北京部分社区老年人共病及老年综合征调查分析

目的调查北京部分社区老年人慢性疾病(简称慢病)及老年综合征的患病情况,为优化和配置卫生资源提供依据。方法对2013年2—5月北京市朝阳区香河园街道4个社区自愿接受调查的老年人进行问卷调查,调查内容包括一般情况、慢病、老年综合征和躯体功能等。结果共1187例老年人接受调查,中位年龄76(65~98)岁,平均(75.7±7.0)岁;其中男性561例,女性626例。受访老人中,最常见的慢病依次为高血压病[611例(51.5%)]、骨关节病[439例(37.0%)]和糖尿病[251例(21.1%)];至少患有1种慢病者为1016例(85.6%),至少有2种者(共病)为676例(57.0%),有3种及以上慢病者为345例(29.1%)。受访老人中,97.2%(1154例)的老年人至少有1种老年综合征,患老年综合征中位数为4种(0~12种)。慢病数量与老年综合征数量呈正相关(r=0.360,P=0.000)。慢病≥3种的老年人与慢病3种的老年人比较,躯体功能较差(χ~2=21.56,P=0.000)。老年综合征数量与老年人Barthel ADL评分呈负相关(r=-0.438,P=0.000),而慢病数量与其相关性则较小(r=-0.140,P=0.000)。结论社区老年人患有共病和老年综合征的比例均较高,且二者数量呈正相关。老年综合征较慢病对老年躯体功能影响更大。     

社区常见慢性疾病老年人生命质量及影响因素

目的研究唐山市社区慢性病对老年人群生命质量(QOL)的影响。方法应用生命质量简表(SF-36)对社区的1 350例常见慢性疾病老年人进行QOL评测,结合一般资料(包括性别、年龄、文化程度、经济情况、家庭功能、医保情况、社区卫生服务情况)及所在社区功能情况分析相关影响因素。结果生理功能(PF)维度较差者占74.0%,一般中等水平占14.1%,优良者占11.9%;生理职能(RP)维度较差者占81.5%,一般中等水平占11.1%,优良者占7.4%;躯体疼痛(BP)维度较差者占80.0%,一般中等水平占10.4%,优良者占9.6%;一般健康(GH)维度较差者占77.8%,一般中等水平占20.7%,优良者占1.5%;活力(VT)维度较差者占68.9%,一般中等水平占23.7%,优良者占7.4%;社会功能(SF)维度较差者占85.2%,一般中等水平占11.9%,优良者占2.9%;情感职能(RE)维度较差者占76.3%,一般中等水平占20.0%,优良者占3.7%;精神健康(MH)维度较差者占77.8%,一般中等水平占19.3%,优良者占2.9%。逐步多元回归分析显示PF、RP、BP、GH维度评分与年龄、慢性疾病的种类及病程及医保情况、社区卫生服务情况相关;VT、RE、MH维度评分与文化程度、慢性疾病的种类、家庭功能、社区卫生服务情况相关;SF维度评分与文化程度、慢性疾病的种类及病程、家庭功能相关。结论社区常见慢性疾病老年人QOL处在较差水平,除慢性疾病本身的影响外,其他影响因素复杂,应根据相关因素给予预防干预。     

社区老年人衰弱评估的临床研究

目的在企业社区老年人体检中采用老年综合评估方法,筛查老年人衰弱状态,并评估慢病及老年综合征与衰弱的相关性。方法选择2013年6~8月在中国石油天然气集团公司中心医院老年科进行常规体检的254例老年人(≥65岁)。每位老年人在完成常规体检项目基础上,由专人采用老年人群疾病与功能评估的流程,完成老年综合评估,对衰弱及衰弱前期的老人进行筛查。结果(1)本研究中的社区老人有7.5%符合Fried衰弱量表的衰弱诊断,40.2%符合衰弱前期诊断。年龄是衰弱的重要危险因素。(2)合并有心脏病、肾功能不全、脑卒中这些常见慢性病的老年人更容易合并衰弱或处于衰弱前期。(3)跌倒评估相关项目与衰弱指标有明确的相关性,其中5次起坐测试对衰弱诊断有较好的诊断敏感性但特异性较差。(4)衰弱与其他老年综合征中的认知障碍等有明确的相关性,衰弱老人都已处于失能或半失能状态,而绝大多数衰弱前期老人的生活尚可自理(占该人群97.1%)。结论在社区老年人体检中应用老年综合评估可以有效地发现衰弱及衰弱前期老人,在合并某些慢性病中更易出现衰弱,衰弱老人更易合并其他类型老年综合征。     

农村地区老年压疮高危人群照顾者压疮知识的现状调查

目的 调查农村地区老年压疮高危人群照顾者对压疮知识的认知情况,为农村地区防治老年人压疮提供科学依据. 方法 2012年3月至2013年5月选取7个农村地区216例老年压疮高危人群照顾者为调查对象,采用调查问卷对其压疮认知情况进行调查. 结果 照顾者对于压疮知识认知率为41.5％,照顾者中女性(174例)多于男性(42例),且照顾者中以41～50岁为主[124例(57.4％)]、相关工作年限1～2年居多[94例(43.5％)]、受教育程度低者为主[小学及以下170例(78.7％)]和多数人未接受过专业培训[178例(82.4％)].年轻照顾者问卷调查得分明显高于年长照顾者,差异有统计学意义(F=2.483,P＜0.05);工作年限长的照顾者问卷调查得分明显高于工作年限短的照顾者(F=3.624,P＜0.05);教育程度高的照顾者问卷调查得分明显高于教育程度低的照顾者(F=5.139,P＜0.01);接受过专业培训照顾者的问卷调查得分明显高于未接受专业培训的照顾者(t=7.346,P＜0.01). 结论 农村地区老年压疮高危人群照顾者对压疮知识认知率比较低,应加强对压疮高危人群照顾者相关知识的指导培训,以降低农村地区压疮高危人群压疮的发生率和医疗成本,提高老年压疮患者的生活质量.     

通过老年综合评估分析北京市社区老年人的营养状况

目的通过包括微型营养评定简表(MNA-SF)、慢病、生活方式以及其他老年问题的老年综合评估(CGA),了解北京市老年人营养状况及其影响因素。方法对北京市朝阳区4个社区941例≥65岁、同意接受调查的老年人进行面对面调查。结果 4个社区老人年龄(75.8±7.0)岁,中位年龄76岁;体质量指数(BMI)(23.8±4.2)kg/m~2。MNA-SF提示营养不良(0~7分)34例,占3.6%,营养不良风险(8~11分)407例,占43.3%,营养问题总计441例(46.9%)。营养问题的风险因素有:≥85岁(χ~2=9.65,P=0.002)、女性(χ~2=6.82,P=0.01)、单身(χ~2=5.63,P=0.02)、仍工作(χ~2=4.36,P=0.04)、合并≥3种慢病(χ~2=3.71,P=0.05)及患慢性肺病(χ~2=5.21,P=0.02)。结论营养问题是社区常见的老年问题,建议加强教育,将营养筛查与评估纳入常规健康查体,尤其应关注高龄及共病老人。     

社区老年人抑郁症状的调查与分析

目的 :调查上海市社区老年抑郁症患病率及其影响因素。方法 :随机抽取上海市4个社区年龄≥60岁老年人,采用老年抑郁量表(geriatric depression scale,GDS)及自制调查表进行访谈,对各因素进行单因素分析,在单因素分析中差异具有统计学意义的因素进行多因素分析。结果:本研究调查共488名,GDS得分>10分者有39名,经医师评估确诊为老年抑郁症者为33例,老年抑郁症的检出率为6.8%。老年抑郁症女性的患病率高于男性(χ~2=2.891,P=0.039);患慢性疾病如心脏病、糖尿病的老年人患抑郁症的概率较高(分别为χ~2=16.588,P=0.001;χ~2=0.238,P=0.017);有睡眠障碍的老年人较无睡眠障碍的老年人更易患抑郁症(χ~2=0.036,P=0.046),有午睡习惯的老年人患抑郁症的概率较低(χ~2=4.208,P=0.040);受教育水平高者,患老年抑郁症的概率低(χ~2=2.440,P=0.035);脑力劳动者、有业余爱好的老年人患抑郁症的可能性小(分别为χ~2=0.024,P=0.046;χ~2=9.229,P=0.002)。在单因素分析中差异具有统计学意义的研究因素作为自变量,以逐步法建立条件Logistic回归模型,在α=0.05水平上,共有4个因素进入回归模型,性别、职业、业余爱好、慢性疾病(心脏病)与老年抑郁症状的发生显著相关,差异具有统计学意义(P<0.05)。结论:性别、文化程度、职业、业余爱好、慢性疾病、睡眠障碍是老年人患抑郁症的影响因素,应采取针对性的措施预防老年抑郁症的发生。     

北京农村老年人慢性病及老年综合征分析

目的 应用《社区老年健康综合评估量表》在北京市农村社区分析农村老年人慢性病及老年综合征的患病情况。方法 2014年5~10月在北京市密云县巨各庄镇30个行政村/居委会符合条件的2122例常住老年人,采用《社区老年健康综合评估量表》对该人群进行横断面调查慢性病发生情况,以高血压、糖尿病和血脂异常为慢性病分析指标。最终纳入1836例,合格率86.5%,年龄60~92(69.4±6.8)岁,其中男性713例,女性1123例。结果女性老年人慢性病患病率明显高于男性(64.1%vs 35.9%,P=0.000),总人群中,患病率最高的慢性病为慢性疼痛,高达23.9%。女性患有≥2种老年综合征比例明显高于男性(19.2%vs 10.5%,P0.01)。通过老年健康综合评估,入选者高血压、糖尿病、血脂异常的检出率分别提高了14.9%、13.2%和29.1%。51.3%老年人患有老年综合征。结论 通过开展社区老年健康综合评估,能显著提高农村老年人主要慢性病的检出率,发现重要的老年综合征和主要健康危险因素。     

慢性心力衰竭患者及家庭照顾者疾病管理和生活质量现况

目的了解慢性心力衰竭(CHF)患者及其家庭照顾者的疾病管理和生活质量情况。方法选取2010年2月至2013年9月CHF患者及其家庭照顾者各89例,采用心力衰竭患者自我护理行为量表(SCHFI)及明尼苏达州心力衰竭生活质量量表(MLHFQ)对CHF患者进行调查,采用疾病管理行为问卷及家庭照顾者生活质量量表(FAMQOL)对CHF患者家庭照顾者进行调查。结果 CHF患者SCHFI得分为(39.66±5.42)分,自我护理行为执行良好占8.99%,执行一般者占39.33%,执行较差者占51.69%;家庭照顾者疾病管理行为分数(56.27±13.81)分,其中家庭照顾者疾病管理行为执行良好者占15.73%,执行一般占37.08%,执行较差占47.19%。Pearson相关性分析显示,CHF患者自我护理行为得分与家庭照顾者疾病管理行为得分呈正相关(P<0.05),CHF患者生活质量评分与其家庭照顾者生活质量评分呈正相关(P<0.05)。结论 CHF患者和家庭照顾者对该病管理现状不合理,二者的生活质量均受损,临床上应采取措施进行干预,建立并完善CHF家庭康复体系,培养具备高水平疾病管理能力的家庭照顾者,切实改善CHF患者生活质量。     

社区管理对老年慢性心力衰竭患者自我管理能力及预后的影响

目的:评估社区与自我管理相结合的疾病管理模式对出院老年慢性心力衰竭(心力衰竭)患者自我管理能力及预后的影响。方法:入选在我院出院的老年心力衰竭患者200例,随机分为干预组(n=100)、对照组(n=100),出院后对干预组进行上门随访、定期社区门诊就诊、自我管理教育;对照组患者仅出院时接受常规出院指导。于分组后12个月比较患者的预后、自我管理能力和生活质量。结果:干预组患者死亡与再住院联合终点显著低于对照组(51%vs.74%,P0.05);经干预后,干预组患者的自我管理能力明显高于对照组[欧洲心力衰竭自我护理行为量表评分(28.53 vs.35.97,P0.05)];干预组患者的生活质量高于对照组[明尼苏达生活质量问卷评分(29.71 vs.34.65,P=0.068)]。结论:社区管理与自我管理相结合的疾病管理模式可改善老年慢性心力衰竭患者的预后,提高自我管理能力,改善生活质量。     

1206例65岁以上老年人体检肾功能分析

目的:分析≥65岁老年人体检结果,尤其肾功能检查结果,有助于老年人慢性疾病尤其慢性肾脏病的早期发现、诊断和治疗,并有助于制定体检项目. 方法:收集1 299例长宁区某社区≥65岁老年人检查资料,对体检健康状况做出统计分析,并重点分析肾功能异常情况. 结果:在1 206例资料完整的居民中,高血压的患病率为65.92％,知晓率为83.27％;空腹血糖控制不佳者占55.49％;血脂升高明显,以胆固醇(45.4％)和低密度脂蛋白(29.6％)升高显著;体质量指数(BMI) ＞25 kg/m2者达45.27％;肾功能指标中尿酸升高明显(24.4％),肾功能下降[估算的肾小球滤过率(eGFR)＜60 ml/(min·1.73m2)]比例达9.2％,明显高于普通人群. 结论:1206例≥65岁老年人肾功能下降相关危险因素有高尿酸血症、贫血、蛋白尿、高血压.老年人血清肌酐(SCr)与尿蛋白检查异常的差异较大,体检时必须进行SCr、尿素氮的检查;同时加测或改测尿微量白蛋白.     

Healthcare professional training: a comparison of geriatric competencies

Health professionals specializing in geriatrics are a unique but scarce resource who nevertheless play a critical role in shaping the care of older adults. An interdisciplinary didactic and clinical training milieu would have the potential to maximize training opportunities for geriatric healthcare professionals. The fact that little is known about the concordance between discipline-specific geriatric competencies hampers the creation of interdisciplinary geriatric training opportunities. Discipline-specific geriatric experts compared the geriatric competencies specified by geriatric-certifying bodies of five healthcare professions: dentistry, medicine, nursing, pharmacy, and social work. Overlap and differences in geriatric competencies across disciplines are presented, and opportunities and barriers to interdisciplinary geriatric education are discussed.     

住院患者老年综合评估规范及初步效果分析

目的：探讨在老年住院患者中进行老年综合评估（CGA）对于老年人全面综合管理的作用。方法制定标准的CGA流程,采用标准流程对北京协和医院老年病房2013年9月至2014年9月连续入院的≥65岁患者进行CGA,分析其筛查老年综合征的效果。结果标准化的评估流程便于临床使用,接受评估的179例患者中,年龄（72.5±8.1）岁。通过CGA发现,视力异常患者占62.0%,睡眠障碍41.3%,听力异常40.8%,慢性疼痛34.6%,跌倒25.7%,多重用药23.5%,便秘21.8%,抑郁焦虑18.4%,尿失禁16.2%,谵妄10.6%。以不同主诉入院的15例患者最终诊断为老年综合征,占8.4%。结论老年综合征在老年患者中普遍存在,运用标准化的CGA方法可以进行有效筛查,有利于老年患者的全人管理。     

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.     

The current state of geriatric medicine: a national survey of fellowship-trained geriatricians, 1990 to 1998

The rapid growth of the older population has focused national attention on the need for physicians trained in geriatric medicine. To gain insight into the evolving status of the field, with particular focus on career decision-making and academic career development of trainees, we conducted a survey of physicians recently completing geriatric fellowships. The 107 accredited extant geriatric fellowship programs in the United States and Puerto Rico were contacted to identify trainees from 1990 to 1998. A mailed survey addressed relevant career development and training issues. Four hundred ninety out of 787 (62%) physicians responded; 20% completed 1 year and 80% 2 or more years of training. Half made the decision to pursue a career in geriatrics during residency, 27% decided before/during medical school, and a mentor influenced 48%. Currently, 80% have a Certificate of Added Qualifications in geriatric medicine, 69% hold academic appointments, 78% teach, 39% participate in research, and 44% author publications. Most are doing predominantly clinical work in multiple settings. Further analysis of the 1996-to-1998 cohort revealed that those completing fellowships of 2 or more years are more likely to identify all geriatrics as their professional focus, conduct and author research, work with multidisciplinary teams, and participate in professional geriatric societies. This national survey documents career decision-making and the academic and clinical profiles of physicians completing geriatric fellowship training in the past decade. Longer fellowship training is associated with academic career development. Although there is a national need to train clinical geriatricians, the additional need to train and fund future geriatric academic leaders requires increased attention.     

老年住院患者的综合管理

衰老、共病、老年综合征、老年问题等多方面因素共同作用,影响老年人的健康情况和功能状态,需要进行全面的老年综合评估来发现老年住院患者各个方面的问题,针对可以处理、能够逆转的问题进行个体化的干预,才能使老年患者真正获益。除了针对入院疾病的诊疗之外,还要重视相关的老年问题,采取跨学科团队干预,可以有效地处理其健康问题,改善老年患者的功能状态、提高生活质量。     

A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early‐career clinician–educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician–educators with no similar alternatives. GACA recipients were surveyed in this cross‐sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA‐related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA‐like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.     

老年综合评估及多学科团队服务在老年共病干预中的应用

目的 探讨住院老年患者通过老年综合评估(CGA)及多学科团队服务(GITS)进行多维度诊疗,为老年患者提供科学、合理的个性化诊疗模式,有效改善共病诊疗效果及生活质量.方法 选取年龄≥60岁的老年科共病患者,分为观察组和对照组.使用自主开发的"老年综合评估软件V2.0"对210例老年患者入院7天内进行老年综合评估,随后观...     

Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).     

National survey of geriatric medicine fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs Geriatrics Workforce Policy Studies Center

This article documents the development of geriatric medicine fellowship training in the United States through 2009. Results from a national cross-sectional survey of all geriatric medicine fellowship training programs conducted in 2007 is compared with results from a similar survey in 2002. Secondary data sources were used to supplement the survey results. The 2007 survey response rate was 71%. Sixty-seven percent of responding programs directors have completed formal geriatric medicine fellowship training and are board certified in geriatrics, and 29% are board certified through the practice pathway. The number of Accreditation Council for Graduate Medical Education-accredited fellowship programs has slowly increased, from 120 (23 family medicine (FM) and 97 internal medicine (IM)) in 2001/02 to 145 in 2008/09 (40 FM and 105 IM), resulting in a 21% increase in fellowship programs and a 13% increase in the number of first-year fellows (259 to 293). In 2008/09, the growth in programs and first-year slots, combined with the weak demand for geriatrics training, resulted in more than one-third of first-year fellow positions being unfilled. The number of advanced fellows decreased slightly from 72 in 2001/00 to 65 in 2006/07. In 2006/07, 55% of the advanced fellows were enrolled at four training programs. In 2008/09, 66% of fellows were international medical school graduates. The small numbers of graduating geriatric medicine fellows are insufficient to care for the expanding population of older frail patients, train other disciples in the care of complex older adults, conduct research in aging, and be leaders in the field.