Systematic intervention for elderly inpatients with delirium: a randomized trial.

OBJECTIVE: To assess a systematic intervention in cases of delirium in elderly inpatients. DESIGN: Randomized, controlled trial. SETTING: University-affiliated, primary acute care hospital. PATIENTS: Patients aged 75 years or over admitted to the medical department. They were screened within 24 hours after admission, and 88 patients with delirium (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third revised edition) were detected and enrolled in the trial. The patients were randomly allocated to the treatment group (42) or the control group (46); all were followed up until the end of the study. INTERVENTION: Patients were assessed on enrolment and 1, 2, 4 and 8 weeks later. Those in the treatment group received a consultation by a geriatric internist or psychiatrist and follow-up by a liaison nurse. Those in the control group received regular medical care. OUTCOME MEASURES: Short Portable Mental Status Questionnaire (SPMSQ), Crichton Geriatric Behavioural Rating Scale (CGBRS), use of restraints, length of hospital stay, discharge to a setting providing more care than was needed before admission and mortality rate. RESULTS: Two weeks after admission, patients in the treatment group showed an improvement in their mean SPMSQ scores, from 8.2 (standard deviation [SD] 1.9) to 7.9 (SD 2.5), whereas the control group showed a deterioration, from 8.4 (SD 1.7) to 9.1 (SD 1.1); this difference had disappeared by the end of the 8-week period (p < 0.05). Mean CGBRS scores were higher in the treatment group (32.0 [SD 8.6]) than the control group (28.5 [SD 9.4]) on enrolment and had improved more markedly by the end of the 8-week period (to 23.9 [SD 7.8] v. 25.0 [SD 7.0], p = 0.06). There was no statistically significant difference between the groups in use of restraints, length of hospital stay, discharge to a setting providing more care than was needed before admission or mortality rate. CONCLUSION: The beneficial effects of systematic detection and intervention in cases of delirium in elderly inpatients were small.     

Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization

Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.     

Physicians' Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objective s The in-hosptial palliative care consultation (PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital. Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally (requested from the department other than the Geriatrics) and informally (by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform. Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine (n=8), Gynaecology (n=16) and Surgery (n=13), rotating residents (n=30), visiting doctors (n=16) in Geriatric department, and PCC team members (n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients’ life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree “PCC service helps the physicians better understand palliative care” than PCC members (97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine (100% vs. 96.4%, P>0.05). Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.     

内科老年患者心理护理在基层医院急诊科的创新实践

目的探讨将内科老年患者心理护理应用于基层医院急诊科质量管理中,以提高急诊科护理质量的创新护理模式。方法将100例老年患者随机分为试验组与对照组各50例,对照组予以常规护理,试验组在常规护理基础上应用内科老年患者心理护理制度,采用汉密顿焦虑量表(HAMA)评分,统计比较两组患者护理前后的焦虑总分、精神状况和躯体状况。结果试验组比对照组在焦虑总分、精神状况和躯体状况方面均有改善,差异具有统计学意义(P<0.05)。结论内科老年患者心理护理制度有助于提升基层医院急诊科服务质量的整体水平,作为一种创新护理模式值得临床实践。     

PDCA循环管理模式在医养结合护理质量持续改进中的应用

目的:探讨PDCA循环管理模式在医养结合护理质量持续改进中的应用.方法:收集院内收治的处于"医"或"养"状态的老年患者172例,随机分为试验组和对照组,各86例.入院后,对照组患者予以医养结合养老模式,予以常规安全护理方法,试验组在对照组的基础上予以接受应用PDCA循环管理模式后的护理服务,对比两组患者对服务态度、业务水平、病区管理、健康教育、护理质量情况、满意度调查评价以及安全事件发生情况.结果:干预后,两组护理评价得分均较干预前显著提高(P<0.05);试验组PDCA循环管理模式后服务态度、业务水平、病区管理以及健康教育等护理评价显著优于对照组(P<0.05);与对照组相比,试验组"危重患者、分级护理、病区管理、护理安全"认可度较高;且院内服务满意度各指标显著较高(P<0.05).同时,试验组安全事件发生率较低(P<0.05).结论:应用PDCA循环管理模式开展优质护理,为医养结合护理患者提供优质、安全、满意的护理服务,能够持续改进患者满意度以及临床护理质量.     

Effects of a medical team coordinator on length of hospital stay.

OBJECTIVE: To determine the effect of a medical team coordinator (MTC) on the length of stay in a teaching hospital. DESIGN: Randomized controlled trial. SETTING: Two of four general medical clinical teaching units (CTUs). PATIENTS: Patients admitted to the CTUs between July and October 1990 except those who were admitted directly to an intensive care unit or whose death was expected within 48 hours. The 267 patients were randomly assigned to receive either standard medical care or standard medical care plus MTC services. INTERVENTION: The MTC was a baccalaureate nurse whose role was to facilitate administrative tasks such as discharge planning, to coordinate tests and procedures, and to collect and collate patient information. MAIN OUTCOME MEASURES: Length of hospital stay. A subgroup of 40 patients was asked to complete a brief survey on medical care information and satisfaction. RESULTS: The MTC intervention reduced the mean length of stay by 1.97 days (p less than or equal to 0.04, 95% confidence interval [CI] 1.02 to 2.92 days). Subanalysis by diagnostic group revealed that most of this effect was in an ill-defined group of disorders. In the survey more patients in the MTC group than in the other group reported being satisfied with their medical care (89% v. 62%; p less than or equal to 0.05, 95% CI 2% to 52%). CONCLUSIONS: The services of an MTC help to reduce the length of hospital stay for some groups of patients. Further research is necessary to examine which components of the MTC intervention are most effective and in what conditions.     

老年人社区居家养老服务需求的调查分析

目的:调查分析某社区老年人对居家养老需求的情况,为政府有关部门制定相应措施改善老年人居家养老条件提供依据。方法:采用自行设计的《老年人社区居家养老服务需求调查问卷》,使用便利抽样的方法,对上海市静安区北站街道社区的189名老年人进行入户调查。结果:被调查的老年人中对居家养老服务需求率最高的项目是“老年人服务热线”105人（55.6%）,需求最少的项目是“托老所”7人（3.7%）。不同年龄段老年人对服务项目需求率不同的项目有10项;对康复治疗、上门护理、陪同看病、上门看病、日托站、托老所和法律援助7个项目的需求率随年龄增大而降低（P<0.05～P<0.01）;对服务热线需求率,60～70岁组老年人最高（P<0.01）,其次为≥80岁组（P<0.01）,70～80岁组最低（P<0.01）;对帮助日常购物需求率随年龄增大而上升（P<0.05）;对上门做家务需求率,70～80岁组高于其他2组（P<0.05）。不同职业性质老年人对服务项目需求率不同的有7项;对康复治疗、上门护理、上门看病、老年人服务热线和法律援助5个项目的需求率,脑力劳动组高于体力劳动组（P<0.05～P<0.01）;对聊天解闷和帮助日常购物需求率,脑力劳动组低于体力劳动组（P<0.05和P<0.01）。与子女居住情况不同对老年人居家养老服务需求有影响的为5项;对康复治疗、上门护理、陪同看病、上门看病和服务热线5个项目的需求率,同村/社区和同城组老年人的需求率高于其他地区组（P<0.05～P<0.01）。结论:不同人口社会学资料的老年人对居家养老有不同的需求,政府相关部门要根据实际需求情况提供相应的服务项目。     

Nursing dependency in registered nursing homes and long term care geriatric wards in Edinburgh

There has been growing interest and public investment in registered nursing homes, apparently based on the assumption that these homes are the private equivalent of hospital long term care. We have tested this hypothesis in a survey comparing 400 patients in 18 registered nursing homes with 217 patients in 11 geriatric long term care wards in Edinburgh. The nursing home patients formed a distinct and separate group: 362 (92%) were women, 392 (98%) were single or widowed, and 358 (90%) were self financing, whereas in the geriatric long term care group 148 (68%) were women and 35 (16%) were still married. Patients in nursing homes were also far less dependent than those in geriatric long term care wards (p less than 0.005). This study suggests that there may be large differences between the patients in these two types of institution, particularly with regard to nursing dependency. This finding has important implications in the future planning of long term places for the dependent elderly.     

护理干预对普外科老年患者术后谵妄的效果观察

观察积极的护理干预措施对普外科老年患者术后谵妄的影响。方法选择160例普外科手术后老年患者并按随机数字表法分为2组。常规护理组80例,接受医院常规护理;护理干预组80例,在接受医院常规护理的基础上给予特殊护理干预措施如心理护理、护理教育、音乐护理等个体化护理。采用意识障碍评估法(CAM)评估2组患者术后24、48、72h及出院前有无谵妄发生并作比较,统计2组患者平均住院时间、手术并发症发生例数。结果护理干预组患者术后谵妄例数、平均住院时间、术后并发症发生率明显少于或低于常规护理组(均P<0.05)。结论护理干预能有效降低普外科老年患者术后谵妄发生率,减少了并发症的发生,缩短病程,减少住院时间,提高了康复程度。     

Medical home care services for the housebound elderly.

In our health jurisdiction the proportion of elderly people is more than double the national average, and there is a severe shortage of both home care services and long-term care beds. To help the many elderly housebound people without primary medical care we initiated a medical services home care program. The goals were patient identification, clinical assessment, medical and social stabilization, matching of the housebound patient with a nearby family physician willing and able to provide home care and provision of a backup service to the physician for consultation and help in arranging admission to hospital if necessary. In the program's first 2 years 105 patients were enrolled; the average age was 78.9 years. More than 50% were widowed, single, separated or divorced, over 25% lived alone, and more than 40% had no children living in the city. In almost one-third of the cases there had never been a primary care physician, and in another third the physician refused to do home visits. Before becoming housebound 15% had been seeing only specialists. Each patient had an average of 3.2 active medical problems and was functionally quite dependent. Thirty-five of the patients were surveyed after 1 year: 24 (69%) were still at home, and only 1 (3%) was in a long-term care institution; 83% were satisfied with the care provided, and 79% felt secure that their health needs were being met. One-third of the patients or their families said that it was not easy to reach the physician when necessary. We recommend that programs similar to ours be set up in health jurisdictions with a high proportion of elderly people. To recruit and retain cooperative physicians hospital geriatric services must be willing to provide educational, consultative and administrative support.     

医养结合模式在骨科老年患者术后康复中的应用研究

目的 探讨医养结合模式在骨科老年患者术后康复中的应用及对老年患者生活质量、幸福指数的影响。 方法 选择2016年2月-2017年2月蚌埠医学院第一附属医院骨科收治的老年手术患者80例,按随机数字表法分为研究组和对照组各40例。研究组应用医养结合模式为主的术后康复,对照组采用常规模式,比较2组患者术后康复1、3、6个月的自护能力、简明健康测量表(SF-36)的评估;测量其总体幸福感量表(GWB)、孤独感自评量表(UCLA)得分,以及患者对术后康复的满意度。 结果 实施医养结合模式康复1、3、6个月术后自护能力、SF-36评估,2组比较差异有统计学意义(P<0.05)。研究组老年患者的总体幸福感得分均高于对照组(P<0.05),研究组患者对术后康复的满意度为95%,对照组为89%,明显高于对照组。 结论 医养结合模式在骨科老年患者术后康复中的应用是现有模式的延伸和升级,更突出的是强调养老服务的特殊性,更注重的是老年人的生活照料和健康保健,是集医疗康复服务、健康检查咨询、大病康复以及临终关怀为一体的养老服务模式,医养结合模式为主的术后康复能大大降低术后并发症发生率,有效提高骨科老年患者自护能力,全面改善老人的生活质量,提高患者的满意度,减轻其孤独感,提升老人的幸福指数。      

A study of serum zinc, albumin, alpha-2-macroglobulin and transferrin levels in acute and long stay elderly hospital patients.

Serum zinc levels measured by atomic absorption spectrophotometry were found to be low (less than 10.5 mumols/l) in 38% of acute geriatric admissions, 69% of long stay geriatric patients and 19% of a control group of elderly hospital patients with a normal serum albumin. There was a significant positive correlation between serum zinc and serum albumin in all groups. In acutely ill geriatric patients only, there was a weak but statistically significant positive correlation between serum zinc and alpha-2-macroglobulin (A2M) (r = 0.20), P less than 0.05). Serum transferrin was low in 46% of acute geriatric patients and 22% of long stay geriatric patients but there was no correlation between serum zinc and serum transferrin levels in any patient group. There were significant differences in serum zinc, A2M and transferrin levels between the acute and long stay geriatric patients. The differences in serum zinc levels between these patients groups could not be explained by changes in serum A2M, transferrin or albumin. Changes mediated by an acute phase response may have influenced results in the acute geriatric group of patients.     

Comprehensive health care for the elderly

Health care for the elderly in the United States remains fragmentary and noncomprehensive despite concern for the needs of an expanding elderly population and a new emphasis on geriatrics. Model health care programs for the elderly have been few and not generally applicable to central city populations. A model health care program has been designed to offer a continuum of comprehensive, multidisciplinary health care to Milwaukee elderly. An acute care unit for the elderly, rehabilitation-oriented nursing home, outpatient clinic, home care service, outreach clinics, rehabilitation day hospital, Alzheimer's Disease Day Care program, and acute geriatric psychiatric unit have been developed and integrated into one continuum of care. The program serves chiefly the frail elderly, who are demonstrated to be markedly impaired physically, mentally, and socially, requiring the services of multiple professionals to enable the patients to achieve maximum independence. Alternatives to institutionalization are emphasized, and geriatric education and research programs are part of the model program.     

阿立哌唑与喹硫平治疗老年精神分裂症对照研究

目的:观察阿立哌唑与喹硫平治疗老年精神分裂症的疗效及安全性。方法:回顾性分析我院2009年2月～2011年11月精神科收治的84例老年精神分裂症患者临床资料,随机分为两组,其中A组42例采用阿立哌唑治疗,B组42例采用喹硫平治疗。治疗8周后,采用PANSS量表评定疗效,采用TESS评定从患者治疗前后的体重指数、血糖、血脂指标差异评定不良反应。结果:两组疗效相当无显著性差异(P>0.05);B组采用喹硫平治疗后患者血糖水平升高,A组采用阿立哌唑对患者血糖影响不明显,B组血清总胆固醇水平升高,A组患者胆固醇影响不明显,两组甘油三酯水平均有升高。A组阿立哌唑组不良反应较B组喹硫平组轻,其中震颤、静坐不能、肌强直等发生率低于B组(P<0.05)。结论:阿立哌唑与喹硫平治疗老年精神分裂症疗效相当,阿立哌唑不良反应较喹硫平少,能有效改善患者阴、阳性症状及认知功能,利于治疗效果的巩固。     

A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.     

Elderly patients after they leave hospital

A follow-up survey was conducted of 125 patients, aged 75 years and over, who had been discharged from a general teaching hospital in western Sydney. Assessments were made of the patients' functional status, living arrangements, reliance on family care and use of health and community services in the three-month period after discharge. Results indicate that immediately after leaving hospital more patients were living with family or friends than were prior to hospitalization and there was a slight increase in the number of patients who were living in nursing homes. However, by three months after discharge, the living arrangements resembled the pattern of arrangements before the hospital admission. At three months after discharge from hospital, 66% of patients were fully independent with regard to basic activities of daily living such as bathing, dressing and eating, but only 34% of men and 17% of women were fully independent in broader activities such as shopping and meal preparation. By this stage, 88% of patients were in daily contact with family carers who were providing for many of their elderly relatives' needs. A consideration of the needs of carers upon admission to hospital of elderly patients and the provision of support services for carers after discharge should become high priorities in comprehensive geriatric care.     

延续性护理对胃癌根治术后患者生活质量的影响

目的 探讨延续性护理对胃癌根治术后患者生活质量的影响.方法 将90例胃癌根治术后患者随机分为试验组和对照组各45例,对照组患者给予常规出院指导和电话随访,试验组患者给予延续性护理方案,比较两组患者出院时、出院后14 d、出院后1、2、3、6个月的总生存质量和各领域生存质量评分,对护理的满意度,术后并发症发生情况,出院14 d内、30 d内再次入院人数等指标.结果 试验组患者的总生存质量、角色功能、认知功能、情绪功能、社会功能等维度的评分均高于对照组,而疲劳、失眠、纳差、便秘等维度的评分均低于对照组(均P<0.05);试验组患者对护理的满意度高于对照组(P<0.05),且出院14 d内再次就诊人数少于对照组(P<0.05).结论 延续性护理较常规护理能提高胃癌根治术患者术后的生活质量和患者对护理的满意度,减少患者出院后短期内的再次就诊次数.     

基于IMB模型的健康教育对慢性乙肝患者自我管理能力的影响

目的 探讨基于IMB模型的健康教育对慢性乙肝患者自我管理能力的影响。方法 选择2018年7～12月在我院诊断治疗的慢性乙型肝炎患者100例为研究对象,随机分为干预组与对照组各50例,对照组进行常规健康教育,干预组给予基于IMB模型的健康教育。比较两组干预后自我管理动机评分以及自我管理能力。结果(1)出院后1个月两组自我护理动机自我评价得分均显著高于入组时,差异有统计学意义(P0.05);出院后1个月干预组自我护理动机自我评价显著高于对照组,差异有统计学意义(P0.05)。(2)出院后1个月两组疾病治疗管理、日常生活管理、心理社会管理、疾病信息管理评分均显著高于入组时,差异有统计学意义(P0.05);出院后1个月,干预组疾病治疗管理、日常生活管理、心理社会管理、疾病信息管理评分均显著高于对照组,差异有统计学意义(P0.05)。结论 基于IMB模型的健康教育能够显著提高慢性乙型肝炎患者的自我管理能力。     

三种管理模式对老年高血压患者血压、血脂、心血管事件影响的多中心研究

目的探讨健康管理减少老年高血压患者心血管事件风险的效果。方法选择本院2008年6月～2009年6月收治的老年高血压患者160例,将其随机分为健康管理组（53例）、药物管理组（53例）、对照组（54例）,对照组患者入院时给予常规用药指导及健康教育,药物管理组在对照组基础上给予用药监督及调整;健康管理组根据个人情况制订个性化健康管理方案,从健康教育、生活方式干预、用药指导、心理干预四个方面进行综合健康管理,并监督实施,随访2年,观察患者生活习惯、血压、血脂等指标改善情况和心血管事件情况,并进行组间比较。结果健康管理组患者随访2年内心血管事件发生率低于药物管理组,药物管理组低于对照组,三组间比较,差异有统计学意义（P〈0.05）;干预后三组收缩压、舒张压均降低,健康管理组和药物管理组脉压降低,对照组脉压略微升高。健康管理组收缩压、脉压低于对照组（t=3.934、4.021,P〈0.05）,且收缩压低于药物管理组（t=3.267,P〈0.05）,药物管理组脉压低于对照组（t=2.791,P〈0.05）。三组干预后三酰甘油、低密度脂蛋白均下降,高密度脂蛋白升高,健康管理组低密度脂蛋白、三酰甘油明显低于对照组（t=5.719、4.361,P〈0.05）,药物管理组低密度脂蛋白明显低于对照组（t=4.015,P〈0.05）。结论老年高血压患者系统的健康管理可以明显减少心血管事件发生率,改善血脂和血压,效果优于常规的药物治疗及健康教育。     

杭州市居家养老的医养护结合现状调查

  目的  调查杭州市居家养老的医养护结合现状,发现存在的供给和需求不匹配问题,从而提出开展针对性养老服务和养老服务供给侧改革的建议。  方法  于2019年对杭州市西湖区和江干区共5个社区的居家养老人群,共调查942人,按照日常生活能力量表评分结果分为自理组(707人)和失能组(235人)进行问卷调查和实际走访调查,以了解医养护结合需求和供给现状。  结果  居家养老人群中失能组的年龄比自理组的年龄大(P < 0.05);2组性别比例差异无统计学意义(P=0.273),均为女性较多;2组的生活照料人员比较差异有统计学意义(P < 0.05),老年人的主要生活照顾者是伴侣,失能老人独居比例下降,依靠子女和保姆比例增加;除了慢病管理、建立电子档案和健康知识教育外,老年人接受其他项目的公共卫生服务比例均 < 50%;失能老年人接受上门服务、家庭病床、助医服务的比例 < 50%,提示基本医疗的可及性差;接受管道护理、压疮护理服务比例 < 50%,提示老年专科特色医疗护理欠缺;除了急慢性颈肩腰腿疼痛,接受其余康复项目服务的比例均 < 50%,提示专业的康复缺乏。  结论  通过对杭州市居家养老的医养护结合现状调查,发现存在供给与需求不匹配问题,建议有条件的单身人士尽可能结婚,以应对将来老年期的生活照料问题,建议社区养老服务中心增加上门服务和短期照料服务以增强家庭养老能力;建议社区卫生服务机构提高针对老年人公共卫生服务的质量,提高基本医疗的可及性,培训老年专科护士,建设专业康复科室。