昆明市老年人群接受医养结合意愿及其影响因素

目的了解昆明市老年人群接受医养结合服务的意愿及其影响因素。方法对昆明市344名≥60岁的老年人进行问卷调查。结果78.8%的老年人有接受医养结合服务的意愿。多因素逐步Logistic回归分析结果显示,年龄、文化程度、慢性病患病种数和医养结合认知度是昆明市老年人医养结合服务意愿的影响因素。结论昆明市政府应加强医养结合服务的宣传,调整和完善医保制度;医养结合机构应该重视老年人的健康管理和慢性病预防控制。     

石河子市老年人医养结合养老模式认知

目的掌握石河子市老年人关于医养结合养老模式的认知情况。方法采用问卷调查法对石河子市老年人养老服务需求进行便利抽样调查。结果石河子市样本老年人对医养结合养老模式的知晓率不高;其入住医养结合养老机构的意愿及子女的支持度较高,但其本人支付能力又较低。结论在发展医养结合养老模式应注重加大医养结合养老模式的宣传力度;加强医养结合模式精神文化建设;提供一体化的医疗保健服务;整合多方资源,完善社会保障完善社会保障。     

山东省居家、机构医养老年人患慢性病及中医药服务需求现状对比分析

目的 探讨山东省居家、机构医养老年人患慢性病状况、健康行为及对中医药服务的需求情况。方法2022年1月—10月,在山东省抽取8家医养结合机构及80户选择居家医养的家庭,采用自制调查问卷对抽取的555例老年人的个人基本情况、患慢性病状况及健康相关行为、中医药服务需求情况进行调查分析。结果 555例调查对象绝大部分患有慢性病（501例,90.3%）。居家医养老年人基本自理能力较强,多患关节炎、高血压,更多的认为自己口味偏咸或偏甜,缺乏体育锻炼（P均<0.05）;机构医养老年人就医次数维持在较低水平,多患有两种以上慢性病且患有脑血管疾病的人数多,在控制饮酒方面做得更好,自认为心理负担较轻（P均<0.05）。机构医养老年人接受过情志疏导、穴位敷贴、中药内治、拔罐、针灸、推拿、刮痧的较少,在希望得到中医用药指导、药膳、中药熏蒸方面的意愿也不如居家医养老年人高（P均<0.05）。结论 山东省医养结合机构应按需向老年人提供健康宣传教育、中医药服务等服务项目,提高机构的服务水平和服务能力,降低慢性病对老年人健康水平的影响,提高老年人群的生活质量。     

经济因素对医养结合养老认知及意愿的影响

目的了解不同经济水平家庭对医养结合养老机构的认知与意愿的差别。方法对徐州地区2家公立医院的45例老年患者及281例陪护子女进行问卷调查。结果调查对象对医养机构认知率总体偏低,87.12%从未听说或只是听说但不了解医养机构,医养机构认知、养老意愿及费用标准与经济因素差异显著(均P<0.05)。结论与普通养老机构相比,经济因素是老年人选择医养机构更重要的影响因素。老年人群体经济状况较差且参差不齐,目前应建立在以居家养老为基础、社区养老为依托,形成多元化养老模式、多档次养老保障的综合养老服务体系的基础上,大力宣传、发展医养结合式养老机构,以满足高龄、失能、慢性病老人的养老需求。     

浙江省老年人医养结合模式需求偏好影响因素

目的分析老年人口医养结合养老模式需求偏好及其影响因素。方法采取随机抽样法,对浙江省内345名60岁及以上老年人进行问卷调查,分析其医养结合模式偏好的影响因素。结果老年人居家养老、机构养老和合作养老模式的偏好都受子女数量影响。慢性病是居家养老模式的显著性影响因素。居住地是合作养老模式的显著性影响因素。受教育程度影响居家养老和机构养老模式偏好。房产数量影响老年人居家养老和医院养老模式偏好。结论医养结合模式偏好的影响因素与养老模式偏好的影响因素存在很多共性。资产而非月收入是影响老年人医养结合模式选择的制约因素。居家养老是浙江省老年人最偏好的医养结合模式。居家养老模式中,老年人对依托家庭医生开展社区卫生服务的需求意愿较强,但是农村老年人出现养老和医疗服务需求分离的问题。建议大力发展精准型医养结合供给服务;促进医疗及养老资源逐级下沉。     

贵州不同类型医养结合智慧化养老服务需求

目的 调查不同类型医养结合养老机构老年人对智慧化养老服务的需求现状。方法 采用整群和随机抽样方法,利用自行设计的智慧化养老服务需求量表对贵州省第一批、第二批医养结合试点示范单位内居住的老年人进行调查。结果 不同类型养老机构老年人智慧化养老服务需求依次均为智慧化安全监护、医疗服务、健康管理、生活照料和精神慰藉;不同类型养老机构老年人智慧化养老服务有差异(F=17.019,P<0.05),其中以医为主型总分最高,以养为主型次之,医养并重型最低。结论 不同机构性质的老年人对智慧化养老服务需求空间较大,对智慧化养老服务需求侧重点各不相同,相关从业者应结合其需求,认真开展精准服务,以提升医养结合的智慧化养老服务水平。     

老年人新型冠状病毒肺炎防控的权威指南荟萃

新型冠状病毒肺炎人群普遍易感。老年人免疫功能减弱,且多合并慢性基础疾病,感染后往往进展迅速且多为重症病例。死亡病例也多见于老年人。目前的诊疗方案主要针对普通成人,尚缺乏适用于老年人的防控指南。本文在普通成年人新型冠状病毒肺炎防控指南的基础上,针对老年人群的特点,对目前发布的最新的权威指南中老年病区、养老机构及老年人防控要点进行梳理,供基层医养机构参考。     

老年人新型冠状病毒肺炎防控的权威指南荟萃

新型冠状病毒肺炎人群普遍易感。老年人免疫功能减弱,且多合并慢性基础疾病,感染后往往进展迅速且多为重症病例。死亡病例也多见于老年人。目前的诊疗方案主要针对普通成人,尚缺乏适用于老年人的防控指南。本文在普通成年人新型冠状病毒肺炎防控指南的基础上,针对老年人群的特点,对目前发布的最新的权威指南中老年病区、养老机构及老年人防控要点进行梳理,供基层医养机构参考。     

不同类型医养结合模式下老年人孤独感与主观幸福感

目的调查不同类型医养结合养老机构老年人孤独感与主观幸福感的情况。方法应用自行设计的调查问卷,对413名实施医养照护模式的老年人,按照医养结合类型的不同,测量其照护前、照护后半年、照护后1年的孤独感自评量表评分和主观幸福感评分,采用重复测量方差分析法,对不同时间医养结合照护的老年人孤独感和主观幸福感进行比较。结果照护半年、1年后,3组老年人的孤独感自评量表评分较照护前均明显降低(P0.05),老年人的主观幸福感得分较照护前明显升高(P0.05)。结论不同类型的医养结合照护模式均能明显减轻老年人孤独感并提升其主观幸福感,对老年人养老生活中心理健康有所帮助。     

老年人医养结合服务系统需求及问题的系统评价

目的系统总结和分析中国医养结合服务系统存在的问题,运用管理学和护理学理论结合实际情况提出相应的对策及建议。方法通过系统的文献复习的方法,经检索人员讨论确定检索词及检索策略,电子检索CNKI数据库、万方数据库和维普数据库,查找2013年至今发表的所有有关老年人医养结合的文献。由两名研究者按照纳入与排除标准独立进行文献筛选、资料提取并交叉核对,如有分歧讨论解决,必要时参考第三方意见。结果最终纳入77篇文献,地区分布包括北京市、上海市、山东省、江苏省、河北省等25个省市自治区,研究人群包括社区老年人、入住养老机构的老年人、居家老人等;老年人医养结合服务需求一般包括生活照料、医疗康复保健、精神慰藉三个方面。医养结合存在制度政策、政府机构、医务人员和老年人自身三个方面的问题。结论中国实行的医养结合政策仍存在问题,需不断完善各项制度政策,强化政府机构责任,加大对医务人员管理力度和老年人的指导。     

A survey on the onset of tuberculosis in nursing homes

PURPOSE: To obtain the informations how to promote early detection and prevention of nosocomial infection of tuberculosis in nursing homes for the elderly. SUBJECT: Fifteen elderly patients who developed tuberculosis from 1998 to 2002 at nursing homes within a certain health center jurisdiction area which has a total of 23 nursing homes were investigated. METHOD: We collected informations on these 15 patients concerning the clinical conditions, details of contact examinations and status of chemoprophylaxis by using TB registration card in the health center and interviewing with the members of staff of the nursing homes and hospitals, and case conferences conducted at the health center. RESULTS: Four patients died within 10 days after the diagnosis due to the delay in referring them to doctors. The most common symptoms leading to the detection was fever, followed by cough. DISCUSSION: Early diagnosis is the key to prevent early death and nosocomial infection of tuberculosis in nursing homes. A similar study will be useful at each health center or region to improve the tuberculosis control in nursing homes. CONCLUSION: Tuberculosis control programs in nursing homes should be strengthened. The staff of nursing homes should be trained for closer observations of the elderly about their health conditions such as fever and cough, and their early reference to physicians when such symptoms were observed. Two step tuberculin skin tests to the staff is also important for the contact investigations.     

Psychic and somatic symptoms of depression among young adults, institutionalized aged and noninstitutionalized aged.

Beck Depression Inventory scores were obtained from 48 elderly who had been residing in homes for the aged for more than one year, 31 elderly residing in the community and waiting to enter an old-age home, and 424 young adults enrolled in a fist-year psychology course. The residents of old-age homes reported no more symptoms of depression than the waiting-list controls, a finding that provides no support for the hypothesis that the institional nature of old-age homes increases depression in the elderly. Both the institutionalized and noninstitutionalized aged reported more somatic symptoms of depression than the young adults, but no greater cognitive or affective symptoms of depression. These results were interpreted as providing no support for the widely belief that the aged are more depressed than any other age group. Finally, it was argued that somatic complaints can be valid indicators of depression in the elderly if normative differences between young and old are taken into account.     

Purple urine bag syndrome in nursing homes: Ten elderly case reports and a literature review

Purple urine bag syndrome (PUBS) is a rare occurrence, in which the patient has a purple-colored urine bag following urinary catheterization for hours to days. Most of authors believe it is a mixture of indigo (blue) and indirubin (red) that becomes purple. Previous study showed that PUBS occurred predominantly in chronically catheterized, constipated women. We collected 10 elderly patients with PUBS in two nursing homes. The first two cases were identified by chart review in 1987 and 2003, and then later eight cases (42.1%) were collected among 19 urinary catheterized elderly in the period between January 2007 and June 2007. In the present report, PUBS probably can occur in any patients with the right elements, namely urinary tract infection (UTI) with bacteria possessing these enzymes, diet with enough tryptophan, and being catheterized. Associations with bed-bound state, Alzheimer’s, or dementia from other causes are reflections of the state of such patients who are at higher risk for UTI, and hence PUBS occurred. Although we presented PUBS as a harmless problem, prevention and control of the nosocomial catheter-associated UTIs (CAUTIs) has become very important in the new patient-centered medical era. Thus, we should decrease the duration of catheterization, improve catheter care, and deploy technological advances designed for prevention, especially in the elderly cared for in nursing homes.     

Life satisfaction of elderly individuals in regular community housing, in low-cost community housing, and high and low self-determination nursing homes

Numerous studies have found that giving nursing home residents more control or self-determination in their daily lives increases their life satisfaction. However, it is not known if elderly people living in high self-determination nursing homes are as satisfied with life as elderly people living in the community. In this study, it was found that elderly persons living in regular community housing, in low-cost community housing, and in high self-determination nursing homes reported similar levels of life satisfaction, and more life satisfaction than elderly people living in low self-determination nursing homes. Health and sociodemographic variables could not account for these findings. The common assumption that nursing homes have detrimental effects on life satisfaction appears unwarranted in the case of those that provide opportunities for self-determination.     

In-Home Programs of Prevention and Comprehensive Geriatric Assessment: International Perspectives

Abstract. Innovative geriatric care programs have developed worldwide in the past two decades to better address the special problems and care needs of the growing elderly population. Many of these have been based in the home setting and involved basic concepts of prevention and comprehensive geriatric assessment (CGA). Some have focused on periodic screening of relatively healthy and independent elderly persons in their homes and provision of prevention-oriented services, others have targeted more frail and disabled individuals (eg. post-hospitalisation), still others involve entire population groups of elderly persons and provide both prevention and treatment. A common thread has been the use of CGA to evaluate patient problems, understand needs for care, help arrange for services and plan follow-up. Benefits have included more complete diagnosis, discovery of important treatable problems, improvement in drug regimens, reductions in use of hospitals and nursing homes, improved function and satisfaction and reduced mortality. Meta-analysis has confirmed some of the most important of these benefits: improved functional status, reduced mortality and reduced use of institutional services. In this symposium, reports on in-home prevention and geriatric assessment programs were presented from six countries: Australia, Denmark, Italy, Switzerland, the UK and the US.     

Housing for the elderly in Taiwan

Traditionally, the care of elderly persons was the responsibility of families. However, the structure of families is changing, while the number of aged persons, particularly the frail elderly, is rising. The current living arrangements in housing include living in multigenerational dwellings, family dwellings and institutions or collective dwellings. Frail elderly in need of long-term care live in nursing homes. In the future, housing options must have better space standards and must be barrier-free. Elderly residents must have access to support services and health services in the community. There is a growing demand for institutions and nursing homes because of the special care needs of the frail elderly. A Commissioner of the National Council on Ageing Welfare.     

Care and nursing in remodeling long term care insurance

Long term care insurance was changed in 2006. The main purpose of remodeling is to support preventive care and to develop community comprehensive care center and community based services. Community based services are composed by group homes, night care services, small multi-function complex care services, day care services for dementia, satellite nursing homes. Preventive care in long term care insurance is composed of muscle training, oral care and improvement of nutrition. Visiting nurse services can provide day care at nurse stations. These arrangements are strongly expected to support care workers and visiting nurses. An assessment for dementia, Center version was developed by the Tokyo Center for Dementia Care Training and Research. It is intended to lead to person-centered care for elderly people with dementia. An act to prevent abuse of the elderly has been started in 2005. This was established to protect the property of the elderly, even if they might have cognitive dysfunction. A support doctor system has been started to educate primary care doctors and to make early diagnosis for dementia. These changes are expected to provide better care for old people.     

A mobile rehabilitation team program to assist patients in nursing homes rehabilitate and return to their homes

A slow-stream rehabilitation program for frail elderly patients was developed utilising nursing homes visited by a mobile rehabilitation team (MRT) based at the hospital from which these patients had been discharged following major illness. The nursing homes were able to provide physiotherapy and the MRT contributed medical, nursing, occupational therapy and social work support through weekly visits. The supported group and a control group (also discharged to nursing homes from the same hospital but unsupported) were matched for age, sex and ADL level. Outcomes for the two groups were compared and were significantly different. Of the supported group (N = 33), 64% (N = 21) were discharged home compared with only 9% (N = 2) of the 23 control subjects (χ² = 15.6, df. = 1, P < 0.05). The potential for patient rehabilitation in a modestly supported nursing home was realised.     

Effect of a Statewide Fall Prevention Program on Incidence of Femoral Fractures in Residents of Long-Term Care Facilities

OBJECTIVES: To evaluate the effect of a statewide dissemination of a modified evidence-based fall prevention program on incidence of femoral fractures in nursing homes.
DESIGN: Observational study of a staged implementation of a successful fall prevention program.
SETTING: One thousand three hundred fifty-nine nursing homes in two federal states in the south of Germany.
PARTICIPANTS: Nine thousand seventy-seven residents in the intervention homes and 43,583 residents in control homes from the same and a different federal state.
INTERVENTION: Staff education on fall prevention, advice on environmental adaptations, and progressive strength and balance training over at least 1 year.
MEASUREMENTS: Incident femoral fractures.
RESULTS: One thousand five hundred eighteen femoral fractures occurred in the total study population during the intervention period. The crude incidence rate of femoral fractures was 39.5/1,000 person-years in residents from the intervention homes and 40.9 and 39.7/1,000 person-years in residents from two sets of control homes. In a multivariate model, there was no evidence of an effect of the fall prevention program on incidence of femoral fracture when compared with control homes from the same federal state (adjusted hazard ratio (AHR)=0.96, 95% confidence interval (CI)=0.83–1.11) or from a different federal state (AHR=1.00, 95% CI=0.86–1.16).
CONCLUSION: The statewide dissemination of a multifactorial fall prevention program did not appear to reduce the burden of femoral fractures in residents of nursing homes.     

Insomnia in institutionalized older people in Cairo,Egypt: Prevalence and risk factors associated

Insomnia symptoms are highly prevalent among the elderly. Nearly half of the elderly population reported difficulty in initiation and maintaining sleep. The presence of insomnia affects the quality of life of elderly and increases the risk of falls. This study aims to measure the prevalence of insomnia among a group of elderly living in geriatric homes in Cairo and to assess the factors affecting it. A cross sectional study was conducted on 184 elderly living in two geriatric homes in Cairo. Athens insomnia scale was used to assess insomnia through an interview questionnaire. The prevalence of insomnia among the studied elderly in geriatric homes in Cairo was 36.4%. Higher prevalence of insomnia was found among males and married elderly. Also, insomnia was associated with longer stay in geriatric homes. Feeling sleepy during the day (59.2%) was the most prevalent symptom. Suffering pain (73.5%), nocturia (42.7%), and suffering from chronic diseases (40.4%) were significantly associated with insomnia. A significantly higher percentage of elderly with bad self-perception of owns health, suffered of insomnia (77.8%). This study reveals that changes in lifestyle, optimization of living environment and symptom control can reduce the burden of insomnia and improve quality of life of institutionalized elderly in Egypt.