Net economic costs of dementia in Canada.

OBJECTIVE: To estimate the net economic costs of dementia in Canada in 1991 by comparing costs related to elderly patients with dementia with those related to elderly people without dementia. DESIGN: Cost-of-illness study. DATA SOURCES: Most of the data analysed in this study were from the Canadian Study of Health and Aging (CSHA), in which 10,263 Canadians aged 65 years and over were randomly selected, surveyed and, when appropriate, given clinical examinations. Data on patients with dementia and on people without cognitive impairment (control subjects) were used for this analysis. Data on activities of daily living (ADLs) were taken from a separate study under the CSHA, in which the principal caregivers of the subjects in the prevalence study were interviewed. SETTING: Community and institutional settings in Canada, excluding those in the territories. PATIENTS: All patients with dementia 65 years and older as determined from the CSHA. Patients with dementia under 65 were also considered. OUTCOME MEASURES: Costs of paid and unpaid services in the community, care in long-term care institutions, drugs, hospitalization, diagnosis and research. RESULTS: The total annual net cost of dementia was estimated to be over $3.9 billion. Costs associated with elderly patients in the community were estimated to be $1.25 billion ($615 million for paid services, $636 million for unpaid services), whereas costs for patients in long-term care institutions were $2.18 billion. Costs were about $74 million for drugs, hospitalization and diagnosis, $10 million for research and $389 million related to patients under age 65. CONCLUSION: The annual net economic cost of dementia in Canada is at least $3.9 billion. The most significant component of the total cost was for care in long-term care institutions and for assistance with ADLs by professionals, family and friends in the community. The economic burden of dementia is significant not only for patients, their families and friends, but also for society.     

人口老龄化对公共卫生服务提出的挑战及对策

中国正面临老龄化问题带来的巨大医疗挑战。预计到2050年,中国65岁及以上人口将达到4亿,其中80岁及以上人口将达到1.5亿。通过文献综述系统回顾中国人口老龄化演变及现状,从经济学视角分析中国人口老龄化带来的一些公共卫生问题:卫生服务利用不足;卫生费用快速上涨;对护理服务的巨大需求。建议应加强老年人健康教育,扩大护理服务,为其提供个体化护理,并进一步完善医疗保障体系以及构建可持续发展的长期照护保险制度。     

SOCIAL EPIDEMIOLOGY OF AGING IN THE UNITED STATES

Unprecedented changes in the structure of the population have led to a "graying" of America. Increase in life expectancy and de- clining birth rate have resulted in a larger pro- portion of Americans who are elderly. At the beginning of this century, less than 10% 0f the population were aged 55 0r older-about 7.1 million people; in 1982, more than one-fifth of the population were over the age of 55-an estimated 48.9 million persons. In the year 2050, one in three persons is expected to be over the age of 55. During the past two decades, the 65-plus population grew twice as fast as the rest of the population, and those over 85 years of age comprised the fastest growing segment of the U.S. population. In 1960, those over the age of 85 comprised one-half of i% of the population; just 20 years later, this proportion was doubled and is expected to double again t0 1.9% in the year 2000. Given current projec- tions, the 85-plus age group will comprise more than 5% 0f the population in the year 2050. There are currently more than 2.2 million peo- ple in the U.S. over the age of 85 and this age group is expected to increase t0 16 million in 2050 (Figs l,2).     

Cardiovascular disease burden in acute public hospitals in Ireland: estimates for 2021 and 2031

Background

Ireland is undergoing a demographic shift to a higher proportion of older people in the population. It is expected that this demographic shift will significantly increase the burden of care on an already overstretched acute hospitals system.

Aim

This study was conducted to estimate the future burden of care on acute public hospitals pertaining to ‘diseases of the circulatory system’ and ‘procedures on cardiovascular system’ in Ireland using Hospital In-Patient Enquiry (HIPE) data for 2006 and population projections for 2021 and 2031.

Methods

Age-specific rates derived from HIPE data for 2006 and census figures for the same year were applied to population projections for 2021 and 2031 to get case number estimates in those years.

Results

The number of discharges with a primary diagnosis of diseases of the circulatory system is estimated to increase by 51 % by 2021 and 97 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 65 % by 2021 and 133 % by 2031 relative to 2006 case numbers. The number of procedures performed is estimated to increase by 47 % by 2021 and 82 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 63 % by 2021 and 120 % by 2031 relative to 2006 case numbers.

Conclusion

The results reflect the aging of the Irish population. The expected increases in case numbers will pose significant burden on acute public hospitals and the cost of providing care.     

Geriatric assessment unit in a teaching hospital.

A geriatric assessment unit has been in operation in a Canadian teaching hospital since October 1979. In the first 15 months of operation there were 203 admissions involving 153 persons aged 65 years or older, many of whom were impaired both physically and mentally.In many cases these patients could be discharged back to the community following assessment and rehabilitation. Only a few had to be placed immediately in extended care facilities. The mean stay in the unit was less than 3 weeks. There was a mortality of 3% among patients in the unit. For older persons who present with complex health problems a geriatric assessment unit provides an environment for comprehensive assessment, treatment and rehabilitation. A thorough assessment at, or preferably before, the point at which their health breaks down enables older people to return to and remain in the community and helps to prevent them from being admitted to an institution while they are still able to function with reasonable independence.     

社区老年病人怎样评价社区卫生服务的质量

目的通过分析老年病人在接受社区卫生服务过程中的体验信息,探讨老年病人对社区卫生服务质量的认识,以促进社区卫生服务质量的持续改善。方法选择北京市某社区病人体验和满意度监测中的700例病人,≥65岁的老年人206人(老年组),<65岁者494人(非老年组)。结果63.0%的老年病人对社区卫生服务"比较满意"、"很满意"和"非常满意",53.5%的老年病人认为社区卫生服务机构提供了"一些"、"不少"和"非常多的帮助"。在42个质量监测项目中,老年组病人对其中12个项目的评价结果与非老年组病人间差异有显著性意义(P<0.05)。老年病人认为社区卫生服务的质量优势主要体现在医生服务方面,包括技术服务质量和人际服务质量。他们认为社区卫生服务的可及性、病人意见和投诉管理、安排复查和转诊、隐私保护等方面的服务质量需要进一步提高。结论通过掌握老年病人对社区卫生服务的看法和质量评价,可以掌握老龄化社区的社区卫生服务需要,并以此为依据促进以社区为基础的健康老龄化以及和谐的社区卫生服务发展。     

Transition care: will it deliver?

Transition care is a new program to Australia that is designed to facilitate transitions of frail older people between the hospital and aged care systems. This program is designed to deliver potentially important improvements to the Australian health care system--but will it deliver? The current evidence base regarding the efficacy of this type of program is mixed, and there is little evidence to indicate improved patient outcomes. An average transition care episode is expensive (about $11 000). Therefore, careful consideration of the relative cost-effectiveness compared with other interface programs such as inpatient subacute services is essential. Transition care services should be established within the context of overall regional plans for aged care, incorporating hospital acute and subacute inpatient services, and long-term community and residential care programs.     

Quality of the last year of life of older adults: 1986 vs 1993

CONTEXT: The population is aging and life expectancy is increasing, but whether morbidity and disability late in life also increase is unknown. OBJECTIVE: To examine whether the use of health care services, disability and cognitive function, and overall quality of life in the year before death among older adults has changed over time. DESIGN AND SETTING: The 1986 and 1993 National Mortality Followback Surveys, which were probability samples of all deaths in the United States with response rates of next of kin of 90% and 88% for those aged 65 years and older. PARTICIPANTS: Next of kin were asked to report the health status of a total of 9179 decedents who were 65 years and older in 1986 and 6735 in 1993, representing 1.5 and 1.6 million decedents aged 65 years and older. MAIN OUTCOME MEASURES: Days of hospital or nursing home stays, number and length of disability in 5 activities of daily living, duration of impairment in 3 measures of cognitive function, and an overall sickness score among individuals aged 65 through 84 years and those aged 85 years and older. RESULTS: Women used significantly fewer hospital and nursing home services in the last year of life in 1993 vs 1986 (mean reduction, 3.3 nights for both age groups for hospital services; mean reduction 18.4 nights for nursing home for women aged 65-84 years and 42.3 nights for women > or =85 years). Men had no changes except those aged 85 years and older had a decline in nursing home nights of 32.6. The proportion of women aged 85 years and older with restriction of at least 2 activities of daily living decreased from 62.5% in 1986 to 52.1% in 1993 (P<.01), and those with normal cognitive function increased from 50.3% to 56.2% (P<.05). Their mean overall sickness score decreased and quality-of-life improved. Among women aged 65 through 84 years, the number with normal cognitive function increased and the mean sickness score decreased, but those with at least 2 activities of daily living impairments increased and the overall quality of life declined. A similar pattern of change was found in the oldest-old men except that cognitive function worsened. Most parameters for men aged 65 through 84 years did not change significantly. CONCLUSIONS: Men and women at least 85 years old in the US experienced a better overall quality of life in the last year of life in 1993 than those in 1986. Most measures for men and women aged 65 through 84 years improved or did not change.     

什么是成功和健康的老龄

发展中国老龄事业包括设计适宜的卫生服务和老年保健服务，其前提条件是必须要清楚老年人是怎样理解成功和健康的老龄。老年人是中国社区卫生服务的主要服务对象，为了达到社区卫生服务最大的效率和效益，需要把社区卫生服务目标与老年人的期望和个人目标联系起来。本文通过对成功和健康老龄概念的文献研究，发现研究老年人自己对成功和健康老龄理解的报告很少，而且针对不同文化背景的老年人群的研究更少。目前，中国和澳大利亚学者合作在两国开展了一项跨文化研究，研究不同文化背景下的老年人对成功和健康老龄的理解，为完善老龄化和社区卫生服务政策提供证据。[编者按]     

社区高血压病患者分组管理状况分析

目的调查社区内高血压病分组管理状况，为社区预防控制高血压病提供依据。方法2007年7—9月对徐汇区斜土街道社区≥35岁常住居民进行高血压患病的性别、年龄构成及分组管理的情况进行分析。结果本社区现有高血压管理对象共2052名，其中高血压重点管理对象1917人，男女之比为l：1．22，男性患者中65岁以上者占72．19％，女性患者中65岁以上者占70．77％。其中很多高血压患者伴发有糖尿病、冠心病、脑中风、血脂紊乱等其他慢性疾病。结论高血压病管理是社区卫生服务的重要内容，开展健康教育和健康促进是目前管理和控制高血压的有效方法，管理时应根据患者的不同特点如不同伴随疾病，制定不同的方法和目标，并针对薄弱环节加以改进。     

做好社区为老服务和医疗保健 提高老年人的生存质量

介绍了如何从做好“社区为老服务”入手,做好社区老年医疗保健服务,提高老年人生存质量的经验.一是,坚持以家庭为基础,以社区为依托、以居(家)委会为核心、以实现“五个老有”为目标的三个原则.二是,围绕“五个老有”开展各种社区为老服务.三是,不断学习别人先进经验、总结自己的经验、从中找出差距,不断改进完善,把试点工作不停地向前推进.     

Smoking in the elderly--it's never too late to quit

Approximately 3.5 million persons aged 65 years and older smoke cigarettes in the United States--10.9% of this age group in Oklahoma smokes. Up to half of all smokers will experience death or disability related to smoking. Cigarette smoking has been clearly linked to the most common causes of death in the elderly and contributes to the morbidity and disability associated with many chronic illnesses that are common in this age group. The health benefits of smoking cessation in the elderly have been clearly demonstrated. Although there are barriers to smoking cessation that are specific to the older age group, interventions to promote quitting that are successful in younger smokers have been found to be effective in elderly smokers. The extended longevity and quality of life in this country for persons who achieve old age highlights the need for aggressive practices related to smoking cessation in the elderly.     

Dementia, sexuality and consent in residential aged care facilities

Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose. For older people with dementia living in residential aged care facilities (RACFs), however, the issue becomes more complex. Staff often struggle to balance residents' rights with their duty of care, and negative attitudes towards older people's sexuality can lead to residents' sexual expression being overlooked, ignored, or even discouraged. In particular, questions as to whether residents with dementia are able to consent to sexual activity or physically intimate relationships pose a challenge to RACF staff, and current legislation does little to assist them. This paper will address these issues, and will argue that, while every effort should be made to ensure that no resident comes to harm, RACFs must respect the rights of residents with dementia to make decisions about their sexuality, intimacy and physical relationships.     

Oral health care in the elderly population in Malaysia--a review

One of the undeniable facts about living is that everyday we are getting older. By 2050, it is projected that one out of every five Malaysians will be 60 or older. The economic challenge of this demographic change will affect development and the financial implications of sustaining well being of this group are formidable and complex. This population group has extensive oral disease, medical problems that complicate their oral care, and unique dental treatment challenges. The authors discuss the problem of oral healthcare among the aged, its impediments and propose some approaches for improvement to better serve the needs of this group of vulnerable members of our nation.     

The physician's role in patients' nursing home care: "She's a very courageous and lovely woman. I enjoy caring for her"

More than 1.5 million adults live in US nursing homes, and approximately 30% of individuals in the United States will die with a nursing home as their last place of residence. Physicians play a pivotal role in the rehabilitation, complex medical care, and end-of-life care of this frail and vulnerable population. The reasons for admission are multifactorial and a comprehensive care plan based on the Minimum Data Set guides the multidisciplinary nursing home team in the care of the patient and provides assessments of the quality of care provided. Using the cases of 2 patients with different experiences, we describe the physician's role in planning for admission, participating as a team member in the ongoing assessment and care in the nursing home, and guiding care at the end of life. The increasing population of older adults has also promoted community-based and residential alternatives to traditional nursing homes. The future of long-term care will include additional challenges and rich innovations in services and options for older adults.     

Lower than expected morbidity and mortality for an Australian Aboriginal population: 10-year follow-up in a decentralised community

OBJECTIVE: To examine mortality from all causes and from cardiovascular disease (CVD), and CVD hospitalisation rate for a decentralised Aboriginal community in the Northern Territory. DESIGN AND PARTICIPANTS: For a community-based cohort of 296 people aged 15 years or older screened in 1995, we reviewed hospital and primary health care records and death certificates for the period up to December 2004 (2800 person-years of follow-up). MAIN OUTCOME MEASURES: Mortality from all causes and CVD, and hospitalisation with CVD coded as a primary cause of admission; comparison with prior trends (1988 to 1995) in CVD risk factor prevalence for the community, and with NT-specific Indigenous mortality and hospitalisation rates. RESULTS: Mortality in the cohort was 964/100,000 person-years, significantly lower than that of the NT Indigenous population (standardised mortality ratio [SMR], 0.62; 95% CI, 0.42-0.89). CVD mortality was 358/100,000 person-years for people aged 25 years or older (SMR, 0.52; 95% CI, 0.23-1.02). Hospitalisation with CVD as a primary cause was 13/1000 person-years for the cohort, compared with 33/1000 person-years for the NT Indigenous population. CONCLUSION: Contributors to lower than expected morbidity and mortality are likely to include the nature of primary health care services, which provide regular outreach to outstation communities, as well as the decentralised mode of outstation living (with its attendant benefits for physical activity, diet and limited access to alcohol), and social factors, including connectedness to culture, family and land, and opportunities for self-determination.     

Disability in older Australians: projections for 2006-2031

OBJECTIVES: To provide detailed projections for the prevalence of disability and associated common health conditions for older Australians for the period 2006-2031. DESIGN: Secondary analyses of datasets (national 1998 Survey of Disability, Ageing and Carers; and projections of Australia's population from 2006-2031) collected by the Australian Bureau of Statistics. OUTCOME MEASURES: (i) The projected number of people with differing levels of disability (core activity restrictions in self-care, mobility or communication) up to 2031; (ii) The projected number of people with the main health conditions associated with disability in 2006 and 2031. RESULTS: Projections indicate a 70% increase in the number of older people with profound disability over the next 30 years. The main conditions associated with profound or severe core activity restriction in older Australians are musculoskeletal, nervous system, circulatory and respiratory conditions and stroke. CONCLUSIONS: In the future, there will be many more older Australians requiring assistance because of disability. This will present a challenge to families, friends, volunteers and paid service providers. The Australian planning ratio for residential aged-care services and community aged care services should be changed to take account of the shift to an older population with greater need of support.     

The prevalence of high blood cholesterol levels among adults in the United States

Using the National Cholesterol Education Program's Guidelines for the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the most recent nationally representative serum total cholesterol and lipoprotein data for adults (ages 20 to 74 years) from the second National Health and Nutrition Examination Survey (1976 to 1980), it is estimated that 41% of adults should have lipoprotein analysis after an initial measurement of serum total cholesterol. Furthermore, it is estimated that 88% of those who need lipoprotein analysis, or 36% of all adults aged 20 to 74 years, are candidates for medical advice and intervention for high blood cholesterol levels. We estimate, based on 1986 population data, that approximately 40 million Americans between the ages of 20 and 59 years are candidates for medical advice and intervention. An additional 24 million Americans aged 60 years and older are candidates. Overall, we estimate that about 60 million Americans aged 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol, although a less intensive approach might be appropriate for elderly patients.     

Screening for hypercholesterolemia among Canadians: how much will it cost?

OBJECTIVE: To determine the cost of screening all Canadians aged 30 years or more without coronary heart disease (CHD) for hypercholesterolemia. DATA SOURCES: The expected results of initial screening of the serum cholesterol level were estimated on the basis of 1986 Canadian census data and the 1978 Canada Health Survey. The results of repeat testing were estimated on the basis of data from the Lipid Research Clinics Prevalence Study. Lipid profile results were extrapolated from tests at the Montreal General Hospital's clinical chemistry laboratory. Laboratory costs and primary care practitioner costs were provided by the Canadian Society of Clinical Chemists and provincial fee schedules respectively. MAIN RESULTS: Among 12,479,356 Canadians free of CHD 48.7% would be identified as being at high risk, 4.8% would be identified as being at moderate risk, and 46.6% would be reassured that their lipid risk for CHD was low. The total cost of implementing the program in the first year would be $432 million to $561 million ($325 million for laboratory tests and $107 million to $236 million for visits to primary care practitioners). CONCLUSION: The substantial cost of implementing a nationwide screening program must be weighed against the expected benefits to ensure that the final result is both practical and economically feasible.     

乌鲁木齐市米东区卡子湾社区诊断

目的发现并确定社区主要健康问题,分析并提出社区需要优先解决的卫生问题,为制订社区卫生服务规划提供依据。方法采用现有资料收集和问卷调查的方式收集社区相关资料。结果 2010年社区人口中≥60岁者占13.17%;社区的总死亡率为1.88‰,主要死因为呼吸系统疾病(48.19/10万);社区居民传染病报告发病率为181.27/10万;慢性病以高血压为主,患病率为10.00%;社区儿童卡介苗接种率为100.00%,乙肝、脊髓灰质炎、百白破疫苗全程接种率为96.37%、95.38%、84.82%。社区卫生服务中心的卫生技术人员中,本科及以上学历者仅占12.50%;职称以中级职称为主,占66.35%;全科医师为2人。结论人口老龄化问题是该社区面临的主要卫生问题,社区需要预防和控制以高血压为主的慢性非传染性疾病,加强妇幼保健工作力度,做好人力资源储备工作,增加全科医师的数量和调整人员配置结构。