中国听力残疾老年人生活自理能力影响因素分析

目的分析中国听力残疾老年人生活自理能力现状及其影响因素。方法运用2006年第二次全国残疾人抽样调查数据,以≥60岁单纯听力残疾者为研究对象,对听力残疾的老年人基础性生活自理能力现状进行描述性分析,运用多因素logistics回归对听力残疾的老年人生活自理能力相关因素进行分析。结果中国≥60岁听力残疾老年人生活不能自理率为23.62%。多因素logistics回归分析结果显示,年龄越高听力障碍残疾等级越高(极重度OR=2.97,95%CI=2.68~3.29)、家庭人均户收入低于等于国家平均水平听力障碍老年人发生生活不能自理的风险越高(OR=1.17,95%CI=1.08~1.28);居住在农村(OR=0.86,95%CI=0.79~0.95)、所在地为东部(OR=0.59,95%CI=0.55~0.63)、受教育程度高(高中及以上OR=0.62,95%CI=0.53~0.72)听力障碍老年人发生生活不能自理的风险越低。结论个体因素和环境因素构成的情境因素与听力残疾老年人活动受限密切相关,影响其日常生活功能。     

A prospective study of patient identified unmet activity of daily living needs among cancer patients at a comprehensive cancer care centre

Cancer, as a chronic illness, demands a new focus in physical and emotional support. Thus, an assessment of activities of daily living needs among cancer patients was completed. A 1-week, cross-sectional survey of patients was undertaken, by using the Modified Barthel Index, the Eastern Co-operative Oncology Group performance status, a Modified Instrumental Activities of Daily Living Scale and a screening tool. As functional status declined, the number of unmet needs per patient increased. At least one-third of patients who would benefit from assessment were not referred. Without simple screening tools, the needs of this population are not always being recognised or met. Patient identified needs, when analysed by functional level and treatment intent, challenge existing assumptions of service provision. In conclusion, there is an unmet need in this cancer population. By using the Screening Tool on referral, and with each change in level of function (as measured by the Eastern Co-operative Oncology Group), it would help identify patients who may benefit more from occupational therapy assessment.     

Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review

Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.     

Rapid decrease in length of stay in institutional care for older people in Sweden between 2006 and 2012: results from a population‐based study

There is limited knowledge about older people's length of stay (time until death) in institutional care and how it has changed over time. The aim of this study was to analyse changes in the length of stay for older people in institutional care between 2006 and 2012. All persons 65+ living in Kungsholmen (an urban area of Stockholm), who moved to an institution between 2006 and 2012, were included (N = 1103). The data source was the care system part of a longitudinal database, the Swedish National Study on Aging and Care. The average length of stay was analysed using Laplace regression for the 10th to the 50th percentile for the years 2006–2012. The regressions showed that in 2006, it took an average of 764 days before 50% of those who had moved into institutional care had died. The corresponding figure for 2012 was 595 days, which amounts to a 22.1% decrease over the period studied (P = 0.078). For the lower percentiles, the decrease was even more rapid, for example for the 30th percentile, the length of stay reduced from 335 days in 2006 to 119 days in 2012, a decrease of 64.3% (P < 0.001). The most rapid increase was found in the proportion that moved to an institution and died within a short time period. In 2006, the first 10% had on average died after 85 days, in 2012 after only 8 days; a decrease in the length of stay of 90.5% (P = 0.002). In general, there was a significant decrease in the length of stay in institutional care between 2006 and 2012. The most dramatic change over the period studied was an increase in the proportion of people who moved into an institution and died shortly afterwards.     

中国社区老年居民日常生活活动能力失能状况调查

目的 调查我国城乡社区老年人失能现状及其流行特征。方法 调查对象来自2015年老年期重点疾病预防和干预项目。采用多阶段分层整群随机抽样,抽取6省市共23 803名≥ 60岁城乡社区老年人,对其进行问卷调查和身体测量,采用日常生活活动能力量表（ADL）评估老年人失能情况。采用χ²检验分析基础性日常生活活动能力量表（BADL）和工具性日常生活活动能力量表（IADL）各项功能受损率及BADL/IADL失能率在不同特征老年人群间的差异,采用多因素logistic回归模型分析失能的影响因素。结果 BADL功能中洗澡受损率最高（1.7%）,吃饭受损率最低（0.6%）;IADL功能中打电话受损率最高（16.6%）,其次是乘公共汽车（5.5%）,吃药受损率最低（1.8%）。社区老年人BADL失能率2.1%,IADL失能率19.1%。BADL失能率在女性、无配偶、文盲、低体重和肥胖老年人中较高（P<0.05）。IADL失能率在女性、农村、无配偶、低文化程度和低体重老年人中较高（P<0.05）。多因素分析显示,BADL失能的危险性随年龄增加而升高,非正常体重也增加其危险性,而文化程度较高的老年人群BADL失能的危险性相对较低。增加IADL失能的危险因素有女性、增龄、农村、无配偶和低体重;而文化程度高和肥胖的老年人群IADL失能的危险性相对比较低。结论 本研究结果显示,受年龄老化和人口学诸多因素影响,我国老年人群失能率仍维持在一个高水平,加强老年人群躯体性的和工具性的日常生活活动能力下降预防和干预工作是非常必要的。     

Experiences of home‐care workers with the ‘Stay Active at Home’ programme targeting reablement of community‐living older adults: An exploratory study

To face the challenges of an ageing population, many Western countries nowadays stimulate an ageing in place policy to empower older adults to grow old in their own homes with the highest degree of self‐reliance. However, many community‐living older adults experience limitations in (instrumental) activities of daily living ((I)ADLs), which may result in a need for home‐care services. Unfortunately, home‐care workers often provide support by taking over tasks, as they are used to doing things for older adults rather than with them, which undermines their possibilities to maintain their self‐care capabilities. In contrast, reablement focuses on capabilities and opportunities of older adults, rather than on disease and dependency. Consequently, older adults are stimulated to be as active as possible during daily and physical activities. The 'Stay Active at Home' programme was designed to train home‐care workers to apply reablement in practice. To explore the experiences of home‐care workers with this programme an exploratory study was conducting in the Netherlands, between April and July, 2017. In total, 20 participants were interviewed: nine nurses (including a district nurse), 10 domestic support workers and the manager of the domestic support workers. The semi‐structured interviews focused on the experienced improvements with regard to knowledge, skills, self‐efficacy and social support. Furthermore, the most and least appreciated programme components were identified. The study has shown that home‐care workers perceived the programme as useful to apply reablement. However, they also need more support with mastering particular skills and dealing with challenging situations. Future implementation of the 'Stay Active at Home' programme can potentially benefit from small adaptions. Furthermore, future research is needed to examine whether the programme leads to more (cost‐) effective home care.     

Care co‐ordination for older people in the third sector: scoping the evidence

The third sector has played a significant role internationally in the delivery of adult social care services for many years. Its contribution to care co‐ordination activities for older people, however, in England and elsewhere, is relatively unknown. A scoping review was therefore conducted to ascertain the character of the literature, the nature and extent of third sector care co‐ordination activity, and to identify evidence gaps. It was undertaken between autumn 2013 and summer 2014 and updated with additional searches in 2016. Electronic and manual searches of international literature using distinct terms for different approaches to care co‐ordination were undertaken. From a total of 835 papers, 26 met inclusion criteria. Data were organised in relation to care co‐ordination approaches, types of third sector organisation and care recipients. Papers were predominantly from the UK and published this century. Key findings included that: a minority of literature focused specifically on older people and that those doing so described only one care co‐ordination approach; third sector services tended to be associated with independence and person‐centred practice; and working with the statutory sector, a prerequisite of care co‐ordination, was challenging and required a range of features to be in place to support effective partnerships. Strengths and weaknesses of care co‐ordination practice in the third sector according to key stakeholder groups were also highlighted. Areas for future research included the need for: a specific focus on older people's experiences; an investigation of workforce issues; detailed examination of third sector practices, outcomes and costs; interactions with the statutory sector; and an examination of quality assurance systems and their appropriateness to third sector practice. The main implication of the findings is a need to nurture variety within the third sector in order to provide older people and other adults with the range of service options desired.     

Living with Parkinson's disease: Elderly patients' and relatives' perspective on daily living

Background/aim:  Parkinson's disease is a progressive neurodegenerative disorder resulting in significant disability. We examined how Parkinson's disease affects daily living from the perspective of both patients and relatives.
Methods:  Qualitative interviews were performed with seven patients with Parkinson's disease and nine relatives from families other than those of the interviewed patients. Patients and relatives were recruited from an outpatient geriatric unit at a university hospital in Sweden. The interviews were transcribed and analysed qualitatively.
Results:  A conceptual framework encompassing aggravating factors, consequences in daily living and facilitating factors is presented. Patients perceived activity restrictions, changed habits, decreased socialisation and anxiety. Relatives reported changed roles and habits, decreased socialisation, strain and anxiety about the future. Facilitating factors included accessibility, strategies and psychological support for both patients and relatives.
Conclusions:  The results show that Parkinson's disease affects daily living not only for patients but also for relatives. They need to be seen, heard and supported in this burden. Services must be adapted to the needs of both patients and relatives with accessibility to health-care facilities with deep knowledge about the disease and its consequences. The identified factors are areas of concern in occupational therapy.     

A prospective study of unmet activity of daily living needs in palliative care inpatients

Aim: To define the unmet needs of activities of daily living as defined by patients and caregivers in a palliative care inpatient unit. Methods: A cross‐sectional prevalence study of a convenience cohort of a dyad of patient/caregiver. Functional status and unment needs were assessed. Agreement between respondents was analysed. Results: Caregivers identified significantly more unmet needs than patients (2.5 vs 2.5; p = 0.03). Areas of unmet need included mobility, leisure and bathing. Conclusion: Routine screening for unmet needs in function should be part of all inpatient palliative care assessments.     

中国城乡老年人群两年内日常生活活动能力受损发生情况及影响因素

目的 了解中国城乡社区老年人群2年内日常生活活动能力（ADL）下降情况及其影响因素。方法 调查对象来自老年期重点疾病预防和干预项目。该调查采用多阶段分层整群随机抽样的方法,于2015年从我国6个省份抽取23 803名研究对象进行基线调查,2017年进行随访,剔除死亡、失访、数据不完整和2015年基线调查ADL受损的研究对象后,共计18 785名≥ 60岁的老年人符合纳入标准。以第6次全国人口普查数据为标准人口对样本数据进行加权后,分析不同特征老年人群2年内ADL、基础性日常生活活动能力（BADL）和工具性日常生活活动能力（IADL）受损发生率,并采用多因素logistic回归模型分析相关影响因素。结果 经过2年的随访,队列人群中共有1 959例发生ADL受损,ADL受损的2年累计发生率为12.0%,其中,BADL受损的2年累计发生率为1.6%,仅IADL受损的2年累计发生率为10.4%。多因素logistic回归模型分析结果显示,增加仅BADL受损发生风险的因素是年龄增加、肥胖、≥ 2种共病以及认知功能异常;增加仅IADL受损发生风险的因素为年龄增加、女性、低体重和认知功能异常。降低仅IADL受损发生风险的因素包括小学或初中及以上文化程度、超重或肥胖。结论 年龄增加、认知功能异常均增加BADL和IADL受损发生的风险。患有≥ 2种疾病的老年人BADL受损风险较高;肥胖增加老年人BADL受损发生风险,但降低IADL受损发生风险;女性比男性发生IADL受损风险高;高文化程度的老年人IADL受损风险低。     

Cost‐minimisation analysis of home care reablement for older people in England: A modelling study

Many governments have introduced or encouraged home‐care reablement schemes for older people at home with the aim of improving outcomes and reducing costs. We examined if such schemes have the potential to reduce costs from the perspective of the National Health Service (NHS) and Personal Social Services (PSS) in England. Our study was carried out to inform recommendations of a national guideline. Cost‐minimisation analysis was carried out using decision‐analytic Markov modelling. Home‐care reablement was compared with standard home care. Costs included those of the intervention, home care and hospital admission. Uncertainty was explored using univariate and probabilistic sensitivity analysis. Mean costs per person were £56,499 (95% confidence interval 55,690 to 57,307) in the reablement group, and £58,560 (95% confidence interval 57,800 to 59,319) in the standard care group. The mean difference was ‐£2,061 (95% confidence interval 1,933 to 2,129). The probability that home‐care reablement costs less than standard home care was 94.5% (95% confidence interval 93.1 to 95.9). In sensitivity analyses, this probability remained above 85% in all scenarios. Home‐care reablement can be a successful cost‐minimisation strategy for supporting some older people. More research is needed about the impact of home‐care reablement on health outcomes for different groups of older people; and the effects of different durations of reablement on outcomes and costs for different subpopulations.     

The effectiveness of inter‐professional working for older people living in the community: a systematic review

Health and social care policy in the UK advocates inter‐professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990–31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user‐relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost‐effectiveness for IPW, although well‐integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user‐defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.     

Excess winter morbidity among older people at risk of cold homes: a population-based study in a London borough

BACKGROUND: Fuel poverty frequently affects older low-income households, in homes that are difficult to heat. Excess winter deaths occurring in Britain are widely attributed to effects of cold. This pilot study examined the demonstrability of a relationship between older people's health and fuel poverty risk, using morbidity data. METHODS: An observational, population-based study was made of 25,000 residents aged >or=65 years in the London Borough of Newham (LBN). Using Hospital Episode Statistics (HES) data over 1993-1997, anonymized at enumeration district (ED) level, we calculated excess winter morbidity, based on emergency hospital episodes for all respiratory diagnosis codes. EDs were variously aggregated after ranking against a proposed Fuel Poverty Risk Index (FPR), including factors of energy inefficient housing, low income, householder age and under occupation. RESULTS: FPR is a predictor of excess winter morbidity. In particular, FPR was observed showing a significant relationship with high winter morbidity counts for 2 of 4 years studied. Using FPR as a two-level factor (high and non-high), the model provides odds ratios: for 1993, winter/summer morbidity ratio for high FPR is 1.7 higher than the corresponding ratio for non-high FPR [95% confidence interval (CI)=1.1-2.7], and for 1996, the odds ratio is 1.6 (95% CI=0.9-2.8). In a regression with grouped EDs, having allowed for FPR, no other variables in our set contribute to the difference between winter and summer morbidity counts. CONCLUSIONS: Results may indicate supporting evidence of a relationship between energy inefficient housing and winter respiratory disease among older people, with public health implications for increasing health-driven energy efficiency housing interventions.     

山东省老年人生活自理能力及影响因素分析

目的了解山东省老年人生活自理能力及其影响因素。方法采用多阶段随机抽样的方法抽取山东省30个县的5 400名≥60岁老年人进行入户问卷调查,采用描述性分析、χ²检验和Logistic回归等方法进行分析。结果生活完全自理的老年人4 462人,占82.6%,基本自理者805人,占14.9%,完全不能自理者占0.5%,部分依赖者110人,占12.0%;Logistic回归分析结果显示,婚姻、年龄、文化程度、收入、锻炼、慢性病、患病是否及时诊治是老年人生活自理能力的影响因素。结论老年人生活自理能力较好,有配偶、锻炼和老有所医是生活自理能力的保护因素,高龄、患慢性病、低文化程度和低收入是危险因素。     

脑卒中患者社会支持与日常生活能力和焦虑关系

目的 探讨社会支持在日常生活能力与焦虑关系中调节作用,为社区脑卒中患者管理、降低脑卒中患者焦虑水平提供依据.方法 采用便利抽样法在辽宁省5个城市选择22个社区以其中800例脑卒中患者作为调查对象,采用自制人口特征问卷、焦虑自评量表、日常生活评定量表、领悟社会支持量表对调查对象进行问卷调查,运用SPSS统计软件分析脑卒中患者日常生活能力与焦虑关系及社会支持的调节作用.结果 社区脑卒中患者日常生活能力得分为(67.69±24.37)分,领悟社会支持得分为(60.05±13.58)分,焦虑得分为(55.70±11.06)分.相关分析结果显示,脑卒中患者日常生活能力和领悟社会支持分别与焦虑呈负相关(r=-0.29、-0.22,P <0.05);多元分层回归分析结果显示,领悟社会支持与日常生活能力在焦虑上存在显著的交互作用(β=-0.11,P <0.05).结论 脑卒中患者日常生活能力和社会支持对焦虑有很好的预测作用,社会支持在日常生活能力与焦虑关系中具有一定调节作用.     

不同类型日常生活活动能力与老年人抑郁的关联

目的  了解中国老年人抑郁及日常生活能力现状,并分析两者的联系。方法  选取2018年7月10日—9月13日中国健康与养老追踪调查中60岁及以上老年人,运用χ²检验和logistic回归分析模型探索日常生活能力对老年人抑郁的影响。结果  中国老年人抑郁检出率为43.82%;基本日常生活自理能力(basic activity of daily living, BADL)受损率为8.78%;工具性日常生活自理能力(instrumental activity of daily living, IADL)受损率为25.82%。BADL(OR=1.621, 95% CI: 1.304~2.016, P < 0.001)、IADL(OR=1.520, 95% CI: 1.321~1.748, P < 0.001)受损老年人抑郁可能性较高。IADL受损对不同地域老年人抑郁皆有影响,而BADL受损对中部地域老年人抑郁作用不明显。结论  日常生活能力受损老年人抑郁的可能性较高。建议将心理健康服务融入失能老年人的照护体系,配置相应的养老资源时注重地域差异。