but not women, suggesting that changes in home health care can affect elderly mortality and differences in mortality between men and women. For men aged between 65 and 74, the Interim Payment System was associated with an increase in mortality equal to 0.6%, an effect in absolute value comparable to the mortality response to a one percentage point change in unemployment rates and within the range of other estimates of the impact of health insurance on elderly mortality.     

The cyclicality of informal care

This paper measures the cyclicality of an important input into elderly health: informal care. Using independent survey measures of informal caregiving and care receipt over the past two decades, we find that informal care from adult children to their elderly parents is countercyclical. By contrast, informal care from spouses is procyclical among individuals in their sixties. We find little corresponding change in the use of formal care, highlighting the potential for unmet care needs across the business cycle. These findings suggest that informal health inputs may play an important role in the interpretation of the cyclicality of elderly mortality.     

Community-based case management: a model for outcome-based research for non-institutionalized elderly

Medical treatment and research has changed subsequent to a paradigm shift in fiscal management strategies for health care. The demand for greater fiscal and clinical accountability in health care has resulted in more bureaucratic control of physicians, health care providers and health care delivery. Institutional-based care has been deferred to community-based care, and outcomes-based measurement of treatment interventions are becoming the benchmark of effective care. The increase in our elderly population's numbers and longevity of life, combined with fiscal and clinical constraints, invite a potential health care delivery crisis for our noninstitutionalized elderly. Interdisciplinary programs, such as community-based case management, that promote the health and well-being of our noninstitutionalized elderly can be an effective response to this crisis. However, the need for empirical evidence of their effectiveness is essential.     

养老机构流行性感冒防控策略研究进展

 流行性感冒是由流感病毒引起的一种急性呼吸道传染病。老年人是流行性感冒的高危人群。在老年人聚集的养老机构容易出现流行性感冒暴发疫情。这不仅使老年人住院率和病死率增高,影响其生命质量,增加家庭和社会经济负担,也会加重养老机构的照护负担。本文就国内外养老机构在流感疫苗接种、医院感染管理、流感监测和抗病毒药物预防的防控策略研究进展进行综述,以期为养老机构更好地进行流感防控提供参考。     

慢性病老年人养老方式选择的影响因素研究

目的 了解慢性病老年人养老方式选择的影响因素,为其提供合适的养老方式。方法 通过多阶段分层抽样调查厦门市60岁及以上常住老年人的人口学资料、养老方式选择及慢性病患病情况等,采用χ2检验和多分类Logistic回归分析慢性病老年人养老方式选择的影响因素。结果 1 276名老年人中慢性病患病率为61.4%,慢性病老年人（相比未患慢性病老年人）选择社区居家养老和机构养老的比例均较高。以家庭养老为参照,慢性病老年人选择社区居家养老与机构养老的影响因素分别是与子女关系、居住地、文化程度、婚姻、孤独感,独居、与子女关系、文化程度、年龄、居住地。结论 慢性病老年人养老方式选择仍以家庭养老为主,但较未患慢性病老年人低。独居、年龄、婚姻、居住地、孤独感是慢性病老年人养老方式选择特有的影响因素。     

基于熵权TOPSIS法的社会照料服务投入水平的地区差异研究

社会照料服务水平是考量人口老龄化社会应对老年人照料服务需求的重要指标。本研究通过构建社会照料服务投入指标体系，基于熵权TOPSIS法，对我国29个省、市（自治区）的社会照料服务投入水平进行综合评价。研究结果表明，我国各地区的社会照料服务水平存在显著差异。社会照料服务投入水平最高的三个地区依次是北京、上海和贵州，最低的三个地区为广西、河南和云南。建议通过完善投入机制、大力发展经济、开发老龄服务人力资源，缩小社会照料服务投入水平的地区差异。     

An opinion survey of caregivers concerning caring for the elderly in Ilorin metropolis, Nigeria

The aim of this study was to determine the opinions of caregivers towards caring for the elderly in Ilorin. The caring patterns and relationships that exist between the elderly and caregivers, caregivers' attitudes, and ways to improve care of the elderly were also examined. This cross-sectional study using structured questionnaires was conducted in seven of 11 wards within Ilorin metropolis over a 6-month period. Of the respondents, 44.4% were daughters, 18.3% were sons and only 1.4% were employees to the elderly. The majority (90.7%) of respondents chose home as the place of care, and only 9.3% opted for institutional care. The majority (98.1%) of caregivers had a positive attitude towards caring for the elderly. Religious teaching was an important influence on this positive attitude. The difference between respondents with and without formal education concerning where to care for the elderly was not statistically significant (P > 0.05).     

Rural physicians' attitudes toward the elderly: evidence of ageism?

Rural elderly patients receive health services primarily in the outpatient setting, with their primary care provider often serving as their only point of contact with the health care system. Little is known however about the attitudes of physicians, and more specifically attitudes of those practicing in rural locations, toward differing age groups of the elderly. The current study was undertaken to examine the perceptions and attitudes of rural Florida physicians who routinely provide care for the elderly. We utilized an existing and validated survey instrument designed to measure the perceptions and attitudes of health professionals toward 3 different cohorts of elderly people: the elderly population in general, the elderly population older than 85 years, and the nursing home population. The study provides evidence that physicians who routinely provide care for the elderly in rural Florida demonstrate ageist perceptions, especially against those older than 85 years and the nursing home population. The trends identified are important because they may directly influence the quality of care that this population receives.     

The health status, health services utilization, and support networks of the rural elderly: a decade review.

Research from the 1980s on several dimensions of health and health care among the rural elderly is reviewed. Following a brief discussion of the demographic patterns and life conditions of the rural elderly, the current state of knowledge regarding health status, health services utilization, and the potential for informal and familial care of the elderly is examined. The review concentrates on studies that include comparisons between rural and urban populations and/or control for additional variables that are known to covary with residence. Such analyses permit the documentation of the effects of residential location on health indicators net of other factors. The review concludes that the rural elderly are relatively disadvantaged in terms of both health status and access to health care services, and have little if any advantage over the urban elderly in their access to informal sources of care. Following the review, an agenda for future research is identified.     

海口市老年人健康状况及居家养老医疗服务需求调查分析

目的 了解海口市老年人健康状况及居家养老医疗服务需求,为制定卫生规划提供科学依据。 方法 采用多阶段整群随机抽样方法抽取海口市60岁以上老年人3 601名,通过入户问卷调查了解老年人基本情况、慢性病患病情况、养老方式选择以及对居家医疗服务需求。 结果 共回收有效问卷3 544份,有效应答率98.42%。老年人文化程度主要以小学及以下为主,占43.68%,93.28%的老人与配偶和(或)子女同住,6.30%的老人独居;4.77%的老年人生活不能自理,30.11%的老年人部分自理需要照顾。60岁以上老年人慢性病患病率为65.83%,其中高血压、糖尿病、冠心病、脑卒中、精神或心理疾病、慢性阻塞性肺疾病、消化系统疾病、骨及关节疾病以及其他疾病患病率依次为31.94%、13.54%、2.51%、2.51%、0.90%、2.20%、3.02%、4.23%和17.41%。78.89%老年人选择居家养老并有居家养老医疗服务需求,11.91%老年人选择机构养老。二元logistic回归分析结果显示家庭关系、自评健康状况与居家养老医疗服务需求存在相关性;居家养老医疗服务费用可接受范围在1 000元以下的占70.67%;希望提供医疗服务项目的前五位依次为定期体检(37.69%)、疾病诊治(17.17%)、预防保健(16.72%)、健康教育(9.70%)、康复护理(6.90%);希望提供的服务形式前五位为患者直接到机构(54.25%)、医生定期上门服务(29.18%)、提供专业护理入户服务(8.26%)、医生预约上门服务(2.64%)和开设老年病社区讲座(2.07%)。 结论 海口市老年人慢性病患病率高,居家养老是首选的养老方式,居家养老医疗服务需求较高,应根据服务需求建立切实有效的服务体系,为老年人提供多形式、多途径的居家养老医疗服务。     

Experiencing diversity through home care of the elderly--challenges and advances

The present article is a study about the nursing care of elderly people. The diversity of experiences generated by the care of the elderly in their homes has opened news area of research, improved and promoted the nursing care. The objective of this work is to characterize the home-care of elderly as an area of interest for the work of the nursing professionals. The study describes aspects of the dynamics of this work based on a critical analysis of an experience carried out with a group of elderly and pointing out its advances and challenges. The methodology used in this investigation were records of the experience of some elderly people who had undergone surgery and were still in need of nursing care at their homes. Results show that there were improvements in terms of the nursing practices, especially the practices of educational and ethic-legal nature. The practices of educational nature could propitiate a sense of citizenship and freedom, which are prerogatives for the lives of these people. The ethic-legal practices promoted more involvement of the nursing professionals in the interdisciplinary team.     

Mobile medical care units: an innovative use of Medicare funding

Medicare is an underutilized payment source for home-delivered health care services for homebound elderly. An innovative service provision for home health care, Mobile Medical Care Units (MMCU), is presented. MMCU consist of a multidisciplinary team of health care professionals who are responsible for following the health care needs of their elderly patients on a continuous long-term basis across settings. This comprehensive care has significant impacts on homebound elderly and the health care industry. MMCU have the potential to be covered more inclusively by primary or supplemental health insurance plans, including Medicare, Medicaid, and HMO's, or by special funding from state aging departments.