A health monitoring system for elderly people living alone

We have developed a health monitoring system for elderly people living alone. We monitored the in-house movements of eight subjects (average age 81 years) by placing infrared sensors in each room of their homes. Because their movements were unrestricted, monitoring could last longer than other forms of monitoring. Continuous monitoring was performed for 80 months in total. We found that each subject had a specific pattern of movements. We estimated their health condition by comparing the duration of stays in specific rooms, such as the lavatory, with previously recorded data. If after analysis an unusual state was detected, we informed the family of the incident. Final decisions should be made by the family members, not automatically by computer software. For example, after contacting the subject or a neighbour by telephone, family members could call for an ambulance or arrange a visit by a doctor or home help. Thus, this system reduced anxiety for both the elderly subjects living alone and their family members.     

Burden and trends of activities of daily living disability in elderly Spanish people

BACKGROUND: The progressive increase in population aging, specially evident in Spain, remark the importance to estimate the volume and the prevalence trends of dependency in the 65 years and over Spanish population. METHODS: The dependency volume was calculated applying the 1993 and 1999 estimated prevalences in the longitudinal study "Aging in Leganes" to the Spanish population of 1991 and 2001. A random study sample of 1560 subjects 65 years was selected in 1993 in the city of Leganes (Madrid). Response rate at baseline was 82% (n = 1283). New information was collected in 1995 (n = 827), 1997 (n = 666) and 1999 (n = 475). Dependency was defined as needing help in at least one of eight Activities of Daily Living ADL. A multilevel model for repeated measures was fitted regressing ADL dependency on age, sex, education and survey year. RESULTS: There is a decline in ADL dependency by age in both, men and women. At advanced ages, this trend is reversed and there is an apparent increase in dependency. The prevalence is higher in women and in low educated subjects. The total number of ADL dependent people increased from 903,276 to 995,338 from 1991 to 2001 although the average age of dependent older people increased. CONCLUSIONS: Postponement of disability means longer healthy life expectancy and increasing volumes of very elderly disabled people, particularly women. Consequences for health, labour reform and social security systems can be very important.     

Food accessibility and perceptions of shopping difficulty among elderly people living alone in Japan

Objectives

This aim of this study was to describe the association between shopping difficulty and food accessibility for elderly people living alone in Japan.

Design

A cross-sectoral, multilevel survey was designed to measure shopping difficulty from a food accessibility perspective. The questionnaire was distributed by mail.

Setting

The sample was drawn from seven towns and cities across Japan.

Participants

A geographic information system was used to select the sample: it identified the proximity of elderly people living alone to a supermarket. In total, 2,028 elderly people (725 men and 1,303 women) responded to the questionnaire.

Measurements

The binary dependent variables were shopping is easy/shopping is difficult. A logistic regression analysis adjusting for age and area of residence and using stepwise variable analyses was performed.

Results

The response rate was 58.6%. Overall, 14.6% of elderly men and 21.7% of elderly women consider shopping difficult. The stepwise logistic analysis showed that the food accessibility factors strongly related to shopping difficulty are infrequent car use (women: OR = 6.97), walking difficulties (men: OR = 2.81, women: OR = 3.48), poor eyesight (men: OR = 2.26, women: OR = 1.75), not cooking lunch by oneself (men: OR = 1.63, women: OR = 1.72), not having anyone to help with food shopping (women: OR = 1.45) and living over 1 km away from a supermarket (men: OR = 2.30, women: OR = 2.97).

Conclusion

The study concludes that elderly people’s assessment of shopping difficulty is related to their food accessibility. Important food accessibility aspects include car or motorbike ownership, walking continuously for 1 km, poor eyesight, and having cooking skills and having someone to help with shopping. These physical activity restrictions have a greater influence on shopping difficulty than do either income or proximity to a supermarket.

     

我国独居老人自评健康状况及其影响因素研究

目的 了解影响我国独居老人自评健康状况的影响因素,为改善我国独居老人健康及生活质量提供参考依据。方法 通过自评问卷调查方法,采用2018年中国老年健康影响因素跟踪调查（CLHLS）数据,了解独居老人健康状况,采用卡方检验以及多因素logistic 回归方法分析独居老人健康状况的影响因素。结果 1236名独居老年人中,自评健康较好的有551人,占比44.6%,较差的685人,占比55.4%;子女经常看望（OR =1.840,95%CI:1.080~3.135)、体育锻炼（OR =1.813,95%CI:1.385~2.372)、饮酒（OR =1.531,95%CI:1.061~2.209）、体检（OR =1.347,95%CI:1.033~1.756）、慢性病(OR =0.682,95%CI:0.532~0.875)、霉味(OR =0.533,95%CI:0.391~0.726)、睡眠6~9小时（OR =0.528,95%CI:0.393~0.710）、睡眠时间>9小时（OR =0.411,95%CI:0.283~0.597）与独居老人自评健康有关。结论 我国独居老人自评健康状况总体较差。应重视独居老人的子女关怀、生活行为方式、居住环境及慢性病状况等,更好地改善独居老人的健康状况。     

Non-invasive monitoring of the activities of daily living of elderly people at home--a pilot study of the usage of domestic appliances

We conducted a feasibility study of a system for non-invasive monitoring of subjects at home. Electrical activity was recorded from room lights and from electrical domestic appliances; this was translated into the probability of physical activity or a particular Activity of Daily Living (ADL). Thirteen volunteer subjects were monitored for a period of 6.4 months (range 3-8). The mean age of the subjects was 80 years and they all lived alone at home; one had moderate Alzheimer's disease. A one-week validation was carried out to ascertain whether the recorded activity actually occurred. The results showed that daily and nocturnal activity could be well differentiated. The probability of having eaten, taken a bath and going to the toilet could be calculated each day. Eating was the most accurately measured ADL; toileting and bathing results were less accurate. The system appears to be a promising component of home telecare.     

Demographic determinants for change in activities of daily living: a cohort study of the elderly people in Beijing

To describe changes in activities of daily living (ADL) of community-dwelling Beijing elderly people, observed for 8 years, and to identify the demographic characteristics that predict the functional change. Four sets of interview data from 1992 to 2000 were used to evaluate changes among Beijing elderly aged 55 years and over. Results revealed that prevalence of disability increased from 3.9% to 7.1% during the 8 years of follow-up with the average increasing rate of disability was 0.41% per year. Meanwhile an increasing likelihood of recovery from disability is observed with age and time. Women, aged 75 or more, experienced higher disability than men though it was in the opposite for younger ages. In addition, certain demographic subgroups (such as women, unmarried, illiterate and living in non urban area) appeared to be at higher risk for ADL impaired. The patterns of ADL change is in both the direction of improvement and declination. Demographic variables emerged as a significant predictor in estimating functional outcomes. Furthermore, it is recommended that the demarcation factor for the evaluation of ADL should be 75 years of age.     

济南市城市社区不同自理能力老年人养老意愿及其影响因素

目的 了解山东省济南市城市社区不同自理能力老年人的养老意愿及其影响因素,为政府合理配置养老资源提供参考依据。方法 于2011年3月-2015年11月采用方便抽样方法在山东省济南市5个城市社区抽取887名父母和（或）配偶父母居住在济南市城区的≥40岁居民进行问卷调查,调查其居住在济南市城区的父母和（或）配偶父母共1381名老年人的养老意愿,分析不同自理能力老年人养老意愿的主要影响因素。结果 1 381名城市老年人中,完全自理者418人（30.3%）,基本自理者478人（34.6%）,部分自理者358人（25.9%）,不能自理者127人（9.2%）;期望“与子女同住,不雇人照料”者805人（58.3%）,期望“与子女同住,雇人照料”者151人（10.9%）,期望“不与子女同住,不雇人照料”者317人（23.0%）,期望“不与子女同住,雇人照料”者68人（4.9%）,期望“与子女同住,白天在日托中心”者17人（1.2%）,期望“住养老公寓”者23人（1.7%）;期望在家养老者1 341人（97.1%）,不期望在家养老者40人（2.9%）。多因素非条件logistic回归分析结果显示,年龄≥70岁和与（孙）子女同住的完全自理老年人更倾向于与子女同住,年龄≥70岁、无配偶、与（孙）子女同住和思维明显减退或混乱的基本自理老年人更倾向于与子女同住,经济不独立的不能自理老年人更倾向于与子女同住;文化程度高中或中专及以上和与其他人同住的基本自理老年人更倾向于雇人照料,无配偶的基本自理老年人更倾向于不雇人照料,男性和文化程度高中/中专及以上的部分自理老年人更倾向于雇人照料,经济不独立的不能自理老年人更倾向于不雇人照料。结论 与子女同住、不雇人照料是当前城市社区老年人的主流意愿,但随自理能力的下降,老年人养老意愿也有所改变;性别、年龄、文化程度、婚姻状况、居住方式、经济来源、思维能力是城市社区老年人养老意愿的主要影响因素。     

Food- and nutrition-related attitudes of elderly persons living alone

The objective of this study was to identify food- and nutrition-related attitudes of elderly persons living alone. We interviewed 66 individuals who were retired and 60 years of age or older. The instrument used to assess the attitudes consisted of 97 belief statements relating food and nutrition to food use, cost, convenience, health, social status, aesthetic-sensory perceptions, and quality. We analyzed the responses to all belief statements by factor analysis and calculated attitude scores for each respondent. Four salient attitude factors emerged and were labeled “social-adventuresome,” “frugal-utilitarian,” “qualitative-pleasurable,” and “nutritious-healthful.” Although these attitudes were predominant among the respondents, there was variation to what degree each respondent agreed or disagreed with each attitude factor, as measured by the respondent's attitude score. None of the attitude factors correlated with age. The identified attitude factors have been observed among other population groups, a finding that suggests that segmenting a population by chronological age instead of by needs is not the best approach to the development of a food and nutrition education program.     

中老年人日常活动能力变化与抑郁症状关系的研究

目的 研究中老年人日常活动能力变化与抑郁症状发生风险的关系。方法 选取"2011、2013年中国健康与养老追踪调查"中基线无抑郁症状、情感及精神方面问题和记忆相关疾病的≥ 45岁中老年人为研究对象,通过入户问卷调查和健康体检,收集人口学变量及健康状况功能等,采用简版流调中心抑郁水平评定量表评定抑郁症状,躯体生活自理量表和工具性日常生活活动能力量表测评日常活动能力。利用log-rank检验比较不同抑郁症状组躯体生活自理能力/工具性日常生活活动能力的变化差异。以是否为抑郁症状作因变量,利用Cox回归模型,分析日常活动能力变化与抑郁症状发生风险关系。结果 log-rank检验表明,不同躯体生活自理能力和工具性日常生活活动能力变化下,抑郁症状发生风险有差异,且差异具有统计学意义。Cox回归分析表明,躯体生活自理能力/工具性日常生活活动能力变差与抑郁症状发生风险显著相关（P<0.01）,相对于不变组,躯体生活自理能力和工具性日常生活活动能力变差组抑郁症状发生风险的HR值（95%CI）分别为1.45（1.20~1.76）和1.64（1.36~1.98）。农村中老年人躯体生活自理能力变差组其抑郁症状发生风险的差异有统计学意义（P<0.01）,而工具性日常生活活动能力在城乡间的差异均有统计学意义（P<0.01）。结论 中老年人日常活动能力变差与抑郁症状发生风险相关,躯体生活自理能力/工具性日常生活活动能力表现不同,且具有城乡差异。     

上海市闸北区社区独居老人居家致跌环境调查

目的通过对社区老年人居家环境进行安全性评估,促进居家致跌危险环境改造和降低老年人跌倒的发生提供依据。方法对上海市某社区2008年8月1日—2009年8月1日期间全部80岁以上独居老人共395户、481人进行居家致跌危险环境的入户评估和老年人跌倒情况回顾性调查。结果跌倒发生率为17.05%,发生次数发生率为24.32%,其中发生2次以上跌倒占32.93%,因跌倒住院占5.19%。居家致跌环境主要包括在地面或通道未使用防滑地砖(38.23%)、室内照明亮度不够(47.85%)、浴缸(淋浴房)未使用防滑垫(62.78%)和浴缸(淋浴房)旁未安装扶手(70.89%)等。结论独居老人是发生跌倒的高危人群,居家致跌环境因素增加了老人跌倒发生的风险,开展有针对性的居家危险环境评估其意义重大。     

An electronic medication reminder, supported by a monitoring service, to improve medication compliance for elderly people living independently

We conducted a pilot study of a personal medication reminder unit, supported by a monitoring service. A total of 31 elderly residents were offered the reminder service for a period of eight weeks (1736 person-days of service). A telephone call from the monitoring service was made after four weeks to check that each participant was happy with the service and keen to continue. No one opted out and users of the service found it easy to manage, helpful and acceptable. There was a significant improvement (P = 0.012) in the rate of self-assessed medication compliance, from pre (52%) to post (81%) service introduction. There was a significant improvement in people's perceived ability to look after themselves at home (self-care ability) (P = 0.001). The percentage of participants rating their ability to look after themselves at home as excellent increased from 42% to 68%. Health-related quality of life measures, such as physical and mental health, showed positive improvement, but the changes were not significant. The service has the potential to improve health and well-being outcomes for people on multiple medications living independently in the community.     

Determination of whether the association between serum albumin and activities of daily living in frail elderly people is causal

Objectives  

Serum albumin and activities of daily living (ADL) are associated with each other, but whether the association is causal is not known. The purpose of this study was to determine whether a causal association exists between serum albumin and ADL levels.     

北京市社区老年人群日常活动能力状况及城乡比较

目的 探讨北京市社区老年人群日常活动能力（ADL）状况及主要影响因素,并对城乡老年人群的差异进行比较。方法 2010－2014年在北京市海淀区万寿路地区和密云县巨各庄镇对社区≥60岁的老年人群进行两阶段分层整群随机抽样。结果 共纳入4 499名（其中男性1 815名,女性2 684名）社区老年人,年龄60～95（70.3±6.7）岁。相对于城市老年人,农村老年人文化程度较低（小学及以下85.2%）、吸烟（22.8%）、饮酒（43.1%）比例较高。共有87.9%的老年人生活完全自理,ADL受损（含不同程度功能障碍）情况农村（12.4%）高于城市（11.8%）,差异有统计学意义（P=0.039）。不同年龄组比较,ADL受损随年龄增加而显著增加（P<0.05）。多因素分析结果显示,除了城乡差异（P=0.031）,年龄（P=0.013）、文化程度（P=0.015）、体育锻炼（P=0.001）、患有脑卒中（P<0.001）等均是影响ADL受损的重要因素。结论 北京市社区老年人群ADL受损率相对较低,农村高于城市,年龄、文化程度、体育锻炼、患有脑卒中等均与ADL受损有关。     

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。     

De-institutionalization and ageing: some results from monitoring the effects in an area-based system of long-term care for elderly people and people with disabilities

This paper illustrates the usefulness of regular monitoring for an area-based system of long-term care for elderly people and people with a disability by presenting data which describe the combined effects of de-institutionalization and population ageing. Data were collected between 1985 and 1989 in Solna, Sweden by means of annual surveys involving registraion of received services and assessment of needs and disability. The sample, (n=2026 year 1, n=1755 year 5), were all the residents of Solna, who, on the day of the survey, were in receipt of long-term public medical and/or social services care from the public sector. Data were collected on demographic variables, actual and appropriate levels of care. The class of disability was based upon five different measures of disability. The number of long-term care hospital and nursing home beds were reduced by 23% whilst the number of people aged over 85 in the area increased by 31%. This development had effects on all levels of care. Actual development of resources fell short of those projected according to population trends, by 15–35% depending on level of care. The proportion of clients, who were ‘under-served’, in the sense that they received a lower level of care than assessed as appropriate by the responsible staff, more than doubled during the period-increasing from 10(n=2026) to 21% (n=1755). Domiciliary services were actually reduced and concentrated on fewer clients with more severe disabilities. There was a general increase in the prevalence and severity of disability in all levels of care except sheltered housing. Incontinence showed the most rapid increase. The findings of this study demonstrate the importance of providing decision-makers with quantitative data which reflect trends in population needs.     

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。     

Scale for assessing interests of Japanese elderly people in their daily life

OBJECTIVE: Programs to support independent living for elderly people are generally designed taking into account physical and psychological conditions. The interests of individuals are diverse even when the physical conditions are the same. Interests in daily life are important factors for adequate planning of the programs for independent living. The purpose of this study was to examine an evaluation structure of interests of Japanese elderly people in their daily life. METHODS: Focus group interviews were conducted to collect items for interests in daily life by several researchers targeting activity groups of elderly people. Eighteen items were extracted from a total of 50 following the principles: (1) Items with similar meanings are brought together; (2) Items which might have big differences in meaning depending on the subject were excluded; and (3) Items which were double barreled were excluded. The questionnaire 18 items were designed to give a 4-point Likart scale for answers from "very important" to "not important at all". The survey was conducted in 20 municipalities all over Japan in 2000. From residents aged 65 years and over, 6,094 individuals were selected randomly as the study population. RESULTS: Of 5,565 participants, 4,527 individuals answered all 18 items. "To have a good time with the family" was the favorite answer (54.8%), rated as "very important". Four factors (eigenvalue > 1) were extracted by applying principal component analysis: "to live with good communication", "to achieve one's purpose", "to live socially", and "to live comfortably". "To live with good communication" showed the highest score and "To live socially" showed the lowest score. CONCLUSION: With this scale, we could precisely determine the diversity of interests of Japanese elderly people in their daily life. We suggest that this scale might be useful not only to analyze the interests of individuals, but also to plan programs in terms of quality of life or independent living in late life.