医学生团体照护服务对养老机构失能老年人幸福度的影响

目的探讨医学生团体照护服务对养老机构失能老年人幸福度的干预效果。方法随机选取2所公立养老机构的失能老年人,并以抛硬币法将2所养老机构随机设为干预组(126人)和对照组(113人)。对照组按养老机构常规照护模式服务,干预组在养老院常规照护服务的基础上实施在校医学生团体照护服务,每周1次,每次4 h,连续12周。结果干预后干预组正性情感、一般正性体验维度得分及幸福度总分显著高于对照组,负性情感、一般负性体验维度得分显著低于对照组(均P 0. 01)。结论由在校医学生对养老机构失能老年人实施团体照护服务,能有效改善养老机构失能老年人的生理和心理健康,从而提高失能老年人的幸福度。     

全人照护对老年膀胱癌患者生活质量及心理社会适应的影响

目的 促进老年膀胱癌手术患者身心康复.方法 对39例老年膀胱癌术后患者实施身心社灵四方面的全人照护,包括建立老年膀胱癌全人照护小组并培训相关人员、给予心灵支持、开设健康教育大讲堂、探访患者及组建泌尿造口患者俱乐部等.实施3个月后评价效果.结果 干预后生命质量测评量表（FACT）及疾病心理社会适应量表（PAIS-SR）评分,除PAIS-SR中的自尊和自我接纳维度与干预前改善不显著外（P＞0.05）,另10项均有显著改善（P＜0.05,P＜0.01）.结论 全人照护有利于提高老年膀胱癌术后患者的生命质量及心理社会适应性.     

社区高血压老年人智慧医养照护志愿服务实践效果评价

目的 探讨智慧医养照护志愿服务在社区高血压老年人健康管理中的实践效果。方法将100例社区高血压老年人随机分为对照组和观察组各50例,对照组给予常规接触式社区医养照护志愿服务管理,观察组给予智慧医养照护志愿服务管理。管理6个月后,比较两组管理前后血压、血糖、健康促进生活方式及依从性的变化。结果管理后观察组收缩压、舒张压、空腹血糖、餐后2 h血糖、糖化血红蛋白显著低于对照组;健康促进生活方式得分显著高于对照组（均P<0.05）。结论智慧医养照护志愿服务能有效控制社区高血压老年人的血压、血糖水平,提高其自我健康管理能力,可为医养照护志愿服务模式及社区慢病智慧化管理提供参考。     

医养结合机构脑卒中失能患者长期照护需求指标体系构建

目的 构建医养结合机构脑卒中失能患者长期照护需求指标体系,为脑卒中失能患者的长期照护提供参考。方法 基于文献研究法初步拟定医养结合机构脑卒中失能患者长期照护需求指标,结合德尔菲专家函询法对养老管理、老年护理研究、老年护理教育等专业领域的19名专家进行2轮函询,根据咨询结果调整指标并采取优序图法确定指标权重。结果 构建的指标体系包括医疗服务和养老照护2项一级指标、9项二级指标、57项三级指标。其中医疗服务和养老照护2项一级指标权重分别为0.409、0.591;排在前三的二级指标依次为医疗康复0.211、日常生活照料0.185、健康指导和环境安全并列第三0.148;排在前三的三级指标权重依次为认知功能康复0.078、辅助用餐和长期照护经费的来源和支持并列第二0.052、呼吸功能康复0.032。结论 构建的医养结合机构脑卒中失能患者长期照护需求指标体系较可靠,可为推进医养结合机构脑卒中失能患者长期照护服务建设提供参考。     

全人照护对老年膀胱癌患者生活质量及心理社会适应的影响

目的促进老年膀胱癌手术患者身心康复。方法对39例老年膀胱癌术后患者实施身心社灵四方面的全人照护,包括建立老年膀胱癌全人照护小组并培训相关人员、给予心灵支持、开设健康教育大讲堂、探访患者及组建泌尿造口患者俱乐部等。实施3个月后评价效果。结果干预后生命质量测评量表(FACT)及疾病心理社会适应量表(PAIS-SR)评分,除PAIS-SR中的自尊和自我接纳维度与干预前改善不显著外(P0.05),另10项均有显著改善(P0.05,P0.01)。结论全人照护有利于提高老年膀胱癌术后患者的生命质量及心理社会适应性。     

基于实证的团体干预对社区养老院老年人满意度的影响

目的 了解社区养老院老年人满意度现况,并探讨针对性团体干预对社区养老院老年人满意度的影响。方法 将58名社区养老院老年人按照楼层分为观察组和对照组,采用汉化版养老院入住老年人满意度问卷进行调查,对照组给予院内常规服务,观察组在此基础上根据满意度调查结果实施每周3次的团体活动。比较干预前后两组老年人满意度评分。结果 社区养老院老年人满意度评分为(127.02±18.66)分;干预后观察组活动、照顾者、幸福感、餐饮维度及满意度总分显著高于对照组(均P<0.05)。结论 养老院老年人满意度处于中等水平,基于调查结果实施团体干预能有效提升老年人满意度。     

老年人正式入住医养结合养老机构前服务沟通方式的改进

目的探讨老年人入住医养结合养老机构前服务沟通方式的改进策略。方法将115例预约试住医养结合养老机构的老年人随机分为观察组58例和对照组57例。对照组采用传统方法,于老年人试住当天讲解《试住期合同》内容后,为老年人提供2周的试住期服务。观察组以团队服务模式行分阶段服务与沟通为老年人提供试住期照护。结果试住期满后,观察组对试住期满意度、对《试住期合同》主要内容知晓程度、正式入住率显著优于对照组(P0.05,P0.01)。结论对有入住医养结合养老机构意愿的老年人,采取团队式分阶段服务沟通的方式,有利于提高老年人试住期满意度和正式入住率。     

快速康复护理路径对骨科手术患者术后患肢功能及康复进程的影响

目的探讨快速康复护理路径对骨科手术患者术后患肢功能及康复进程的影响。方法将99例接受骨科手术患者的分为观察组(50例)和对照组(49例)。观察组术后实施3个月的快速康复路径护理干预,对照组术后仅给予常规护理干预。比较2组患者术后恢复情况及并发症发生率,记录其出院前关节功能评分。结果观察组术后卧床时间、住院时间、骨折愈合时间、关节功能恢复时间、并发症发生率、出院前各患肢关节评分均明显优于对照组,2组差异有统计学意义(P0.05)。结论对骨科手术患者予以快速康复护理路径,效果显著,可有效缩短康复进程,促进术后患肢功能恢复。     

综合康复干预措施对提高髋关节置换术后患者功能水平的效果分析

目的探讨综合康复干预措施对全髋关节置换术(total hip replace,THR)后患者功能康复的作用。方法将符合纳入标准的人工THR患者70例,等量随机分为两组,即综合康复组(35例)和常规康复组(35例),常规康复组执行骨科常规治疗及护理,综合康复组在骨科临床治疗及躯体照护基础上,以个体化原则设计康复干预计划,突出全程化功能锻炼指导的观念,重视术前康复程序的实施并将干预措施向院外延伸;所有患者随访均大于6个月,于出院时、术后3、6个月不同时间点,采用Harris髋关节功能评分量表及Barthel日常活动能力指数量表评价两组患者相关功能水平。结果综合康复组在术后3、6个月两个时间点的Harris及Barthel量表评分均优于常规康复组(均P<0.05)。结论综合康复干预措施可有效促进患者髋关节的功能恢复、改善患者的日常活动能力,对提高THR后患者远期预后具有重要价值。     

综合康复干预对全髋关节置换术后患者功能水平的影响

目的 探讨综合康复干预措施对全髋关节置换术后患者功能康复的作用。方法 将符合纳入标准的人工全髋关节置换术患者70例,等量随机分为两组,即实验组（35例）和对照组（35例）,对照组执行骨科常规治疗及护理,实验组在骨科临床治疗及躯体照护基础上, 以个体化原则设计康复干预计划,突出全程化功能锻炼指导的观念,重视术前康复程序的实施并将干预措施向院外延伸;所有病人随访＞6个月,于出院时、术后3个月、6个月不同时间点,采用Harris髋关节功能评分量表及Barthel日常活动能力指数量表评价两组患者相关功能水平。结果 实验组在术后3个月、6个月两个时间点的Harris及Barthel量表评分均优于对照组(P<0.05)。 结论 综合康复干预措施可有效促进患者髋关节的功能恢复、改善患者的日常活动能力,对提高全髋关节置换术后患者远期预后具有重要价值。     

居家模拟培训对老年髋关节置换患者康复效果的影响

目的探讨开展居家模拟培训提高老年髋关节置换患者康复的效果。方法按住院时间将老年髋关节置换患者162例分为对照组80例和观察组82例,对照组采取骨科常规护理方式进行康复指导,观察组在常规护理基础上由高级责任护士实施全程居家生活与出行路径的模拟培训。于入院时、术后1个月、3个月、6个月评价两组Harris髋关节功能评分与Barthel指数。结果观察组Harris髋关节功能评分及Barthel指数评分显著高于对照组(均P<0.01)。结论开展居家模拟培训有利于促进老年髋关节置换术后患者康复,提高日常生活能力。     

综合护理干预预防老年髋部骨折患者术后谵妄

目的探讨综合护理干预对老年髋部骨折术后谵妄的预防效果。方法将186例髋部骨折手术老年患者分为对照组94例、观察组92例。对照组行常规护理;观察组实施针对性综合护理干预措施,包括心理干预、疼痛管理、氧疗、视听觉及谵妄前兆的观察、睡眠管理,渐进式功能锻炼。结果观察组谵妄发生率及住院时间显著低于/短于对照组,患者满意率显著高于对照组(P0.05,P0.01)。结论对老年髋部骨折手术患者实施针对性综合护理干预能有效降低术后谵妄发生率,缩短住院时间,从而提高患者满意度。     

加速康复外科及图文式健康教育模式对老年腹股沟疝手术患者心理状态的影响

目的探究加速康复外科及图文式健康教育模式对老年腹股沟疝手术患者心理状态的影响。 方法前瞻性选取2020年1月至2021年10月西南医科大学附属医院收治的120例老年腹股沟疝手术患者,随机分为对照组和观察组,每组患者60例。对照组采用常规护理模式;观察组采用加速康复外科及图文式健康教育模式。观察2组患者术后恢复情况、术后疼痛程度、围手术期焦虑抑郁程度及满意度评价。 结果观察组患者肛门排气时间、肠鸣音恢复时间、下床活动时间以及住院天数均少于对照组（P<0.05）;观察组患者术后6 h及出院时疼痛视觉模拟评分均低于对照组（P<0.05）;出院时,2组患者汉密尔顿焦虑量表和抑郁量表评分均明显降低,且观察组降低程度明显优于对照组（P<0.05）。观察组患者非常满意度（41.67%）及满意度（90.00%）均明显高于对照组（23.33%,75.00%）,差异均有统计学意义（P<0.05）。 结论加速康复外科及图文式健康教育模式应用于围手术期能有效控制老年腹股沟疝患者疼痛程度,缩短患者住院时间,促进患者术后恢复,并能有效调节患者心理状态,缓解其焦虑抑郁情绪。     

肢体功能锻炼八步操在脑卒中患者早期康复训练中的应用

目的探讨肢体功能锻炼八步操对脑卒中患者运动功能及生活自理能力的影响。方法将212例脑卒中患者按住院单双日分为干预组(110例)和对照组(102例)。对照组给予脑卒中常规护理,干预组在此基础上采用肢体功能锻炼八步操进行康复锻炼。结果两组患者干预28d后运动功能(Fugl-Meyer评分)、生活自理能力(Barthel指数)和神经功能缺损(NIHSS)评分较干预前显著改善(均P0.01);干预组干预后3项评分显著优于对照组(均P0.01)。结论肢体功能锻炼八步操对脑卒中患者肢体运动功能、生活自理能力及神经功能的的恢复有良好的促进作用。     

老年痴呆患者基于精神运动康复学理论的干预

目的探讨基于精神运动康复学理论的干预对老年痴呆患者认知、生活自理能力及抑郁的影响。方法将44例老年痴呆患者按时间段分为观察组21例和对照组23例,两组患者均接受常规护理,观察组在此基础上进行为期24周的基于精神运动康复学理论的干预,包括多元运动计划、多感官刺激疗法、改善生理障碍和改善心理障碍4个方面。分别在干预前、干预后采用简易智能状态量表(MMSE)、Barthel指数和康奈尔痴呆抑郁量表(CSDD)进行效果评价。结果干预后,观察组MMSE的记忆力、回忆能力、语言及视空间能力得分和Barthel指数得分显著高于对照组,抑郁得分显著低于对照组(P<0.05,P<0.01)。结论基于精神运动康复学理论的干预有助于改善老年痴呆患者部分认知功能和日常生活活动能力,减轻抑郁症状。     

ICU and critical care outreach for the elderly

Average life expectancy has increased over the past century resulting in a shift in world population demographics. There are more elderly people alive now than throughout all of human history. The burden of comorbid disease and dependency rises with age and has been shown to independently predict need for hospitalization, institutionalization and mortality. Accordingly, there are more elderly persons living longer in more tenuous states of health. The relative proportion of patients admitted to hospital and intensive care who are elderly is considerable and recent data have suggested an increasing trend. There is likely significant selection bias amongst elderly patients triaged for access to finite critical care services. In fact, data have shown that elderly patients often receive less intensive therapy and have greater support limitations when admitted to an intensive care environment. "Chronologic" age has been an inconsistent predictor of prognosis in elderly patients who present with critical illness. However, surrogate measures of "physiologic" age are likely more relevant, such as an assessment of frailty, to aid in prognostication and informed decision-making and that ultimately correlate not only with short-term survival but additional outcomes such as functional status, institutionalization and quality of life after an episode of critical illness. There is a paucity of literature on the specific interaction of rapid response systems (RRS) and hospitalized "at-risk" elderly patients; however, the RRS may have particular application for this cohort. In particular, data have emerged to suggest mature ICU-based RRS respond commonly to elderly patients and are increasingly participating in end-of-life care discussions. In addition, another aspect of the RRS, critical care outreach (CCO), may facilitate the identification of elderly patients for timely goal-oriented advanced care planning prior to clinical deterioration.     

Quality of life after radical prostatectomy in elderly men

Objectives:   To evaluate the impact of radical prostatectomy (RP) on health-related quality of life (HRQOL) in elderly men with prostate cancer.
Methods:   Between January 2002 and December 2006, a total of 205 elderly men (≥70 years) undergoing RP participated in our longitudinal outcome study. Patients completed general (Short Form 36) and disease-specific (University of California, Los Angeles Prostate Cancer Index) HRQOL questionnaires. A t-test was used to compare each HRQOL score after RP with the baseline scores and Cox proportional hazard models to characterize the recovery trends.
Results:   Patients undergoing RP showed physical problems, which diminished over time. Several emotional domains significantly improved during the follow-up period. By 2 years postoperatively, 57% and 81% of subjects had fully returned to baseline urinary function and bother, respectively. Mean recovery time to baseline urinary function and bother was 8.3 months and 4.7 months, respectively. When incontinence was defined as 'no pad', 82% of patients reported continence. Whereas only 25% of patients returned to the baseline sexual function level, 83% had reached baseline sexual bother. Among those returning to their own baseline scores, the mean recovery time was 10.9 months for sexual function and 5.3 months for sexual bother.
Conclusions:   Selected elderly patients can achieve satisfactory functional outcomes after RP. These outcomes should be considered when decisions about treatment are made.     

Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial

Aim The aim of the study was to evaluate the efficacy and safety of fast‐track rehabilitation in elderly patients over 65 years of age, following laparoscopic surgery to remove colorectal cancer. Method A total of 78 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast‐track care programme (n = 40) or the conventional perioperative care protocol (control group, n = 38). Medical personnel conducting the study were blinded to patients’ clinical outcomes prior to statistical analysis. The fast‐track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. Results The length of time to regain bowel function, including the passage of flatus[31 (26–40) h vs 38 (32–51) h, P = 0.001], to the first bowel movement [55 (48–63) h vs 64 (48–71) h, P = 0.009] and to start a liquid diet (12 [11–16] h vs 47 [35–50] h, P = 0.000) were significantly shorter in patients receiving the fast‐track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast‐track program than in those receiving conventional care (P = 0.0001). A reduced percentage of patients who developed general complications was also observed in the fast‐track group (5.0%vs 21.1%, P = 0.045). Conclusion This randomized controlled trial has shown that in the elderly undergoing laparoscopic colorectal surgery, the fast‐track recovery programme resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol.     

基于4Ms理论的老年食管癌患者围术期支持性照护方案的构建与应用

目的 基于4Ms理论构建老年食管癌患者围术期支持性照护方案并评价应用效果。方法将108例拟行食管癌根治术的老年食管癌患者按入院时间分为对照组55例和试验组53例。对照组行常规围术期护理，试验组构建并实施基于4Ms理论的老年食管癌患者围术期支持性照护方案。结果试验组胸腔引流管留置时间、术后首次排气和排便时间、术后住院时间显著短于对照组（均P＜0.05）；试验组出院前生活质量总分显著高于对照组（P＜0.05）。结论基于4Ms理论的老年食管癌患者围术期支持性照护方案的应用，可促进老年患者康复并改善术后早期生活质量。