家庭参与老年人机构养老的干预研究进展

老年人入住养老机构后,家庭成员的参与对改善老年人身心健康、提升其养老生活质量发挥着不可替代的作用.本文对家庭参与老年人机构养老的内容及其干预进行综述,旨在为实施家庭参与老年人机构养老的干预提供参考.     

社会养老机构老年人主观幸福感及相关因素研究

目的 探讨社会养老机构老年人主观幸福感(SWB)及其相关影响因素.方法 采用自制问卷、纽芬兰大学幸福度量表(MUNSH)对西安市城区20所社会化养老机构的462名老年人的SWB进行调查,并分析人口社会因素、负性生活事件等对老年人SWB的影响.结果 社会养老机构老年人的MUNSH总分32.93±12.23,高SWB水平者246名(53.25%),低SWB水平者47名(10.17%),不同性别、年龄、婚姻状况老年人的SWB比较,差异无显著性意义(均P＞0.05).多元逐步回归分析结果表明,养老机构老年人SWB的主要影响因素排序依次为:个性、经济状况自评、在社会家庭中地位、健康恶化、对养老公寓满意度、子女就业困难、体育锻炼.结论 社会养老机构老年人SWB不容乐观,应采取针对性措施提高其SWB水平.     

养老机构老年人家庭支持需求问卷的编制与信效度检验

目的 研制适用于我国养老机构老年人的家庭支持需求问卷,检验其信效度。 方法 基于社会支持理论及护-患沟通模型,经文献研究、半结构式访谈、小组讨论、德尔菲专家函询构建45个条目的养老机构老年人家庭支持需求初始问卷;抽取334名养老机构老年人及遴选6名专家进行信效度检验。 结果 养老机构老年人家庭支持需求问卷为38个条目4个公因子,累积方差贡献率为64.268%;内容效度为0.927;问卷Cronbach′s α系数为0.962,重测信度为0.952,折半信度为0.836。 结论 本问卷具有良好的信度和效度,可用于养老机构老年人家庭支持需求的测评。     

养老机构老年人抑郁情绪发展轨迹及预测因素分析

目的探讨养老机构老年人抑郁的异质性发展轨迹类型,并分析日常生活活动能力(ADL)对抑郁发展轨迹的预测作用。方法采用纵向研究设计,对符合条件的296名养老机构老年人采用Barthel指数评定表、患者健康问卷-2(PHQ-2)、社会网络量表对ADL、抑郁和社会支持进行调查,并在6个月、12个月随访抑郁发生情况。结果养老机构老年人抑郁患病率基线调查为14.9%(44/296),第1次随访为20.9%(51/244),第2次随访为17.2%(36/209);以完成2次调查的250人为样本拟合出2条老年人抑郁的异质性轨迹,即高风险(14.8%)和低风险(85.2%);年龄、既往职业、ADL得分影响其抑郁发展轨迹(P0.05,P0.01)。结论养老机构老年人抑郁存在异质性轨迹,ADL低者抑郁呈恶化趋势。应关注机构老年人日常生活能力的锻炼,减少抑郁的发生。     

养老机构非卧床老年人衰弱影响因素的路径分析

目的探讨养老机构非卧床老年人衰弱的影响因素,并进行路径分析。方法采用一般情况问卷、养老机构老年人衰弱评估问卷、简明精神状态量表、老年抑郁量表对上海市9所养老机构中符合纳入排除标准的218名老年人进行调查。结果养老机构非卧床老年人的衰弱总分为(55.02±11.75)分,各维度按其条目均分从高到低排序为:心理维度、生理维度、社会维度。路径分析显示,抑郁评分、活动情况、认知评分、睡眠情况、患病情况、文化程度及婚姻状况直接或/和间接影响老年人衰弱(总效应依次为0.59、-0.42、-0.27、0.21、0.17、-0.15、0.09)。结论养老机构非卧床老年人存在不同程度的衰弱,其衰弱受多种因素影响,养老机构应采取积极措施,延缓老年人衰弱的进展。     

社会养老机构老年人主观幸福感及相关因素研究

目的探讨社会养老机构老年人主观幸福感（SWB）及其相关影响因素。方法采用自制问卷、纽芬兰大学幸福度量表（MUNSH）对西安市城区20所社会化养老机构的462名老年人的SWB进行调查，并分析人口社会因素、负性生活事件等对老年人SWB的影响。结果社会养老机构老年人的MUNSH总分32.93士12.23，高SWB水平者246名（53.25％），低SWB水平者47名（10.17％），不同性别、年龄、婚姻状况老年人的SWB比较，差异无显著性意义（均P〉0.05）。多元逐步回归分析结果表明，养老机构老年人SWB的主要影响因素排序依次为：个性、经济状况自评、在社会家庭中地位、健康恶化、对养老公寓满意度、子女就业困难、体育锻炼。结论社会养老机构老年人SWB不容乐观，应采取针对性措施提高其SWB水平。     

老年人入住养老机构体验及影响因素调查

目的了解老年人养老机构入住体验现状及其影响因素,为养老机构照护服务改进以提升照护质量和老年人生活质量提供依据。方法采用横断面调查方法,方便抽取5家医养结合型养老机构的老年人202人,采用自行设计的老年人养老机构入住体验问卷进行调查。结果医养结合型养老机构老年人入住体验总得分为73～150(123. 82±17. 39)分,各维度得分由高到低依次为可靠性、有形性、保证性、关怀性、连续性。年龄、月收入、亲人支持程度、子女个数对老年人入住体验有显著影响(P 0. 05,P 0. 01)。结论老年人对养老机构入住体验评价较好,但在人文关怀性和医疗连续性上有待加强。亲人支持程度能在很大程度上提升老年人的入住体验,养老机构需提供条件促进子女与老年人的联系,以提升老年人的生活质量。     

养老机构老年人营养不良现状及影响因素分析

目的 了解养老机构老年人营养不良现状,分析其影响因素,为针对性干预提供参考.方法 采用基本信息调查表、老年人营养素养问卷、老年人营养不良风险评估表对重庆市8所养老机构的201名老年人进行调查.结果 老年人营养不良风险评分(22.07±3.81)分;其中营养不良24名,存在营养不良风险95名,营养良好82名.logist...     

养老机构老年人主观认知下降现况及影响因素研究

目的 了解养老机构老年人主观认知下降现况,并分析其影响因素,为制订相关干预措施提供参考。方法 选取广州市2所养老机构的212名老年人为研究对象,采用主观认知下降问卷、基础版蒙特利尔认知评估量表、日常生活能力量表、Hachinski缺血指数量表、匹兹堡睡眠指数量表、广泛焦虑障碍量表、病人健康问卷抑郁自评量表进行调查。结果 86名(40.57%)老年人存在主观认知下降。高龄、焦虑及抑郁症状是养老机构老年人主观认知下降的危险因素,饮茶是其保护因素。结论 养老机构老年人主观认知下降发生率较高,养老机构医务人员应重视早期认知筛查,关注老年人心理健康。     

养老机构老年人家庭参与的研究进展

介绍家庭参与的概念和发展,阐明家庭参与对机构老年人身心健康发挥积极作用,简述老年人机构养老后家庭成员角色的变化,深入探讨养老机构老年人家庭参与的具体内容,全方面分析家庭参与的影响因素,旨在明析养老机构老年人家庭参与机制和内涵,以提高机构老年人的晚年生活质量。     

A systematic review of social support and related factors among burns patients

Burn injuries, as a major public health problem, can lead to high morbidity and mortality. Burns is considered as one of the most devastating injuries globally and the fourth most common injury after traffic accidents, falls and interpersonal violence. Burn injuries can affect human life, such as physical and mental health, functional skills, and performance. Changes in appearance, social isolation, stress, anxiety, depression, low self-esteem, unemployment, financial burden and family problems can occur in these patients. These burn complications can be exacerbated without adequate social support. This systematic review evaluated burn patients' social support and related factors. A systematic search was performed on the international electronic databases such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as ‘Burns’, ‘Social support’, ‘Perceived social support’ and ‘Social care’ from the earliest to 30 April 2022. The quality of the included studies in this review was assessed using the appraisal tool for cross-sectional studies (AXIS tool). A total of 1677 burn patients were included in this review from 12 studies. Mean score of social support in burn patients based on multidimensional scale of perceived social support, Phillips's social support questionnaire, social support questionnaire, social support scale and Norbeck social support questionnaire were 5.04 (SD = 1.59) of 7, 22.06 (SD = 3.05), 78.20 (SD = 15.00) of 95, 82.24 (SD = 13.70) and 4.14 (SD = 0.99), respectively. Factors such as income, educational attainment, burn surface area, reconstructive surgery, quality of life, self-esteem, socialisation, posttraumatic growth, spirituality, and ego resilience had a significant positive relationship with social support of burns patients. Social support in patients with burn had a significant negative relationship with factors such as psychological distress, having children, life satisfaction, neuroticism and post-traumatic stress disorder. Overall, patients with burns had moderate levels of social support. Therefore, it is recommended that health policymakers and managers make it easier for burn patients to adapt to burns by providing psychological intervention programs and the social support needed by burn patients.     

社会参与视角下养老机构适老宜居评价体系的构建

目的 构建养老机构适老化宜居环境评价指标体系,为养老机构适老宜居环境评价提供工具。方法 基于文献检索建立指标库,运用DPSIR模型法提取并梳理初始指标体系,通过Delphi法对专家进行2轮函询并确定指标,应用优序图法、G1法、决策实验室法组合赋权确定各指标权重。结果 2轮函询的专家积极系数分别为90.91%、90.00%,专家权威系数分别为0.72、0.72,协调系数分别为0.112、0.298(均P<0.05)。构建的指标体系包含社区水平、社区设施、老年人主观属性、老年人人际关系、社区服务、社区活动、老年人心理状态、老年人老化态度、制度政策9个一级指标和36个二级指标。结论 建立的评价指标体系综合考虑了养老机构客观环境与老年人自身主观感受,可用于养老机构及其他以社区为单位的组织适老宜居环境的评价,以建立优质养老机构,促进老年人社会互动、参与社会活动。     

社会参与视角下养老机构适老宜居评价体系的构建

目的 构建养老机构适老化宜居环境评价指标体系,为养老机构适老宜居环境评价提供工具。 方法 基于文献检索建立指标库,运用DPSIR模型法提取并梳理初始指标体系,通过Delphi法对专家进行2轮函询并确定指标,应用优序图法、G1法、决策实验室法组合赋权确定各指标权重。 结果 2轮函询的专家积极系数分别为90.91%、90.00%,专家权威系数分别为0.72、0.72,协调系数分别为0.112、0.298（均P＜0.05）。构建的指标体系包含社区水平、社区设施、老年人主观属性、老年人人际关系、社区服务、社区活动、老年人心理状态、老年人老化态度、制度政策9个一级指标和36个二级指标。 结论 建立的评价指标体系综合考虑了养老机构客观环境与老年人自身主观感受,可用于养老机构及其他以社区为单位的组织适老宜居环境的评价,以建立优质养老机构,促进老年人社会互动、参与社会活动。     

乳腺癌术后化疗患者社会限制现状及影响因素研究

目的 调查乳腺癌术后化疗患者社会限制现状并分析其影响因素，为制定针对性护理干预策略提供参考。 方法 以便利抽样法选取湖北省武汉市2所三级甲等医院的214例乳腺癌患者，采用一般资料调查表、社会限制量表、社会影响量表、情绪抑制量表及癌症患者自我管理效能量表进行调查。 结果 乳腺癌术后化疗患者社会限制总分为26.20±7.40；乳腺癌术后化疗患者的社会限制与社会影响、情绪抑制呈正相关，与癌症自我管理效能感呈负相关（均P＜0.05）。 多元线性回归分析显示，社会影响、年龄、文化程度和家庭人均月收入是乳腺癌术后化疗患者社会限制的主要影响因素（均P＜0.05），可解释总变异的48.80%。 结论 乳腺癌术后化疗患者感知社会限制处于中等偏下水平，感知社会限制受多因素影响。医护人员需特别关注年轻、低收入、高文化程度乳腺癌患者社会限制的评估，采取针对性干预措施，降低患者的社会限制水平，促进其身心健康。     

乳癌患者社会支持与生活质量的相关性研究

目的了解社会支持与乳癌患者生活质量的关系，据其结果提出护理对策，以提高患者生活质量。方法对80例乳癌患者进行生活质量和社会支持问卷调查，分析其相关性。结果乳癌患者情感状况、功能状况、附加关注得分较低，可获得的社会支持较高；社会支持与其生活质量呈显著正相关（P〈0．05，P〈0．01）。结论社会支持与乳癌患者的生活质量密切相关，护理过程中重视社会支持系统可以改善护理效果，提高乳癌患者的生活质量。     

The experiences of individuals with a traumatic brain injury, families, physicians and health professionals regarding care provided throughout the continuum

Primary objective: To investigate the experiences of individuals who had sustained a traumatic brain injury, their families and the physicians and health professionals involved, from the critical care episodes and subsequent rehabilitation.

Research design: Semi-structured interviews were conducted with individuals who had sustained a TBI (n = 8) and their families (n = 8) as well as with the health professionals (or service providers) (n = 22) and physicians (n = 9) who provided them care.

Main outcomes and results: Results revealed the difficulties encountered by the different people involved, from the standpoint of the readjustment of the individual with the TBI and their family, the relationships among the various actors and the continuity of care.

Conclusions: This study brings to light the importance of including the family and the person with a TBI in the care process by calling for their participation and by setting up suitable structures that prioritize a meaningful partnership among the key individuals.     

消化性溃疡病患儿的社会参与护理

目的：寻求学龄消化性溃疡病患儿有效的治疗、护理措施。方法：将62例消化性溃疡病患儿分为对照组（30例）和护理组（32例）。对照组采用常规药物治疗；护理组在常规治疗的基础上，指导家长和老师参与护理。观察6个月，比较两组治疗效果。结果：两组患儿症状消失和治愈时间比较，均P＜0．05，差异有显著性意义。结论：医护人员在对患儿进行药物治疗的同时，指导家长主导式护理和老师协同式护理，有助于儿童消化性溃疡病的治疗，促进患儿早日康复。     

Trajectories of re-engagement: factors and mechanisms enabling patient return to HIV care in Zambia

Introduction

While disengagement from HIV care threatens the health of persons living with HIV (PLWH) and incidence-reduction targets, re-engagement is a critical step towards positive outcomes. Studies that establish a deeper understanding of successful return to clinical care among previously disengaged PLWH and the factors supporting re-engagement are essential to facilitate long-term care continuity.

Methods

We conducted narrative, patient-centred, in-depth interviews between January and June 2019 with 20 PLWH in Lusaka, Zambia, who had disengaged and then re-engaged in HIV care, identified through electronic medical records (EMRs). We applied narrative analysis techniques, and deductive and inductive thematic analysis to identify engagement patterns and enablers of return.

Results

We inductively identified five trajectories of care engagement, suggesting patterns in patient characteristics, experienced barriers and return facilitators that may aid intervention targeting including: (1) intermittent engagement;(2) mostly engaged; (3) delayed linkage after testing; (4) needs time to initiate antiretroviral therapy (ART); and (5) re-engagement with ART initiation. Patient-identified periods of disengagement from care did not always align with care gaps indicated in the EMR. Key, interactive re-engagement facilitators experienced by participants, with varied importance across trajectories, included a desire for physical wellness and social support manifested through verbal encouragement, facility outreach or personal facility connections and family instrumental support. The mechanisms through which facilitators led to return were: (1) the promising of living out one's life priorities; (2) feeling valued; (3) fostering interpersonal accountability; (4) re-entry navigation support; (5) facilitated care and treatment access; and (6) management of significant barriers, such as depression.

Conclusions

While preliminary, the identified trajectories may guide interventions to support re-engagement, such as offering flexible ART access to patients with intermittent engagement patterns instead of stable patients only. Further, for re-engagement interventions to achieve impact, they must activate mechanisms underlying re-engagement behaviours. For example, facility outreach that reminds a patient to return to care but does not affirm a patient's value or navigate re-entry is unlikely to be effective. The demonstrated importance of positive health facility connections reinforces a growing call for patient-centred care. Additionally, interventions should consider the important role communities play in fostering treatment motivation and overcoming practical barriers.