城市社区健康状态较差老年人的状况评估及分析

目的了解社区健康状态较差的老年人的需求,为合理干预提供依据。方法 2013年2月至2013年5月对北京市部分社区≥65(79.2±8.3)岁、健康状态较差的209位老年人进行老年综合评估。结果巴氏日常生活活动能力(Barthel-ADL)正常者50例(23.9%),功能受损者159例(76.1%);所有老年人均有≥2个多种慢性状况(MCC),受调查者有老年综合征3.9[4(3,5)]个,高于平均慢性疾病数3.5[3(2,4)]个,功能受损组老人慢性疾病及老年综合征数均高于功能正常组(P=0.007,P=0.05)。需要他人照顾者占79.9%,其中照顾者为配偶者占50.3%。每年规律接种流感疫苗者仅占8.1%,规律体检者占14.8%。结论老年综合征对该人群影响更大,应予以重视;社区针对失能老年人的医学照护模式、照顾者负担等问题仍需关注。     

老年糖尿病的诊疗进展

糖尿病呈流行之势,65岁以上的老年糖尿病患者亦呈逐年增加趋势.老年糖尿病患者的身体状况各有不同,而针对老年糖尿病患者的临床试验相对缺乏,这些问题对于管理老年糖尿病患者提出了挑战.临床医师应该根据共患病的情况、认知和功能状态确定不同的血糖控制目标.每一种药物在老年糖尿病患者中的应用有其特殊之处.了解不同降糖药物的优缺点有利于个体化治疗.与非糖尿病老年人相比,老年糖尿病患者更易发生影响生活质量的老年综合征,如认知功能障碍、抑郁、跌倒、营养不良、尿失禁等,及时发现并处理老年综合征有助于更好的管理老年糖尿病患者.     

老年综合评估在脑梗死恢复期患者康复中的应用效果

目的探讨老年综合评估(CGA)在脑梗死恢复期患者康复中的应用效果。方法脑梗死恢复期住院患者100例随机分为观察组和对照组各50例。对照组给予常规护理,观察组根据CGA结果给予针对性干预。干预12 w后比较两组生活质量。结果干预后观察组生活质量在躯体健康、心理健康、角色功能、社会功能、生理功能、活力和精力、机体疼痛、总体健康的结果均显著优于对照组(P<0.05)。结论对老年脑梗死恢复期患者进行CGA干预可有效提高患者生活质量。     

老年精神障碍合并糖尿病患者的临床特点及护理干预

目的探讨老年精神障碍合并糖尿病患者的临床特点,提出针对性的护理方法。方法选取2012年3月—2014年10月该院收治的老年精神障碍合并糖尿病患者的临床资料及护理干预经验进行回顾性分析。结果老年精神障碍合并糖尿病患者经过特定的护理措施后,有效治愈率为66.7%,无效死亡率为3.8%。结论老年精神障碍合并糖尿病患者依存性差,治疗难度大,可针对患者临床特点进行饮食护理、运动疗法、预防感染、健康教育等护理干预,有助患者健康,提高生存质量。     

游戏疗法在老年慢性病健康干预中的应用研究进展

慢性病是威胁人类健康的疾病之一,是造成全世界死亡率和患病率逐年上升的主要因素。随着人口老龄化日趋严重,老年慢性病发病率逐年上涨,已成为严重的公共卫生问题。相关研究表明,良好的健康干预模式能提高老年慢性病的治疗率和控制率,而传统健康干预模式较单一,因此实施具有适老性、趣味性和心理治疗性的健康干预模式对于提升教育效果至关重要。游戏疗法作为积极心理学视角下的一种新兴、简便、安全、经济的健康干预方法,对改善慢性病患者的身心健康具有重要意义。本文就游戏疗法的概念、分类及戏疗法在老年慢性病群体健康干预中的应用现状及效果进行阐述,以期为促进游戏疗法在老年慢性病患者健康干预中的应用提供新视角和新思路,促进我国健康老龄化发展。     

老年冠心病患者加强人性化护理干预对预后影响分析

目的：探讨人性化护理干预对老年冠心病预后的影响。方法本次选取100例老年冠心病患者,均为我院心血管内科2013年6月至2014年6月收治,随机分组,就常规护理方案（对照组,n=50）与人性化护理干预（观察组,n=50）效果进行比较。结果两组均康复出院,观察组物质状态、躯体功能、心理功能、社会功能生活质量评分优于对照组,差异有统计学意义（P〈0.05）。结论加强老年冠心病患者人性化护理干预,可显著改善预后,保障患者生活质量,具有非常重要的实施价值,值得临床广泛推广应用。     

老年综合评估在老年医学工作中的应用

老年综合评估是老年医学的核心内容和基本工作方法,广泛应用于老年人连续医疗的各个环节。本文介绍了老年综合评估在老年人急性医疗、亚急性医疗、院内会诊、转诊医疗、门诊和居家健康管理中的应用。应用老年综合评估,并进行相应的干预,有助于最大程度地维持老年人的功能状态,提高其生活质量,并减轻社会负担。     

心理干预在老年糖尿病患者中的应用

目的探讨和分析适合老年糖尿病(DM)患者的心理护理策略。方法选取2013年1月—2014年6月期间,于该院住院的老年DM患者116例,随机分为干预组83例,对照组33例。干预组针对患者心理状态给予针对性的心理护理,对照组给予常规护理,观察两组临床疗效。结果干预组与对照组相比,治疗依从性明显提高,焦虑、抑郁等心理状态明显改善,差异有统计学意义(P0.05)。结论对老年糖尿病患者给予针对性的心理护理干预,可显著提高临床疗效,降低心理疾病发生率,在治疗中具有重要意义。     

农村老年高血压患者依从性的影响因素及其对策

目的 针对影响农村老年高血压患者依从性的因素,探讨有效干预措施来提高患者的依从性.方法 采用自设问卷调查,对102例农村老年高血压患者进行依从性及影响因素调查.结果 农村老年高血压患者依从性不佳,与文化程度、自身因素、药物因素等影响因素有关.结论 农村老年高血压患者需大力加强健康教育,改善就医条件,提高服务质量.     

专项预见性干预减少老年透析患者动静脉内瘘并发症观察

目的观察专项预见性干预减少老年透析患者动静脉内瘘相关并发症。方法选择2017年1月至2018年6月在我院血液透析科首次接受维持性血液透析治疗的老年患者85例,随机分为预见性干预组(43例)及对照组(42例),预见性干预组另行专项护理干预,内容包括进行健康教育、指导围术期功能锻炼、采用弹力包扎预防出血、预防假性动脉瘤形成、预防内瘘血栓形成。结果接受维持性血液透析治疗1年后,预见性干预组的内瘘闭塞、动脉瘤样扩张、血栓形成及并发症总例数均明显低于对照组(P<0.01,P<0.05)。结论专项预见性干预可以明确减少老年透析患者动静脉内瘘相关并发症。     

Healthcare professional training: a comparison of geriatric competencies

Health professionals specializing in geriatrics are a unique but scarce resource who nevertheless play a critical role in shaping the care of older adults. An interdisciplinary didactic and clinical training milieu would have the potential to maximize training opportunities for geriatric healthcare professionals. The fact that little is known about the concordance between discipline-specific geriatric competencies hampers the creation of interdisciplinary geriatric training opportunities. Discipline-specific geriatric experts compared the geriatric competencies specified by geriatric-certifying bodies of five healthcare professions: dentistry, medicine, nursing, pharmacy, and social work. Overlap and differences in geriatric competencies across disciplines are presented, and opportunities and barriers to interdisciplinary geriatric education are discussed.     

住院患者老年综合评估规范及初步效果分析

目的：探讨在老年住院患者中进行老年综合评估（CGA）对于老年人全面综合管理的作用。方法制定标准的CGA流程,采用标准流程对北京协和医院老年病房2013年9月至2014年9月连续入院的≥65岁患者进行CGA,分析其筛查老年综合征的效果。结果标准化的评估流程便于临床使用,接受评估的179例患者中,年龄（72.5±8.1）岁。通过CGA发现,视力异常患者占62.0%,睡眠障碍41.3%,听力异常40.8%,慢性疼痛34.6%,跌倒25.7%,多重用药23.5%,便秘21.8%,抑郁焦虑18.4%,尿失禁16.2%,谵妄10.6%。以不同主诉入院的15例患者最终诊断为老年综合征,占8.4%。结论老年综合征在老年患者中普遍存在,运用标准化的CGA方法可以进行有效筛查,有利于老年患者的全人管理。     

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.     

The current state of geriatric medicine: a national survey of fellowship-trained geriatricians, 1990 to 1998

The rapid growth of the older population has focused national attention on the need for physicians trained in geriatric medicine. To gain insight into the evolving status of the field, with particular focus on career decision-making and academic career development of trainees, we conducted a survey of physicians recently completing geriatric fellowships. The 107 accredited extant geriatric fellowship programs in the United States and Puerto Rico were contacted to identify trainees from 1990 to 1998. A mailed survey addressed relevant career development and training issues. Four hundred ninety out of 787 (62%) physicians responded; 20% completed 1 year and 80% 2 or more years of training. Half made the decision to pursue a career in geriatrics during residency, 27% decided before/during medical school, and a mentor influenced 48%. Currently, 80% have a Certificate of Added Qualifications in geriatric medicine, 69% hold academic appointments, 78% teach, 39% participate in research, and 44% author publications. Most are doing predominantly clinical work in multiple settings. Further analysis of the 1996-to-1998 cohort revealed that those completing fellowships of 2 or more years are more likely to identify all geriatrics as their professional focus, conduct and author research, work with multidisciplinary teams, and participate in professional geriatric societies. This national survey documents career decision-making and the academic and clinical profiles of physicians completing geriatric fellowship training in the past decade. Longer fellowship training is associated with academic career development. Although there is a national need to train clinical geriatricians, the additional need to train and fund future geriatric academic leaders requires increased attention.     

A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early‐career clinician–educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician–educators with no similar alternatives. GACA recipients were surveyed in this cross‐sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA‐related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA‐like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.     

老年综合评估及多学科团队服务在老年共病干预中的应用

目的 探讨住院老年患者通过老年综合评估(CGA)及多学科团队服务(GITS)进行多维度诊疗,为老年患者提供科学、合理的个性化诊疗模式,有效改善共病诊疗效果及生活质量。方法 选取年龄≥60岁的老年科共病患者,分为观察组和对照组。使用自主开发的“老年综合评估软件V2.0”对210例老年患者入院7天内进行老年综合评估,随后观察组根据评估结果给予共病、老年综合征、心理、认知及生活方式等全面综合干预,对照组仅给予共病干预。干预3个月后行第2次老年综合评估,比较观察组与对照组共病及生活质量改善情况。结果 (1)观察组比对照组血压、血糖控制效果更好(P<0.05),观察组比对照组慢性心衰急性加重、慢性阻塞性肺疾病急性加重发生人数减少(P<0.05)。(2)老年综合征及生活质量：观察组比对照组Barthel指数得分及MMSE得分显著提高(P<0.05),观察组比对照组营养、抑郁、焦虑、跌倒、衰弱均有显著改善(P<0.05),因促眠药物的应用观察组与对照组睡眠障碍均有改善,改善程度无显著差异(P>0.05)。结论 老年患者住院期间进行老年综合评估并结合多学科团队服务,可以及...     

Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).     

National survey of geriatric medicine fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs Geriatrics Workforce Policy Studies Center

This article documents the development of geriatric medicine fellowship training in the United States through 2009. Results from a national cross-sectional survey of all geriatric medicine fellowship training programs conducted in 2007 is compared with results from a similar survey in 2002. Secondary data sources were used to supplement the survey results. The 2007 survey response rate was 71%. Sixty-seven percent of responding programs directors have completed formal geriatric medicine fellowship training and are board certified in geriatrics, and 29% are board certified through the practice pathway. The number of Accreditation Council for Graduate Medical Education-accredited fellowship programs has slowly increased, from 120 (23 family medicine (FM) and 97 internal medicine (IM)) in 2001/02 to 145 in 2008/09 (40 FM and 105 IM), resulting in a 21% increase in fellowship programs and a 13% increase in the number of first-year fellows (259 to 293). In 2008/09, the growth in programs and first-year slots, combined with the weak demand for geriatrics training, resulted in more than one-third of first-year fellow positions being unfilled. The number of advanced fellows decreased slightly from 72 in 2001/00 to 65 in 2006/07. In 2006/07, 55% of the advanced fellows were enrolled at four training programs. In 2008/09, 66% of fellows were international medical school graduates. The small numbers of graduating geriatric medicine fellows are insufficient to care for the expanding population of older frail patients, train other disciples in the care of complex older adults, conduct research in aging, and be leaders in the field.     

Community Physicians' Knowledge on Basic Health Care for Elderly Persons in Israel: Comparing Findings From 2006 to 1996

Community physicians should be knowledgeable of basic geriatrics to cope with the challenges posed by the growing number of older patients and their complex needs. A survey of knowledge in basic health care for elderly persons, carried out by our team in 1996, revealed that it was insufficient. The authors repeated this survey in 2006, by using the same methodology, namely, a mailed questionnaire sent to 500 randomly sampled community physicians. No significant changes were found after this 10-year period. Likewise, no difference was evidenced between physicians that participated in geriatric training of any kind and those who did not. This lack of change requires health system leaders to coordinate their efforts and develop efficient teaching programs to prevent similar findings 10 years from now.