社区老年人监护卡的设计和应用效果分析

老年人是社区卫生服务的主要对象 ,是一组易患多种慢性病、多种器官同时损害、活动能力减退、生活难以自理 ,以及对生活照料、社区健康服务、医疗需求较多的人群[1] 。为进一步增强社区卫生服务功能 ,提供有效的、初级的、连续的、综合的和整体的医疗照顾 ,开拓、发展家庭保健功能 ,充分利用现有条件 ,对老年人实施分级管理 ,定时服务 ,我们在社区建立了社区70岁以上老年人监护卡 ,观察监护效果。1　对象与方法1.1　对象对社区 2个居委 70岁以上老年人建立监护卡。随机选取1居委老年人作为监护服务对象 ,另 1居委作为对照。 2个居委 70岁以…     

上海市徐汇区老年人日常活动能力和健康期望寿命研究

目的 了解徐汇区老年人日常生活能力( ADL)的影响因素并计算该人群的健康期望寿命(DFLE).方法 杜克ADL计分法评价日常活动能力,Sullivan法计算健康期望寿命.结果 本地区男、女性60岁老年人的健康期望寿命分别为17.7岁和17.5岁,期望寿命损失率分别为26.7％和37.7％.年龄大、离婚(丧偶)、慢性病为影响老年人日常活动能力的危险因素,文化程度、锻炼为保护因素.结论 本地区老年人的健康期望寿命达到甚至超过发达国家水平.为提高老年人的健康期望寿命,应加强老年人尤其是老年女性的保健服务.     

社区老年人认知能力现状调查

目的了解社区老年人认知能力状况及采取相应的干预措施。方法对社区≥60岁的无语言障碍老年人应用蒙特利尔认知评估量表(MoCA量表)评定,经过测试筛选。结果有102例轻度认知功能障碍的老年人,通过对这些老人的分析显示认知功能随年龄增加而递减的趋势明显,受教育程度对认知功能的有正面影响,男性认知健全比例高于女性。结论老年人认知能力随年龄增加而递减、随教育程度增高而增加、其中男性认知能力障碍比女性较少。     

太原市社区老年人认知功能现状及影响因素分析

目的 了解太原市社区60岁以上老年人认知功能现状及相关影响因素,为建立认知功能障碍的社区早期干预模式提供依据。方法 于2018年9 - 10月采用随机抽样方法,在太原市5个社区选取60岁以上老年人410名进行问卷调查,包括MoCA量表,GDS量表和FAQ量表,结合社会人口学、生活方式、健康状况来探讨社区老年人认知功能障碍的影响因素。结果 有效调查老年人共407名,平均年龄(71.47±7.446)岁,平均认知功能水平(24.01±4.727) 分,处于较低水平;认知功能障碍检出186人,检出率为45.70%。多因素logistic回归分析发现年龄、吸烟、日常活动障碍和抑郁为老年人认知功能障碍的危险因素,婚姻状态、教育水平和体育锻炼为保护因素。结论 对教育水平低、独居的高龄老年人进行关注,鼓励其积极参加锻炼或有益于身心健康的活动,改变过去的不良生活习惯,以延缓和预防认知障碍的发生。     

沈阳市社区老年人认知功能现状调查

目的了解沈阳市社区老年人的认知功能情况,为今后社区心理服务工作的开展提供参考。方法通过简明精神状态检查量表测评沈阳市铁西区266例≥60岁老年人的认知功能现状。结果轻度认知障碍者81例、中重度认知障碍者32例,有认知功能损害者占总人数的42．48％。并且随着年龄的增加,认知功能损害发生率呈上升趋势。结论社区应坚持定期组织老年人参加社区活动,帮助老年人养成良好的生活方式,并通过集体活动增加老年人的社会交往,保持其社会功能,并提供社会支持,以减缓老年人认知功能障碍的发生。     

天平街道老年人综合健康状况调查

目的了解天平街道老年人综合健康状况。方法对上海市天平街道１９４１名６０岁以上社区老年人的健康状况进行描述性分析。结果７１．８％的老年人有不同程度的躯体健康功能障碍,各种慢性疾病患病率高达８１．６％,其中以高血压病患病率最高,为３３．０％;７９．６％的老年人罹患一种以上慢性病;１１．８％的老年人有轻中度日常活动能力障碍,４．２％有重度或完全障碍;４．７％的老年人有生理失能情形;有２４．３％的老年人有不同程度的视力障碍;１５．６％的老年人有一定程度的听力障碍。结论影响老年人综合健康的主要因素有慢性病种数及其主观影响程度、年龄、性别、文化程度、婚姻、职业、是否参加体育锻炼、经济资源及生活习惯。     

社区老年人糖尿病流行特点分析

糖尿病(DM)是以高血糖为主要标志的内分泌性疾病,以中老年人高发,严重威胁人类的健康。为了解哈尔滨市社区老年人糖尿病的流行特征,参照《中国糖尿病流行特点的研究》项目操作指南,于2001年开展了本次调查。     

老年人对社区护理需求的调查研究

目的探讨老年人对社区护理的需要。方法通过对100名随机抽样的60岁以上老年人对社区护理需求的调查，得出心理护理对不同职业、文化程度、性别人群在健康促进方面所起的作用。结果100名随机抽样人群，经社区心理护理后对健康知识的了解程度明显增加，负性情绪明显下降。结论根据老年人不同的年龄、文化背景、家庭状况，采取积极有效的社区护理模式，有助于改善人的心理及身体健康。     

社区老年人糖尿病认知功能障碍及危险因素调查

目的 探讨老年人糖尿病与认知功能障碍之间的关系及影响因素.方法 在北京市宣武区社区居民健康体检管理档案中,随机抽取60岁及以上符合2型糖尿病诊断标准的糖尿病患者308例,其中单纯糖尿病144例,糖尿病合并高血压164例,作为研究对象,并随机抽取225例原发性高血压病和186例相同年龄段及性别的健康老年人作为对照组,进行简易智能状态量表(MMSE)测查,同时进行统一问卷调查、体格检查,测定血糖、血脂,糖尿病者加测糖化血红蛋白.结果 单纯糖尿病组认知功能障碍发生率高于正常对照组,糖尿病合并高血压组认知功能障碍发生率明显高于对照组;血糖对认知功能障碍存在单独效应,高血压对认知功能障碍有协同作用,而且两者存在交互效应.空腹血糖及糖化血红蛋白达标率与认知功能障碍呈负相关,糖尿病病程与认知功能障碍呈正相关.结论 糖尿病是老年人认知功能障碍的危险因素.糖尿病合并高血压等血管危险因素时,可加重认知功能障碍.     

上海市社区老年人高尿酸血症发病率及其影响因素分析

目的 了解上海市社区老年人高尿酸血症（HUA）发病率及其影响因素,为HUA的社区预防和干预提供实证依据。方法 采用随机整群抽样方法抽取上海市泥城社区2014年体检血尿酸正常的3 455名≥65岁常住居民作为随访队列进行为期1年的随访,于2015年4-6月对其进行问卷调查、体格检查和实验室检测,分析其HUA发病率及影响因素。结果 上海市3 455名社区老年人中,完成随访者3 248人,随访率为94.01%;3 248名随访老年人中,HUA新发病例165例,发病率为5.08%;多因素非条件logistic回归分析结果显示,饮酒、摄入海鲜≥3次/周、体质指数≥24.0 kg/m²、高血压、甘油三酯≥2.26 mmol/L、低密度脂蛋白胆固醇≥4.14 mmol/L和血肌酐>97 μmol/L是上海市社区老年人HUA发病的危险因素,而参加体育锻炼和糖化血红蛋白≥6.5%是上海市社区老年人HUA发病的保护因素。结论 上海市社区老年人HUA发病率较高,体质指数、甘油三酯、低密度脂蛋白胆固醇、血肌酐、糖化血红蛋白、海鲜摄入频次及是否高血压、饮酒、参加体育锻炼是该社区老年人HUA发病的主要影响因素。     

中国老年人日常活动能力的影响因素——基于CHARLS数据的分析

目的了解老年人日常生活能力(Activities of daily living,ADL)现状,分析ADL的影响因素,尤其是医疗保险的作用。方法利用2011年"中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)"数据,对中国健康与养老追踪调查的28个省区150个县级单位449个村级或社区单位7 188名60岁及以上的老年人ADL状况及影响进行分析。结果老年人的ADL受损率为22.38%。Logistic分层回归分析显示,年龄、受教育程度、是否饮酒、睡眠状况、是否患慢性病、抑郁、地域、医疗保险是ADL的影响因素。其中,城市职工医疗保险、公费医疗的老年人,其ADL受损率是无保险老年人的0.612倍,而其他类型保险的老年人(城市居民医疗保险、新型农村合作医疗、商业保险和其他保险),ADL受损率与无保险老年人无显著差异。结论中国老年人ADL受损率较高,个体社会经济因素、躯体健康、抑郁状况、医疗保险是影响ADL功能的重要因素。应采取措施,尽量缩小不同保险制度之间保障水平差异,保障与提高国民健康水平和生活质量。     

The ADL taxonomy for persons with mental disorders – adaptation and evaluation

Background: There is a lack of occupation-focused instruments to assess Activities of Daily Living (ADL) that are intended for persons with mental disorders. The ADL Taxonomy is an instrument that is widely-used within clinical practice for persons with physical impairment. The aim of this study was to adapt the ADL Taxonomy for persons with mental disorders and evaluate its validity.

Methods: An expert group of Occupational Therapists (OTs) from psychiatric care adapted the ADL Taxonomy to fit the client group, including creating three new items. OTs in psychiatric care collected client data and evaluated the instrument for usability. Rasch analysis was used to evaluate the contruct validity of 16 activities separately.

Results: The OTs collected 123 assessments from clients with various mental disorders. Ten activities had excellent, and four had acceptable, psychometric properties with regard to item and person fit and unidimensionality. The activity managing the day/time gave complex results and would benefit from further development. The OTs found the test version intelligible, relevant and easy to use.

Conclusions: The ADL Taxonomy for persons with mental disorders has 16 activities with three to six actions each, and is now ready for clinical use.     

养老机构老年人骨质疏松与日常生活活动能力相关性分析

目的：探讨养老机构老年人骨质疏松与日常生活活动能力(activities of daily living,ADL)的相关性。方法于2014年12月—2015年4月,采用整群随机抽样调查,抽取北京市6个养老机构147名老年人作为调查对象,进行骨密度测定。根据骨密度值分为3组：骨量正常组、骨量减少组及骨质疏松组。用改良 Bathel 指数量表(Modified Bathel Index,MBI)分别评价3组老年人 ADL 情况,并比较组间差异,分析骨密度值与 ADL 的相关性。结果与骨密度正常组、骨量减低组比较,骨质疏松组的骨密度值和 MBI 值差异均有统计学意义(P =0.001和0.016)。随着骨密度水平的下降,老年人活动能力水平也相应下降,两者呈正相关(r =0.29,P =0.001)。结论养老机构老年人 ADL 下降程度与骨质疏松密切相关,预防骨质疏松发生,可能会延缓老年人 ADL 下降。     

Self-determination among community-dwelling older persons: explanatory factors

Background Although it is acknowledged that exercising self-determination in daily activities affects older people’s health and well-being, few studies have focused on the explanatory factors for self-determination in daily life. Objective To investigate explanatory factors for self-determination in the context of community-dwelling older persons. Method: This cross-sectional study combined two sets of data that included community-dwelling persons 80 years and older (n?=?456). A bivariate logistic regression was performed to analyse the association of self-determination and a set of explanatory factors. Results The final bivariate logistic regression model revealed five explanatory factors that were significantly associated with perceiving reduced self-determination: high education (OR?=?2.83), frailty (OR?=?2.70), poor self-rated health (OR?=?2.54), dissatisfaction with physical health (OR?=?6.50), and receiving help from public homecare service (OR?=?2.46). Conclusion Several explanatory factors related to the ageing body and environmental aspects were associated with reduced self-determination. To help older people maintain self-determination, healthcare professionals should consider using a person-centred and capability approach to care.     

Utilizing AMPS ability measures to predict level of community dependence

The aim of the study was to examine the efficacy of utilizing Assessment of Motor and Process Skills (AMPS) ability measures as evidence for determining level of community dependence. The sample for the study was drawn from existing data from the AMPS International Project database, and consisted of adults from numerous world regions, with varying diagnoses and levels of ability (n=64,466). Findings support using ADL motor and process ability measures as evidence of a client's level of community dependence. When using ADL motor or process ability measures to identify the need for moderate to maximal assistance, the areas under the ROC curves were 0.74 (fair discrimination power) and 0.82 (good discrimination power), respectively. New ADL motor and process cutoff measures demarcating maximum assistance were set at 1.00 logit (sensitivity=0.70, specificity=0.66) and 0.70 logit (sensitivity=0.79, specificity=0.69), respectively. While ADL process ability continues to be the better predictor, the highest accuracy estimates occurred when motor and process decisions matched (n=30,835). For the first time, multiple AMPS cutoff measures, demarcating independent in the community and in need of maximal assistance, have been proposed.     

山东省老年人生活自理能力及影响因素分析

目的了解山东省老年人生活自理能力及其影响因素。方法采用多阶段随机抽样的方法抽取山东省30个县的5 400名≥60岁老年人进行入户问卷调查,采用描述性分析、χ²检验和Logistic回归等方法进行分析。结果生活完全自理的老年人4 462人,占82.6%,基本自理者805人,占14.9%,完全不能自理者占0.5%,部分依赖者110人,占12.0%;Logistic回归分析结果显示,婚姻、年龄、文化程度、收入、锻炼、慢性病、患病是否及时诊治是老年人生活自理能力的影响因素。结论老年人生活自理能力较好,有配偶、锻炼和老有所医是生活自理能力的保护因素,高龄、患慢性病、低文化程度和低收入是危险因素。     

贵州某少数民族地区农村留守老年人日常生活功能状况及影响因素分析

目的 了解贵州某少数民族地区农村留守老年人日常生活功能情况及分析影响因素。方法 采取多级整群抽样方法,从贵州省黔南布依族苗族自治州4个县抽取符合要求的1 260名留守老年人,采用面对面问卷调查的方式进行一般情况、健康状况及日常生活功能等相关情况的调查。结果 贵州某少数民族地区农村留守老年人日常生活功能明显障碍率为10.87%。多因素Logistic回归分析结果显示,高龄（OR=2.851, 95% CI:2.233~3.642）、少数民族（OR=1.486, 95% CI:1.029~2.174）、患慢性病（OR=1.246, 95% CI:1.047~1.482）、与家人关系差（OR=1.835, 95% CI:1.397~2.409）等因素是留守老年人日常生活功能明显障碍的危险因素;家庭经济收入高（OR=0.657, 95% CI:0.494~0.876）、文化程度高（OR=0.723, 95% CI:0.559~0.935）是留守老年人日常生活功能明显障碍的保护因素。结论 贵州某少数民族地区农村留守老年人日常生活功能明显障碍率高,少数民族留守老年人为高危人群,建议加强少数民族地区留守老年人的健康教育、慢性病管理、提高健康知识知晓率等预防性措施,延缓或减少其日常生活功能下降或障碍,提高其生活质量。     

Elderly persons with disabilities in Sweden: their experiences of everyday life

The aim of this study was to describe the everyday life experiences of 22 elderly persons with physical disabilities in Sweden. The participants were aged between 65 and 91 years. Interviews were conducted and analysed according to a qualitative research approach. Disengagement in activities and social contacts resulted in feelings of resignation and dejection for some participants, while others delegated tasks as a satisfactory alternative. Participants also described how activities and social contacts continued, albeit in a different way, and being active and socializing gave feelings of pleasure and a sense of belonging. While receiving help was experienced as valuable, it also increased the fear of becoming dependent. Occupational therapy intervention should be directed at increasing social contacts and engagements in meaningful activities, as well as strengthening the individual's autonomy. The transferability of the study can be questioned as the sample only included elderly persons with physical disabilities from urban areas. Further research is needed to address the impact of occupational therapy interventions on life satisfaction.     

蚌埠市老年人日常生活能力现状及影响因素

目的 调查安徽省蚌埠市老年人日常生活能力（ADL）现状,探讨影响老年人ADL的因素。方法 于2013年11-12月,从蚌埠市204个社区中随机整群抽取1个社区,对符合纳入标准的746位老年人进行入户调查。调查工具包括一般情况调查表、日常生活能力量表（ADL）、社会支持量表（SSRS）及居家不出（housebound）调查表。结果 蚌埠市老年人日常生活能力平均值为（17.45±7.30）分,211位老年人出现ADL受损,受损率为28.28%。年龄大（OR=21.66,95%CI=10.91~43.00）、从不锻炼身体（OR=3.46,95%CI=1.90~6.27）、患慢性疾病（OR=0.07,95%CI=0.03~0.16）、有housebound（OR=0.10,95%CI=0.05~0.20）是影响老年人ADL的危险因素。结论 影响老年人ADL的因素包括躯体、社会和环境各方面,应根据具体影响因素采取相应措施,预防和控制老年人ADL受损。     

Risk factors for methicillin-resistant staphylococcus aureus (MRSA) infection in a Japanese geriatric hospital

A case control study on MRSA infection was carried out, with the purpose of evaluating the effect of age, gender, hypoalbuminemia, the limitation of activities of daily living (ADL), the administration of antibiotics and the use of the new cephems which include third generation cephalosporins and monobactam and carbapenems, on the occurrence of MRSA infection among the inpatients in a geriatric hospital. From April 1991 to March 1994, 285 patients underwent a bacterial culture in the various clinical aspects. 118 patients were positive for MRSA, who were then used as cases while 167 patients who were negative for MRSA were used as controls. The level of serum albumin and the ADL score were lower in the MRSA group than in the non-MRSA group (P < 0.01) while the number of antibiotics administered before bacterial culture was greater in the MRSA group than in the non-MRSA group (P < 0.01). The third generation cephems were more commonly used in the MRSA positive patients than the negative patients (P < 0.01). Even after controlling for the other factors, hypoalbuminemia (OR = 1.73, 95% CI = 1.27–2.36), the limited ADL (partially limited vs without limitation: OR = 1.88, 95% CI = 1.19–2.96, completely limited vs without limitation: OR = 2.50, 95% CI = 1.64–3.82), the use of antibiotics other than the third generation cephems (vs without antibiotics: OR = 1.73, 95% CI = 1.20–2.50) and the administration of the third generation cephems (vs without antibiotics: OR = 3.12, 95% CI = 2.16–4.50) increased the risk of MRSA infection.