对老年病人医疗康复的探讨

对老年病人医疗康复的探讨常芬，郑曙峰随着物质生活的改善，老年人口逐渐增加，离退休干部也逐年增多，老年病人的医疗康复问题愈来愈显得突出和重要。如何采取科学的对策，做好老年人的医疗和康复工作，是摆在我们医疗保健工作者面前的一个重要课题。本文试对这个问题作...     

日本老年人医疗保健制度

日本国民的平均寿命在世界上最长,2008年男性平均寿命79岁,女性为86岁,其原因除了清洁的自然环境外,主要得益于日本建立了独特的老年人医疗保健制度,为老年人提供医疗保健服务.该保健制度不同于国民医疗保险,也不同于日本的介护保险制度,是针对老年人的独立的医疗保健制度.随着日本老年人口的快速增长,老年人医疗费用占全体国民医疗费用的比例达到1/3,老年人的医疗保健问题已经引起日本政府的高度关注.我们在此介绍日本老年人医疗保健制度的发展过程、内容、改革措施及存在的问题,旨在为建立我国的老年人医疗保健制度提供参考.     

利用乡镇卫生院资源优势 构建农村老年医疗保健服务体系

人口老龄化趋势的快速发展,带来了一系列社会问题,其中老年医疗保健工作成为人们关注的焦点,尤其是广大农村老年人医疗保健更是一大难点。目前我国尚未建立起一套行之有效的老年医疗保健服务体系。在当前形势下,如何做好农村老年医疗保键工作,笔者认为应充分利用乡镇卫生院现有资源优势,发挥其主导作用,构建具有农村特点的老年医疗保障服务体系。 1 人口老龄化现状及老年医疗保健问题 人口老龄化是经济发展的必然结果,人口发展的普遍规律,社会文明进步的具体表现,但对医疗卫生事业却是一项巨大挑战。一是老年人患病率高,尤其是慢性病患者多,全     

云南省城市社区老年人医疗保健现状及对策

１９９９年１０～１１月,我们对云南省部分城市６０岁及以上老年人医疗保健状况进行现状研究。结果显示：城市老年人两周患病率为３２．１％,慢性病患病率为８０．６６％;两周就诊率为２７．００％,一年住院率为２８．１０％;医疗费用过高、报销困难成为影响老年人医疗保健服务利用的重要因素,建议：建立健全医疗保健保障制度;完善老年卫生服务网络,开展社区老年医疗保健服务;加强健康教育。提高自我保健能力。     

中间设施与老年医疗保健体系的改革

关于我国老龄人口增加的对策,大家谈得较多的是医疗技术和设备的问题。在老年医疗保健体系方面的讨论还不多见。笔者结合对武汉市老年人医疗现状的调查,谈一点粗浅的看法。     

湖南省老年医疗保健问题研究

人口老龄化给湖南的社会经济发展和老年医疗保健带来了重大影响，作者对湖南老年人的医疗保健情况进行了抽样调查和分析，并为解决老年医疗保健问题提出了相应的对策。     

我国城市社区老年医疗保健服务

为了探索城市社区老年医疗保健服务的有效途径,特介绍两种城市社区老年医疗保健服务模式,供各地参考。①社区老年医疗保健的三级监护。即将社区内的全部老年人,根据其生活自理能力、年龄、患病情况,划分为一、二、三级监护对象,分别提供不同的医疗保健服务。②社区老年医疗保健的三段服务。即根据疾病发展的过程。在患病阶段提供医疗服务,对疾病的恢复期、慢性病的迁延期和残疾患者提供康复服务,对预后不良的重危患者和老年多器官衰竭患者提供临终关怀服务。搞好社区老年医疗保健必须得到街道办事处和有关部门的支持,必须得到市、区两级政府和有关部门的支持,必须健全三级医疗保健网,充分发挥地段医院的作用。     

老年社区护理浅探

随着社会变革、经济发展、科学进步及医疗水平的提高,人类平均寿命不断延长,老年人口逐渐增加,有资料显示,我国在1999年时60岁以上老年人就达到了1.29亿,占总人口的10.15%,已经步入了老龄化社会[1]。随着老年人口的增多,老年人问题已成为当今社会的重要问题之一。单纯的老年人口增加并不代表问题的所在,关键在于老年人群所展现的特殊需求增加,如社会福利、养老保险、家庭照顾、医疗保健等,其中最重要的是老年赡养和医疗保健问题。为了满足日益增长的老年人健康及医疗护理需求,势必需要开展形式多样、内容丰富的社区护理,老龄化社会需要更多…     

建立健全老年医疗保健制度——附536名干部医疗保健情况调查

据我国某些学者推测,中国到2025年,60岁以上老人将达到二亿八千万人,因此,有必要从现在起象控制人口那样,重视老年人的医疗保健及社会福利问题。目前在全国范围内,还没有统一的老人医疗保健制度,因此建立旨在以预防保健为主的老人医疗保健制度势在必行。老年人保健制度就是对于社会高龄化和随之而产生的医疗费增大问题所采取的措施。这些措施是以医疗服务从壮年期开始的健康管理,以老年性疾病预防为目标的制度。为了预测老年人对医疗保健的需求,我     

老年人卫生服务利用情况及影响因素分析

[目的]了解江西省60岁以上人群医疗服务利用情况及其影响因素，为卫生服务管理与决策提供依据。[方法]采用整群抽样，以家庭卫生服务调查表及问卷调查的方式对老年人的一般健康状况及卫生服务利用情况进行调查。[结果]老年人中两周就诊率7.01%，年住院率6.00%。城市老年患者主要选择县区级医院就诊，农村老年患者主要选择私人开业的医疗场所就诊，对社区卫生服务站的利用较低。人均住院费用占人均医疗总费用的79.49%。两周门诊就诊费用和住院费用都主要集中在县级医院和省级医院，占总各费用的81.01%和68.29%。[结论]医疗费用与经济收入成为影响老年人对卫生服务的合理利用的重要因素。完善医疗保障制度，积极开展社区卫生服务是解决老年人医疗保健问题的有效途径。     

Comparing United States versus international medical school graduate physicians who serve African- American and White elderly

OBJECTIVE: To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. DATA SOURCES: Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. STUDY DESIGN: Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and chi2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. DATA COLLECTION/EXTRACTION METHODS: Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. PRINCIPAL FINDINGS: Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. CONCLUSION: IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.     

TARGETING HOME CARE SERVICES TO VULNERABLE ELDERS:

This investigation evaluates how successfully the Massachusetts model of home care targets services to vulnerable elders. It compares data from a random sample of home care recipients with a probability sample of non-institutionalized elders in Massachusetts. The data indicate that the Massachusetts statewide system developed under minimum regulation and decentralized management has successfully reached the vulnerable elders, particularly those living alone and the widowed. The demand for home services exists but is neither excessive nor uncontrollable. These findings support the continued use of a social model of home care delivery instead of a more restrictive medical model.     

Targeting home care services to vulnerable elders: Massachusetts' Home Care Corporations

This investigation evaluates how successfully the Massachusetts model of home care targets services to vulnerable elders. It compares data from a random sample of home care recipients with a probability sample of non-institutionalized elders in Massachusetts. The data indicate that the Massachusetts statewide system developed under minimum regulation and decentralized management has successfully reached the vulnerable elders, particularly those living alone and the widowed. The demand for home services exists but is neither excessive nor uncontrollable. These findings support the continued use of a social model of home care delivery instead of a more restrictive medical model.     

Facilitating advance care planning with ethnically diverse groups of frail,low‐income elders in the USA: perspectives of care managers on challenges and recommendations

This study examined care managers' perspectives on facilitating advance care planning (ACP) with ethnically diverse elders enrolled in a managed long‐term care programme that coordinates medical and long‐term care for frail, poor elders in the USA. Seven in‐depth interviews and two focus groups were conducted with 24 lead supervisors and care managers of care management teams between July and August 2008; data were analysed with qualitative thematic analysis method. Participants identified four main sources of challenges: death and dying are taboo discussion topics; the dying process is beyond human control; family and others hold decision‐making responsibility; and planning for death and dying is a foreign concept. Participants' recommendations to address these challenges were to develop trust with elders over time; cultivate cultural knowledge and sensitivity to respect value orientations; promote designating a healthcare proxy; recognise and educate families and community leaders as critical partners in ACP and provide practical support as needed throughout the illness experience. These findings suggest important practice implications for care managers working with increasingly diverse cultural groups of elders at the end of life.     

医疗和养老保险与高龄失能老人长期照料支出——基于CLHLS数据的实证分析

我国尚未建立全国性的长期护理保险制度,老年人的长期照料费用主要由家庭承担,老年人拥有的医疗和养老保障是否影响其长期照料服务利用尚不清楚。利用2011年中国老年健康长寿调查(CLHLS)数据,构建两部模型,分析医疗与养老保险对我国城乡高龄失能老人长期照料支出的影响。研究结果表明,我国城镇高龄老人的长期照料支出显著高于农村高龄老人。公费医疗保险、新农合和养老保险对高龄老人长期照料支出有显著影响,且存在城乡差异。城镇高龄老人享有的医疗和养老保险既影响长期照料支出发生与否,又影响长期照料支出的多寡;农村高龄老人享有的医疗和养老保险仅对其是否发生长期照料支出有影响,对支出数量的影响不显著。建议通过加大医疗和养老保障强度,建立长期护理保险制度,减轻高龄老人家庭长期照料经济负担。     

不同依托单位的医养结合机构健康养老服务提供现状与困境

目的了解不同依托单位的医养结合型健康养老服务提供现状、成果以及遇到的各种困难,为建设医养结合型健康养老服务提供借鉴依据。方法 2019年1月对江苏省24家依托于不同单位的医养结合机构提供的健康养老服务内容与现状、遇到的困境、医护服务人员缺失程度和各主体在服务过程中作用缺失程度进行调查分析。结果 83.33%的医养结合机构为半自理老人、失能老人提供健康养老服务,八成机构提供个性化健康管理服务(83.33%)和重大疾病转诊服务(79.17%),仅有50.00%的机构考虑帮助老人实现心愿;70.83%的机构认为政策保障力度不足、制度障碍是开展医养结合服务遇到的最大难点;83.33%的机构认为医生和护士资源最为缺乏。结论应注重老年人精神需求,重视专业人才培养,建立医养结合政策体系,提高医疗资源供给力度;完善长期医疗护理保险制度,促进医养结合多方主体协同。     

Quality of Care for Depressed Elders in Post-Acute Care: Variations in Needs Met Through Services

This paper addresses quality of post-acute care for older adults going home after hospitalization for depression. Quality was conceptualized and assessed in terms of services received for four domains of need: psychiatric, medical, functional, and psychosocial. At discharge, needs for care was assessed using medical records, standardized instruments, and patient interviews; quality of care was assessed by whether or not needs were met by services through the first 6 weeks of post-acute care. Quality of care varied across type of need: psychiatric needs were most likely, and psychosocial needs were least likely, to be met. Urban elders received better psychiatric care than did rural elders. Elders in worse physical health received better medical and psychosocial care, but poorer psychiatric care. Elders with psychoses and living with others had better care for functional dependencies. The competing demands perspective suggests that medical illness may take priority over psychiatric care.An earlier version of this paper was presented at The International Conference on Practice Evaluation, Tampere, Finland, July 4–6, 2002.Nancy Morrow-Howell, PhD, George Warren Brown School Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, USA.Mi Jin Lee, MSW, George Warren Brown School Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, USA.Jessica Gledhill, MSW, Family and Children Services, 650 South Peoria, Tulsa, OK 74120, USA.Wayne Blinne, MA, George Warren Brown School Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130, USA.     

山东省农村老年人卫生服务利用现状及影响因素分析

目的了解农村老年人卫生服务利用情况,并探讨其影响因素。方法采用分层随机抽样方法,从山东省不同经济发展水平的11个地、市随机抽取610名农村老年人,采用国家卫生服务调查问卷对农村老年人卫生服务进行现场调查,了解农村老年人卫生服务利用状况,采用单因素分析和多元Logistic回归分析方法对农村老年人卫生服务利用的影响因素进行分析。结果本次调查共发放调查问卷610份,回收有效问卷603份,农村老年人两周患病率为26.20%,两周就诊率为13.27%,患病而未就诊者占49.37%,多元Logistic回归分析发现影响农村老年人两周就诊率的因素有:医疗保险、抚养人口数、健康自评和居住地等。结论农村老年人对卫生服务利用率较低,应大力发展农村经济,不断完善医疗保障制度,并加强农村老年人的健康教育,逐步提高其卫生服务利用率。     

The unmet needs of the elderly with diabetes in home health care

The implementation of the Prospective Payment System (PPS) in Medicare home health care has raised concern about health outcomes of elderly patients since its intention is to curb spending. This study examines the unmet needs of older diabetic patients while receiving home health care and post-discharge from home health care (N = 129) in order to explore any effects of PPS on patients' need. The study found that a higher proportion of elders had unmet needs 30 days post-discharge compared with while receiving home health care. The specific unmet needs identified by the elderly diabetic patients included social work services, home health aide, homemaker services, and need for medical equipment. The study explores the role of social work to better manage the unmet needs of diabetic elders who live in the community.     

某大城市社区老年人就诊机构流向分析

目的 分析某大城市社区1999名60岁及以上老年人的就诊机构流向及其影响因素，为制定社区老年保健服务计划提供参考。方法 利用入户调查资料进行分层分析。结果 某大城市社区老年人就诊机构主要流向市级及以上机构(52．5％)，老年人就诊机构流向主要是合同医院(71．6％)和距离近(22．0％)。流向的影响因素主要有性别、文化程度、工作单位、工作类型、月均收入和医疗保障形式等。结论 加快城市区域卫生医疗改革，明确各级门诊机构的职责，发挥各自的优势，加强老年人健康教育，合理引导消费和利用有限的卫生资源。