慢性阻塞性肺疾病与老年综合征——老年科医师的视角

【摘要】 慢性阻塞性肺疾病（COPD）是我国常见和重要危害国人身体健康的慢性呼吸道疾病。随着年龄的增长，慢阻肺患病率呈指数型增加，其亦是一种增龄相关性疾病(老年病)。衰弱和肌少症是老年医学科临床上重要的两种老年综合征，往往与慢阻肺患者的临床不良结局密切相关。本文就衰弱和肌少症的临床评估工具，慢阻肺时两种老年综合征的流行病学，生物学机制及可能的干预策略等做一述评。     

Strategies for Distance Education

Abstract

Advances in and access to technology have loosened academia's ties to the traditional classroom. In this paper we present our experiences in developing, implementing, and evaluating three approaches to distance education. The first program was delivered by interactive videoconferencing and provided multiple gerontological lessons for Extension agents gathered at two different sites in Virginia. The second program was a graduate-level course taught simultaneously at multiple sites also using interactive videoconferencing. The third program was a full-fledged Internet course whose target audience included students enrolled in a gerontology certificate program. The overall strengths of the programs included enhancing the instructors' ability to reach students in a variety of locations without leaving campus and expanding the flexibility and availability of course offerings. The weaknesses and constraints of the various approaches centered on the amount of instructor time necessary to develop and implement the instructional units, technological problems, and student involvement and motivation.     

A Review of “Aging with HIV: Psychological,Social, and Health Issues,by Janice E. Nichols,David C. Speer,Betty J. Watson,Mary R. Watson,Tiffany L. Vergon,Coletter M. Vallee,and Joan M. Meah”

No abstract available for this article.     

Health Care Providers' Perceptions of the Elderly and Level of Interest in Geriatrics as a Specialty

This study has examined knowledge of the elderly, as measured by the FOA Quiz, and levels of interest in geriatrics for samples of health care students and practitioners in North Carolina. Groups studied included medical students, physician's assistant students, practicing physician's assistants, family physicians, family practice residents, and dentists. Results of the study indicated (1) a relatively low level of interest in geriatrics as a specialty, with medical students reporting the lowest interest; (2) considerable similarity both between and within groups with respect to overall knowledge and perceptions, and also in terms of specific errors in knowledge; and (3) prior experience with the elderly (before entering school or practice) is positively related to interest in geriatrics for both students and practitioners. Multivariate analyses of other background characteristics identified additional variables predictive of knowledge and interest in geriatrics.     

Integration or specialization? Similarities and differences between Sweden and the United States in gerontology education and training

ABSTRACT

This article examines the similarities and differences in the education and training of gerontologists and others who work with older people in Sweden and the United States. It outlines the aging trends in both countries and assesses the level of training for those who provide care in a variety of fields. Both countries are aging, but the programs for gerontological training are quite different in the two countries, reflecting underlying cultural values. Sweden’s education is generally more oriented toward the integration of some aging education in more disciplinary fields, such as nursing and social work and thus could benefit from more specialized, aging-specific courses. The United States is highly specialized, with multiple programs in various subfields of aging (e.g., geropsychology; aging services administration) and could benefit from integrating more aging knowledge into courses in other disciplines. The authors challenge professionals to consider if there is a basic but global curriculum and/or set of competencies in gerontology that could be agreed upon. As an increasingly global village, the ability to share and learn is more easily achievable. Sweden and the United States have much to learn from each other in terms of appropriately educating and training those who support our older people.     

STOP-FALLING: A Simple Checklist Tool for Fall Prevention in a Nursing Facility

Falls are highly prevalent and lead to major health morbidity and mortality in older adults. We developed a “STOP-FALLING” checklist as a multifactorial intervention tool kit for a single long-term care facility. The objective of this study was to determine feasibility and adherence of the checklist, and to determine whether STOP-FALLING reduces total number of falls, frequent fallers, and fall-related injuries.This is a quality improvement demonstration project comparing the effect on falls 3 months before and 3 months after introducing a STOP-FALLING checklist. All older adult patients who lived in the long-term care unit of a single facility were included. PTs, geriatricians, and registered nurses participated in the STOP-FALLING initiative. Staff were surveyed on satisfaction by 8-item questionnaires, which were obtained 3 months after checklist implementation. Data on the rate of falls, the number of recurrent fallers, the number of minor injuries, and the number of major injuries 3 months prior and 3 months after the intervention were collected by facility fall log.A total of 32 patients were screened using the STOP-FALLING checklist. Staff survey revealed a high satisfaction rate with ≤15 minutes to complete the checklist. Data at 3 months after initiation of the checklist revealed a reduction in the fall rates (2.80-1.65 falls per person-year), number of frequent fallers (5.00-2.30/mo after), number of falls without injuries (3.00-1.67/mo), number of minor injuries (4.00-2.67/mo), and number of major injuries (0.33-0/mo).We observed excellent staff satisfaction using the STOP-FALLING checklist. Our pilot project suggests that the intervention may decrease fall rates and other fall-related injuries.     

Cultural correlates of self perceived health status among Chinese elderly

This study examines self-perceived physical and mental health among 213Chinese elderly who visited the Geriatric Outpatient Clinic of BeijingHospital, the Peoples Republic of China. The study hypothesizes thatcultural factors, specified by family relations, along with demographicfactors, number of diseases, economic well-being, and living conditionshave a significant impact on subjects self-perceived health status.Pearson correlation, linear and logistic regression analyses areperformed. Results indicate that age, number of diseases, perceived familyrespect, neighborhood relations, and percentage of income spent on rentare significant predictors of self-perceived physical health. These samefactors plus preference to live with a son and personal monthly income aresignificant predictors of self-perceived mental health. Socio-culturalimplications of these findings are examined.     

Insulin-independent diabetes mellitus: Metabolic characteristics

Glucose intolerance in patients with insulin-independent diabetes mellitus can theoretically arise from a loss of normal tissue sensitivity to insulin (insulin resistance) and/or from a decrease in insulin secretory capacity. A review of available literature indicates that both of these defects can exist in these patients. Thus, patients with insulin-independent diabetes mellitus demonstrate a decrease in tissue sensitivity to insulin, and there is a significant relationship between the severity of the glucose intolerance and the magnitude of the insulin resistance in these patients. The relationship between glucose intolerance and insulin secretion in patients with insulin-independent diabetes is more complicated. Patients with mild glucose intolerance tend to have an insulin response to glucose equal to or greater than normal. As the severity of glucose intolerance increases, the insulin response becomes attenuated and patients with severe fasting hyperglycemia become hypoinsulinemic. On the basis of these changes in insulin resistance and insulin secretion, two formulations concerning the pathogenesis of insulin-independent diabetes seem possible. The first is based upon the premise that the basic defect in patients with insulin-independent diabetes is loss of normal tissue sensitivity to insulin. In an effort to maintain glucose homeostasis, increased amounts of insulin are secreted. However, as the need to augment insulin secretion continues, the beta cell may lose the ability to compensate, and frank hypoinsulinemia can supervene. Alternatively, patients with insulin-independent diabetes can be viewed as representing a metabolically heterogeneous group composed of individuals with various degrees of increased insulin resistance and decreased insulin secretory capacity. In this situation, the degree of glucose intolerance will vary as a function of the relative severity of the two metabolic defects. These relatively simple formulations are confounded by the fact that insulin deficiency can lead to insulin resistance, and vice versa, and that obesity will greatly affect insulin resistance and insulin secretion. Thus, the degree of glucose intolerance in any individual is the result of a complex series of relationships between both intrinsic and environmental factors controlling insulin resistance and insulin secretion. Our ability to understand the pathogenesis of insulin-independent diabetes mellitus will depend upon better understanding of these various relationships.     

Residential care for the destitute elderly: A comparative study of two institutions in Zimbabwe

This study evaluates the facilities provided by two black residential care facilities for the elderly in Zimbabwe. One home was structured on a model of residential care developed by the colonial government while the other was an experimental co-operative run by the residents. The aim was to discover how the forms of care provided by the two homes influenced the quality of life experienced by the residents. Data were collected through personal observation and lengthy interviews with residents. Interest centered on the particular characteristics of the institutions that most affected overall satisfaction with the homes. It is argued that despite the greater economic resources controlled by the traditional residential care facility, the social environment created by the co-operative led to a more fulfilling life for the elderly.I would like to take this opportunity to acknowledge my debt to Father Joe Hampson for his professional supervision of this study. I would also like to thank Trish Swift, Veronica Brand and other lecturers at the Harare School of Social Work for their helpful advice. Finally, I must thank my wife and family for their encouragment during the course of my study.