养老机构非卧床老年人衰弱影响因素的路径分析

目的探讨养老机构非卧床老年人衰弱的影响因素,并进行路径分析。方法采用一般情况问卷、养老机构老年人衰弱评估问卷、简明精神状态量表、老年抑郁量表对上海市9所养老机构中符合纳入排除标准的218名老年人进行调查。结果养老机构非卧床老年人的衰弱总分为(55.02±11.75)分,各维度按其条目均分从高到低排序为:心理维度、生理维度、社会维度。路径分析显示,抑郁评分、活动情况、认知评分、睡眠情况、患病情况、文化程度及婚姻状况直接或/和间接影响老年人衰弱(总效应依次为0.59、-0.42、-0.27、0.21、0.17、-0.15、0.09)。结论养老机构非卧床老年人存在不同程度的衰弱,其衰弱受多种因素影响,养老机构应采取积极措施,延缓老年人衰弱的进展。     

浙江省城乡老年人衰弱比较

目的 了解浙江省城乡老年人衰弱水平、分析影响因素的异同, 为针对性干预提供参考。方法 采用多阶段抽样法，随机抽取浙江省城市老年人482人和农村老年人719人为研究对象，采用自编老年人一般情况调查表、中文版Tilburg衰弱量表以及Barthel指数评定量表进行问卷调查，进行影响因素分析。结果 城市老年人衰弱得分及衰弱发生率显著低于农村老年人（均P<0.05）；logistic回归分析显示婚姻状况、三餐规律、与子女关系和日常生活活动能力是城市老年人衰弱的影响因素（均P<0.05）；居住方式、家庭人均月收入、三餐规律、睡眠质量、慢性病、自评健康状况和日常生活活动能力是农村老年人衰弱的影响因素（均P<0.05）。结论 浙江省老年人衰弱发生率较高，农村老年人衰弱水平高于城市老年人。应针对城乡老年人衰弱水平及不同影响因素制定干预措施，延缓衰弱的发生。     

养老机构老年人衰弱现状及影响因素分析

目的了解养老机构老年人衰弱现状,分析其影响因素,为制订养老机构老年人衰弱干预计划提供参考。方法选取武汉市养老机构老年人245人为调查对象,采用自行设计的一般情况调查表、老年人衰弱评估量表修订版、中文版健康促进生活方式量表、生活质量量表简版(SF-12)进行面对面调查。结果衰弱140人(57.14%),衰弱总评分为(8.16±3.72)分,生理衰弱维度最为严重。多元线性回归分析显示,性别、年龄、文化程度、慢性病、入住时长、睡眠质量、健康促进生活方式是养老机构老年人衰弱的影响因素(均P0.01)。不同衰弱程度老年人生活质量得分比较,差异有统计学意义(P0.01)。结论养老机构老年人衰弱现象普遍,且受多种因素影响,需采取针对性干预措施,改善老年人衰弱现状,延缓衰弱进程。     

养老机构老年人认知衰弱现状及影响因素分析

目的了解养老机构老年人认知衰弱现状及影响因素,为开展针对性干预提供参考。方法采用便利抽样法,选取重庆市6个主城区13所养老机构中的303名老年人作为研究对象,应用衰弱表型(FP)、蒙特利尔认知评估量表(MOCA)、临床痴呆评定量表(CDR)进行认知衰弱评估;并采用一般情况调查表、简易营养评估量表(MNA-SF)、简版老年抑郁量表(GDS-15)、孤独量表进行问卷调查。结果 126人(41.6%)存在躯体衰弱,116人(38.3%)存在轻度认知障碍,82人(27.1%)存在认知衰弱。Logistic回归分析发现,文化程度、居住环境、体育锻炼、智力活动、疾病情况、抑郁情绪是养老机构老年人认知衰弱的主要影响因素(P0.05,P0.01)。结论养老机构老年人认知衰弱发生率较高,医护工作者应重视机构老年人认知衰弱问题,并结合老年人具体情况提供针对性、多角度的综合干预措施,以延缓或减轻机构老年人认知衰弱的发生发展。     

山西省农村老年人衰弱现状及影响因素分析

目的了解山西省农村老年人衰弱现状并探讨其影响因素,为实施针对性干预提供参考。方法对山西省平遥县483名老年人采用一般资料调查表、衰弱表型、咀嚼物软件色彩分析法对衰弱情况进行调查与测评。结果衰弱206例(42.7%),无衰弱277例(57.3%)。Logistic回归分析显示年龄、服用药物、自然牙齿数量、义齿情况和咀嚼能力为农村老年人衰弱危险因素(均P<0.01)。结论农村老年人衰弱发生率较高,其衰弱受多种因素影响。医护人员应重视农村老年人衰弱筛查并针对影响因素尽早干预。     

城市失能老年人医养结合社区支持服务利用现状调查

目的了解失能老年人的医养结合社区支持服务利用现状及其影响因素。方法采用一般资料调查表、Barthel指数评定量表及城市失能老年人医养结合社区支持服务现状调查问卷,对杭州市298名失能老年人进行问卷调查。结果失能老年人服务利用现状前5项均为基本医疗服务,只有4项服务利用率超过50%,22项服务利用率不足20%。多元线性回归结果显示,月收入、是否患有高脂血症、疾病数量是影响服务利用现状的因素(P<0.05,P<0.01)。结论城市失能老年人医养结合社区支持服务利用现状不理想,社区医务人员应加强服务宣传,完善整改相关服务项目,并加快失能老年人医养结合社区照护体系建设。     

老年糖尿病患者衰弱现状及影响因素

目的 调查住院老年糖尿病患者的衰弱现状及影响因素,为临床护理干预提供参考。方法 选取老年糖尿病患者221例,采用中文版埃德蒙顿衰弱量表和老年人抑郁评定量表简表进行问卷调查。结果 老年糖尿病患者衰弱得分6（5,9）,衰弱发生率62.0%。抑郁、高龄、多重用药、牙齿咀嚼功能差、胰岛素注射治疗、个人月收入低是老年糖尿病患者衰弱的主要影响因素（P＜0.05,P＜0.01）。结论 老年糖尿病患者的衰弱发生率较高,临床医护人员应加强对老年糖尿病患者衰弱的关注,做好筛查工作,制定个体化的衰弱干预策略,延缓其衰弱进程。     

老年人入住养老机构体验及影响因素调查

目的了解老年人养老机构入住体验现状及其影响因素,为养老机构照护服务改进以提升照护质量和老年人生活质量提供依据。方法采用横断面调查方法,方便抽取5家医养结合型养老机构的老年人202人,采用自行设计的老年人养老机构入住体验问卷进行调查。结果医养结合型养老机构老年人入住体验总得分为73～150(123. 82±17. 39)分,各维度得分由高到低依次为可靠性、有形性、保证性、关怀性、连续性。年龄、月收入、亲人支持程度、子女个数对老年人入住体验有显著影响(P 0. 05,P 0. 01)。结论老年人对养老机构入住体验评价较好,但在人文关怀性和医疗连续性上有待加强。亲人支持程度能在很大程度上提升老年人的入住体验,养老机构需提供条件促进子女与老年人的联系,以提升老年人的生活质量。     

异基因造血干细胞移植后长期幸存者衰弱与社会疏离感现状及影响因素分析

目的 了解异基因造血干细胞移植术后长期幸存者衰弱和社会疏离感现状及其影响因素,为制订干预方案提供参考。方法 采用一般资料调查表、Fried衰弱表型量表、抑郁自评量表、一般疏离感量表对312例异基因造血干细胞移植术后≥2年患者进行调查分析。结果 异基因造血干细胞移植术后长期幸存者衰弱发生率为26.9%,社会疏离感总分39.53±7.24。衰弱与社会疏离感呈正相关（P<0.01）。衰弱、返回工作岗位与否、抑郁、并发症是患者社会疏离感的主要影响因素（调整R²=0.451,均P<0.01）。结论 异基因造血干细胞移植术后长期幸存者衰弱发生率和社会疏离感水平较高,衰弱、未返回工作岗位、抑郁及并发症是导致或加重其社会疏离感的影响因素;应及时评估并进行针对性干预,以减轻衰弱和降低社会疏离感。     

老年慢性阻塞性肺疾病患者衰弱现状及影响因素的Meta分析

目的 系统评价老年慢性阻塞性肺疾病患者衰弱现状及其影响因素。 方法 计算机检索各数据库，检索时限为2000年至2022年2月。由2名研究者独立进行文献筛选、质量评价、信息提取，分别采用Stata12.0和RevMan5.3软件进行患病率及影响因素的Meta分析。 结果 共纳入26篇文献，6 849例患者。Meta分析结果显示，COPD患者衰弱患病率为34%，其中年龄（OR=1.15）、GOLD分级（OR=3.00）、呼吸困难指数（OR=3.44）、抑郁（OR=3.36）、并存疾病（OR=3.39）、多重用药（OR=4.09）、营养不良（OR=5.79）是衰弱的主要危险因素。 结论 老年慢性阻塞性肺疾病患者衰弱发生率高，影响因素较多。应针对衰弱危险因素进行早期筛查、早期干预，以减少不良结局对患者的影响。     

基于养老服务管理者及老年人视角的社区嵌入式养老服务的SWOT分析

目的 分析社区嵌入式养老服务优劣势、机遇及威胁,为社区嵌入式养老服务持续健康发展提供参考。 方法 采用目的抽样法及滚雪球抽样法抽取天津市6名社区嵌入式养老服务管理者及6名接受服务的老年人,对其进行半结构式深入访谈,使用内容分析法分析资料,基于SWOT模型从优势、劣势、机会、威胁4个维度对社区嵌入式养老服务进行分析评价。 结果 社区嵌入式养老优势包括提供服务多元、满足情感需求、统筹整合优质资源、开放式养老;劣势为场地资源受限、盈利困难;机遇有服务需求量大、政府有力支持、信息技术发展日益成熟;威胁包括功能定位模糊、护理员短缺、老年人缺乏自主消费观念。 结论 在积极推进“互联网+社区养老”的背景下,天津市社区嵌入式养老因其服务多元,形式灵活,兼具地缘优势,具有良好的社会反响。未来,需在运营中进一步加强政府引导及监督,细化功能定位、稳定护理员队伍,以切实满足社区老年人多元化养老服务需求。     

Carotid endarterectomy in the elderly

The records of 146 patients 80 years of age or older who underwent 183 carotid endarterectomy operations from 1964 through 1990 were reviewed to determine surgical risk. The indications for operation were asymptomatic patients with carotid stenosis (n=36); ipsilateral transient ischemic attacks (n=46); ipsilateral stroke (n=28); ipsilateral retinal embolus (n=15); nonlateralizing symptoms (n=40); and asymptomatic side in patients with contralateral symptoms (n=18). Postoperatively, three patients (1.6% of operations) had a stroke with a residual deficit and three (1.6%) died. All deaths were from myocardial infarction. For comparison, during the same time period, the combined stroke with residual deficit and death rate for patients less than 80 operated upon for similar indications was 3.5%. Since 80-year-old patients have a life expectancy of at least five years, the authors conclude that elderly patients should be evaluated for carotid endarterectomy using criteria similar to that used for younger patients.Presented at the Tenth Annual Meeting of the Southern California Vascular Surgical Society, September 27–29, 1991, Marina Del Rey, California.     

Prosthetic joint infectionsin the elderly

Total joint arthroplasty is among the most remarkable advances in orthopaedic surgery for the elderly, enabling themto regain physical function and be free of pain. Although uncommon, infection of the prosthetic joint causes serious morbidity leading to poor functional outcome with a mortality approaching 8% in the elderly. Most infections occur through inoculation of the prosthesis at the time of implantation and are due to Gram-positive cocci, although a third of the episodes are due to Gram-negative bacilli from a secondary focus. The management presents a major clinical and therapeutic challenge due to systemic and local comorbid conditions in the elderly. Medical and surgical treatment decisions for infected joint prosthesis are complex and should be individualized in each case. Optimal nutrition is essential for a successful outcome. Adverse reactions to medications are more common in the elderly due to end organ dysfunction and drug-drug interactions.     

Anaesthesia in the elderly

Older people are undergoing increasingly complex surgery with much greater mortality and morbidity than the younger adult population. In this article, we discuss the physiological changes that take place in the older patient, and how these may affect anaesthetic technique. Perioperative risk in the elderly is discussed, with focus on emergency surgery and frailty.     

Anaesthesia in the elderly

Older people are undergoing increasingly complex surgery with much greater mortality and morbidity than the younger adult population. In this article, we discuss the physiological changes that take place in the older patient, and how these may affect anaesthetic technique. Perioperative risk in the elderly is discussed, with focus on emergency surgery and frailty.     

Non-syncopal falls in the elderly in relation to home environments

Methods of prevention of falls in the home may differ for healthy and frail individuals. We therefore sought to determine whether measures of health and functioning in older persons are more useful in predicting falls at home not involving home hazards (non-environmental falls) than falls at home related to home hazards (environmental falls), and whether these relationships differ among those who fell once and those who fell multiple times during follow-up. Data for this analysis are from a 1-year prospective cohort study of 325 community-dwelling volunteers aged 60–93 years who had fallen during the year before baseline. In general, associations were stronger between poor functional ability and non-environmental falls than between poor functional ability and environmental falls. Independent predictors of non-environmental first falls during follow-up included Parkinson's disease (adjusted odds ratio (AOR) 7.66, 95% confidence interval (95% CI) 1.15–51.1) and being home alone 10 or more hours per day (AOR 2.36, 95% CI 1.20–4.61); independent predictors of environmental first falls during follow-up included arthritis (AOR 2.60, 95% CI 1.32–5.09) and poor depth perception (AOR 0.73, 95% CI 0.59–0.89, for each unit increase in depth perception score). Also, associations between poor function and falls were generally stronger among participants who fell repeatedly than among individuals who fell only once during the follow-up year. In conclusion, poor function predisposes to non-environmental falls at home in older persons and, to a lesser extent, environmental falls in those who fall repeatedly. Certain functional characteristics such as poor depth perception may predispose to environmental falls to a greater extent than do other disabilities.     

瑞芬太尼应用于老年患者的研究进展

瑞芬太尼是一种新型的阿片μ受体激动剂,可迅速被广泛存在于血液和组织中非特异性酯酶水解.瑞芬太尼具有独特的药理学特性,起效迅速,超短效,清除率快且不依赖于肝肾功能,长期静脉输注不产生明显蓄积作用.因此瑞芬太尼适用于老年患者全麻诱导插管、麻醉维持及门诊麻醉,有利于术后认知功能的早期恢复.然而,对于瑞芬太尼所产生的心动过缓、低血压、呼吸抑制和肌肉僵直等副作用,应积极采取预防和补救措施.     

Laparoscopic radical nephrectomy in the elderly

Authors from Innsbruck present their work in laparoscopic radical nephrectomy in elderly patients. They evaluated the outcome of this technique in patients over 75 years old and compared the results with a similar number of patients aged less than 75 years who had the same procedure. Despite more comorbid conditions in the older group the final outcome was equally as good as in the younger patients. Hormone‐refractory prostate cancer is becoming a matter of great concern, and authors from Paris describe their experience with a combination of docetaxel and zoledronic acid in this condition. In this early report, they found the use of these agents to be promising, and recommend the setting up of a prospective randomized trial.

OBJECTIVE

To evaluate the efficacy and outcome of laparoscopic radical nephrectomy (LRN) in patients aged >75 years, and to compare the results with those obtained from patients younger than this undergoing laparoscopic surgery for the same indication.

PATIENTS AND METHODS

From a retrospective review of 33 patients aged >75 years undergoing LRN, 28 were for tumour. A group of 28 consecutive patients aged <75 years undergoing laparoscopy for the same indication were used for comparison. The two groups were compared for American Society of Anesthesiology (ASA) physical status score, comorbidity, previous surgical history, operative duration, estimated blood loss, tumour size, complications during and after surgery, conversion rates, time to oral intake and drain removal, perioperative mortality and hospital stay.

RESULTS

Only the initial ASA score was significantly higher for the older patients. All other variables before, during and after surgery were similar for both groups.

CONCLUSIONS

The final outcome of laparoscopic surgery in elderly patients was as promising as in their younger counterparts. Therefore, elderly patients should not be excluded from LRN, even though they usually present with more comorbidities.

     

机器人辅助胰十二指肠切除术在高龄患者的应用

目的探讨达芬奇机器人辅助胰十二指肠切除术(robotic pancreaticoduodenectomy,RPD)在高龄患者的安全性及临床效果。方法回顾性分析2016年12月至2020年5月于中山大学附属第一医院胆胰外科接受RPD、年龄≥70岁患者的临床资料,分析术后转归。结果共16例年龄≥70岁的患者接受RPD,其中男9例、女7例;年龄70~85岁,平均(73.6±4.2)岁。所有患者均顺利完成RPD,无中转开腹。病因包括6例壶腹癌、6例胰腺导管腺癌、1例胰腺神经内分泌肿瘤、1例胰管内乳头状黏液性肿瘤、1例十二指肠乳头癌、1例十二指肠乳头腺瘤伴高级别上皮内瘤变。中位手术时间413 min(IQR:366~522 min),中位术中出血量50 ml(IQR:50~62.5 ml),16例患者均获得R0切除。3例(18.8%)患者术后发生并发症,包括1例(6.2%)术后早期胰肠吻合口出血,通过再手术止血;3例(18.8%)B级胰瘘合并腹腔内感染;1例(6.2%)胃排空延迟。无围手术期死亡。中位术后住院时间13 d(IQR:12~18 d)。结论RPD对于高龄患者安全可靠,近期治疗效果满意。     

老年腰椎间盘突出症的治疗

目的：探讨老年腰椎间盘突出症的临床表现和治疗特点。方法：对1988年1月-1998年1月84例60岁以上因腰椎间盘突出症住院治疗的病人,手术治疗41例,保守治疗43例。二组病人随访2.5年至10年,平均5.5年。并对其临床资料进行回顾性分析。结果：随访病人84例,有效率分别为：保守治疗组35/43（81%）,手术治疗组38/41（92.7%),优良率分别为保守治疗组20/43（46.5%),手术治疗组29/41（70.7%)。结论：老年腰椎间盘突出症在临床上有其特殊性,有手术指征和手术条件应尽早手术。