保定市养老机构入住老人健康促进生活方式现状调查

摘要:目的 了解养老机构入住老人健康促进生活方式现状、特征及其相关影响因素,为养老机构制定针对性干预策略和措施提供理论依据。方法 采用整群抽样的方法,对保定市5所养老机构193名老年人进行现场问卷调查。结果 保定市养老机构老年人健康促进生活方式得分为126.72±22.43分,其中,具有健康生活方式的老人占45.08%,不健康的占54.92%,营养分量表得分最高,为24.52±5.29分,体育运动分量表得分最低,为17.97±5.15分;Logistic多因素回归分析显示,文化程度(OR=0.554)、子女数(OR=0.730)、婚姻状况(OR=0.256)是影响养老机构入住老人健康促进生活方式水平的因素。结论 保定市养老机构老年人健康促进生活方式得分总体处于不健康水平,营养维度水平最高,体育运动维度水平最低。建议针对不同婚姻状况入住老人采取不同的措施,充分发挥家庭、亲情的支持作用,帮助其改善不健康的生活方式。     

Evaluation of Charlson's comorbidity index in elderly living in nursing homes

The object of this article was to validate the predictive value of Charlson's comorbidity index for the prediction of short-term mortality or morbidity in elderly people. The design was a cohort study comparing survival and hospitalization in institutionalized elderly people with different levels of comorbidity at baseline. The setting was 16 Flemish nursing homes for the elderly. The subjects were 2,727 inhabitants of which full data were available for 2,624. The outcome measures were hazard ratios resulting from Cox regression analysis, comparing 6 months survival in patients with moderate and a high level to low level of comorbidity. Odds ratios resulting from multiple logistic regression analysis comparing the occurrence of at least one hospitalization during the follow-up period in surviving patients of the same groups. Mortality adjusted for age group was significantly increased in patients with a moderate (HR = 2.00) and even more in those with a high level (HR = 3.62) of comorbidity. Hospitalization was more frequent in both groups (OR = 1.54 and 2.19, respectively), with statistical significance only being reached for the highest group. Adjustment for age, gender, mobility status, and disorientation did not change the general picture. Charlson's comorbidity index is a predictor of short-term mortality in institutionalized elderly patients and, to a lesser extend, also of hospitalization. These results support its use as a measure for introducing comorbidity as a covariable in longitudinal studies with a geriatric population.     

健康老龄化: 理念、体系、能力与评估

分析2008 — 2018年中国老年人社区为老服务需求发展轨迹及影响因素,为发展多层次养老服务体系及促进健康老龄化的实现提供参考依据。

收集中国老年健康影响因素跟踪调查（CLHLS）2008、2011、2014和2018年相关数据,应用Mplus 8.3构建潜变量增长模型（LGM）,采用无条件最小二乘法测量不包含协变量的社区为老服务需求的变化轨迹,并构建有条件的LGM分析2008 — 2018年中国老年人社区为老服务需求变化轨迹及影响因素。

中国老年人2008、2011、2014和2018年社区为老服务需求得分分别为（4.89 ± 2.27）、（5.49 ± 1.94）、（5.38 ± 2.06）和（5.21 ± 2.05）分,不同年份老年人社区为老服务需求得分差异无统计学意义（P > 0.05）。无条件LGM分析结果显示,二次函数无条件LGM为中国老年人社区为老服务需求发展轨迹的最优模型,且社区为老服务需求的初始水平显著 > 0（截距 = 4.91,P < 0.01）,在2008 — 2011年呈上升趋势（斜率 = 0.38,P < 0.01）,而2011 — 2018年则呈下降趋势（斜率 = – 0.12,P < 0.01）。有条件LGM分析结果显示,年龄（β = 0.026）、婚姻状况的截距（β = 0.260）、居住地（β = – 0.567）和教育年限（β = 0.224）对中国老年人社区为老服务需求的截距均有显著影响（均P < 0.05）;其中年龄和教育年限对斜率1均呈正向预测（β₁ = 0.021,0.018,均P < 0.05）,对斜率2的预测均不显著（均P > 0.05）;婚姻状况截距和斜率对斜率1均呈正向预测（β₁ = 0.118,0.021,均P < 0.05）,对斜率2亦均呈正向预测（β₂ = 0.146,0.049,均P < 0.05）;居住地对斜率1和斜率2均呈正向预测（β₁ = 0.707,β₂ = 0.046,均P < 0.05）。

中国老年人2008 — 2018年社区为老服务需求呈曲线增长的变化轨迹,初始水平及增长速度均存在个体差异,年龄、婚姻状况、居住地和教育年限是中国老年人社区为老服务需求水平及增长速度的主要影响因素。

     

Site of death among veterans living in Veterans Affairs nursing homes

ObjectivesTo determine predictors of dying in VA nursing homes, community living centers (CLCs), compared with dying in a hospital.DesignRetrospective cohort study.SettingVA CLCs.ParticipantsIncluded were 7408 CLC decedents from FY2005 to FY2007.MeasurementsOutcome: Site of death obtained from VA Vital Statistics files. Predictors of Death Site: VA-MDS variables defining patient demographics, functional status, cognitive status, major diagnostic categories, and care planning documentation.AnalysisLogistic regression was used to estimate the odds ratio of death in the CLC relative to the hospital for patient and facility characteristics.ResultsAmong decedents, 87% died in the CLC and 13% in a hospital. More than half of all decedents were neither enrolled in hospice nor designated as having end-stage disease. The strongest predictor of site of death in a CLC relative to a hospital was being enrolled in hospice (OR = 20.94; 95% CI: 12.38, 35.44). A designation of end-stage disease increased the odds of death in a CLC by 3.9 times (95% CI: 2.78, 5.47) compared with death in a hospital. Advance directive rates in CLCs were high (73.4%); having any advance directive increased the odds of death in a CLC by 1.57 times (95% CI: 1.35, 1.82).ConclusionRecognition of end-stage disease and documentation of advance directives are powerful determinants of site of death for CLC residents. Receipt of hospice care in a CLC is a strong predictor of site of death in a CLC even in the absence of collaboration with community-based hospice and financial incentives to avoid hospitalization.     

天津、唐山养老机构老年人跌倒现况及其影响因素研究

目的 分析天津、唐山两地养老机构老年人发生跌倒的现况及其影响因素,为采取有效措施减少跌倒发生提供理论依据。方法 采用便利抽样法,选取唐山市和天津市8所养老机构内490位老年人为研究对象,调查其在调查日前过去一年内发生跌倒的情况。采用一般资料调查表、Barthel指数、Morse跌倒评估量表和焦虑自评量表收集资料。采用x2检验或Fisher确切概率法进行比较。采用logistic回归分析养老机构老年人发生跌倒的影响因素。结果 223位（45.5%）老年人在调查日前一年内发生跌倒。多因素分析结果显示,年龄90~95岁（x2=4.744,P=0.029）、是否害怕跌倒（x2=14.769,P＜0.001）、跌倒风险（x2=94.526,P＜0.001）、日常生活轻度依赖（x2=6.691,P=0.010）、护理人员对老年人进行跌倒评估（x2=12.613,P＜0.001）和经常提醒老年人注意预防跌倒（SymbolcA@²=18.828,P＜0.001）是跌倒发生的影响因素。结论 养老机构老年人跌倒发生率较高,可通过进行跌倒风险评估等方式减少养老机构老年人跌倒的发生。     

Vitamin B12 status in hospitalized elderly from nursing homes and the community

OBJECTIVE: To assess vitamin B(12) status in a large sample of hospitalized, inner-city older adults from nursing homes and communities with low socioeconomic status. To determine additionally if hypoalbuminemia can help identify older subjects who are at risk for vitamin B(12) deficiency. DESIGN: A cross-sectional study of hospitalized, inner-city older residents. SETTING: Acute Care Geriatrics Division, a 75-bed inpatient care service at Our Lady of Mercy Medical Center (OLMMC), a University Affiliate of New York Medical College. PARTICIPANTS: A total of 466 older patients (aged 65 to 102 years) from the community (n = 374) and nursing homes (n = 92) who were admitted to the acute care geriatrics division from 1993 to 1996. MEASUREMENTS: Patients admitted to the hospital had serum vitamin B(12) and albumin levels determined along with other nutritional parameters, routine blood tests, and physical examinations. RESULTS: On admission, 19% of hospitalized subjects had marginal serum B(12) levels (200-350 pg/mL) and 6% had low serum B(12) levels (<200 pg/mL). Mean serum B(12) levels did not differ significantly between patients from nursing homes and those from the community. Sixty-four percent 64% of all patients had low serum albumin levels (alb < 3.5 g/dL), with patients from nursing homes showing significantly lower mean serum albumin than patients admitted from the community (P <.000). We observed no positive correlation between serum albumin and serum vitamin B(12) in our older hospitalized patients from either nursing homes or community. CONCLUSIONS: In this sample of hospitalized older adults, 24% were found to have marginal or low serum B(12) status. Thus, we believe that periodic determinations of serum B(12) would be a useful addition to the general health and nutritional assessment in this age group. Our findings also suggest that hypoalbuminemia is not helpful as a predictor of low B(12) status in older hospitalized persons.     

Characteristics of elderly people living in non-air-conditioned homes

The present study aimed to clarify the characteristics of elderly people living in non-air-conditioned homes. A questionnaire survey conducted in Misato city in July 2013 revealed that 96.1 % of elderly individuals lived in air-conditioned homes. Elderly individuals living without air conditioners tended to be men, and those who were unmarried, living alone, or living in an apartment. The results suggest that most elderly individuals without air conditioners lived in multi-unit apartments.     

Activities of daily living and costs in nursing homes

Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.     

Determinant factors of functional status among the elderly

OBJECTIVE: To investigate the impact of health-related demographic and socioeconomic factors, as well as the impact of factors associated to social activity and the subjective health evaluation on the functional status of elderly people. METHODS: A cross-sectional multicentric study was conducted in a representative population sample in the city of S?o Paulo, Brazil, in 1989. Functional status was evaluated using a scale of activities of personal and instrumental daily living. It was studied as a dichotomous variable: absence of dependency - disability/difficulty in none of the activities in contrast with moderate/severe dependency - disability/difficulty in 4 or more activities. Multiple regression analysis was applied to hierarchically clustered factors. RESULTS: Those with the following features were more associated to moderate/severe dependency: illiterate, retired, pensioner, house keeper, living in a rented home, age over 65 years, multigenerational family composition, hospitalization in the last 6 months, mental health screening case, no visiting friends, and having a pessimistic perception of his/her own health when compared to their peers. CONCLUSIONS: The identified features associated to moderate/severe dependency suggest a complex net of causes for the declining functional status. However, one can assume that preventive measures directed to specific factors can benefit these population by improving their well-being.     

Health status and socioeconomic factors related to home remedy practices among elderly subjects living in a community in Okinawa

OBJECTIVE: The purpose of the present study was to clarify health status and socioeconomic characteristics of elderly persons who practice home remedies as complementary alternative medicine. Whether such usage is associated with health-related factors was also assessed. METHODS: The subjects are 243 independent elderly living at home in A-village of Okinawa prefecture, aged 65 years or older. A self-administered questionnaire was mailed to all subjects in 2001. Included were questions on socioeconomic indicators, health status, IADL, health habits, social network, social support and home remedy practices. All data were statistically analyzed by Student's t test and the chi-square test. In addition logistic regression was used to calculate the odds ratios for current practitioners for each of the factors. RESULTS: The present study included 200 subjects who responded and completed all questions. (Table 2). The main results are as follows: The practitioner rate for home remedies was 50.8% in males and 71.9% in females, the difference being significant (P<0.05). Usage was found to be significantly related to hypertension (P<0.05), arthritis and rheumatic disease (P<0.01), some health habits and provision nursing of social support (OR = P<0.05). Logistic regression analysis adjusted for age, gender, and income revealed current practitioners of acupuncture to have a significantly higher level of history of hospital admission in the previous year (OR = 0.2 P<0.05), food control habits (OR = 4.3 P<0.05) and provision nursing of social support (OR = 4.2 P<0.05) than non-current practitioners. CONCLUSION: The findings of this study suggest that home remedy practices are associated with health-related habit and provision of social support for good quality of elderly life. The purpose is not only physical care but also health maintenance and promotion.     

独居老年人生活及精神健康状况调查

目的分析山东省济南市独居老年人生活现状及精神健康状况。方法采用调查问卷收集160名独居老人和911名非独居老人的生活现状及精神健康状况等,应用2χ检验和秩和检验进行统计分析。结果独居老人中女性99人,占61.88%,男性61人,占38.12%,平均年龄为74.45岁,文化程度小学及以下105人,占65.62%;城乡独居老人的平均月收入分别为1 816.40和274.46元,非独居老人分别为1 911.37和372.59元;城乡独居老人中从不与亲戚、朋友交往的比例分别为20.93%和25.68%;从不参加体育活动的比例为60.47%和94.59%;独居老年人的精神健康得分为45.21分,低于非独居老年人的46.81分。结论与非独居老人相比较,独居老年人尤其是农村独居老人的生活状况较差,精神健康水平较低,需进一步改善。     

新疆养老机构老年人健康素养与社会支持的现状及分析

目的 了解养老机构老年人健康素养与社会支持的现状并进行分析.方法 2011年9月至2012年6月,采用整群抽样法对新疆乌鲁木齐市、昌吉市、石河子市、克拉玛依市的44所养老机构老年人进行调查,将其中符合标准的1452名老年人作为研究对象,发放健康素养量表、社会支持量表及一般状况量表.通过t检验、方差分析及Pearson相关分析,探讨养老机构老年人健康素养与社会支持的现状.结果 有效问卷1396份,有效率96.14％.老年人平均年龄（77.4±8.5）岁.健康素养总分为（71.7±28.4）分,4个维度中健康知识得分（32.5±16.9）分,健康信念得分（22.8±7.4）分,健康行为得分（9.6±3.9）分,健康技能得分（6.2±5.1）分,均处于较低水平.社会支持总分为（31.3±7.3）分,3个维度中客观支持得分（6.1±2.3）分,主观支持得分（18.1±4.9）分,对支持的利用度得分（7.2±2.3）分,处于较低水平.健康素养得分比较：男性高于女性,汉族高于少数民族,教育水平中以大学及以上最高.社会支持得分比较：年龄越大,社会支持越少;教育水平越高,社会支持越多;婚姻状况中,已婚者社会支持最高,其次为丧偶者.Pearson相关分析表明,健康素养与社会支持之间的相关系数为0.30,总分及各维度之间相关系数均具有统计学意义（P＜0.05）,呈正相关关系.结论 养老机构老年人是一个既缺乏社会支持,健康素养又较低的人群,是一个更加脆弱的群体,面临更大的健康风险,需要社会及相关专业人士给予更多的关注和帮助.     

Health status,staffing, and medicaid reimbursement in nursing homes: 1985 to 1995

CONTEXT: Policy changes implemented by Medicaid and Medicare in the early 1980s resulted in a functionally more dependent nursing home population. OBJECTIVES: This paper contends that (1) staffing in nursing homes has become more efficient; (2) nursing home residents are functionally more dependent;(3) Medicaid per diem reimbursement is inadequate. DATA SOURCES: Staffing data came from the National Nursing Home Facility Survey conducted by the National Center for Health Statistics (NCHS) in 1985 and 1995. Functional dependency data, defined as assistance with any of six Activities of Daily Living (ADLs), came from the NCHS National Nursing Home Current Resident Surveys in 1985 and 1995. Reimbursement rates came from the State Medicaid Reimbursement Surveys conducted by the University of California at San Francisco to which the Consumer Price Index, Hospital and Related Services Item was applied. DATA SYNTHESIS: Administration decreased by 4.4 full-time equivalents (FTEs) (80.0%) per 100 beds, whereas patient care increased by 8.2 FTEs (18.9%). Residents requiring assistance with four or more ADLs increased by 9.9%, and the mean number of ADLs per patient increased from 3.9 to 4.3. Applying the Consumer Price Index to the 1984 reimbursement rate indicated an annual deficit of 5526.00 dollars for each Medicaid patient by 1995. CONCLUSIONS: This research strongly supports its contentions but fails to demonstrate them conclusively. The data indicate that long-term care facilities have reallocated staffing to accommodate the requirements of more functionally dependent residents and that Medicaid reimbursement has failed to maintain its initial purchasing power.     

Nutritional status in older adults with mild cognitive impairment living in elderly homes in Cairo,Egypt

Objectives  

To delineate the difference in nutritional risk between older adults with normal cognitive function and mild cognitive impairment living in elderly homes.     

西藏孤寡老人睡眠质量及其与心理健康关系

目的 探讨西藏孤寡老人的睡眠质量及其与心理健康的关系,为改善西藏孤寡老人睡眠质量,提高其心理健康提供参考依据.方法 于2018年9-11月采用随机整群抽样方法对在西藏自治区拉萨市、山南市、林芝市、日喀则市6家五保集中供养服务中心抽取的275名孤寡老人进行问卷调查.结果 西藏275名孤寡老人中,睡眠质量较好、一般和较差者...     

The functional status and utilization of care of elderly people living at home

A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international.The more limitations, the higher the proportion of professional care utilization. The factors use of informal care and not living alone were inversely related to the utilization of professional care.The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful.The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.Carla M.A. Frederiks M.Sc. M.P.H. is a senior staff member of the Department of Epidemiology and Health Care Research, University of Limburg, P.O. Box 616, 6200 MD Maastricht, Netherlands. Margreet J.M. te Wierik M.A. is a junior staff member of the same department. Adriaan Ph. Visser M.A. Ph.D. is a senior investigator in the research project Services for the elderly and a senior staff member of the Department of Health Economics at the same university. Ferd Sturmans M.D. Ph.D. is professor at the Department of Epidemiology and Health Care Research at the same university.     

浙江省农村老年人健康状况及影响因素分析

目的 探讨浙江省农村老年人健康状况及影响因素,为建立新型农村社区卫生服务模式提供科学依据.方法 采取分层随机整群抽样的方法获取样本,采用自行设计的问卷及日常生活能力(ADL)量表对2 184名老年人进行调查.结果 老年人2周患病率为53.9%(1 107/2 184),其中83.4%(981/1 007)为慢性病延续到2周内;慢性病患病率为68.1%(1 494/2 184),居前5位的分别是高血压(46.9%7,01/1 494)、关节炎(9.2%1,37/1 494)、糖尿病(5.8%,87/1 494)、胃肠炎(5.6%,84/1 494)、冠心病(5.2%7,8/1 494);ADL正常的占74.1%(1 618/2 184);男性打电话、乘车、自理经济能力高于女性;除家庭收入外,其他人口学特征对2周患病、慢性病患病、ADL有重要影响.结论 浙江省农村老年人2周患病率较高,存在着慢性病与感染性疾病的双重负担,糖尿病和冠心病已成为近年来影响老年人健康的重要疾病,其ADL正常率高于其他地区.     

Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey

In France, although there are 445,000 beds in nursing homes (NHs) for elderly people, no studies on the burden of infections in NHs have been published. We sought to estimate the prevalence of infection among the residents and to assess the extent to which infections were associated with the residents’ risk factors. We performed a nationwide, multicentre, cross-sectional, clustered period prevalence survey over five one-month periods. Cases of infection were classified as definite or, in the absence of laboratory confirmation, as probable. A total of 44,869 residents in 578 volunteer facilities were enrolled in the survey. The overall prevalence rate of infections was 11.23% [95% confidence interval (CI): 10.50–11.97] and differed significantly (P < 0.001) across survey periods (the time of the year the survey was carried out). The rate of definite cases was 4.60% (95% CI: 4.04–5.54) and the rate of probable cases was 6.63% (95% CI: 5.77–7.98). Respiratory tract infections were the most frequent and accounted for 41% of all infections. Infections were significantly associated with age, length of stay, full disability, urinary device, bedsores and the survey period. Only prevention programmes may reduce the impact of infections on this frail population.     

Vitamin C status in elderly women: A comparison between women living in a nursing home and women living independently

The vitamin C status in blood fractions in 135 elderly women aged 65 years and older was studied within the framework of the Dutch Nutrition Surveillance System. Mean (± standard deviation) vitamin C intake (mg/day) was lower among women living in a nursing home (54±27 mg/ day) than among women living in service flats (97±55 mg/ day) and women living independently (132 ± 44 mg/day). (Service flats are apartments in which the rent includes housekeeping and, when ordered, meal service.) Marginal vitamin C values (<23 μmol/L) in blood fractions and even levels as low as those found in clinical scurvy (<11 μmol/L) were frequently observed. In the nursing home, 35% of the women had plasma vitamin C values below 11 μmol/L, and 23% had values between 11 and 23 μmol/L. Blood levels were not significantly affected by age, smoking status, or use of particular drugs but were strongly (r = .47 or, after logarithmic transformation, r = .64) associated with daily intake of vitamin C. Low intake of vitamin C resulted from an overall low food consumption and selective restriction of food products rich in vitamin C. Vitamin C losses caused by food preparation practices and distribution in the nursing home's catering system reduced actual vitamin C intake levels but these losses were not substantially greater than those that are assumed to occur as a result of preparation practices by women living independently.