社区老年人老化期望现状及影响因素分析

目的 了解社区老年人老化期望水平及其影响因素,为后续干预措施的制订提供参考.方法 采用一般资料调查表、老化期望量表21、感知年龄歧视调查表和家庭支持量袁对唐山市滦南县城社区217名老年人进行横断面调查.结果 社区老年人老化期望总分为45.86±12.28,4个维度中精神健康均分最高(2.68±0.66),认知功能均分最低(1.87±0.55);多元线性回归分析结果显示,感知年龄歧视、年龄、家庭支持、自评健康状况、家庭人均月收入、爱好、慢性病数量是社区老年人老化期望的影响因素(调整R2=0.762,P＜0.05,P＜0.01).结论 社区老年人老化期望表现呈中等偏下水平,其中精神健康期望最高、认知功能期望最低;护理人员应重点关注影响因素,制订精准干预措施,平衡和满足其老化期望.     

农村老年人老化期望现状及影响因素研究

目的 了解农村老年人的老化期望现状，分析其影响因素，为针对干预提供参考。 方法 采用一般资料调查表、UCLA孤独感量表简化版、老化期望量表、简版自我感知老化量表对199名农村老年人进行问卷调查。 结果 老化期望总分为32.72±9.18，孤独感得分为15.11±3.82，自我感知老化得分为52.75±2.76；多元线性回归分析显示，性别、婚姻状况、患慢性病种数、独居、孤独感、自我感知老化及经济来源是农村老年人老化期望的影响因素（调整R2=0.612，均P＜0.05）。 结论 农村老年人的老化期望水平较低，女性、孤独、无配偶、患慢性病较多、老化态度消极及低收入人群是关注的重点。     

微视频培训对社区护士老年人口腔健康筛查能力的影响

目的 提高社区护士对老年人口腔健康保健的知识和技能,促进老年人群口腔疾病早期防治。方法 制作老年人口腔健康保健及筛查的微视频,对45名社区护士进行线上微视频与线下实操相结合的培训。培训前、后对社区护士进行知识测试;同时分别选取90名社区老年人,由社区护士与口腔专科医生分别采用口腔健康状况评估量表进行独立评价并比较两者的差异。结果 培训后社区护士口腔相关知识评分显著高于培训前（P＜0.05）。培训前,社区护士与口腔专科医生对老年人口腔健康状况评价总分及各条目评分比较,差异有统计学意义（均P＜0.05）;培训后除牙齿疼痛外,其余方面及总分比较差异无统计学意义（均P＞0.05）。结论 基于微视频的培训可提高社区护士的老年人口腔健康保健及筛查的知识和技能。     

老龄化时代的普通外科

随着物质生活水平的提高和医疗条件的改善,我国人均寿命不断延长,已进入人几老龄化时代.老年人的年龄界线,无统一规定.1982年中华医学会老年医学分会曾建议以60岁作为我国划分老年人的界限.这是20多年前以当时的社会、经济、国民健康水平、人均寿命等条件而提出的建议.时至今日,情况已有很大变化.从目前城镇居民的一般健康状态来看,将>60岁即算作老年人似乎有些偏早.欧美国家通常以65岁以上定为老年人.老年人的个体差异比较大,不少人的历法年龄虽已进入老年人行列,但其重要生理系统、器官仍保有较好的结构和功能,其"生物年龄"尚相对年轻.     

老年人老化期望量表的汉化及信效度检验

目的 对老年人老化期望量表进行汉化和信效度检验。方法 采用Beaton法对英文版老年人老化期望量表进行正译、综合、回译、专家委员会讨论及预试验形成中文版老化期望量表初始版本;采用便利抽样法选取378名社区老年人进行横断面调查,评价量表的信效度。结果 项目分析删除11个条目;探索性因子分析删除6个条目,提取4个公因子（身体健康、精神健康、认知功能、功能独立性）,累积方差贡献率为68.635%,形成的中文版老化期望量表包含4个维度、21个条目;量表的内容效度指数为0.97;量表总的Cronbach′s α系数、折半信度、重测信度分别为0.944、0.952、0.936。结论 中文版老化期望量表具有良好的信效度,可作为老年人老化期望的测评工具。     

全膝关节置换患者术前结果期望及影响因素研究

目的调查全膝关节置换术患者术前结果期望现状,并分析其影响因素。方法采用骨关节炎指数量表及特殊手术医院-全膝关节置换期望调查工具对198例拟行全膝关节置换术的患者进行调查。结果患者术前结果期望平均分为89.17±13.89。回归分析结果显示,患者年龄、居住同伴、术前关节功能活动评分等级是术前结果期望水平的影响因素(均P0.01)。结论全膝关节置换患者术前结果期望处于较高水平。需加强患者术前期望评估及管理,以提高患者满意度、改善医患关系。     

成都市城市人群慢性肾脏病流行病学调查

目的 探讨成都市城市人群中慢性肾脏病(CKD)的患病情况和相关危险因素,以及危险人群CKD的患病情况.方法 通过对成都市常住居民中的铁路职工健康体检,进行CKD及相关危险因素的问卷调查(既往史、吸烟、饮酒等)、体格检查(血压、身高和体质量等)和相关血尿指标检测(血糖、血脂、血尿酸、血肌酐、尿微量白蛋白/肌酐比值、尿常规等),了解成都市城市人群CKD的患病情况及相关危险因素,以及危险人群CKD的患病情况.结果 在5326例资料完整的人群中,经过人口年龄和性别构成比校正后,白蛋白尿的患病率为11.54％,肾功能下降的患病率为5.54％,血尿的患病率为3.87％.该人群中CKD的患病率为18.32％,知晓率为1.93％.3098例高血压、糖尿病和高血脂人群中,白蛋白尿的患病率分别为23.79％、28.00％、14.08％;肾功能下降的患病率分别为4.76％、4.53％、3.26％;血尿的患病率分别为2.94％、3.20％、2.37％.多因素Logistic回归提示,女性、高血压、糖尿病、高血脂和高体质量指数是白蛋白尿的独立危险因素;女性、年龄、高尿酸和高血压是肾功能下降的独立危险因素,丽饮酒与肾功能下降呈负相关;女性和年龄是血尿的独立危险因素.结论 成都市城市人群中,CKD的患病率较高,知晓率较已报道的城市人群低.相关危险因素包括年龄、女性、糖尿病、高血压、高血脂、高尿酸、高体质量指数等.控制代谢性疾病的发生发展可减少CKD的发生.     

邢台山区65岁以上老年人骨质疏松症患病情况及其影响因素分析

目的探讨邢台山区65岁以上老年人骨质疏松症（OP）患病情况及其影响因素。 方法调查选取2016年3月至2018年12月邢台山区65岁以上老年人1 207例，采用自制《老年人OP问卷》调查OP患病情况及其影响因素。 结果本次调查的1 207例老年人中，有OP者129例、患病率为10.69%；单因素分析结果显示，有无OP老年人的年龄、体质量指数、运动量、吸烟、奶品摄入、OP家族史比较，差异有统计学意义（P<0.05）；Logistic回归分析结果显示，75~80岁、体质量指数>28 kg/m²、吸烟、OP家族史是老年人OP患病的独立危险因素，经常运动、奶品摄入是老年人OP患病的独立保护因素（P<0.05）。 结论邢台山区65岁以上老年人OP的患病率高，其与多种因素有关，提示应重点关注75~80岁、体质量指数>28 kg/m²、吸烟、OP家族史等老年人群，并应指导老年人进行合理的运动、奶品摄入。     

老年股骨颈骨折患者的护理体会

随着社会的进步,人民生活水平的提高,医疗卫生保健事业的不断完善,使我国人均寿命不断提高,进入老年化社会,股骨颈骨折是老年人常见病,多发病,因年龄大,病程长易出现各种并发症,有针对性的预防和控制并发症是患者早日康复和度过危险期,降低病死率的关键.     

肿瘤晚期患者参与临床决策期望的现况研究

目的探讨肿瘤晚期患者参与临床决策的期望,以期更好地为患者提供医疗护理服务。方法采用患者参与医疗决策期望问卷对200例肿瘤晚期患者进行调查。结果该组人群参与临床决策期望总分为(34.74±3.03)分,信息需求、交流需求和决策需求3个维度的条目均分分别为(2.87±0.32)、(2.88±0.24)和(2.21±0.53)分。相比女性患者,男性患者在信息需求方面期望更高(P0.05);相比66岁及以上的患者,年龄18~50岁和51~65岁患者参与临床决策期望总得分和信息需求维度得分更高(均P0.01)。结论肿瘤晚期患者参与临床决策的信息需求和交流需求较高,而决策需求偏低。不同性别、年龄的患者参与临床决策的期望不同。在实际临床工作中,医务人员有必要关注患者参与临床决策的期望,并根据不同患者参与决策的期望开展医疗护理服务,以满足患者对疾病及治疗等相关知识的需求,促进患者参与决策的积极性,进而提高患者治疗依从性和满意度。     

Aging men--challenges ahead

The prolongation of life expectancy and the drastic reduction of fertility rate are the primary cause of an aging world. It is projected that the elderly (above 65) will increase within the next 25 years by 82%, whereas the new born only by 3%. Despite the enormous medical progress during the past few decades, the last years of life are still accompanied by increasing ill health and disability. The ability to maintain active and independent living for as long as possible is a crucial factor for aging in health and dignity. Therefore, the promotion of healthy aging and the prevention of disability in men, must assume a central role in medical research and medical practice as well as in the formulation of national health and social policies. Effective programs promoting health and aging will ensure a more efficient use of health and social services and improve the quality of life in older persons by enabling them to remain independent and productive. The most important and drastic gender differences in aging are related to organs and or systems dependant or influenced by reproductive hormones. In distinction to the course of reproductive aging in women, with the rapid decline in sex hormones and expressed by the cessation of menses, aging men experience a slow and continuous decline of hormones. This decline in endocrine function involves: A decrease of testosterone, dehydroepiandrosterone (DHEA), oestrogens, thyroid stimulating hormone (TSH), growth hormone (GH), insulin-like growth factor-1 (IGF-1), and melatonin. This decrease is concomitant with an increase of LH and FSH. In addition sex hormone binding globulin‘s (SHBG) increase with age resulting in further lowering the concentrations of free biologically active androgens. Interventions such as hormone replacement therapy may prevent, delay or alleviate the debilitating conditions which may result from secondary partial endocrine deficiency. Primary and secondary preventive strategies such as the promotion of asafe environment, healthy lifestyle including proper nutrition, appropriate exercise, avoidance of smoking, avoidance of drug and alcohol abuses, if done effectively, should result in a significant reduction of the health and social costs, reduce pain and suffering, increase the quality of life of the elderly and enable them to remain productive and contribute to the well-being of society. In light of this, public awareness of medical knowledge needs to be increased and basic, clinical, socio-economic and epidemiological research intensified.     

Life expectancy and functional prognosis after femoral neck fractures in hemodialysis patients

OBJECTIVES: To identify whether differences exist in the outcomes between patients undergoing hemodialysis and elderly nonhemodialysis patients with a femoral neck fracture. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/INTERVENTIONS: A total of 71 femoral neck fractures in 62 patients undergoing hemodialysis treated nonoperatively or operatively. MAIN OUTCOME MEASUREMENTS: Clinical outcomes were analyzed to identify factors that may be correlated with life expectancy and functional prognosis. RESULTS: The overall survival rates in this study at 1-year and 5-years postfracture were found to be 89.8% and 51.5%, respectively. There were significant correlations among the survival rate, patients' age, type of treatment, prefracture ambulation status, and prefracture activities of daily living status. However, using multivariate analysis, the only significant predictor of life expectancy was prefracture ambulation status. As for functional prognosis, the rates of total ambulation recovery and total activities of daily living recovery at 1-year postfracture were 50.0% and 71.2%, respectively. Both patients' age and age at the onset of hemodialysis may contribute considerably to functional prognosis in patients undergoing hemodialysis after femoral neck fracture. CONCLUSIONS: The present study suggests that the clinical outcomes of patients with femoral neck fractures who undergo hemodialysis are considerably superior to those of previous studies. In addition, when those fractures are treated surgically with specific management in patients undergoing hemodialysis, it may be possible to expect a life expectancy and functional prognosis similar to elderly nonhemodialysis patients with hip fractures.     

Life expectancy after total hip arthroplasty

A total of 3,807 patients undergoing total hip arthroplasty (THA) between the years 1970 to 1995 were evaluated for mortality. Patient age groups were designated in 10-year intervals as follows: age <40; 41–50; 51–60; 61–70; 71–80; age >80. The life expectancy estimate of the patients with THA was calculated by the Kaplan-Meier method, and that of the normal population was obtained from standard life-tables. Statistical significance was evaluated using 95% confidence limits. A significant difference in life expectancy was found in patient age groups >60 (61–70, 71–80, >80) demonstrating significantly higher survival rates among THA patients when compared with the normal population.     

The optimal management of malrotation diagnosed after infancy: a decision analysis

BACKGROUND: The benefit of a prophylactic Ladd's procedure in older children and adults with malrotation is controversial. The purpose of this study was to determine the role of the Ladd's procedure in patients with asymptomatic malrotation diagnosed after infancy. METHODS: A Markov decision analysis was used to compare the quality adjusted life expectancy with and without a Ladd's procedure among patients with asymptomatic malrotation. Data obtained from the Nationwide Inpatient Sample were used to estimate the age-related probability of emergency surgery or volvulus among patients with malrotation. Estimates of the mortality of elective and emergency surgery, mortality of volvulus, and utilities of each health state were obtained from the literature. RESULTS: After infancy, the gain in quality adjusted life expectancy associated with a prophylactic Ladd's procedure was highest when asymptomatic malrotation was treated at 1 year old and steadily declined until asymptomatic malrotation was treated at 20 years old. An increasing advantage of observation over prophylactic surgery on life expectancy was observed after the second decade of life. A 2-fold increase in mortality risk for an elective Ladd's procedure decreased the age threshold to 14 years, whereas a 4-fold increase decreased the threshold to 7 years. These results were found to be robust by sensitivity analyses and Monte Carlo simulation. CONCLUSION: A Ladd's procedure should be considered for children diagnosed with asymptomatic malrotation, particularly those who are younger and with a low risk of postoperative mortality. The rare occurrence of midgut volvulus does not justify performing a prophylactic Ladd's procedure on most adults with malrotation.     

Predicting life expectancy in men with clinically localized prostate cancer

PURPOSE: The choice of appropriate management for localized prostate cancer depends in part on the estimated life expectancy of a man. Little is known about the accuracy of existing rules for deriving these estimates. We developed a new prediction rule and examined the accuracy of 2 others in our data set. MATERIALS AND METHODS: A retrospective cohort was assembled, consisting of 506 men who were diagnosed or received initial treatment at a community based, tertiary care health center between 1987 and 1989 for clinically localized prostate cancer (stages A, B, I, II or T1-2N0M0) and had at least 13 years of followup. Most patients did not have prostate specific antigen levels available. Proportional hazards regression was used to create a nomogram for deriving survival estimates. Discrimination of the new and external prediction rules was assessed by the c-statistic. Calibration curves compared predicted to actual survival at 10 years. RESULTS: Estimates for survival at 5, 10 and 15 years, and for median life expectancy were determined. Discrimination was modest with a c-statistic of 0.73. The rules of Albertsen and Tewari et al had comparable discrimination in our data with a c-statistic of 0.71 and 0.70, respectively. Predicted life expectancy according to our rule and that of Tewari approximated actual survival experience. Predictions according to the Albertsen study underestimated actual survival in our group but in consistent fashion. CONCLUSIONS: Overall life expectancy can be predicted with a moderate degree of accuracy, sufficient for informing patient-clinician discussions but inadequate as the only determinant of the optimal management approach.     

Quality of life and functional level in elderly patients surviving surgical intensive care

BACKGROUND: The elderly consume up to one third of health care resources and have become a target for cost reduction efforts. This study was performed to evaluate elderly survivors of surgical critical illness using perceived quality of life and activities of daily living as indicators of value of care. STUDY DESIGN: Six hundred seventy-two patients age 70 years and older admitted to a surgical intensive care unit between October 1, 1992 and March 31, 1995 were studied. Intensive care unit and hospital length of stay, admission type and service, and severity of illness were integrated with preadmission and current activities of daily living in survivors. Perceived quality of life was assessed where obtainable from patient or direct proxy. RESULTS: Activities of daily living were obtained on 342 (50.9%) and perceived quality of life evaluations on 240 (35.7%) of the initial study population. Median duration from admission to evaluation was 21 months. Activities of daily living scores decreased significantly overall from 4.75+/-0.72 (mean; +/- standard deviation) to 4.22+/-1.41, the proportion of completely independent patients fell from 84.9% to 72.0%, and the number of completely dependent patients rose from 0% to 3.8%. Perceived quality of life scores were not significantly different than scores in healthy patients living in the community. Using regression models, age, service, APACHE II score, and emergent operation or admission did not demonstrate relationships to changes in activities of daily living scores. CONCLUSIONS: Although overall functional levels fell, rates of full dependency rose only slightly and perceived quality of life was high in a group of elderly patients surviving surgical intensive care. High hospital and postdischarge mortality should not motivate restriction of care for elderly patients requiring surgical intensive care given their high postillness subjective quality of life measures.     

Urbanisation and women's health in Khayelitsha. Part II. Health status and use of health services

A study was conducted among women in Khayelitsha to determine the relationship between urbanisation, health status and use of health services; 722 households were visited, and 659 female respondents provided information on acute and chronic illness for the 3,229 individuals who were members of their households. In addition, they provided information concerning their reproductive health, AIDS awareness, knowledge of cervical smears and use and knowledge of health services. Acute illness was reported for 4.3% of the study population, the commonest complaints being diarrhoea, abdominal pain and upper respiratory infections; 4.4% reported chronic illness, the commonest complaints being hypertension and tuberculosis; 16.2% of women reported gynaecological illness; 86% had of heard of AIDS (although their knowledge of transmission and prevention was poor); and 45% had heard of cervical smears. Patterns of illness and knowledge and use of health services vary in the different areas of residence of Khayelitsha. This appears to be related to urbanisation, age, and environmental and socio-economic factors.     

Global and domain-specific life satisfaction among older adults with long-term spinal cord injury

ObjectiveAlthough life expectancy after spinal cord injury (SCI) has increased, knowledge of life satisfaction and associated factors among older adults with long-term SCI is still very limited. The objective of this study was, therefore, to assess global and domain-specific life satisfaction among older adults with long-term SCI and investigate the association with sociodemographics, injury characteristics and secondary health conditions.DesignCross-sectional cohort study. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS).SettingCommunity settings in southern Sweden.ParticipantsSeventy-eight individuals (32% women, injury levels C1-L3, American Spinal Injury Association Impairment Scale (AIS) A-D) mean age 68 years, mean time since injury 31 years.InterventionsNot applicable.Outcome measuresThe Life Satisfaction Questionnaire (LiSat-11).ResultsThe participants were at least rather satisfied with most of the 11 life domains. They rated the lowest satisfaction with sexual life, activities of daily living and somatic health. Having a partner and being vocationally active was associated with greater satisfaction with life as a whole and with several other life domains. Participants with AIS D injuries were less satisfied with their somatic health than those with tetraplegia AIS A-C and paraplegia AIS A-C injuries. More secondary health conditions were negatively associated with satisfaction in five life domains.ConclusionLife satisfaction can be affected many years after SCI. The social context, participation in meaningful activities and minimizing secondary health conditions seem to be important for maintaining life satisfaction in older adults with a long-term injury.     

ICU and critical care outreach for the elderly

Average life expectancy has increased over the past century resulting in a shift in world population demographics. There are more elderly people alive now than throughout all of human history. The burden of comorbid disease and dependency rises with age and has been shown to independently predict need for hospitalization, institutionalization and mortality. Accordingly, there are more elderly persons living longer in more tenuous states of health. The relative proportion of patients admitted to hospital and intensive care who are elderly is considerable and recent data have suggested an increasing trend. There is likely significant selection bias amongst elderly patients triaged for access to finite critical care services. In fact, data have shown that elderly patients often receive less intensive therapy and have greater support limitations when admitted to an intensive care environment. "Chronologic" age has been an inconsistent predictor of prognosis in elderly patients who present with critical illness. However, surrogate measures of "physiologic" age are likely more relevant, such as an assessment of frailty, to aid in prognostication and informed decision-making and that ultimately correlate not only with short-term survival but additional outcomes such as functional status, institutionalization and quality of life after an episode of critical illness. There is a paucity of literature on the specific interaction of rapid response systems (RRS) and hospitalized "at-risk" elderly patients; however, the RRS may have particular application for this cohort. In particular, data have emerged to suggest mature ICU-based RRS respond commonly to elderly patients and are increasingly participating in end-of-life care discussions. In addition, another aspect of the RRS, critical care outreach (CCO), may facilitate the identification of elderly patients for timely goal-oriented advanced care planning prior to clinical deterioration.     

117例亲属肾移植供者术后生活质量调查及多因素分析

目的 探讨亲属肾移植供者术后生活质量及相关影响因素,为提高供者术后生命质量提供参考依据.方法 运用横断面调查研究方法以统一印制的调查表对本中心2006-2008年所实施的1 17例亲属肾移植供者术后实施问卷调查,并以同期健康人群作为对照组.调查内容包括社会人口学特征、手术并发症、经济状况、对亲属活体肾移植知晓状况、家庭支持情况、医疗保障及社会福利、术后日常锻炼等,以中文版SF-36量表测定生活质量.以t检验、方差分析和逐步回归对每一种影响因素进行分析.结果 亲属肾移植供者心理健康高于健康人群(P＜0.05);生活质量总分及其他各维度评分与健康人群比较,差异无统计学意义(P均＞0.05).单因素分析时,年龄、文化程度、经济状况、体育锻炼等4种因素与生活质量的多个领域均有关系.进一步多因素分析,在排除了各因素之间的相互影响后,对供者术后生活质量的主要影响因素分别是文化程度、经济状况、体育锻炼(P＜0.05).结论 术前应从社会心理等多角度对供者进行严格筛选,良好的社会心理背景、必要的心理指导及术后定期随访是保障供者术后良好生活质量的关键.