长期照护保险视角下失智失能老年人的评估综述

随着老龄化进程的加快,失智失能老人的照护问题成为世界各国关注的焦点。为保障失智失能老年人的护理需求,各个国家都对长期照护保险进行了探索。本文探讨了我国推行长期照护保险试点工作后出现的问题,相应地提出对策建议,建议将失能失智检测与长期照护保险制度结合,构建统一的失智失能等级评估标准(避免多份评估工具叠加使用,同时增加检测类目、打破量表间的界限),对老年人的失能失智状况做出综合性评价,并将老年人的分级照护制度融入长照险体系。     

居家失智老人照顾者介护技能培训效果评价

目的 通过对居家失智老人照顾者进行专业的介护知识与技能的培训,以提高照顾者的护理技能。方法 选取赵巷镇社区40例居家失智老人照顾者进行为期6个月的介护知识与技能的集中培训、电话回访及个案指导。结果 居家失智老人照顾者护理技能与失智老人日常生活能力明显提高,经统计学检验差异有显著意义(P<0.05)。结论 介护技术的运用,能有效改善居家失智老人的生活质量。     

互联网+居家上门照护服务的探索与实践——以南京市江宁区为例

在我国老龄化形势背景下,多元化的居家养老服务模式发展为解决养老问题提供了众多思路,本文以江宁区“小江家护”互联网+居家上门照护服务项目为例,探索开展在互联网技术支持下的居家上门照护服务的创新实践,并从互联网技术、医养结合、智慧养老产品、政策支持、复合型人才培养等方面提出分析对策,从而推进居家上门照护服务的高质量发展。     

城市失智老年人居家照护社会支持服务需求及影响因素研究

目的调查城市失智老年人居家照护社会支持服务需求及影响因素, 为完善失智老年人居家照护社会支持服务提供决策依据。方法采用分层抽样法于2021年3月至2022年3月随机抽取武汉市4个中心城区4所三级甲等医院就诊的386名失智老年人家庭照顾者进行横断面调查。采用城市失智老年人居家照护社会支持服务需求问卷调查城市失智老年人居家照护社会支持服务需求现状和属性, 采用Better-Worse系数法和敏感度公式计算城市失智老年人居家照护社会支持服务需求的重要度。采用最优尺度回归模型分析自变量对城市失智老年人居家照护社会支持服务需求的影响因素及作用力。结果城市失智老年人居家照护社会支持服务需求得分(88.67 ± 29.71)分。各项社会支持服务需求Better系数均大于Worse系数绝对值。1项(压疮预防及处理指导)需求为一维属性, 其余29项为魅力属性。重要度排序前6位是信息性支持2个条目(压疮预防及处理指导;家庭照顾者提供电话咨询指导)、工具性支持1个条目(为家庭照顾者提供经济援助)和社会陪伴支持3个条目(文化娱乐/体育锻炼活动、上门陪伴、陪同老年人参加社交活动)。最优尺度回归模型检验:城市失智...     

长期护理保险制度下家庭赋权方案在脑卒中患者居家照护中的应用

目的 探讨长期护理保险制度下,家庭赋权方案在首发脑卒中出院患者居家照护中的应用效果。方法 采用前瞻性研究方法,便利抽取80例首发脑卒中患者作为研究对象,试验组40例,对照组40例。试验组接受家庭赋权方案干预,对照组接受住院期间的健康教育、出院指导及延续护理,应用中风自我管理行为评定量表、Zarit照顾者负担量表及家庭照顾者照顾能力测量表(FCTI)评价干预效果。结果 干预前,两组患者及家庭照顾者的一般资料差异无统计学意义,且两组患者的中风自我管理行为评定量表评分、两组患者家庭照顾者的Zarit照顾者负担量表评分及FCTI量表评分比较,差异均无统计学意义(P>0.05)。干预后,两组患者的中风自我管理行为评定量表评分、两组患者家庭照顾者的Zarit照顾者负担量表评分及FCTI量表评分比较,差异有统计学意义(P<0.05)。结论 长期护理保险制度下,家庭赋权方案能有效改善首发脑卒中患者的自我管理行为,减轻家庭照顾者的照顾负担,提高家庭照顾者的综合照顾能力,从而提高脑卒中患者的家庭照护质量。     

居家失智患者照护者获益感的质性研究

目的 初步研究国内照护者获益感内容,以为后期测量工具的完善及获益感提升干预提供一定参考。方法 2021年6—8月选取14例居家失智患者的亲属照护者进行半结构访谈,采用Colaizzi现象学分析法分析资料。结果 经分析提炼出3个主题：摸索出有效的照护技能,调整自身观念和行为改变,促进健康家庭关系。结论 照护者在照护过程中可体会到多种获益感,未来可通过强化外部支持资源,如照护培训班、针对性的照护服务、照护知识科普、照护者联谊会等途径,加强照护者技能培训,指导照护者压力调节方法,为照护者获益感提供干预。     

南丁格尔志愿者参与社会困难失智老人服务关怀项目

[本刊讯]为改善上海市一些生活完全不能自理且经济困难失智老人的生存窘迫,维护他们最后的生命尊严,2009年上海市红十字会启动了“社会困难失智老人服务关怀项目”试点工作。今年1“月,该项目在全市30个街（镇）开展,半年内已累计为5330人次的失智老人提供护理用品和关怀服务。为确保该项目实施的规范、有序,上海市红十字南丁格尔志愿护理服务队受市红十字会邀请,     

长期护理保险照护服务等级评定现状

综述国内外长期护理保险服务等级认定标准、评估工具和分级方法,以期为进一步发展和完善我国长期护理保险服务等级评定体系提供科学依据。     

某试点地区长期照护保险保障对象服务项目选择的现况研究

目的:调查某试点地区长期照护保险保障对象对服务项目的选择现状,分析不同照护模式和日常生活能力状况下项目选择的差异,为长期照护保险相关政策的制定与完善提供参考.方法:于2019年6—7月采用自设问卷对该地区长期照护保险的81位长期照护保险保障对象进行服务项目选择现状的追踪调查.结果:该地长期照护保险保障对象选择服务项目为...     

上海市中心城区长期护理保险护工服务质量调查

目的 调查了解黄浦区150名从事长期护理保险服务的护工基本情况,评估长期护理保险服务对象对护工满意度情况。方法 研究对象来自上海市老西门街道、淮海中路街道和南京东路街道3个社区,从已经通过评估失能程度为二至六级且已经享受相应的长期护理保险待遇的居民名单中,以随机方式从中抽样,每个社区抽取50名护工完成问卷调查。结果：护理人员入职门槛低,文化水平普遍不高,护工年龄集中在41-50 岁之间,高中以上学历只有23人, 占15.2%,以农村户口居多,所占比例为56.95%;护理人员没有工作热情,对职业规划不强,工作比较盲目; 前期从事养老护理行业的人员较少,仅17.21%,68.87%的护工从事该工作的主要原因是收入较多,而爱好护理行业的人员仅占17.88%;各年龄段和文化程度对服务效果影响不明显(无统计学意义);但在老人的认可度比较中,文化程度高中的护理人员,老人认可度越高。结论： 因服务内容多限于生活照料,技术含量不高,所以对护工年龄、文化程度要求不高;政策宣传不足,居民对长护险提供的内容了解不透彻;定位不清晰,目前服务项目倾向于养老服务的生活护理,医疗护理内容较少,护理内容容易产生误解。     

Influence of policies on nursing practice in long-term care environments for older people

AIM: This paper reports a study exploring nurses' awareness of, access to and use of policies within long-term care environments for older people in Scotland. BACKGROUND: The provision of the highest quality of nursing care for older people with continuing care needs is facilitated through a number of strategic mechanisms. These encompass regulatory systems, national and local policies and care guidance. Failure of practitioners to engage with the 'policy context' may compromise care standards. METHOD: This was a two-stage investigation. A Delphi approach with 33 panel members was used to generate consensus as to the 10 most important current policies in this area of practice. A postal survey was undertaken with 2072 nurses to identify the practice impact of policies, including the 10 identified items. FINDINGS: Identification of the 10 most important policies proved challenging for panel members. Initially they identified 137 policy items, which were reduced after clustering and two further rounds to 10 items (consensus agreement 57%). Completed questionnaires were returned by 986 (48%) nurses. A long list of problems limited access to policy information. Nurses reported little time to keep up to date, compounded by communication inefficiencies and limited access to the internet. Awareness of the 10 selected items ranged from 46 to 83% and clarity of the practice message was high (85-94%); however, the reported influence on practice varied, with 10-26% of respondents indicating no effect. Professional priorities did not coincide with the priorities of older people themselves. CONCLUSION: Nurses appear bewildered by the number and status of policy items. Current methods to provide nurses with information and keep them up to date were not ideal. Processes need to be developed that will engage nurses in policy and pursue closer alignment with the priorities of older people. Strategies are required to identify key policies and promote their implementation.     

咸宁市社区老年人居家护理服务供需调查及原因分析

目的调查社区老年人居家护理服务供需现状并分析其相关原因。方法采用社区老年人居家护理服务需求问卷和影响社区卫生服务机构开展居家护理服务因素问卷对523名老年人及120名社区护士进行调查。结果血压监测、血糖监测、相关疾病知识的健康教育、生活方式的健康指导、服药健康指导及心理支持居老年人居家护理服务需求的前6位;社区护士认为影响居家护理开展的前4位因素是人力资源不足、服务风险性高、担心自身安全及没有完善的法律保障。结论社区老年人居家护理供需存在较大差距,主要原因为社区人力资源不足、老年人居家护理工作高风险性、缺乏法律保障、居家护理服务收费及医疗保险制度不完善且老年人经济状况制约其需求等。     

Nutritional status and health outcomes for older people with dementia living in institutions

AIM: This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. BACKGROUND: Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. METHOD: A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. RESULTS: Eighteen percent of the residents were under-nourished (body mass index <18.5). There was a trend toward decreasing body mass index over the 3-month study period. Residents with low body mass index tended to need assistance at mealtimes. Nineteen residents, many receiving naso-gastric tube-feeding, experienced adverse health events during the study period. Dependency in eating was the major factor differentiating residents with normal or low body mass index values, and also in distinguishing those who experienced adverse health outcomes. CONCLUSION: Assessment of eating ability, mode of feeding and measurement of body weight can be used by nurses in long-term care settings for early identification of the nutritional status of older people with dementia.     

Working in long-term care settings for older people with dementia: nurses' aides

Aim. This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan. Background. High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan. Methods. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data. Results. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Conclusion. Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings. Relevance to clinical practice. Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.     

The significance of overlooked objects: Materiality and care at home for people with dementia

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well‐developed, and family care‐givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia.