农村老年人功能健康状况评价研究

目的　评价农村老年人功能健康状况和影响因素。方法　利用日常生活活动 (ADL)、社区日常生活活动 (IADL)和综合功能 (GPF)测量问卷对农村 6 0岁以上老年人的功能健康状况进行了测量和评价 ,分析不同人口特征老年人功能丧失率和各功能项目群功能丧失情况。结果　ADL丧失率为 7.0 % ,IADL丧失率为 2 0 .6 % ,GPF丧失率为 2 2 .8%。ADL和IADL多项同时丧失者占多数 ,而GPF倾向于单项丧失。结论　不同年龄、性别老年人的功能健康状况有明显差异 ,而且功能健康状况随社会经济状况的下降而恶化。     

老年人日常生活活动能力评价及影响因素分析

以南京市城区６０岁以上老年人的健康状况与日常生活活动能力抽样调查资料为基础，综合分析评价老年人的日常生活活动能力及其影响因素。研究结果表明：老年人日常活动能力在不同年龄组间丧失率不同，男女性别的功能丧失率有显著性差异（Ｘ２＝７．７５，Ｐ＜Ｄ．０５）。非条件Ｌｏｇｉｓｔｉｃ回归分析显示：年龄、患慢性病种类、婚姻状况、体育锻炼，生活满意度为影响老年人日常生活活动能力的主要因素。     

老年人慢性病对日常生活功能的影响

目的：研究贵阳市城区老年慢性病人日常生活功能（ＡＤＬ和ＬＡＤＬ）的影响。方法：通过问卷问和体格检查相结合，对贵阳市我９６６名≥６０岁的老年人进行了慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析有关慢性病对老年人日常生活功能损害原作用大小。结果：慢性病患病率为５７．８％，ＡＤＬ损害率为９．４％，ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障、慢性阻塞性肺     

大豆纤维对实验性高脂大鼠动脉粥样硬化的预防作用和抗氧化效果

研究大豆纤维（ＳＦ）对实验性高脂大鼠的血液和肝组织脂质过氧化物（ＬＰＯ）水平、谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）活性和血脂指标的影响。结果表明，大豆纤维膳能明显降低血清总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）和致动脉粥样硬化指数（ＡＩ）（Ｐ＜０．０５）。血清和肝组织ＬＰＯ水平明显下降，ＧＳＨ－Ｐｘ活力显著提高（Ｐ＜０．０５）．ＳＦ对血脂降低和对氧化低密度脂蛋白（Ｏｘ－ＬＤＬ）的阻断作用可能对防止动脉粥样硬化（ＡＳ）的形成起主要作用。     

急性肺损伤大鼠肺灌洗液及血清中LDH，ALP，TC，TG及PL变化研究

对静脉注射油酸引起急性肺损伤的（ＡＬＩ）大鼠，在注射后不同时间收集支气管肺泡灌洗液（ＢＡＬＦ）和血清进行分析，发现其ＢＡＬＦ中乳酸脱氢酶（ＬＤＨ）、碱性磷酸酶（ＡＬＰ）、总胆固醇（ＴＣ）和磷脂（ＰＬ）均有不同程度增加，注射后０．５小时ＬＤＨ即增高达对照组的６．７倍（Ｐ＜０．００１）。血清中ＬＤＨ，ＡＬＰ，ＴＣ及ＰＬ均有异常改变，其中注射后０．５小时血清ＬＤＨ即高达对照组的２倍（Ｐ＜０．０１）。实验组ＢＡＬＦ及血清中甘油三酯（ＴＧ）均比对照组有所降低。实验提示，ＢＡＬＦ和血清中ＬＤＨ升高伴脂类异常，有可能是早期诊断急性肺损伤较特异的组合指标。     

锌对免疫器官的影响

通过建立大鼠缺锌（ＺＤ）、高锌（ＺＥ）模型，研究锌对免疫器官——骨髓、胸腺、脾脏的影响。结果表明：（１）ＺＤ、ＺＥ组体重、体重增长值、饲料效价均非常显著地低于配对（ＰＦ）组和自由喂养（ＡＬ）组，缺锌补锌（ＺＤ＋ＡＬ）组达正常水平。（２）ＺＤ组血清、毛发、股骨、肝脏锌均非常显著地低于ＰＦ、ＡＬ组，而ＺＥ组则相反，ＺＤ＋ＡＬ组达正常水平。（３）ＺＤ、ＺＥ组的胸腺重量、胸腺指数、胸腺肽量和胸腺活性均非常显著地低于ＰＦ、ＡＬ组，ＺＤ＋ＡＬ组达正常水平。（４）ＺＤ、ＺＥ组脾脏重量、脾脏指数均非常显著地低于ＰＦ、ＡＬ组，ＺＤ＋ＡＬ组达正常水平。（５）ＺＤ、ＺＥ组骨髓细胞３Ｈ一ＴｄＲ掺入率和外周血白细胞总数显著下降，其中尤以淋巴细胞减少为着。（６）骨髓细胞、脾脏淋巴细胞周期显示ＺＤ、ＺＥ组静止期细胞明显增高，而增殖期细胞下降，与ＰＦ、ＡＬ组间差别非常显著。以上结果提示，适量锌有促进免疫器官——骨髓、胸腺、脾脏发育和功能活动的作用。而缺锌和高锌则抑制免疫器官的发育和免疫细胞的功能。     

超声心动图测量左房内径在室间隔缺损或动脉导管未闭中应用价值探讨

本文应用ＳＳＨ－６５Ａ彩色超声心动图仪测量１５例室间隔缺损（ＶＳＤ）和４例动脉导管未闭（ＰＤＡ）患儿的左房内径（ＬＡＤ）和主动脉根径（ＡＯＤ）以及ＶＳＤ的直径（Ｄ），并与健康者及手术后所测值进行对比分析。结果表明：患儿的ＬＡＤ和ＬＡＤＩ（左房内径指数）高于正常者（Ｐ＜０．０１）且ＬＡＤＩ与Ｄ／ＡＯＤ具有相关性，其回归方程为Ｄ／ＡＯＤ＝０．０４４ＬＡＤＩ－１．２１（ｒ＝０．８５，Ｐ＜０．０１），但其在手术后早期无明显变化。提示测量ＬＡＤ可为ＶＳＤ和ＰＤＡ患者选择手术治疗提供较可靠的依据。     

不稳定心绞痛与急性心肌梗死血脂变化比较

目的：探讨不稳定心绞痛（ＵＡＰ）和急性心肌梗死（ＡＭＩ）之间血脂变化。方法：对１０９例ＵＡＰ和１４３例ＡＭＩ病人血脂值进行统计学处理分析。结果：ＵＡＰ组ＴＧ（１７１．２±１４６．９）ｍｇ／ｄｌ高于ＡＭＩ组（１３６．９±８４）ｍｇ／ｄｌ（Ｐ＜０．０１）及ＴＧ／ＨＤＬ－Ｃ（５．５±６．２）比（４．１±３．３）和ＬＤＬ－Ｃ／ＨＤＬ－Ｃ（４．０±１．９）比（３．６±１．６）高于ＡＭＩ组（两者均Ｐ＜０．０５）。结论：ＵＡＰ病人ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比值增高可能与其血管病变严重性相关     

老年冠心病患者血胰岛素水平与血脂及血糖的关系

观察老年冠心病患者血胰岛素水平与血清脂质的关系,对９７年老年冠心病患者及４８例老年对照组的血脂、血糖及胰岛素进行了测定。老年冠心病患者血清甘油三脂（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平显著高于对照组;而高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）水平极显著低于对照组（Ｐ〈０．０１）;血清胆固醇（ＴＣ）、载脂蛋白ＡＩ（ＡｐｏＡＩ）、载脂蛋白Ｂ（ＡｐｏＢ）及脂蛋白（ａ）「Ｌｐ（ａ）」水平两组比较无显著性差异;老年冠心病组血胰岛素（ＩＮＳ）水平高于对照组,其差异有极显著性意义;而空腹血糖（ＦＰＧ）水平显著高于对照组;胰岛素敏感性指数（ＩＳＩ）冠心病组显著低于对照组。     

肝外梗阻性黄疸术后应用脂肪乳剂对血清脂类的影响

对２０例恶性肝外梗阻性黄疸（梗黄）行胰十二指肠切除的病人，术后第１～７ｄ行ＴＰＮ支持。随机分为两组：Ｉ组（观察组）热量的３５％～４０％由长链脂肪乳剂提供，Ⅱ组（对照组）单纯由葡萄糖供热。两组其它条件相同，于术前及ＴＰＮ后第１，５，７ｄ分别检测血清８种游离脂肪酸（ＦＦＡ），血脂（ＴＧ，Ｔｃｈ）脂蛋白（ＨＤＬ，ＬＤＬ，ＶＬＤＬ）结果：Ｉ组已升高的Ｔ－ＦＦＡ和Ｔ－ＳＦＡ明显下降，已低下的ＥＦＡ下降不明显     

深圳市老年人群生活质量的流行病学研究

目的：为了解深圳市老年人群生活质量现状及其影响因素。方法：采用随机抽样的方法,对深圳市１１０９例老年人进行了生活质量调查分析。结果：８７．５％的老年人月收入在５００元以上;患病率为６７．２％,有躯体残疾者占３．９％;ＡＤＬ量表评分完全自理者占９２．０％,ＩＡＤＬ量表评分全部能完成者占５６．４％;近２年有负性生活事件者占５３．０％;ＬＳＩＡ（满分４０分）平均得分１９分,男性高于女性,干部高于工人和农民;社会支持量表（满分５２分）平均得分１８．３分;影响健康自评和生活满意度的因素有经济收入、慢性疾病、生活功能、社会支持、严重负性生活事件和深圳市户口等。结论：应从影响生活质量的因素出发制订老年卫生保健政策,有针对性、有重点地开展社区卫生保健项目,以促进老年人生活质量的提高。     

Quality of life: a possible health index for the elderly

To assess whether quality of life (QOL) could be employed as an outcome measure of health programs for elderly populations, we evaluated the relationship between subjective assessment of QOL ("morale scale") and objective constituents of active life such as activities of daily living (ADL), instrumental ADL (IADL) and work status along with determination of active life expectancy (ALE) in a rural district in Japan (n = 13,529). The QOL scale was positively correlated with ADL, IADL and work status but not with age. Validity and test-retest reliability were satisfactory as regards the small subsamples of respondents. ALE of the elderly aged 60 to 64 was 15.2 years, while their life expectancy was 27.1 years. Factors associated with lower ADL included age, lower IADL and joblessness. The QOL measurement and the objective variables can be incorporated into an assessment of the health status of the elderly in addition to conventional indices based on mortality.     

Functional capacity and five-year mortality in a sample of urban community elderly

To assess the validity of a functional status measure in communityelderly, 1317 residents of Barcelona, Spain, aged 65 years orover were interviewed at home in 1986 and their vital statuswas assessed five years later from census data. Functional capacitywas measured by self-reported ability to perform nine basicactivities (ADL) and four instrumental activities (IADL) ofdaily living. Significantly lower survival rates were foundfor males, older age groups, functionally dependent subjectsand for those reporting poor health. Relative risks of death,estimated by Cox's regression controlling for health statusand sociodemographic variables were 3.17 (95% CI=1.98–5.08)for ADL-dependent elderly, and 2.14 (95% CI=1.32–3.46)for IADL-dependent elderly, compared with elderly reportingbeing fully independent. Functional capacity based on ADL stronglypredicts subsequent mortality and provides relevant informationon health status of community elderly. Nevertheless, cross-culturalvalidity of functional capacity based on IADL measures deservesfurther research.     

Functional status of elderly home care users: do subjects, informal and professional caregivers agree?

Professional or informal proxy respondents are frequently used in surveys when physical or mental health may compromise the ability to participate or the quality of responses. Functional status (Katz activities of daily living [ADL], Lawton instrumental activities of daily living [IADL]) was assessed in a sample of 420 chronically dependent elderly receiving home care. Separate in-person interviews were conducted with subjects, main informal caregivers and professionals coordinating home care. We found substantial agreement (Kappa) particularly between subjects and informal caregivers in all ADL except continence and in all IADL except housekeeping. High levels of agreement were also found for cognitively impaired subjects (Mini-Mental State Examination <24). Disagreement was characterized by more frequent reports of dependence from informal and professional caregivers. Our data suggest that proxy responses by informal caregivers conform with answers provided by subjects but produce slightly higher estimates of dependence and that cognitively impaired elderly living in the community will provide accurate information on their functional status in most cases.     

Mini-Nutritional Assessment predicts functional decline of elderly Taiwanese: result of a population-representative sample

Nutrition is a key element in geriatric health and is important for functional ability. The present study examined the functional status-predictive ability of the Mini-Nutritional Assessment (MNA). We analysed the dataset of the 'Survey of Health and Living Status of the Elderly in Taiwan', a population-based study conducted by the Bureau of Health Promotion of Taiwan. Study subjects (≥65 years old) who completed both the 1999 and 2003 surveys were rated with the long form and short form of the MNA at baseline and with the Activities of Daily Living (ADL) and the Instrument Activities of Daily Living (IADL) scales 4 years later (end-point). The ability of the MNA to predict ADL or IADL dependency was evaluated with logistic regression models. The results showed that the elderly who were rated malnourished or at risk of malnutrition at baseline generally had significantly higher ADL or IADL scores 4 years later. Lower baseline MNA scores also predicted a greater risk of ADL or IADL dependency. These associations exist even among the elderly who were free of ADL or IADL dependency at baseline. The results clearly indicate that the MNA is able to predict ADL and IADL dependency (in addition to rating current nutritional status) of the elderly. The MNA, especially the short form, should be a valuable tool for identifying elderly at risk of functional decline and/or malnutrition in clinical practice or community programmes.     

Gender disparity of successful aging in Taiwan

The purpose of this longitudinal study was to examine the association of gender on successful aging during a 6-year follow-up study. Data were drawn from the 1989, 1993, 1996, and 1999 Survey of Health and Living Status of the Elderly in Taiwan, a national representative population survey of 4,049 participants aged 60 years or older; 43% were women. Successful aging indicators were defined as physical (absence of disease and physical disability), mental (normal cognitive function and absence of depression), and social (good social support and participation in productive activities). Gender differences related to successful aging during the 6 years were analyzed with Cox proportional hazards regression model. Significant disparities were found between elderly men and women in activities of daily living (ADL), instrumental activities of daily living (IADL), cognitive function, depressive symptoms, social support and productive activities. When the data included individuals who were deceased, elderly women showed better maintenance of ADL and less vulnerability to IADL impairment than elderly men. However, when the analysis included only survivors during the follow-up, the elderly were more likely to be impaired in IADL and cognitive function, have depressive symptoms, and lack engagement in productive activities. Cumulative disadvantage was associated with health disparities in elderly women. This research demonstrates the need to develop gender-sensitive policies.     

2011年济宁市城区部分老年人日常生活活动能力评价

[目的]了解济宁市老年人基本日常生活活动能力和工具性日常生活活动能力,为社区及乡镇卫生服务机构有效开展老年卫生服务和健康维护提供参考。[方法]2011年3～4月,采用多阶段随机抽样方法,在济宁市城区抽取≥65岁常住户口的老年504人应用Katz日常生活活动量表(Katz-ADL)和工具性日常生活活动量表(Lawton-IADL)进行调查。[结果]测评人504人,Katz-ADL得分为5.66±0.91分。6项功能均保持的占80.95%,6项功能均丧失的占0.79%。6项功能均保持者所占比例,男性为86.67%,女性为74.36%(P<0.01)。测试的504人中,Lawton-IADL得分:男性为3.72±1.59分,女性为5.06±2.83分。其中,男女相同的5项功能均保持者所占比例为33.53%,男性为44.08%,女性为21.37%(P<0.01);5项功能均丧失者所占比例为11.31%,男性为7.78%,女性为15.38%(P<0.01)。[结论]济宁市城区老年人日常生活活动能力和工具使用生活能力较高,多项生活活动能力保持率男性高于女性。     

The Effectiveness of a Health Promotion Program for the Low-Income Elderly in Taipei,Taiwan

This study assessed the effectiveness of a health promotion program for low-income elderly provided by trained low-income home health aides. Indicators of the effectiveness of this program included improvement in physical health, psychosocial health and functional status, including activities of daily living (ADL) and instrumental activities of daily living (IADL) as well as changes in perceived health promotion needs. This evaluation study used a single group pre- and post-test experiment design. After informed consent forms were signed by participants, 89 purposively selected low-income elderly (aged 64–96) completed pre-test structured surveys, while 60 participants (aged 68–96) completed post-test surveys. Post-test scores indicated improved nutritional status (paired t = 2.64, p < .05) and chore management of IADL abilities (paired t = 2.83, p < .01). No significant difference in psychosocial status were found between pre- and post-test scores. Perceived needs for health promotion services decreased after the intervention. The results show that the health promotion services were effective in improving health status and decreasing perceived needs for services among low-income elderly in Taipei. Recommendations based on this study for developing services for the low-income elderly must take health promotion intervention into consideration.     

The impact of socio-economic factors on functional status decline among community-dwelling older adults in China

The purpose of this paper is to examine the impact of baseline socio-economic factors on functional status decline over a period of 3 years among a sample of Chinese older men and women, using the China Health and Nutrition Surveys of 1997 and 2000. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic, health-related and nutritional risk factors. The eligible study population was defined as women and men aged 55 years and over who at baseline were free from any form of disablement in activities of daily living (ADLs) or instrumental activities of daily living (IADL) tasks. Among subjects with complete data at followed-up (N = 976), the overall incidence proportions of any functional status decline, IADL only and ADL declines were 25.8%, 18.9% and 6.9%, respectively. Our study found that education is strongly and inversely associated with incidence of combined functional status decline and IADL only but not with the onset of ADL disability. Similarly, household income per capita was inversely associated with functional status decline and IADL disability incidence, with a clear dose-response relationship, even after adjustment for age and gender. However, multivariate analysis demonstrated that the latter association was highly confounded by other demographic factors, especially urban-rural area of residence. Using a combined measure of socio-economic status that includes years of education and household income per capita, the age and gender-adjusted odds ratio for functional status decline and belonging to lower SES class as compared to middle, upper middle and upper classes was 3.82 (95% CI: 2.15, 6.77) and 2.77 (95% CI: 1.52, 5.03) after further adjustment for urban-rural area of residence and living arrangements. Hence, there are wide socio-economic disparities in the functional health of older adults in China, although such disparities are more seen for IADL decline and are almost exclusively attributed to differentials in educational attainment. Finally, nutritional and health-related risk factors do not seem to act as intermediate factors in this association and hence further research should try to uncover other mechanisms by which SES affects changes in functional health among older adults in China.