漯河市养老院老年人老年痴呆患病率及危险因素

目的 了解漯河市养老院老年人群痴呆现状.方法 采用随机整群调查,以漯河市养老院316名60岁以上人群为调查对象,以简易智能状态量表(MMSE)、日常生活能力量表(ADL)及危险因素问卷进行测量和判别.结果 316名老人,诊断为老年痴呆患者为88例,患病率为27.8％,其中重型占63.6％,中型28.4％,轻型7.95％,单因素分析显示年龄、性别、听力、牙齿、功能状况、保健习惯、婚姻、社会支持水平、经济状况与老年痴呆发生有关(P＜0.05).结论 老年痴呆在漯河市养老院的老年人群中患病率较高,危险因素复杂.     

海南岛阿尔茨海默病的流行病学调查

目的 全面了解海南岛≥55岁人群中阿尔茨海默病(AD)的现况,分析其危险因素.方法 采用人口学、健康史、长谷川痴呆量表( HDS)、哈金斯基缺血指数量表(HIS)、临床痴呆评定量表(CDR)等问卷和量表进行筛查.结果 海南岛55岁及人群AD的患病率为1.45%(中国发达地区平均发病率2.0%),西部、中部及南部地区的患病率分别较北部和东部地区高(P＜0.05);女性患病率比男性高(P＜0.05);随年龄的增长而升高(P＜0.01).单身、听力障碍是AD的危险因素(OR＞1),而脑力劳动、富含鱼饮食则是保护因素(OR＜1).结论 海南岛AD患病率较国内发达地区低,患病率有一定地区差异,高患病率与女性、高龄、单身及存在障碍损伤有密切关系.     

上海徐家汇街道65岁以上人群痴呆主要亚型的患病率

目的 调查上海市徐家汇街道65岁以上人群痴呆主要亚型的患病情况.方法 采取随机整体抽样的方法,抽取徐家汇街道内8个居委65岁以上居民;分三个阶段,第一阶段采用简易精神状态检查表(MMSE)和日常生活功能量表(ADL)进行初筛检查,阳性者进入第二阶段的诊断检查;第二阶段采用由社会功能活动量表、物体记忆测试量表、长谷川痴呆量表、痴呆简易筛查量表、WAIS数字广度测验表、汉密尔顿抑郁量表、Hachinski缺血指数量表组成的诊断量表,并以精神疾病诊断与统计手册第四版(DSM-Ⅳ)国际疾病分类第10版(ICD-10)为诊断标准;第三阶段对第二阶段检查结果进行复查,以确保诊断明确.结果 第一阶段应查2 548人,实查2 442人,实查率95.84％;80岁以上老人747人,占30.59％;经第三阶段复核后符合肯定和很可能痴呆诊断标准者206例,患病粗率为8.44％,经标化后的痴呆患病率为7.92％;其中女性痴呆患病率为8.53％,高于男性的7.18％;在不同年龄段中痴呆患病率随着年龄的增长而增长,至85岁以上时痴呆患病率已达22.09％.结论 随着上海老年人口的增加,老年期痴呆的患者正在不断增加.对痴呆的防控,应引起社区全科医生的足够重视.     

高龄老人慢性病和日常生活能力调查及影响因素

目的 研究高龄老人慢性病的患病状况以及日常生活功能的受损情况,为高龄老年人群的健康管理和医疗保健提供科学依据.方法 采用整群抽样方法,对上海市杨浦区的1027名80岁及以上老年人进行慢性病和日常生活能力(ADL)的问卷调查.结果 高龄老人慢性病患病率为97.66％,ADL受损率高达65.63％,年龄、脑梗死、慢性支气管炎、哮喘、前列腺增生是导致高龄老人ADL损害的主要危险因素.结论 各种慢性疾病可不同程度地引起ADL损害,但与其患病率的高低无直接关系,高龄老人ADL损害受年龄、疾病性质的影响更为明显.应建立高龄老人的网络化管理系统,采取针对性的综合干预措施.     

巴马地区267例长寿老人认知功能与日常生活功能的相关分析

目的 了解广西巴马地区长寿老人认知功能与日常生活功能的相互关系.方法 截断面调查,整群抽取巴马县甲篆乡80岁以上老人.应用"巴马地区长寿老人心理健康调查表",包括人口学资料、简易智力状态检查(MMSE)、日常生活能力量表(ADL).结果 MMSE得分与ADL、躯体生活自理量表(PSMS)、工具性日常生活活动量表(IADL)得分,MMSE各因子均分与ADL得分均呈极显著负相关.按不同年龄、性别、文化程度因素分层后,绝大部分因素的MMSE得分与ADL得分均呈显著负相关.MMSE得分影响因素依次为ADL、文化程度、年龄、性别.结论 广西巴马地区长寿老人的认知功能与日常生活功能存在着密切的相关关系,提高日常生活功能有助于保持认知功能,反之亦然.     

重庆渝中区街道老年期痴呆横断面研究

目的 了解重庆市社区老年期痴呆的流行病学情况。方法 调查4个居委会共计1519≥65岁的老人。用简易精神量表（MMSE）及自选设计的调查表进行初筛。再根据美国精神疾病诊断和统计手册修订第IV版（DSM－IV－R）临床诊断和Hachinski缺血量表进一步确定和区分为Alzheimer型痴呆（AD）和血管性痴呆（VD）。结果 老年期痴呆患病率为5.73%，其中AD患病率为4.8%，VD患病率为0.59%，混合型患病率为0.34%。结论 高龄、低文化水平、丧偶独居、性格内向是AD和VD的共同易患因素，女性可能还是AD的危险因素，VD的危险因素与脑卒中、高血压病有关。     

北京城乡老年期痴呆患病率研究

目的 调查北京城乡老年人群痴呆的患病率及不同类型痴呆的患病率，分析老年期痴呆患病的危险因素。方法 流行病学调查分为2个阶段，第1阶段筛查，由经过培训的调查员，采用逐户访问方式，抽样调查了城乡60岁及以上老人2788例，完成调查问卷及筛查量表（MMSE）测验。第2阶段临床诊断，由神经科专科医师对MMSE低于界值分数的老人和部分MMSE正常的老人进行病史收集，临床体格检查和神经心理测验。根据DSM-Ⅲ-R，NINCDS-ADRDA诊断标准作出痴呆的临床诊断。结果 2788例60岁及以上老年人中患痴呆者208人，占7.5%，标化患病率为5.1%。痴呆分类AD占67.3%。VD占20.7%，混合型为10.1%，其他痴呆占1.9%，痴呆患病率在女性，农村地区及低文化水平的老年人群中增加，随年龄增长，患病率增高，结论 高龄，低教育水平，居住在农村的老年人是痴呆的高发人群。     

上海市社区老年人躯体衰弱与肌少症的相关性研究

目的调查社区老年人衰弱的患病率及危险因素,探讨躯体衰弱与肌少症的相关性。方法随机选取1349例60岁及以上社区老人为研究对象,现场采集一般人口学资料、肌少症筛检问卷(SARC-F)、微型营养评估量表(MNA);测定骨骼肌肌量、握力及步速。采用Fried衰弱表型(FP)进行衰弱评估,将受试者分为衰弱或衰弱前期组和非衰弱组。结果社区老年人中衰弱或衰弱前期患病率为39.88%。衰弱或衰弱前期组和非衰弱组性别、年龄、受教育程度、腰围、臀围、步速、握力、SARC-F、ADL、MNA差异均有统计学意义(P<0.001)。年龄(r=0.36,P<0.001)和握力下降(r=0.39,P<0.001)与衰弱呈正相关。多因素回归分析显示年龄、步速下降、握力下降、肌少症、ADL及MNA是躯体衰弱的危险因素,而性别是衰弱的保护因素。肌少症患者中,年龄、握力下降、ADL和MNA是衰弱的危险因素,而性别和臀围是衰弱的保护因素。结论社区老年人衰弱患病率不低,衰弱和肌少症密切相关,高龄、营养不良的肌少症患者更易发生躯体衰弱。     

2004年乌鲁木齐市城区居民慢性病及危险因素调查

目的通过对慢性病患病现状及危险因素分析,探讨预防对策。方法2004年将乌鲁木齐市城区居民40万人作为研究对象,通过随机抽样对2 100人入户调查慢性病患病情况及行为危险因素等。结果(1)样本人群慢性病患病率为56.97%,其中男性患病率为55.14%,女性患病率为58.71%,男女患病率均随年龄增长而增高。(2)危险因素调查显示:人群总吸烟率31.33%,酗酒率28.56%,超重率32.71%,不运动率为43.53%。(3)多因素回归分析显示:年龄、性别、吸烟、酗酒、超重和缺乏运动等是慢性病的主要影响因素。结论乌鲁木齐市城区居民慢性病患病率与危险因素均处于较高水平且有迅速增加的趋势,慢性病预防控制策略和措施亟待加强。     

金华市农村老年人轻度认知功能障碍患病率及影响因素

目的调查金华市农村老年人轻度认知功能障碍(MCI)患病率及影响因素。方法多阶段整群随机抽样,使用简易智力状态检查量表(MMSE)、日常生活能力(ADL)量表和基本资料调查问卷对金华1 012例60岁以上农村老人进行现况调查,采用筛查和确诊两阶段法进行调查。结果金华市农村老年人MCI患病率为21.1%。文化程度、年龄、职业、参加劳动、社交活动、运动锻炼、喝茶及睡眠状况是影响农村老年人MCI患病的因素,经常喝茶(OR=0.789,95%CI:0.647～0.961)、良好睡眠(OR=0.723,95%CI:0.586～0.892)、参加劳动(OR=0.589,95%CI:0.472～0.734)是老年人MCI的保护因素,高龄是老年人MCI的危险因素。结论农村老年人MCI患病率较高,应根据农村老年人群特征制定干预方案,增强保护因素,预防MCI的发生。     

The place of the specialist home for the elderly mentally infirm in the care of mentally disturbed old people

In a city where specialist homes for the elderly mentally infirm (EMI) have been extensively developed, a study was carried out to determine if residents in such homes were mentally impaired to a degree intermediate between that of residents in ordinary homes, and those in psychogeriatric beds. The study, using valid measures of cognitive impairment and functional disability, showed that while the proportion of cases of senile dementia was similar in all three settings, the severity of disability was graded in the expected direction. Furthermore, cases of mental illness other than senile dementia were almost exclusively found in the EMI homes and psychogeriatric hospitals. However, one in ten of ordinary home residents suffered from senile dementia of a severity which presented problems to the care attendants and the implication of this finding for the level of provision of psychogeriatric beds is discussed.     

Validity and reliability of the Arabic version of Activities of Daily Living (ADL)

Background

The Activity of Daily Living (ADL) is an instrument that screens elderly respondents for physical functioning and assesses whether they are dependent or independent in their daily activities. This study demonstrates a translation procedure and obtains the reliability and validity of a translated, Arabic ADL.

Methods

The ADL was translated to Arabic through a forward translation method followed by a committee-consensual approach. The ADL and the Arabic Mini-Mental State Examination (AMMSE) were administered to an opportunistic sample of 354 Lebanese elderly living in nursing homes who did not have dementia.

Results

Reliability split half measures, sensitivity, and negative predictive values were high across all dimensions of the ADL with the exception of feeding. There were non-significant differences on the scored ADL between the three age groups: young age, middle age and older old. In addition, a non-significant difference was found on the scored ADL between the high and low AMMSE scores.

Conclusion

Overall, the translated ADL was consistent and valid measure for assessing daily activities in elderly nursing home residents. As it is quick and easy to use, the ADL in Arabic could help caregivers and doctors to prescribe appropriate physical exercise for elderly Arabic speaking patients.     

Low prevalence of skin diseases among patients in a Japanese nursing home

Although increasing numbers of the elderly Japanese reside in nursing homes, few epidemiological studies on skin diseases have been undertaken. We studied this issue in 135 nursing home residents in Yamanashi prefecture, central Japan. Approximately two‐thirds of participants were female (65.9%), with dementia (42.2%), stroke (38.5%) and heart disease (34.1%) being the most common underlying conditions. Age ranged from 50 to 98 years, with an average of 78.6 years. Total duration of stay within the nursing home ranged from 13 to 44 months, with an average stay of 21.7 months, or approximately 1.8 years. Approximately 1 in 12 participants were bedridden (8.1%). Fungal infection (including candida, tinea manum, tinea pedis and tinea unguium) was the most common condition (4.4%), followed by dermatitis (1.5%) and senile xerosis (1.5%). Overall, the prevalence of skin disease was considerably lower than in previous international reports, possibly due to a ‘healthy‐patient effect’. Further research needs to be undertaken to elucidate the overall prevalence of skin disease among Japanese nursing home residents.     

Prevalence of dementia in institutional care

Information about dementia prevalence in residential and nursing care homes helps these institutions to meet residents' needs. We combined residential characteristics ascertained at a screening interview in 1991-93 with dementia diagnoses from assessment interviews in the UK Medical Research Council Cognitive Function and Ageing Study, a population-based study of 13004 elderly people. Almost 5% of people aged 65 years or older lived in institutions--34% (95% CI 30-39) of individuals with dementia. Within institutions, dementia prevalence was 62% (52-71), and was slightly higher in women than in men, with no increase by age. That most residents have dementia has implications for the type of care that institutions provide.     

Prevalence of Long-Term Care Acquired Infections in Nursing and Residential Homes in the Emilia-Romagna Region

Abstract Background: Hardly any data on the occurrence of infection in Italian nursing homes have been published; yet Italy has the second oldest population in the world. The objective of the study was to assess the frequency of infections in a sample of Italian nursing homes. Materials and Methods: A 1-day prevalence survey was conducted in three local health authorities (LHAs) of the Emilia-Romagna region in Italy, aimed at describing the prevalence of patients with long-term care facilityassociated infections and their associated factors among residents of nursing and residential facilities. All nursing homes (NHs) and a stratified random sample of residential homes (RHs) in the three LHAs were included in the study, for a total of 1,926 elderly people in 49 facilities. The following data were recorded: infections, medical condition, activities of daily living (ADL), use of antibiotics. The main outcome of the study was infection prevalence. Results: The prevalence of patients with long-term care facility-associated infection was 8.4/100 residents overall (CI 95% 7.9–9.0), 14.6/100 in NHs and 7.5/100 in RHs (CI 95% 6.8–8.1). The prevalence of infection significantly varied with LHA and facility. It was associated with level of dependency and exposure to invasive procedures, such as urinary catheterization and parenteral procedures. Six percent of residents received a systemic antimicrobial on the day of the study, and in 22% of cases there was no evidence of suspected or diagnosed infections. Conclusion: The prevalence study identified a high prevalence of infected patients in nursing homes in Italy, consistent with observation in other geographic areas.     

Abnormal behavior of residents in a long-term care facility and the associated stress of care staff members

To survey the factors associated with abnormal behavior in 99 elderly residing in a special nursing home, we investigated the relationships between abnormal behavior and depression as well as impairments in cognition and activities of daily living (ADL), and the stress level of 28 care staff members. The clinical criteria for grading of dementia (intellectual level), the Cornell scale for depression in dementia (CSDD), the dementia behavior disturbance (DBD) scale, and rating of performance of ADL were used to assess behavioral and psychiatric symptoms in the elderly patients. Stress levels of care staff members were assessed using the 'burnout' scale. The DBD scale score correlated with the intellectual level, CSDD score, and three categories of ADL (urinary continence, faecal continence, and comprehension of conversation). The DBD scale score correlated negatively with one category of ADL (eating) in men, but did not correlate with ADL in women. No correlation was found between the burnout scale scores of care staff and either their age or work schedules. Present results showed that abnormal behavior in special nursing home residents correlated with depression as well as cognitive impairment. It is believed that the treatment and management of depression will decrease abnormal behaviors and improve their quality of life in special nursing home residents.     

Development of behavior rating scale for the elderly]

The purpose of this study was to develop a behavior rating scale to measure adaptation of the elderly using care staff as evaluators and to examine the reliability and validity of the scale. The behavior rating scale consists of 51 items and 5 subscales to measure areas of ADL, activity, interpersonal relationships, dementia syndromes, and socially irritating behavior. The scale was administered to 280 elderly residing in 4 nursing homes. Each reliability index, including internal consistency, test-retest, and inter-rater agreement was satisfactory. Validity was examined by relating total score or each subscale score to 19 external variables including physical condition, state of daily living, cognitive ability and personality. The correlations between external variables and the scale scores indicated that the behavior rating scale was valid.     

The quality of residential and nursing-home care for people with dementia

OBJECTIVES: to determine the environmental quality of community-based residential and nursing care for people with dementia. DESIGN: survey of a stratified random sample of care homes. SETTINGS: forty-six registered residential and nursing homes in a single health district. MAIN OUTCOME MEASURES: scales for the assessment of environments for people with dementia, including care practices, social activities, social facilities, reality orientation cues, physical condition and space availability. RESULTS: over 90% of the homes had high quality scores on at least two measures. Provision of reality orientation cues was usually poor. Nursing homes catering specifically for 'the elderly mentally infirm' had more restrictive care practices, whilst local-authority residential homes had a better provision of recreational facilities. Private sector homes were in much better condition than public sector homes but their care practices were more institutional--this may be related to the provision of nursing and elderly mentally infirm care almost exclusively by the private sector. CONCLUSIONS: the environmental quality of community-based residential care is generally good, but improvements could be made, particularly with reality orientation cues.     

Mangelernährung und Demenz bei Bewohnern in Einrichtungen der stationären Altenpflege in Deutschland

Background and objective

Dementia is one of most challenging problems for the care of older people in Germany. Although malnutrition in nursing homes is also associated with dementia, few systematic studies have described health care structures in German nursing homes for people with dementia and their individual nutritional status. Therefore, the aim of this study was to determine dementia-specific differences concerning the nutrition situation for the elderly in German nursing homes.

Methods

A cross-sectional multicenter study was performed using a standardized multilevel instrument (observation, questionnaire) developed at the University of Maastricht. Variables are indicators for malnutrition and its risks, quality indicators, care dependency and types of interventions.

Results

In the 2008 and 2009 surveys, 53% of 4,777 participants (77.9% women, 22.1% men, mean age 82 years) were identified (based on care documentation) as having dementia. More than one third of this population (n?=?759, 85.1% women, 14.1% men, mean age 85 years) was probably malnourished; thus, the prevalence rate in the group of people with dementia was 10% higher compared to the group without dementia. People with dementia showed a higher risk in all relevant risk indicators (weight history, body mass index, and food intake) for malnutrition compared to those without dementia. Furthermore, people with dementia had higher care dependency rates and required more assistance for eating and drinking.

Conclusion

The study results confirm the relationship between malnutrition and dementia. The use of standardized nutrition screening tools is not common practice in German nursing homes yet. However, the results suggest that with an increasing risk for malnutrition combined with dementia the proportion of nursing interventions also increases, which means that nurses must react adequately. Nevertheless, the interventions concerning malnutrition should be improved especially with respect to preventive measurements.     

Arthritis in nursing home residents. A validation of its prevalence and examination of its impact on institutionalization and functional status

We studied nursing home residents to validate the method used in national surveys for estimating the prevalence of arthritis, and to examine the impact of arthritis on institutionalization and on the physical function of residents. Five homes were studied using a 3-phase approach. Directors of nursing in each home classified residents (n = 629) with respect to the presence of arthritis and senile dementia. The presence of osteoarthritis or rheumatoid arthritis and their impacts on a resident's initial placement were separately assessed by a physician through a chart review of a stratified subsample. The physician also rated a resident's likelihood of returning to community living. Finally, the functional impact of arthritis was assessed by a physical therapist. The nurses' estimate of the prevalence of arthritis in this population was 23.33%, while the physician estimate was 23.03%. These results are consistent with the 24.6% prevalence found in a 1977 national survey. Arthritis itself was a major cause of nursing home placement in 15% of all residents without dementia. Among those without dementia who also had arthritis, arthritis was a major cause of institutionalization in 31%. None of the residents without dementia showed substantial potential for reintegration into the community. Controlling for age, residents with arthritis had more pain, were more likely to require assistance in functional tasks, and were more likely to use a wheelchair daily than were their fellow residents. Nevertheless, our results suggest that arthritis, despite its impact on function, in and of itself is not a major cause of nursing home placement or ongoing institutionalization.