Physicians’ attitudes toward aging,the aged,and the provision of geriatric care: a systematic narrative review

As the number of older adults in the population increases, the rate of medical care use is expected to rise. As a result, geriatricians and gerontologists are researching predictors of medical care in later life, which includes ageism. Ageism within health care has been widely and frequently reported and it is thought to be a product of negative attitudes toward aging. The current review systematically explores the existing literature in this area and establishes seven themes within the research. From a predominantly American population of papers, themes that emerged were the following: physicians’ attitudes toward aging are complex and mixed; mixed associations among attitude, knowledge, and medical care; aging and disease symptom attributions among physicians; attitudes, knowledge, and exposure to older adults; the role of role models; the influence of the health care culture; and the influence of the health care system. These themes were considered separately and in tandem in order to explore avenues for future research that will clarify the influence that these psychosocial factors have on health care provided to older adults.     

人口老龄化进程中的医疗卫生支出:WHO成员国的经验分析

基于世界卫生组织(WHO)成员国的经验,本文探讨了人口老龄化进程中医疗卫生支出的基本特征和一般规律。研究表明:世界各国医疗卫生水平存在极大的不平衡。随着人口老龄化的加深,医疗卫生支出中政府支出比例趋于上升,而私人卫生支出比例趋于下降。医疗卫生支出占GDP的比例逐步提高,而政府卫生支出占政府总支出比例也趋于提高,人口老龄化进程中政府在医疗卫生支出中将承担更重要的责任。而且,在政府卫生支出中,医疗保障支出比例趋于提高,并将成为政府卫生支出越来越重要的部分。当一国进入老龄化社会后,医疗卫生支出速度将会递增,经济发展和政府财政将承受越来越重的医疗支出负担。"未富先老"的中国面临着医疗卫生支出急剧增长的严峻挑战,这应该成为医疗卫生体制改革关注的议题。     

杭州市城市社区老年护理现状与发展研究

浙江省人口老龄化程度居全国第二,而杭州市60岁以上老年人已达95.99万人,占总人口的14.52%。预计到2010年,杭州市60岁以上老年人口将占总人口的17.17%,并将出现高龄化的发展趋势。因此,进一步完善和推进社区为老服务体系,为居家养老提供保障,是杭州市老龄工作的重点,而社区老年护理服务正是社区为老服务体系的基础。与此同时我国老年护理服务远远不能满足老年人的需要,城市社区老年人的护理服务满足率仅为8.30%。因此,我们对杭州市社区老年人现状及为老服务现状进行了调查。分析社区老年人的护理需求和满足需求的现有条件,探讨社区老年护理服务的内容、形式和管理方式,探索加快杭州市建立社区老年护理服务的相关对策,为决策部门更好地应对人口老龄化提供依据,以促进杭州市社区老年护理工作快速有序地开展。     

Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica

The aging of the world's population is a reality. People are living longer, not just in high-income countries, but it remains unclear whether their extra years will be lived in better health. In fact, an increasing number of older adults will probably require help to perform activities of daily living. Within the framework of its Global Strategy and Action Plan on Ageing and Health, the World Health Organization has called on all countries to create suitable and equitable long-term care systems that meet the needs of older people. The challenge is particularly acute in Latin America. The region is aging faster than other areas in the world, and its less-prepared social protection systems suffer from limited economic resources.Costa Rica is one the first middle-income countries to create a national long-term care system. This article describes the main characteristics of this system and discusses it from an international perspective. The results show that it has been designed to prioritize severity of dependency and cost containment, and to reinforce the formalization of care. The outcome of its implementation will affect the decisions of neighboring countries and those with similar economic conditions concerning the development of their own long-term care systems.     

生物医学传感器与医疗保健系统的发展趋势

生物医学传感器是高质量、低成本的卫生保健系统发展的主要驱动力.以智能生物医学衣服、无损检测传感器、吞服式智能药丸、植入式传感器、无线传感器等为例介绍了生物医学传感器的发展趋势,指出它的发展方向是低成本、低功耗、微型化、智能化、多功能化、无损检测、远程供电、无线传输和采用高级功能生物相客材料,并对未来卫生保健系统的发展进行了展望.     

我国老年长期护理需求测算及保障模式选择

随着我国老龄化形势的加剧,老年长期护理需求呈现加速增长趋势,而传统以家庭为单位的免费护理供给渐见困乏,亟需国家调配资源,建立永续经营的长期护理融资体制,以减轻护理需求者及其家庭的经济负担。从宏观角度分析了我国老年长期护理服务的需求趋势,并根据我国老年人口特征及参照美国、德国、日本的护理服务使用标准,测算出未来我国老年长期护理需求数量、总费用开支等指标,并提出我国发展长期护理保险的战略规划。     

Population aging: a comparison among industrialized countries

Increasing longevity and declining fertility rates are shifting the age distribution of populations in industrialized countries toward older age groups. Some countries will experience this demographic shift before others will. In this DataWatch we compare the effects of population aging on health spending, retirement policies, use of long-term care services, workforce composition, and income across eight countries: Australia, Canada, France, Germany, Japan, New Zealand, the United Kingdom, and the United States. International comparisons suggest that the United States is generally well positioned to cope with population aging; however, three areas should be carefully monitored: heavy reliance on private-sector funding of retirement, coverage of pharmaceuticals for the elderly, and a high proportion of private long-term care financing.     

老年照护服务供给模式国际比较与启示

在人口老龄化和家庭规模小型化的双重背景下,家庭的养老功能日益弱化,养老照护逐渐走向社会化,其中供给模式是落实老年照护服务的关键环节。美国、日本和瑞典三个国家分别代表了私营型、公私合作型和公营型供给模式,分析和比较三种模式的特点、优点和缺点,对建立我国老年照护服务供给模式具有一定启示,具体包括发展以公营为基础、公私合作为主、私营为补充的多元老年照护供给模式;明确界定政府在老年照护服务中的角色与功能;充分发挥企业和非营利组织在老年照护服务中的中坚力量;正确把握老年照护服务供给市场化和家庭化的尺度;建立健全老年照护供给的法律保障。     

如何塑造更有效的卫生福利支出模式？——新加坡案例及启示

新加坡是生产主义福利国家的典型代表,始终保持着东亚国家和地区中最低限度的卫生支出,却也依然保有亮眼的卫生绩效。本研究将揭示其如何塑造更有效的卫生福利支出模式。具体而言,新加坡通过筹资侧的个人责任来激发成本意识和提高医疗服务效率,同时,通过供给侧的政府监管来纠正医疗领域的市场失灵,保证为全体居民提供良好且可负担的医疗服务。尽管在人口老龄化等挑战下,政府在卫生福利模式中加入了更多普遍主义的要素,并提供强大的医疗安全网,但其依然只提供最低限度的卫生福利支出,也依然强调个人和家庭对健康的责任。新加坡政府对卫生支出始终保持审慎态度,但通过积极干预和制度设计,政府实际上发挥了比单纯的卫生福利支出更复杂、有效的作用。     

安徽省60岁以上老年人的家庭医疗需求及影响因素分析

目的：为了解安徽省老年人目前的家庭医疗需求及其影响因素,为当前的医疗体制改革提供科学依据。方法：采用整群随机抽样和单纯随机抽样方法确定调查对象。调查老年人的健康状况、家庭医疗需求及其影响因素。结果：城乡约有6％左右的老人提出开设家庭病床的要求,老的年龄、收入、患病数量、日常生活能力及其患病的种类是家庭医疗需求的主要影响因素,结论：老年人的家庭医疗需求日益增大,但老年人对家庭病床缺乏了解,广泛而深入开展社区卫生服务宣传尤为重要。     

Understanding complex care for older adults within Canadian home care: a systematic literature review

In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.     

Learning from elsewhere: Integrated care development in Singapore

The Singapore healthcare sector faces a myriad of challenges, including a rapidly ageing population, an increasing burden of chronic disease, and the rising cost of healthcare. The Ministry of Health has called for a restructuring and transformation of the current model of care to one that is more accessible, affordable and of higher quality, by the year 2020. In achieving quality health care, care integration through the Regional Health Systems (RHS) is seen as one approach to improving health and social outcomes, increasing healthcare utilisation and increasing satisfaction with healthcare providers. We conducted a qualitative study involving 31 elites from five policy agent clusters, and analysed organisational documents, to explore how the concepts of policy transfer and policy translation, explain the ways in which integrated care was introduced and developed in Singapore, with a focus on the SingHealth (SGH Campus) Regional Health System (RHS). The findings demonstrate that the development of integrated care is mediated by multi-scalar and multi-site networks and contextual features. The multiple and pluralistic interpretations of ‘integrated care’ and ‘policy’ are contested spaces or domains requiring further negotiation and debate. Institutional issues in the SingHealth (SGH Campus) RHS, and in the private and ILTC sectors highlight the need to consider spatial and temporal factors, and the multiplexities in the embedding of integrated care policy.     

A Social Work Perspective: Attitudes Toward End-of-Life Planning

This research examined social workers' attitudes toward end-of-life planning and related factors in a cross-sectional study (N?=?844). Data were gathered on completion of a health care proxy, personal comfort, training experiences of social workers, and demographics. Attitudes toward end-of-life planning were related to personal completion of the health care proxy, personal comfort, and years of social work experience. These measures remained significant in all steps of the regression, regardless of practice grouping (health and aging or other than health and aging), suggesting the relative importance of personal rather than professional aspects. Respondents in the health and aging fields are older than those in other than health and aging, underscoring concerns about workforce issues in the field of aging.     

上海建立老年护理制度的分析与探讨

上海已进入老龄化社会,老年护理需求增加,如何保证“老有所养”成为一个急迫的问题。与此同时,家庭结构的变迁、人口流动性的加大,传统的家庭照顾模式又面临挑战。医疗护理与生活护理的边界不清,带来过度住院问题,造成医疗保险基金的严重压力。建立老年护理制度,成为探索解决这一系列问题的一种途径。     

整合照料式养老服务研究现状及发展趋势

21世纪人口老龄化已成为全球不可逆转的趋势。众多研究显示整合照料式养老服务是应对人口老龄化的有效措施。通过检索Web of science-SCI、PubMed、ScienceDirect、Wiley、中国知网及万方等数据库,查阅国内外近年来发表的所有相关文献,以整合照料的概念、整合照料式养老服务模式、研究现状及现存问题作为框架进行文献综述,以期为我国整合养老服务模式的构建提供参考。     

Financing elderly people's long‐term care needs: Evidence from China

Confronted by accelerated population aging, China is establishing a long‐term care (LTC) system. This study discusses challenges and recommendations for financing China's LTC system. On the basis of the data on elderly people's self‐care ability from the Chinese Longitudinal Healthy Longevity Survey, we calculate the size of the elderly population that need LTC for the period from 2015 to 2030 and analyse the increasing tendency of LTC expenses by considering the impact of price increase. We also analyse the local governments' financial capacity for LTC support by comparing the expense level to the fiscal revenue. The study found that aging will double the LTC expenses by 2030. Therefore, this study suggests the establishment of an LTC insurance system that allocates LTC expenses, which are currently borne by individuals and families, more fairly among the government, individuals, and families. Moreover, with the current LTC reforms, implemented primarily by local governments in China, we believe that the central government should bear some of the fiscal responsibility by conducting fiscal transfers to partially support undeveloped regions that are establishing an LTC system.     

青年人长期护理保险需求意愿及其影响因素分析——基于苏皖两省调查的比较研究

人口老龄化必然带来长期护理服务问题的社会化。建立长期护理保险制度是解决这个社会问题的途径之一。通过对安徽、江苏两省青年人参加长期护理保险意愿调查的多元Logit回归模型分析,研究发现:地区变量不显著,而担心老年无人照料、不了解该制度、担心老年生病、担心将来经济不宽裕和教育程度5个变量达到了显著性水平。在此分析基础上提出了构建我国长期护理保险制度的一些政策建议。     

The Boomers Are Coming: A Total Cost of Care Model of the Impact of Population Aging on Health Care Costs in the United States by Major Practice Category

Objective. To project the impact of population aging on total U.S. health care per capita costs from 2000 to 2050 and for the range of clinical areas defined by Major Practice Categories (MPCs).
Data Sources. Secondary data: HealthPartners health plan administrative data; U.S. Census Bureau population projections 2000–2050; and MEPS 2001 health care annual per capita costs.
Study Design. We calculate MPC-specific age and gender per capita cost rates using cross-sectional data for 2002–2003 and project U.S. changes by MPC due to aging from 2000 to 2050.
Data Collection Methods. HealthPartners data were grouped using purchased software. We developed and validated a method to include pharmacy costs for the uncovered.
Principal Findings. While total U.S. per capita costs due to aging from 2000 to 2050 are projected to increase 18 percent (0.3 percent annually), the impact by MPC ranges from a 55 percent increase in kidney disorders to a 12 percent decrease in pregnancy and infertility care. Over 80 percent of the increase in total per capita cost will result from just seven of the 22 total MPCs.
Conclusions. Understanding the differential impact of aging on costs at clinically specific levels is important for resource planning, to effectively address future medical needs of the aging U.S. population.     

Future Trends in Health and Health Care: Implications for Social Work Practice in an Aging Society

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the “graying of America” promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.     

Modeling manpower requirement for a changing population health needs: The case of ophthalmic nurses and allied health ophthalmic professionals

BackgroundPrevalence of chronic eye conditions has been shown to increase with age. As the global population continues to age rapidly, the demand for eye care services is expected to increase significantly in the near future, requiring effective health workforce planning in order to provide for the needs of the population. The aim of this paper is to synthesize data from a variety of sources to develop a simulation model based on the systems modelling methodology of system dynamics that links population health needs to workforce requirements to generate evidence-based projections for ophthalmic nurses, and allied health ophthalmic professionals in Singapore.MethodsA system dynamics simulation model was developed with active engagement of key stakeholders—such as ophthalmologists, senior nurses, healthcare planners and managers, and senior technicians—to verify the model structure and assumptions. The model project the future requirement of ophthalmic nurses, technicians and patient service assistants.ResultsThe number of Singaporeans with eye diseases is projected to more than double by 2040. As a result, the demand for eye care services and eye care workforce is expected to increase significantly under all the plausible scenarios. The increase in eye disease burden is due mainly to population aging—given that the prevalence of eye disease increases with age.ConclusionThis research provides a future demand outlook for ophthalmic nurses, technicians and patient service assistants in Singapore and has implications for recruitment and training of ophthalmic nurses and allied health professionals in Singapore.