基于Andersen模型的“医养结合”型机构养老需求的影响因素研究

  目的  了解山东省青岛市医养结合机构老年人自评健康状况及其影响因素,为改善医养结合机构老年人的健康状况提供参考依据。  方法  采用分层随机抽样方法于2017年6月 — 2018年8月在青岛市7个区抽取43家医养结合机构1 907名老年人进行问卷调查。  结果  青岛市1 907名医养结合机构老年人中,自评健康状况较好者687人,自评健康率为36.03 %;多因素非条件logistic回归分析结果显示,经济状况为不够用/勉强够用/基本够用/很充足、农业户籍、其他医保类型和可以承担医疗费用的医养结合机构老年人自评健康率较高;文化程度中学及以上、职业为专业技术人员、城乡居民医保类型和日常生活能力障碍的医养结合机构老年人自评健康率较低。  结论  青岛市医养结合机构老年人自评健康率较低;文化程度、职业、经济状况、户籍类型、医保类型、承担医疗费用情况和日常生活能力情况是该地区医养结合机构老年人自评健康状况的主要影响因素。     

城镇失能老人子女照料的影响因素分析 —— 来自CLHLS 2014的经验证据

  目的  了解中国高龄失能老年人长期照料需求满足情况及其影响因素,为我国未来老龄照料服务体系的优化提供参考依据。  方法  收集2018年中国老年健康影响因素跟踪调查(CLHLS)中1561名 ≥ 80岁高龄失能老年人的相关数据,分析高龄失能老年人长期照料需求满足情况及其影响因素。  结果  中国1561名 ≥ 80岁高龄失能老年人中,长期照料需求满足者772人,长期照料需求满足者所占比例为49.46 %。多因素非条件logistic回归分析结果显示,家庭年均收入 > 6万元、名下有房产、生活来源够用、照料者表现为耐心照护、总是向照料者倾诉、有养老保险和有社区生活照料的中国高龄失能老年人长期照料需求更易得到满足,居住在农村、衰弱和照料支出 ≥ 300元/周的中国高龄失能老年人长期照料需求更不易得到满足。  结论  中国高龄失能老年人长期照料需求满足者比例较低,居住地、衰弱情况、家庭年均收入、名下有无房产、生活来源是否够用、照料支出、照料者表现、是否总向照料者倾诉、有无养老保险和社区有无生活照料服务是我国高龄失能老年人长期照料需求满足的主要影响因素。     

中国老年人的失能水平到底有多高?--多个数据来源的比较

目的了解上海市松江区老年人日常生活能力现状。方法采用多阶段随机抽样方法抽取调查对象,采用统一的调查问卷收集相关信息,采用卡方检验分析不同特征老年人口失能率之间的差异。结果本次调查共计收集到4 003份有效调查问卷,调查结果显示松江区老年人平均的失能率为11.8%。人群工具性日常生活能力失能率高于躯体性日常生活能力的失能率。不同性别、年龄、文化程度、婚姻状况等特征老年人的日常生活能力失能率之间差异有统计学意义。结论高龄是老年人生活能力丧失的主要危险因素,女性的失能率高于男性;城区、具有较高受教育水平及在婚状态的老年人其生活能力较完备。     

Time use of people with schizophrenia living in the community

The objective of this study was to describe the time use of people with schizophrenia living in the community in Japan. Time use of participants with schizophrenia was compared with people without schizophrenia. The time use of participants without a work-related routine was also compared with those with a work-related routine. As has been reported in other studies, persons with schizophrenia spend a significantly greater amount of time sleeping and resting than people without schizophrenia. However, participants with schizophrenia chose to participate not only in passive occupational categories but also in active occupational categories by selecting work, co-operative workshops, play, socialization and homemaking. Results also showed that having a work-related routine influenced time use. People with a work-related routine spent much time engaged in the work-related routines and in sleeping, and people without the routine spent much time sleeping, listening to music, watching TV, and reading magazines. The present study contributes to developing knowledge that supports occupational therapy practice focused on occupational choice including routine occupations to build a healthy life for people with schizophrenia living in the community. To explore further the relationship between time use and health, further research would be needed to study individual experiences in occupations.     

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.     

Assessing resistance to activities of daily living in long-term care

OBJECTIVE: The Psychosocial Resistance to Activities of Daily Living Index (PRADLI) was developed for psychiatric nurses, geropsychologists, and clinical social workers to assess the level of long-term care (LTC) residents' resistance to and cooperation with staff in performing activities of daily living. DESIGN: The PRADLI consists of 8 activities of daily living that commonly trigger a psychiatric or psychologic referral when residents resist necessary care in these domains. The PRADLI items were examined for internal consistency and test-retest reliability. Four of the 8 items overlap with most standard ADL scales, and convergent and discriminant validity was investigated using the ADL index from Katz, Ford, Moskowitz, and colleagues. Setting and Participants: Four hundred six residents of LTC facilities were rated for levels of the previously mentioned ADL indices. RESULTS: The PRADLI was evidenced to be a reliable and valid assessment tool for assessing resistance to ADLs in LTC facilities. CONCLUSION: The PRADLI is an instrument that can potentially be used by LTC staff to assess ADLs. Research on the use of the PRADLI as a treatment outcome instrument in multidisciplinary LTC settings is warranted. Assessing ADLs within the context of residents' cooperation with LTC is an important part of understanding residents' overall quality of life.     

Time use and daily activities in people with persistent mental illness

The aim of this study was to investigate time use in work/education, self-care/self-maintenance, play/leisure, rest/relaxation, and sleep in people with persistent mental illness. A further aim was to investigate how time use in the daily activities was associated with health-related variables and social interaction. The study comprised 103 participants with a diagnosis of persistent mental illness who completed self-ratings and interviews in order to assess (1) time use of activities during one 24-hour day, (2) social interaction and (3) health-related factors. The major results indicated that the total time in activity (TTA) and the time spent on work/education and sleep seemed to be related to the majority of the target variables. Four groups of daily rhythm were identified and the daily rhythm groups differed concerning perceived mastery and social interaction. Although the results of this study were statistically significant they did not indicate clinical significance. Therefore, the assumption that there is a relationship between occupation and well-being could not be clearly verified. This study had a cross-sectional design based on a one-time measure, which is an important limitation for the validity of the study. Furthermore, no Bonferroni corrections were made for mass significance and some of the findings would have disappeared if such corrections had been made. More studies concerning time use in daily activities, and daily rhythm in relation to health and well-being are needed.     

Outcomes after stroke: Basic and instrumental activities of daily living, community reintegration and generic health status

This study describes the discharge destination, basic and instrumental activities of daily living (ADL), community reintegration and generic health status of people after stroke, and explored whether sociodemographic and clinical characteristics were associated with these outcomes. Participants were 51 people, with an initial stroke, admitted to an acute hospital and discharged to the community. Admission and discharge data were obtained by chart review. Follow-up status was determined by telephone interview using the Modified Barthel Index, the Assessment of Living Skills and Resources, the Reintegration to Normal Living Index, and the Short-Form Health Survey (SF-36). At follow up, 57% of participants were independent in basic ADL, 84% had a low risk of experiencing instrumental ADL difficulties, most had few concerns with community reintegration, and SF-36 physical functioning and vitality scores were lower than normative values. At follow up, poorer discharge basic ADL status was associated with poorer instrumental ADL and community reintegration status, and older participants had poorer instrumental ADL, community reintegration and physical functioning. Occupational therapists need to consider these outcomes when planning inpatient and post-discharge intervention for people after stroke.     

Activities of daily living (ADL) and instrumental activities of daily living (IADL) items were stable over time in a longitudinal study on aging

OBJECTIVE: The purpose of this analysis was to examine the stability over time of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items in the Aging in Manitoba (AIM) Longitudinal Study and to evaluate the existence of differential item functioning across settings (home, nursing home). STUDY DESIGN AND SETTING: The study used data from 607 participants of the AIM Longitudinal Study who were more than 85 years of age in 1996 and who had complete data from 1983, 1990, and 1996 for all ADL and IADL items. Rasch analysis was used to examine how the rating scale of the ADL and IADL items was used by participants, and to determine if the ordering of items remained stable across three time periods (1983, 1990, 1996) and the two different settings (home, nursing home). RESULTS: The rating scale worked best when dichotomized into "received no assistance" and "receives assistance." Except for four items (making tea, making meals, doing nursing care, and going outside in any weather), the items were stable across administration periods, and across settings. CONCLUSION: The AIM can be used to evaluate changes in disability over time and may have the potential to identify those at risk for transitions in care.     

Disparities in self-reported activities of daily living and instrumental activities of daily living disability among Asian American subgroups in the United States: results from the National Health Interview Survey 2001-2003

BackgroundThe purpose of this study was to compare disability and functional limitations among elderly Asian American subgroups using datasets from the National Health Interview Survey 2001−2003.MethodsThis retrospective cross-sectional study analyzed whether activities of daily living (ADL) and instrumental ADL (IADL) disabilities were different among Asian American subgroups in the United States using data retrieved from the 2001−2003 National Health Interview Survey. For comparing all Asian American subgroups, χ² analysis was applied for the bivariate comparisons.ResultsRates of 7.1% and 12.2% for ADL and IADL disability, respectively, within Asian American group were found. The elder Chinese subgroup accounted for the highest ADL and IADL disability (11.6% and 17.3%, respectively, p < .05). Being female, not married, and older was associated with higher ADL and IADL disability (p < .05).ConclusionsThe findings of the study highlight the intergroup variability among the elder Asian American subpopulations.     

Informal caregiving,time use and experienced wellbeing

Informal carers report lower evaluative wellbeing than non-carers. In contrast to this literature and our own analysis of evaluative wellbeing, we find carers have a small but higher level of experienced wellbeing than non-carers do. To investigate why, we use decomposition analysis which separates explanatory factors into how time is used and how those uses of time are experienced. We analyze activities and associated experienced wellbeing measured in ten-minute intervals over two days by 4817 adults from the 2014/15 UK Time Use Survey. We use entropy balancing to compare carers with a re-weighted counterfactual non-carer group and then apply Oaxaca-Blinder decomposition. The experienced wellbeing gap of 0.066 is the net result of several substantial competing effects of time use. Carers experienced wellbeing would be higher by 0.188 if they had the same patterns and returns to time use as non-carers which is driven by sleep, time stress and alternative characteristics of time use. However, leisure and non-market activities serve to dampen this increase in experienced wellbeing. Initiatives to improve and assess carer wellbeing should pay close attention to how carers spend their time.     

Validation of an Automated Wearable Camera-Based Image-Assisted Recall Method and the 24-h Recall Method for Assessing Women’s Time Allocation in a Nutritionally Vulnerable Population: The Case of Rural Uganda

Accurate data are essential for investigating relationships between maternal time-use patterns and nutritional outcomes. The 24 h recall (24HR) has traditionally been used to collect time-use data, however, automated wearable cameras (AWCs) with an image-assisted recall (IAR) may reduce recall bias. This study aimed to evaluate their concurrent criterion validity for assessing women’s time use in rural Eastern Ugandan. Women’s (n = 211) time allocations estimated via the AWC-IAR and 24HR methods were compared with direct observation (criterion method) using the Bland–Altman limits of agreement (LOA) method of analysis and Cronbach’s coefficient alpha (time allocation) or Cohen’s κ (concurrent activities). Systematic bias varied from 1 min (domestic chores) to 226 min (caregiving) for 24HR and 1 min (own production) to 109 min (socializing) for AWC-IAR. The LOAs were within 2 h for employment, own production, and self-care for 24HR and AWC-IAR but exceeded 11 h (24HR) and 9 h (AWC-IAR) for caregiving and socializing. The LOAs were within four concurrent activities for 24HR (−1.1 to 3.7) and AWC-IAR (−3.2 to 3.2). Cronbach’s alpha for time allocation ranged from 0.1728 (socializing) to 0.8056 (own production) for 24HR and 0.2270 (socializing) to 0.7938 (own production) for AWC-IAR. For assessing women’s time allocations at the population level, the 24HR and AWC-IAR methods are accurate and reliable for employment, own production, and domestic chores but poor for caregiving and socializing. The results of this study suggest the need to revisit previously published research investigating the associations between women’s time allocations and nutrition outcomes.     

Estimating paid and unpaid hours of personal assistance services in activities of daily living provided to adults living at home

OBJECTIVE: To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES: The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conducted from 1994 to 1997. DATA COLLECTION/EXTRACTION METHODS: Data were obtained on persons receiving help with up to 5 ADLs and 10 IADLs, for up to 4 helpers, including the activities they helped with, whether the helper was paid or not, and the number of hours of help provided in the two weeks prior to the survey. The sample consists of 8,471 household-resident adults ages 18 and older receiving help with personal assistance. About 22 percent of the sample has missing data on hours, which we impute by multiple regression models using demographic, ADL, and IADL variables. FINDINGS: We estimate that 13.2 million noninstitutionalized adults receive an average of 31.4 hours per week of personal assistance in ADLs and IADLs per week, with 3.2 million people receiving an average of 17.6 hours of paid help and 11.7 million receiving an average of 30.7 hours of unpaid help. More persons ages 18-64 received help than those ages 65 and older (6.9 versus 6.2 million), but working-age recipients had fewer hours (27.4 versus 35.9) per week, due in part to less severe levels of disability. CONCLUSIONS: Personal assistance provided to adults with disabilities amounts to 21.5 billion hours of help per year, with an economic value in 1996 approaching $200 billion. Only 16 percent of this total is paid, representing $32 billion in home health services spent annually. This study, the first to estimate hours of assistance for both working-age and older adults, documents that older persons are more likely to receive paid personal assistance, while working-age people rely to a greater extent on unpaid help. This study begins to articulate the division of labor in the provision of personal assistance. Estimates of paid and unpaid hours of help by number of ADLs should inform policy concerning eligibility boundaries in long term care.