老年慢性病患者延续性医疗服务模式的构建及效果评价

目的探讨公立医院老年医学科参与中国养老服务体系运行模式的构建,分析老年慢性病患者延续性服务模式的临床价值及社会价值,以进一步评价老年医学科专科医疗延伸服务的重要性。方法选择安徽省立医院老年医学科住院患者200例,随机分为两组,其中观察组100例患者参与住院-居家延续性医疗服务模式(出院时,开展老年综合评估,出院后对各种慢病指导合理用药,并对慢病并发症进行三级预防,对半失能、失能老人进行居家环境评估、功能锻炼指导、家庭护理指导、营养及精神心理指导),另对照组100例患者住院-出院,出院时开展老年综合评估,但未参加延续性医疗服务模式,比较两组患者1年内再次住院的次数、人均年卫生支出费用及患者生活能力(Barthel指数评定表)、家庭及患者对患者自身状况满意度比较。结果观察组再次住院次数与人均年卫生支出费用明显低于对照组,观察组Barthel指数评分及患者自身状况满意度显著高于对照组。结论老年医学科参与的老年慢性病患者延续性服务模式能够有效地提高老年患者的生活质量。     

开展社区老年患者医疗服务提高医学生综合素质

我院社区服务工作开展较早，经过多年的实践，医院院前和院后宣教、服务和管理等工作，尤其是社区医疗健康档案的建立、社区健康宣教、慢性病防治讲座和体检、送医下乡等工作得到了有序开展，形成相对稳定又不断拓展的良好局面，基本形成家庭-社区-医院-社区-家庭的管理模式，体现了“以人为本”的服务理念。在这一有利的条件下，我们坚持积极引导、安排医学生参加社区医疗实践活动。从2002年开始组织温州医学院临床医学本科见习生开展社区（敬老院等）医疗实践活动。     

城镇老年医疗保险患者住院医疗费用分析

目的 探讨城镇老年医疗保险（医保）患者住院医疗费用的影响因素,为医疗保险政策的顺利实施提供理论依据.方法 选择某县2004年度在县、镇级12所医院所有住院治疗的60岁以上医保患者404例,按医院级别、住院日等各因素对其住院医疗费用进行分析,组间比较采用秩和检验,对住院医疗费用的可能影响因素进行多元逐步回归分析.结果 住院日、医院级别是影响城镇老年医保患者住院费用的主要因素.一甲医院住院费用高于二甲医院,随住院日的延长,住院费用增加.结论 缩短平均住院日,是有效控制医疗费用的重要措施.     

基于主成分分析法的某医院老年病科医疗质量与效率的评价分析

目的通过对某医院老年病科2007—2012年的医疗工作质量进行综合评价,为医院和上级部门提供客观、科学的分析管理依据。方法选择10项反映医疗质量和运行效率的指标,应用主成分分析法进行统计分析,对6年的医院老年病科医疗工作做出定量综合评价。结果6年来某医院老年病科医疗工作综合评价显示,医疗质量逐年上升,运行效率逐年下降。结论评价某医院老年病科医疗质量需要针对效率指标和质量指标进行综合分析,以便为老年病科管理部门提供客舰、合理、可行的管理依据。     

老年医院感染患者103例调查分析

为了加强对医院感染的监控,提高医疗质量,现将我院2005年1～12月住院老年患者发生医院感染的情况进行如下分析。     

综合医疗干预在老年心脑血管疾病患者治疗中的临床观察

目的 观察综合医疗干预在老年心脑血管疾病患者治疗中的效果,为治疗该疾病提供方法。方法 选取2022年3月—2023年2月在四川绵阳四〇四医院治疗的老年心脑血管患者120例,采用数字表法随机分为2组：观察组和对照组,每组60例。2组在采取相同的治疗方法的基础上,观察组采取院内综合医疗干预措施,对照组采取院内常规干预措施。2组均持续干预2个月。干预前后,测定并比较2组人体质量指数(BMI)、三头肌皮褶厚度(TSF)及各项血脂指标,比较2组营养状况;采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估并比较2组焦虑和抑郁程度;分别采用自我和谐量表(SCCS)、应对方式问卷(CSQ)评估并比较2组自我和谐情况及疾病应对能力;采用生活质量综合评定问卷-74(GQOL-74)评估并比较2组的生活质量。结果 干预后,观察组BMI、TSF均高于干预前及对照组(P<0.05);观察组总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)水平均低于对照组(P<0.05);观察组SAS、SDS评分均低于干预前及对照组(P<0.05);观察组自我刻板性评分、自我与经验不和谐等SCCS各...     

长沙市区企业老年职工生活质量评价

对555例60岁以上老年企业职工采用中华老年医学学会流行病学组“老年生活质量调查问卷”进行调查检测，所得资料通过多元逐步回归分析作出评价．结果表明，其生活质量（QOL）在中等以上者主、客观评价分别占87.9％和90.8％（P＞0.05）；共同影响因素依次为；身体健康、日常生活功能、经济收入、生活满意度和精神心理．评分低者突出身体健康与经济收入，两者互为因果，且忽视精神心理、生活习惯和社会交往．通过分析，肯定QOL评价的现实意义，提出普及健康教育和心理卫生指导，通过建立合理的生活方式以促进健康，提高QOL．     

老年心脑血管病患者营养状况的评价

目的 调查老年心脑血管病患者营养风险、营养不良发生率,比较营养风险筛查（NRS2002）和简易微型营养评定（MNA-SF）用于老年心脑血管病患者营养状况筛查的适用性和结果.方法 采用定点连续抽样的方法,选择符合入选标准、获知情同意的307例患者于入院次日晨分别采用NRS2002和MNA-SF进行营养筛查.结果 307例患者均完成NRS2002和MNA-SF,NRS2002筛查显示营养风险发生率为41.37%,MNA-SF筛查显示营养不良风险发生率为28.01%,营养不良发生率为14.98%.两种筛查方法在营养风险筛查差异无统计学意义（P＞0.05）,同时NRS2002和MNA-SF评分结果与BMI、Alb主要营养指标相关.结论 NRS2002和MNA-SF两种工具都是老年心脑血管病患者营养评价的好方法.     

老年病科医疗护理的基本伦理道德要求

老年人是医疗保健需求量最大的人群,老年人2 w就诊率为23.75%,远高于其他年龄组的平均2 w就诊率14.66%;老年人住院率为7.26%,比其他年龄组住院率4.36%高得多[1].延长健康期,缩短带病期和伤残期,并尽可能提高老年人的自理能力,是一项长期奋斗的目标[2].加强医护人员伦理道德修养的培养,旨在提高老年病科的医疗护理质量,促进老年慢性疾病的康复.     

农村老年慢性病患者综合老年评价的干预效果

目的评价综合老年评价(CGA)干预模式在农村老年慢性病人群健康干预中的可行性与有效性。方法分层抽取塘雅镇干预组299例和澧浦镇对照组298例的60周岁及以上两种慢性病高血压和(或)冠心病患者,采用定性和定量调查收集相关资料,干预组开展为期1年的CGA健康干预研究,比较两组行为方式、体检指标与医疗费用的变化。结果高盐摄入、吸烟和饮酒等行为在干预后均有明显下降(P<0.001),医疗费用在干预组有略微下降,但无统计学差异(P>0.05);按医嘱服药比例干预组从基线的83.0%上升到干预后的(96.2%;χ2=27.170,P<0.001),是否住院和平均住院的天数无统计学差异(P>0.05);干预组体质指数(BMI)和腰围显著降低(P<0.01),其他均无统计学差异(P>0.05)。结论 CGA干预模式对农村老年慢性病人群健康干预是有效的和可行的,这对改善农村老年慢病人群的行为习惯和生命质量具有示范作用。     

The quality of emergency department pain care for older adult patients

OBJECTIVES: To determine whether there are differences in emergency department (ED) pain assessment and treatment for older and younger adults. DESIGN: Retrospective observational cohort. SETTING: Urban, academic tertiary care ED during July and December 2005. PARTICIPANTS: Adult patients with conditions warranting ED pain care. MEASUREMENTS: Age, Charlson comorbidity score, number of prior medications, sex, race and ethnicity, triage severity, degree of pain, treating clinician, and final ED diagnosis. Pain care process measures were pain assessment and treatment and time of activities. RESULTS: One thousand thirty‐one ED visits met inclusion criteria; 92% of these had a documented pain assessment. Of those reporting pain, 41% had follow‐up pain assessments, and 59% received analgesic medication (58% of these as opioids, 24% as nonsteroidal anti‐inflammatory drugs (NSAIDs)). In adjusted analyses, there were no differences according to age in pain assessment and receiving any analgesic. Older patients (65–84) were less likely than younger patients (18–64) to receive opioid analgesics for moderate to severe (odds ratio (OR)=0.44, 95% confidence interval (CI)=0.22–0.88) and were more likely to more likely to receive NSAIDs for mild pain (OR=3.72, 95% CI=0.97–14.24). Older adults had a lower reduction of initial to final recorded pain scores (P=.002). CONCLUSION: There appear to be differences in acute ED pain care for older and younger adults. Lower overall reduction of pain scores and less opioid use for the treatment of painful conditions in older patients highlight disparities of concern. Future studies should determine whether these differences represent inadequate ED pain care.     

Determining the extent of quality health care for hospitalized patients with cirrhosis

BACKGROUND/AIMS: Since few data are available concerning the clinical course of decompensated hepatitis C virus (HCV)-related cirrhosis, the aim of the present study was to define the natural long-term course after the first hepatic decompensation. METHODS: Cohort of 200 consecutive patients with HCV-related cirrhosis, and without known hepatocellular carcinoma (HCC), hospitalized for the first hepatic decompensation. RESULTS: Ascites was the most frequent first decompensation (48%), followed by portal hypertensive gastrointestinal bleeding (PHGB) (32.5%), severe bacterial infection (BI) (14.5%) and hepatic encephalopathy (HE) (5%). During follow-up (34+/-2 months) there were 519 readmissions, HCC developed in 33 (16.5%) patients, and death occurred in 85 patients (42.5%). The probability of survival after diagnosis of decompensated cirrhosis was 81.8 and 50.8% at 1 and 5 years, respectively. HE and/or ascites as the first hepatic decompensation, baseline Child-Pugh score, age, and presence of more than one decompensation during follow-up were independently correlated with survival. CONCLUSIONS: Once decompensated HCV-related cirrhosis was established, patients showed not only a very high frequency of readmissions, but also developed decompensations different from the initial one. These results contribute to defining the natural course and prognosis of decompensated HCV-related cirrhosis.     

Diabetes support groups improve health care of older diabetic patients.

OBJECTIVE: To assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients. DESIGN: A partially randomized controlled trial involving two groups of patients: Group A, subjects who received an education program followed by 18 months of support group sessions; Group B, only the diabetes education program. A third convenience sample, Group C, received neither intervention. Groups A and B were assessed before and immediately after the education program, and all groups were assessed 2 years after the education program. SETTING: Diabetes clinic at a Veterans Affairs Medical Center. PATIENTS: All subjects were male (mean age = 68 +/- 1.3 years, range = 57-82 years; duration of diabetes = 10 +/- 2 years, range 3-16). Sample sizes were 11 in Group A, 13 in Group B, and 8 in Group C. INTERVENTION: The education program consisted of six weekly sessions covering aspects of diabetes self-care. The support group consisted of 18 monthly sessions for continuing education, discussion, and structured social activities. OUTCOME MEASURES: Diabetes knowledge, psychosocial factors (self-care-related quality of life, stress, family involvement in care, and social involvement), depression, and glycemic control. RESULTS: Group A scored better (at least P less than 0.05) on knowledge, quality of life, and depression than the other groups. Groups A and B showed less stress, greater family involvement, better glycemic control, but less involvement in social activities than Group C. CONCLUSION: Diabetes education programs can have long term benefits on knowledge, psychosocial functioning, and glycemic control for older diabetic patients. The addition of support groups enhances diabetes knowledge and psychosocial functioning.