新疆维哈失能老年人生活满意度与照护者照护负担、社会支持交互作用

目的探讨新疆维哈失能老年人生活满意度与其照护者照护负担、社会支持交互作用。方法应用生活满意度指数B量(LSIB)表、主要照护者负担量表(ZBI)和社会支持量表(SSRS)等对621对维哈失能老年人/照护者进行研究。结果 (1)维哈少数民族失能老年人生活满意度得分为(13.15±3.744)分,低于新疆汉族失能老年人,也低于国内常模;(2)交互作用表明:照护者有照护负担及低社会支持、高龄失能老年女性、重度失能、失能老年人文化程度低、患2种以上疾病、子女经济差是影响维哈失能老年人生活满意度的危险因素。结论照护者有照护负担且社会支持低是影响新疆维哈失能老年人生活满意度的主要危险因素,因素间交互作用大大降低了失能老年人生活满意度。     

支援新疆汉族女性失能老年人生活满意度及影响因素

目的了解支援新疆(援疆)汉族女性失能老年人生活满意度状况,分析其影响因素。方法采用日常生活能力量表(ADL)对援疆汉族女性老年人进行失能筛查,对符合失能标准的284名女性老年人应用生活满意度指数B量表(LSRB)进行调查。结果援疆汉族女性失能老年人生活满意度得分〔(15.50±4.11)分〕与全国常模差异不显著(P0.05);单因素分析结果显示,在职状态、在职时单位性质、月收入、主要经济来源、医疗保障、来疆时间、失能时间及失能程度是影响其生活满意度的因素;经多因素Logistic回归分析得出:来疆时间、在职时单位性质及失能时间是影响援疆汉族女性失能老年人生活满意度的主要因素。结论应针对援疆汉族女性失能老年人制定相关政策,提高该人群的生活满意度。     

代际支持对老年人生活满意度的影响——基于CLHLS2014年数据的实证分析

目的从经济支持、照料支持和情感支持三个维度,研究代际支持对于老年人生活满意度的影响。方法根据全国老年人健康影响因素跟踪调查(CLHLS)2014年数据,采用描述性统计和二元Logistic回归分析,建立嵌套模型对代际支持与老年人生活满意度之间的关系展开定量研究。结果子女对父母的经济支持对老年人生活满意度无显著影响,而父母对子女的经济支持对其生活满意度呈显著的正向影响;照顾支持的作用不是很显著;子女的情感支持对老年人的生活满意度呈正向影响。同时,老年人的生活满意度还受年龄、婚姻、生活水平、失能情况、慢性病、养老保险和社区服务等因素的影响。结论子女应多与老年人沟通与联系,给予老人更多的精神关怀;发展老年人婚恋及提高老年人经济水平亦是提升老年人生活满意度的重要途径;老人们安享晚年目标的实现还有赖于社会保障制度的优化与完善。     

失能老年人社会支持与心理健康状况的相关性

目的 分析失能老年人心理健康状况主要相关因素,探讨其心理健康的干预措施.方法 采用中国科学院心理研究所吴振云研究员编制的老年心理健康问卷和社会支持评定量表(SSRS),对640名石河子市失能老年人的心理状况与社会支持状况进行了调查.结果 失能老人心理健康总体水平低于一般老年人群(P<0.01);失能老人获得的社会支持低于正常人(P<0.01).社会支持与失能老人生活质量呈正相关(P<0.01).结论 社会支持是影响失能老人的心理健康状况的重要因素,社区相关人员应重视社会支持系统对提高失能老人心理健康的作用,拓宽其现有的社会支持渠道,提高其身心健康.     

长株潭地区社区老人失能现状及生活满意度

目的了解长株潭地区社区失能老年人现状及生活满意度。方法对582名社区老年人采用Barthel指数评定量表和自制长株潭地区社区失能老年人生活满意度调查表进行调查。结果长株潭地区轻度、中度和重度失能老年人分别占65.64%、28.52%、5.84%;其生活满意度与失能程度、医保类型、健康管理形式等因素有关。结论所在辖区社区卫生服务中心的级别越高,失能老年人生活满意度越高,有效的生活保健指导能提高失能老年人生活满意度。     

农村失能老年人生活质量及影响因素

目的了解农村失能老年人生活质量现状及影响因素。方法采用分层整群抽样方法,应用自行设计的一般资料调查表和世界卫生组织生活质量简表(WHOQOL-BREF)对开封市398名农村失能老年人进行入户调查。结果农村失能老年人生活质量普遍较低,人口学资料与失能老年人生活质量关系密切,不同年龄、失能时间、失能程度、月均医疗费用支出,照料满意度是影响农村失能老年人生活质量的主要因素(P0.05,P0.01)。结论农村失能老年人的总体生活质量较低,且影响因素较多。因此,在发展农村社区护理服务时,应考虑失能老年人群体的特殊性,制定相应的服务措施,以提高其生活质量。     

盐城市城镇老年人的生活满意度与社会支持

目的 研究影响盐城市老年人社会支持和生活满意度的因素及社会支持与生活满意度之间的关系.方法 采用社会支持评定量表和生活满意度指数A对230位老年人进行问卷调查.结果 生活满意度与社会支持显著正相关(P<0.01);老年人生活满意度与社会支持受健康状况,居住情况、老伴健在与否的影响差异显著(P<0.05);老年人生活满意度与社会支持受性别、学历差异影响不显著(P>0.05).结论 老年人生活满意度受社会支持、健康状况等多种因素的影响.     

长春市老年人失能情况及其影响因素

目的探讨长春市60岁及以上老年人的失能情况及影响因素。方法数据来源于第五次国家卫生服务调查(2013年)吉林省"家庭健康询问调查"中长春市的扩点资料。采用χ2检验分析不同人口社会经济学特征下老年人失能情况的差异,二元Logistic回归分析老年人失能情况的影响因素。结果调查的3 349名老年人中,视力失能占17.3%,听力失能占15.9%,行走失能占9.6%,语言失能占4.8%,伴有两种及以上失能状态占11.3%,总体上,存在失能情况的老人占31.8%。有照顾需求的占失能老人群体的85.3%。Logistic回归分析结果显示,城乡居住地、家庭年人均收入、经济来源和是否患慢性病是影响60~69岁老年人失能影响因素,家庭年人均收入、经济来源和是否患慢性病是影响70~79岁老年人失能影响因素。结论长春市60岁及以上老年人失能情况严峻,且照顾需求较高。家庭、社会和政府应给予失能老人心理和物质、经济帮扶,国家应创造方便失能老人参与社会的支持环境,并尽快推出老年人长期照护保险。     

支持体系对高龄失能老人经济照顾需求的影响

目的了解高龄失能老年人的经济照顾需求状况,探讨家庭、社区、社会多元支持体系对其的影响。方法选取某市10个社区卫生服务中心辖区75岁及以上的老年人,进行入户调查,应用经济来源量表评测高龄失能老人的经济照顾需求。结果 1 664名高龄失能老人中非常需要经济照顾者占15. 87%,最需要提供的照护者为子女。多因素分析显示年龄、接受过国家或社会的生活救助、接受过志愿者提供服务、接受过居委会提供服务、子女提供帮助、其他家庭成员提供帮助、配偶提供帮助、兄弟姐妹提供帮助、文化程度等是高龄失能老年人经济照顾需求的显著影响因素,差异有统计学意义(P<0. 05)。结论高龄失能老年人经济照顾需求突出,家庭成员、社区、社会支持是高龄失能老年人经济照护的重要支柱,应构建高龄失能老人经济保障体系,完善相关制度与政策,提升整体照护水平,实现健康老龄化。     

基于贝叶斯网络的老年人失能风险预测模型构建

目的 探讨老年人失能与相关影响因素间的关系，构建老年人失能风险的贝叶斯网络预测模型。方法 以2018年中国健康与养老追踪调查(CHARLS)数据为基础，使用GeNIe2.3软件制作贝叶斯网络拓扑结构构建老年人失能风险预测模型。根据贝叶斯网络推理，受试者工作特征(ROC)曲线线下面积(AUC)评价模型的预测效果。结果 最终共选取样本5 825例，其中失能老年人1 705例，失能率为29.3%。老年人失能风险贝叶斯网络预测模型含有14个节点、28条有向边，由社会因素、压力因素、个人因素和功能性因素4部分组成，影响老年人失能的风险分别为51%、60%、66%和36%。老年人失能风险的贝叶斯网络预测模型中ROC AUC为0.667。结论 老年人失能的影响因素较多，基于贝叶斯网络构建的失能预测模型能够直观描述老年人失能与影响因素间的复杂关系，且有较好的预测能力，可以为预防老年人失能提供参考。     

Factors enabling home death of the elderly in an institution specializing in home medical care: Analysis of apprehension of the bereaved family

Aim:   To determine the factors enabling home death despite caregiver apprehension about home medical care.
Methods:   This study was an anonymous mailed survey of bereaved family members (the caregiver) of patients who died in a home medical care setting provided by an institution specializing in home medical care in Japan (home death rate, ∼80%). We analyzed the relationships between caregiver apprehension about home medical care, overall satisfaction with home medical care and the place of death.
Results:   Higher caregiver apprehension about home medical care and lower overall satisfaction with home medical care were significantly associated with dying in a hospital. In addition, the home death group with apprehension about home medical care significantly rated higher overall satisfaction with home medical care than the hospital death group. Meanwhile, there was no difference in the overall satisfaction with home medical care between those with or without apprehension about home medical care in the home death group. Factors influencing overall satisfaction with home medical care in the home death group with apprehension about home medical care were: (i) being free from pain or symptoms (partial regression coefficient: 0.83); and (ii) fulfilled medical care service system (partial regression coefficient: 0.40).
Conclusion:   These results suggest that caregiver satisfaction with home medical care is an essential factor to enable home death of the patient despite the caregiver apprehension about home medical care.     

Social support and depression among elderly Chinese people in Hong Kong.

This study examines the association between social support and depressive symptomatology in a representative community sample of 1106 Chinese people in Hong Kong aged sixty years or older. Significant bivariate relationships were found between depression and all dimensions of social support including social network size, network composition, social contact frequency, satisfaction of social support, instrumental/emotional support, and helping others. Using multiple regression models, the authors found that at least one measure of these six dimensions of social support was associated with depressive symptomatology, even after controlling for socio-demographic, and functional disability. We found that social support from family is important for elderly Chinese people in Hong Kong, and satisfaction with support is a more important predictor of depression levels than other objective measures of network relationships. Lastly, it was found that material aid and instrumental support is more important in preventing depression for elderly individuals in Hong Kong than emotional support.     

Factors influencing the death of the elderly at home in an institution specializing home medical care--analysis of survey of the bereaved family

AIM: To determine factors influencing on the death of the elderly at home in an institution specializing in-home medical care (home death rate: about 80%). METHODS: This study was an anonymous mailed survey of bereaved families of patients (the caregivers) who died using the home medical care setting provided by an institution specializing in home medical care in Japan. We analyzed the relationship of demographics of the patients and the caregivers with such factors as the anxiety of the caregiver and eventual death at home, and that of such factors as perceived quality of home medical care by the caregiver, and satisfaction with home medical care, satisfaction with death bed nursing, regret for death bed nursing. RESULTS: The most significant determinant factor associated with home death was that both patients and caregivers preferred death at home (OR=19.42). Determination coefficients (R(2)) in the multiple linear regression analysis of caregiver's satisfaction with home medical care, satisfaction with death bed nursing and regret for death bed nursing were as high as 0.68, 0.55 and 0.62, respectively. Significant influential factors were: peaceful death, psychological consistency of the caregiver, a good relationship with one's physician and fulfillment of the care service system. CONCLUSIONS: Important components of home medical care and death bed nursing for the realization of death of the elderly at home are 1) peaceful death, 2) psychological consistency of caregivers, 3) a good relationship with one's physician, 4) fulfillment of the care service system.     

A Study of Older People with Disability: Evidence from Two Cosmopolitan Cities

It has been widely understood that disability is a fact of human diversity. The people with disability are still not freely functional in society. There are still a considerable number of social circumstances that need to be improved and environmental barriers removed to help this group of people live boundlessly in the community. By employing questionnaire survey, the study explores the social exclusion and life circumstances experienced by older people with disability in two cosmopolitan cities: urban Hong Kong and Shanghai. The purposes of the present study are two-fold: (1) it aims to investigate the link between social exclusion and their life satisfaction, and explores how social exclusion affects the life satisfaction of disabled elderly; (2) it aims to identify the differences in the experience of social exclusion and its relationship with life satisfaction in the two cities. Via proportional sampling, 710 participants were interviewed, among whom 660 were valid. Results showed that disability and functional capacity was associated with the life satisfaction, with neighborhood exclusion as the most salient feature of social exclusion. This implies that social environment is not inclusive for disabled older people under many circumstances. Implications for how to achieve an inclusive society, especially for disabled older adults, are then deliberated in turn.     

Factors related to home discharge of cerebrovascular disease patients: 1-year follow-up interview survey of caregivers of hospitalized patients in 53 acute care hospitals in Japan

In Japan, many disabled elderly people remain hospitalized for long periods. Cerebrovascular diseases (CVD) are the most causes responsible for such disability. To examine the predictors of home discharge in CVD patients, we performed a 1-year follow-up interview of the main caregivers of patients hospitalized with a CVD event. The initial cohort consisted of CVD patients hospitalized in all the second level emergency and general hospitals in Ibaraki Prefecture in February 1992 (N=888 patients in 53 hospitals). In the following year, we performed an interview survey of the main caregivers of these CVD patients. The survey items included the characteristics of the patients (including medical and socioeconomic conditions), caregivers, and family members. The final study population included the main caregivers of 187 home patients and 90 institutionalized patients. We compared these two groups in terms of predictors of discharge to home. The results of multiple logistic regression analysis showed that the following seven factors were related to home discharge; better baseline activities of daily living (ADL), larger improvement in ADL, larger family size, spouse as the caregiver, caregiver without a full-time job, better economic status of the caregiver, and sources of the patient's income. Our study indicated that the caregiver's conditions were closely related to home discharge of the CVD patients. More attention should, therefore, be centered on the caregiver's well-being and economic aspects as well as the patient's conditions in order to encourage home discharge of stroke patients.     

Coping strategies and adaptation for the disabled elderly in Taiwan

Aim: This study explored the relationship between coping strategies and adaptation difficulties for the disabled elderly. Methods: Data were collected during face‐to‐face interviews with the physically disabled elderly in long‐term care institutions and in rehabilitation departments in middle Taiwan. Totally, 505 persons were analyzed. The adaptation to disability was evaluated by health care, domestic environment, family relationships, social life and psychological distress as the dependent variables. Factor analysis and multiple regression models were applied for the analysis. Results: Three types of coping strategies were identified: (i) acceptance and action reduced the difficulty in adapting to disability in the health‐care and social life dimensions; (ii) venting and avoidance increased the difficulty in adapting in the health‐care, domestic environment and psychological distress dimensions; and (iii) seeking support was related to greater adapting to difficulty in terms of family relationships. Conclusion: More effective coping strategies should be offered to the disabled elderly to help them adapt to their disability. Geriatr Gerontol Int 2011; 11: 488–495.     

Frontal function, disability and caregiver burden in elderly patients with major depressive disorder

Caregivers of patients with late-life major depressive disorder experience a significant level of general caregiver burden. Disability in patients is possibly one of the origins of caregiver burden. Frontal lobe dysfunction might be the source of disability. This study investigated if frontal lobe dysfunction (body level) of patients with late-life major depressive disorder was associated with their disability (individual level), and if it led to a high level of caregiver burden (societal level). Thirty-four unselected pairs of caregivers and their family members with late-life major depressive disorder were recruited. Frontal Assessment Battery and Timed Instrumental Activities of Daily Living (TIADL) were used to assess patients' frontal function and disability, and Caregiver Burden Inventory was used to measure caregiver burden. Frontal Assessment Battery correlated with TIADL (r= -0.47; p<0.006). TIADL score was also associated with two subscales of the Caregiver Burden Inventory: social (r = 0.38, p=0.026) and time-dependent (r= 0.37, p= 0.033). This study supported the hypothesis that frontal lobe dysfunction in elderly patients with depression is associated with their disability in instrumental activities of daily living. Disability is related to social and time-dependent aspects of caregiver burden. Further studies to examine proposed cognitive interventions are suggested to reduce patient disability and caregiver burden.     

Caregiver satisfaction with support services: influence of different types of services

Objectives: This article examines factors influencing satisfaction with support services of caregivers of frail older adults and determines what types of support services are associated with greater satisfaction, controlling for frail individual and caregiver characteristics. Methods: The study includes 291 frail older adults-caregiver dyads from Montreal in which caregivers receive support services. The Client Satisfaction Questionnaire-8 is used to measure caregiver satisfaction with these services.Results: Caregivers receiving information, advice, or emotional support, and those caring for seniors receiving integrated care are more likely to be highly satisfied.Other factors increasing satisfaction are fewer number of health problems of frail individuals, caregiver being the spouse of the frail person, as well as greater caregiver perceived health, autonomy in instrumental activities of daily living, and available social support. Discussion: The results support the importance of integrated care for frail seniors and informational services for their caregivers.     

Nursing home residents covered by Medicare risk contracts: early findings from the EverCare evaluation project

OBJECTIVES: To compare the characteristics of a sample of EverCare nursing home residents with two control groups: one composed of other residents in the same homes and another made up of residents in matched nursing homes. To compare levels of unmet need, satisfaction with medical care, and the use of advance directives. DESIGN: Quasi-experimental design using two control groups to minimize selection effects. Information collected by in-person surveys of nursing home residents and telephone surveys of proxies and family members. SETTING: Nursing homes affiliated with EverCare and matched control homes. PARTICIPANTS: Nursing home residents and their family members. MEASUREMENTS: Questionnaire addressing function (activities of daily living (ADLs)), unmet care needs, pain, use of advance directives, satisfaction, and caregiver burden. RESULTS: In general, the experimental and control groups were similar, but the EverCare sample had more dementia and less ADL disability. Family members in the EverCare sample expressed greater satisfaction with several aspects of the medical care they received than did controls. Satisfaction of residents in the EverCare sample was more comparable with that of controls. There was no difference in experience with advance directives between EverCare and control groups. CONCLUSIONS: EverCare appears to be a model of managed care worth tracking. It is producing care that is at least comparable with what is available in the fee-for-service environment, with evidence that families seem to appreciate the added attention. There is some suggestion that it has enrolled a less disabled but more demented population. Pending results on the effects of this care on hospitalization and emergency care should shed useful light.     

Carer distress in the general population: results from the Sydney Older Persons Study.

OBJECTIVE: To assess distress in a sample of carers who were selected from a community survey rather than recruited via community-service agencies. METHODS: A community survey was carried out on 630 people aged 75 or over living in Sydney, Australia. Informants nominated by these elderly people were divided into full carer (n = 21), partial carer (n = 187) and non-carer groups (n = 344). Informants completed the General Health Questionnaire (a continuous measure of psychiatric symptoms), the life satisfaction index (a measure of well-being) and the interpersonal bonding measure (a measure of quality of the relationship with the elderly person). Elderly participants had a medical examination, were assessed for disability and were questioned about use of services. RESULTS: Elderly people who had a full carer were more disabled and had more medical diagnoses. Full, but not partial, carers reported more psychiatric symptoms and lower life satisfaction. In multivariate analysis, the main determinant of carer distress was a relationship in which the carer felt controlled by the elderly person. CONCLUSION: When carers are selected from a population-based sample, only those who are full carers are more distressed. However, relationship factors are the most important determinant of distress.