我国城乡老年人虐待的流行现况及防治策略

老年人虐待是一种犯罪行为或对老人的忽视,老年人虐待分躯体虐待、心理虐待、经济虐待和疏于照料,4种虐待可以同时发生,表现为家庭、医院和养老院等福利机构以及社会的歧视与欺诈。全球4%～6%的老年人曾经遭受过某一种形式的虐待,导致严重身体伤害和长期心理后果,但是这一严重的社会问题一直被隐匿在公众的视野之外。随着人口老龄化趋势的加快,这一问题将变得更加突出。老人虐待在我国是一个讳莫如深的话题,虐待老人的面纱至今还没有被揭开,没有被社会与公众所关注。本文系统阐述了老年人虐待的定义、发生原因及社会影响,通过分析我国城乡老年人虐待发生的流行特征,结合城乡经济和文化特点,在此基础上逐步完善预防老年虐待的措施,构建建设老人权益保障体系,营造社会尊老风尚,提高社区卫生保健、和老年人福利,加强对社会服务机构的监管等策略;分别提出城市和农村的对策重点,为政府和社会制定和执行预防虐待老年人的法律与政策,保障老年人权益提供依据。     

徐州市主城区高知老年人养老需求及其影响因素分析

目的 探讨高知老年人的养老需求特征及其影响因素。方法 采取分层整群随机抽样的方法对徐州市主城区988位高知老年人进行入户调查;应用二分类Logistic回归分析养老需求的影响因素。结果 高知老年人的养老需求程度由高到低依次为:医疗保健(3.50±2.13)分、居住环境改造(2.85±2.22)分、精神生活(2.13±2.01)分、生活照料(0.82±1.63)分;独居、患慢性疾病、自觉健康状况较差、对老年生活满意度感觉一般的老年人对生活照料、医疗保健服务需求较高;独居、小学学历、低收入、采取社区养老的老年人对居住环境改造、精神生活服务需求较高。结论 高知老年人对医疗保健、居住环境服务需求较高,应根据老年人特征与需求完善社区医疗与养老环境建设,推动社区医疗与养老融合发展。     

Hospice: a comprehensive program

Having begun operations in 1991 with six employees, four volunteers, and three patients, the St. Louis-based Incarnate Word Family and Alzheimer's Hospice today boasts 44 professional employees, 6 clerical staff, and more than 100 volunteers. The hospice offers a medically supervised home care program in which staff work closely with patients and families throughout the illness and bereavement period. Using a palliative rather than curative approach, the Incarnate Word Family and Alzheimer's Hospice focuses on enhancing the remaining life of the patient. Patients are enrolled based on their need for care, not on their ability to pay for services. To meet the unique needs of certain patients, the hospice offers a variety of specialized services, including pediatric, Alzheimer's, and AIDS care. Collaborative efforts with local agencies include cross-training, continuing education, client referrals, and support services. In 1993 Incarnate Word introduced hospice services to area residential care facilities (RCFs). The program enables RCF residents who develop life-limiting illnesses to remain in the place that they have come to know as home. In March 1994 Incarnate Word Family and Alzheimer's Hospice opened a branch office in north St. Louis. The new location enables the hospice to serve more people and creates an additional resource for physicians treating terminally ill patients. Volunteers provide rest breaks for care givers, help with meal preparation and simple housekeeping, run errands, comfort patients and family, and listen when others may find their story too overwhelming.     

The use of focus groups in evaluating quality of life components among elderly Chinese people

In Taiwan, to measure the quality of life (QOL) of elderly Chinese, one must rely on instruments developed in other Chinese or Western populations and not specifically for the elderly. The purpose of this study is to understand the components of QOL for elderly Chinese from Taiwan living in residential homes or in their communities. Forty-four elderly men and women divided into six focus groups were interviewed on video tape and the resultant recording was analyzed qualitatively by six independent researchers. The study yielded 15 QOL domains grouped into six dimensions: physical health (physical well-being, impact of illness, medical care), psychological health (mood states, life attitude and retrospection, philosophy of living, self-efficacy), social function (connectedness, exercise and leisure activities, social activities and services), living environment (living environment and arrangements, institutional factors), economic status, and religion and death (religion, death). For elderly Chinese in Taiwan, positive and negative life domains are equally important in the perception of life quality; person-environment interaction is a major consideration in the evaluation of QOL; family ties are an important component of QOL; traditional Chinese beliefs exert a positive influence on perceived QOL; and social functioning and vitality have a different meaning in Chinese compared to Western cultures.     

老年人体质的主要特点和测评方法的研究进展

我国面临严峻的人口老龄化现实,并日趋严重。老年人深受一系列慢性疾病的困扰,不仅严重影响老年人身体健康和生活质量,而且给家庭和社会带来沉重的经济负担。通过对老年人体质评估,可对影响健康的高危因素及时识别。虽然我国在老年人体质评估方面做了一些探索,但仍然缺乏针对老年人生理特点的体质评估指标,且尚未建立适合我国老年人健康和体质的评判标准。因此,本文就对老年人生理特点及体质的评估方法作一综述,旨在为科学地评估老年人体质的内在实质,预测和预防慢病及指导我国老龄化工作提供重要依据。     

The impact of rapid response and telecare services on elderly and vulnerable residents

An ageing population, government funding cuts and pressures on local authorities to provide services that meet the needs of elderly people, particularly those with complex needs, has resulted in challenges for service providers and service users. This study examined the impact on service users and other stakeholders of rapid response services for elderly and vulnerable residents living in social housing in north-east England. The housing provider has a rapid response team for residents as part of its organisational infrastructure. This includes a 24/7 emergency response service combined with a telecare service, funded by the local authority for vulnerable clients with complex needs and self-funded by others. The study utilised semi-structured qualitative interviews to collect data. Participants included service users, commissioners, service providers, adult social care and family carers. Thematic analysis was used to identify key issues. Service users reported feeling safer and more confident knowing someone would be there at times of need. Family carers reported improvements in their own health and well-being, as they no longer felt on call all the time. The number of requests for ambulances as a consequence of falls was reported to have reduced by the rapid response team. Vulnerable people with electronic monitoring/telecare support were able to remain in their own home for longer, reducing the need for residential funding by the local authority. The partnership between the housing association and the local authority resulted in a service able to respond to changing needs as well as identifying deterioration in residents’ health status. In conclusion, the use of a combined rapid response and telecare service resulted in elderly people remaining independent in their homes for longer, which improved their reported quality of life and relieved stress on carers and pressures on other service providers.     

The implications of managing confused and disabled people in non-specialist residential homes for the elderly

Local Authority residential homes for the elderly are caring for substantial proportions of physically disabled and mentally confused residents in non-specialist settings. The results of an intensive study of six homes caring for varying proportions of disabled and confused residents are summarized. The homes are compared in terms of staff training and attitudes, physical care of residents, social environment, and attitudes of residents. The authors suggest that a "mix" of residents can have advantages over segregation and that most homes can manage around 30% confused residents. If this is to be successful, attention should be given to staffing levels, staff training and the role of health service staff in residential homes.     

Psychosocial predictors of mortality among the elderly poor. The role of religion, well-being, and social contacts

Mortality data during a two-year follow-up were obtained on some 400 elderly poor residents of New Haven, Hartford, and West Haven, Connecticut, in 1972-1974. These subjects were cases and controls in a study of the health effects of residential relocation. Initial data collection included a detailed health history, sociodemographic and background variables, and a variety of behavioral and psychological data. The variables selected for analysis in this report were: religious beliefs, social contacts, feelings of well-being, and affective states. Stepwise logistic regressions were used to determine the role of these psychosocial variables in predicting mortality, while controlling for case/control status, demographic variables, and health status (measured by an index maximally predictive of mortality in this sample). Three psychosocial variables were significant predictors: religiousness, happiness (as rated by the interviewers), and presence of living offspring. The first two reduced the risk of mortality primarily among the elderly who were in poor health, while the third one did not interact with health status.     

More Than Just An Eyesore: Local Insights And Solutions on Vacant Land And Urban Health

Vacant land is a significant economic problem for many cities, but also may affect the health and safety of residents. In order for community-based solutions to vacant land to be accepted by target populations, community members should be engaged in identifying local health impacts and generating solutions. We conducted 50 in-depth semi-structured interviews with people living in Philadelphia, Pennsylvania, a city with high vacancy, about the impact of vacant land on community and individual health and safety, as well as ideas for solutions to vacant land. Participants described a neighborhood physical environment dominated by decaying abandoned homes and overgrown vacant lots which affected community well-being, physical health, and mental health. Vacant land was thought to affect community well-being by overshadowing positive aspects of the community, contributing to fractures between neighbors, attracting crime, and making residents fearful. Vacant land was described as impacting physical health through injury, the buildup of trash, and attraction of rodents, as well as mental health through anxiety and stigma. Participants had several ideas for solutions to vacant land in their community, including transformation of vacant lots into small park spaces for the elderly and playgrounds for youth, and the use of abandoned homes for subsidized housing and homeless shelters. A few participants took pride in maintaining vacant lots on their block, and others expressed interest in performing maintenance but lacked the resources to do so. Public health researchers and practitioners, and urban planners should engage local residents in the design and implementation of vacant land strategies. Furthermore, municipalities should ensure that the health and safety impact of vacant land helps drive policy decisions around vacant land.     

社区老年人健康功能多维评价及影响因素

目的 评价福州市社区老年人的健康状况，并探讨影响健康的有关因素。方法 对1767名65岁及以上的老年人进行问卷调查，从日常生活功能、躯体健康、精神健康、社会健康和经济状况等5个基本方面对老年人健康功能状况进行多维评价。结果 研究对象中综合健康状况优良、一般和较差分别占总人数的47．1％，44．6％和8．3％。5项单维健康损害发生率介于37．7％和74％之间，其中躯体健康损害发生率最高。影响老年人健康水平的主要慢性病为高血压、心脏病和糖尿病。结论 慢性病防治、婚姻家庭生活、适度体育锻炼、科学膳食营养以及参与社会活动等均有益于社区老年人健康水平的提高。     

The impacts of dwelling conditions on older persons' psychological well-being in Hong Kong: the mediating role of residential satisfaction

About 11% of Hong Kong's population of 7 million people are aged 65 and over and many of them live in old urban areas. Many of these areas have been subjected to urban redevelopment and some of the residents have been relocated to newer estates in peripheral new towns. Previous studies have focused on the challenges the urban environment has placed on older persons in terms of capability to cope with the demands that the environment places upon them. This paper suggests that dwelling conditions can act as stressors and become contributing factors that impact on older persons' residential satisfaction and psychological well-being (subjective well-being). This study examines the role of residential satisfaction (satisfaction with dwelling unit, estate and district) in mediating the effects of dwelling conditions (interior environment and exterior environment) on psychological well-being. A sample of older persons was recruited from a sampling frame of 16 urban sub-areas located in old urban areas and new towns. 518 older persons (224 males, 294 females) aged 60 and over were interviewed and the findings indicated that residential satisfaction was determined by assessment of both the interior environment and the exterior environment, although these were appraised differently. The interior environment had a greater impact on residential satisfaction than the exterior environment. It appeared that environmental dwelling conditions mainly affected older persons' psychological well-being indirectly and, hence, probably influenced their opportunities for successful ageing. However, subsequent tests revealed that dwelling conditions had no direct impact on psychological well-being. In light of these findings, it is proposed that the role of environmental factors and their relation to older persons' psychological well-being depends on the extent to which a person's expectations of residential satisfaction are met. Some implications of these findings for local housing and social care policy are discussed.     

Descriptive study of carers' support,encouragement and modelling of healthy lifestyle behaviours in residential out‐of‐home care

Objective: Given the high prevalence of overweight/obesity among young people in residential out‐of‐home care (OOHC), and as their carers are in loco parentis, this research aimed: 1) to examine the healthy lifestyle cognitions and behaviours of residential carers; and 2) to describe resources needed to improve diet and/or physical activity outcomes for residents. Methods: Cross‐sectional data were collected from 243 residential carers. Measures included: demographics; knowledge of dietary/physical activity recommendations; self‐reported encouragement/importance of health behaviours; physical activity/screen time (at work); unit ‘healthiness’; and necessary resources for creating a healthy environment. Results: Staff placed importance on the residents eating well and being physically active. However, examination of carer knowledge found significant gaps in staff education. Three key priority areas were identified to help build a healthy food and activity environment in residential OOHC: funding, professional development and policy. Conclusion: Carer knowledge of healthy lifestyles can be improved and they need to be well resourced to ensure children in public care settings live in a healthy environment. Implications: These findings may inform the development of ongoing professional development to improve carers' health literacy, as well as policy to support dietary/activity guidelines for the OOHC sector.     

Representations of aging for community health agents and nursing professionals: psychological aspects of the health-disease process

This paper addresses the aging process in the context of public health, with emphasis to human resources and to how aging is perceived by the public health professionals. The aim of this study was to identify the representations of the aging process for public health professionals and how these representations are expressed in health care, well-being and elderly care. The sample included 27 public health professionals, 10 community health agents and 17 nursing professionals. Two instruments were used, a sociocultural questionnaire and a questionnaire about aging representations. Data analysis included qualitative and quantitative procedures (Chi-square test). Among the main findings, the most representative words used in relation to aging were retirement and rest. For this sample, good family support and care were considered the most important factors contributing to the well-being of the elderly. When it comes to defining care, the most frequent concept referred to biological aspects. Moreover, this sample in general showed some knowledge about Alzheimer Disease. These findings can contribute to the capacitation of human resources. Health agents and nursing professionals should be guided towards construction of a deeper comprehension of the biopsychosocial context of the aging process.     

Health and Well-Being Among Rural Americans: Variations Across the Life Course

This study uses data from the 1988 National Survey of Families and Households conducted by the University of Wisconsin to examine spatial variations in physical, mental, and social well-being among young, middle aged, and elderly American adults. Rural residents of all ages were found to consistently rate their physical health more poorly than nonrural residents. Both young and old rural adults also rated themselves less happy than nonrural residents. However, middle-aged and elderly rural residents appear better off on the majority of six other indicators of well-being, and this group reports the highest proportion of adults with no health impairments. Finally, rural residents of all ages possess distinct advantages in terms of several measures of social ties.     

Aging, health care, and elder care: perpetuation of gender inequalities in China

This article examines gender inequalities in the fields of health and familial elder care in China. Based on interviews conducted from 1997 to 1999 with 110 familial caregivers who were taking care of their physically dependent parents, this study explores various aspects of gender differences in both generations of care recipients and caregivers. The variables studied include health status, health care benefits, and income disparities among care recipients as well as caregiving task performance, employment status, and income levels among caregivers. Findings suggest that elderly female care recipients were more likely to receive no pension and medical benefits than their male counterparts; and female caregivers were more likely to earn less income when employed. Meanwhile, female caregivers were performing more hours of care tasks per week and were more involved in personal care and house chores even though they perceived their health as being poorer compared with their male counterparts. Male caregivers were more likely to provide financial assistance to parents. As the economic reforms continue and future family size reduces to a 4-2-1 inverted pyramid, the author argues that gender inequalities are likely to perpetuate or even worsen. Current female caregivers are likely to suffer from greater disadvantages in terms of reductions in income, retirement benefits, and health benefits due to their greater involvement with elder care. In turn, they are not going to have several adult children to share care responsibilities when they become older and need help.     

家庭无酬照料劳动供给对中老年人健康的影响

伴随人口老龄化的加剧与三孩政策的放开,照料需求也不断增长。在有酬照料服务供给相对不足且质量欠佳,女性越来越多地进入劳动力市场的背景下,由中老年群体提供家庭照料成为了理性的选择。本文利用CHARLS数据库,构建面板数据固定效应模型,探究了家庭无酬照料劳动供给对中老年群体健康的影响。结果表明,提供家庭照料劳动对中老年群体的身体健康不存在显著性影响,但对其精神健康存在显著的负面冲击。提供家庭照料劳动对女性中老年人与农村中老年人精神健康的负面影响更强。中介效应分析表明,家庭照料劳动通过增加家庭总支出与减少花费在主要工作上的工作时间两种渠道对精神健康产生影响。文章最后从关注弱势群体精神健康、增加公共照料服务供给等角度提出了政策建议。     

The impact of relocation on well-being of the elderly

OBJECTIVE: This study examined direct and indirect effects, mediated by social contact, of residential relocation on well-being of the elderly. METHODS: We used longitudinal data of a national representative sample of individual aged 60 years and over (N = 1,474). The initial survey was conducted in 1987, and the follow-up survey was conducted three years later. Well-being was measured with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Life Satisfaction Index A (LSIA). Social contacts were measured in terms of frequency of contacts with relatives, friends and neighbors, as well as frequency of social participation. RESULTS: Relocation had a positive direct effect on well-being, assessed by both CES-D and LSIA, but a negative indirect effect mediated by decline of social contacts. CONCLUSION: Our results suggest that residential relocation indirectly has a detrimental effect on well-being of the elderly through decline in social contacts, though it may directly improve well-being of the elderly.     

Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing

Background

The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.

Methods

We used the database “Health and Social Support of Elderly Population in Community”. Questionnaires were issued in 2013, covering 3 districts in Beijing. A group of 1036 people over 60 years in age were included in the study. The respondents’ profile variables were organized in Andersen’s Model and community healthcare resource factors were added. A multinomial logistic model was applied to analyze the factors associated with the desired aging care models.

Results

Cohabiting with children and relying on care from family was still the primary desired aging care model for seniors (78 %), followed by living in institutions (14.8 %) and living at home independently while relying on community resources (7.2 %).The regression result indicated that predisposing, enabling and community factors were significantly associated with the aging care model preference. Specifically, compared with those who preferred to cohabit with children, those having higher education, fewer available family and friend helpers, and shorter distance to healthcare center were more likely to prefer to live independently and rely on community support. And compared with choosing to live in institutions, those having fewer available family and friend helpers and those living alone were more likely to prefer to live independently and rely on community. Need factors (health and disability condition) were not significantly associated with desired aging care models, indicating that desired aging care models were passive choices resulted from the balancing of family and social caring resources.

Conclusions

In Beijing, China, aging care arrangement preference is the result of balancing family care resources, economic and social status, and the accessibility of community resources. Community facilities and services supporting elderly were found to be insufficient. For China’s future health system, efforts should be made to improve community capacity to provide integrated services to senior citizens.

     

城乡老年人长期照护需求溢出:理论分析与实证检验

首先分析了老年人长期照护需求溢出的内在逻辑,构建了影响长期照护需求溢出内在逻辑的分析框架;然后依据中国综合社会调查(CGSS)2015年数据,运用多项有序Logit回归对老年人长期照护需求溢出的影响因素进行分析,得出以下结论:从全体居民来看,年龄、受教育程度、是否参加基本养老保险和政府在老年人生活帮助中的责任与长期照护外溢成正相关,身体健康状况、子女数、个人地位和家庭经济状况与长期照护需求外溢程度呈负相关。然而,城乡居民的照护需求外溢存在显著差异,城市居民长期照护需求外溢的程度要比农村居民高,影响农村居民照护需求外溢的主要是家庭经济状况,影响城市居民照护需求外溢的主要是养老保险和政府在老年人生活帮助中的责任。因此,要弘扬传统的孝文化,重视家庭的作用;理性定位政府责任边界,优先建立补缺型的照护津贴制度;统筹城乡照护服务发展,补齐农村照护短板。