上海市老年人长期照护需求研究——以长宁区为例

目的 :了解上海市长宁区老年人长期照护需求。方法 :运用日常生活能力(ADL)量表和长期照护需求调研问卷对长宁区所管辖的3个居委会的所有60岁及以上的老年人进行问卷调查,共得到有效问卷1 665份。结果 :在长期照护服务需求的研究中,27.57%老年人需要生活帮助服务,15.56%的老年人需要心理护理服务,25.47%的老年人需要慢性病护理服务,23.00%的老年人需要康复护理,18.50%的老年人需要长期卧床护理服务,19.40%的老年人选择其他医疗专业护理服务。在需要长期照护服务的老年人中,有20%~55%的老年人因经济无力承担而得不到相关的服务。随着年龄和自理能力的下降,老年人对长期护理需求的6个方面的需求都有所增加(OR1),患有慢性病的老年人对长期护理需求更大;独居老人相对于与子女同住的老人对心理护理、慢性病护理、康复护理的需求更大(OR1),学历较低的老人对长期照护服务需求相对较高。结论 :政府应加大对高龄、独居、低收入的老年人的保障,建立完善的长期护理保障制度。     

居住安排对老年人自评生活质量的影响：基于“状态—变化”的分析视角

文章使用2008—2018年中国老年健康影响因素跟踪调查的四期面板数据,利用时间固定效应模型,分析不同居住安排状态及其变化对老年人自评生活质量产生的影响。研究发现,相较于独居老年人,与他人同住的老年人自评生活质量更高,而在各同住情形中,仅与子女同住的老年人自评生活质量最高。居住安排变化同样会影响老年人自评生活质量,相较于始终同住的老年人,始终独居与先同住后独居的老年人自评生活质量通常会更低,但先独居后同住却并不会对其自评生活质量产生显著影响。基于此,为进一步提高老年人的整体生活质量,文章认为应重点加强对空巢、独居老年人的生活关照,同时努力为老年人营造出舒适且稳定的居住条件。     

Formal home‐care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA)

The aim of this study was to provide a population‐based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer‐aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross‐sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%–9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home‐care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7–5.3), older age (Adj OR 3.4, 95% CI 2.4–4.8) and living alone (Adj OR 2.6, 95% CI 1.9–3.8). Almost half of those utilising formal care did not self‐report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long‐term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.     

Health and social status of an elderly urban population in Sri Lanka

Although Sri Lanka has generally a young demographic profile, with decreasing overall mortality and birth rates, its population is aging gradually and will continue to do so in the future. In order to have an idea of the needs of the elderly a survey was conducted in a sample of randomly selected Sinhalese elders living in an urban community. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) assessments were done. Ten percent of the respondents had at least one ADL impairment. Another ten percent had only IADL impairment. The commonest ADL to be affected were bathing and feeding. Children and the family provide all care for the impaired elderly. The family support system should be encouraged and assisted to prevent the necessity for more formal and expensive institutional care. A large proportion of the elderly were handicapped with defects in vision and hearing and the absence of teeth. Correction of these defects would improve both quality of life of these subjects and reduce their risk of accidents.     

Community care for stroke patients in the last year of life: results of a national retrospective survey of surviving family, friends and officials

The quality of community care received in the last year of life by stroke patients and their informal carers is described. This is secondary analysis of data from the Regional Study of Care for the Dying, in which information was collected on a randomly selected sample of people who died in 1990, in 20 self-selected English health districts that were nationally representative in terms of socio-demographic characteristics and health care provision. The respondents comprised 20 spouses, 48 relatives, three friends or neighbours and 40 officials who had known about the last year of life of 111 people who died of stroke, and had spent some time at home (or in a residential or nursing home) in the last year of life. Two-fifths of those who died were reported to have needed more help with personal care (43%), a quarter to have needed more help with domestic chores (27%), and a third to have needed more financial help (31%). Three-fifths had spent some of their last year in a nursing or residential home (63%). Three quarters of respondents who had borne the brunt of caring reported that caring had restricted their own activities to a fair or severe extent (76%); only a third had found it a rewarding experience (32%). Spouses, and those caring for depressed or anxious stroke patients found caring particularly stressful. Stroke patients living in the community need more help with domestic chores and, in particular, with personal care. Informal carers require better support, especially spouses and for those caring for depressed or anxious stroke patients. Further research is required to identify and evaluate the most effective ways of meeting the needs of these patients and their families, and to explore the effects on their care of the Community Care legislation.     

Meeting the needs of elderly with bathing disability

Background/aims: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients’ abilities enabling them to bathe themselves, thus reducing the need for other, more long‐term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy. Methods: A quasi‐experimental non‐equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home‐help allocation were assessed at the baseline and after 15 weeks. Results: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant. Conclusion: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.     

Impact of cognitive and physical impairment on carer burden and quality of life

Background and purpose How the cognitive and/or physical impairment experienced by care recipients impacts on their carers is not well understood. This study investigated the effect of type of impairment of care recipients on the level of burden and quality of life (QOL) of elderly Australian carers. Methods This article describes a nested cross-sectional substudy of 276 older women (aged 78–83 years) enrolled in the Australian Longitudinal Study on Women’s Health who indicated they were providing care for someone living with them. Results In this nationally representative sample of elderly women carers, 60% were looking after people (predominantly their husbands) who had both cognitive and physical impairments. Carers of people with both types of impairments had higher scores for objective burden of caring than those caring for people with either type of impairment alone. In contrast, scores for limitations on their own lives were higher among women caring for people with cognitive impairments (with or without physical impairments). Conclusions The majority of elderly women caring for someone else are likely to suffer multifaceted burdens of caring.     

The quality and adequacy of care received at home in the last 3 months of life by people who died following a stroke: a retrospective survey of surviving family and friends using the Views of Informal Carers Evaluation of Services questionnaire

Stroke is the third leading cause of death in the UK. Despite this, little is known about the care needs of people who die from or following a stroke. In early 2003, a total of 183 questionnaires were returned from a survey of 493 people who had registered a stroke-related death in four Primary Care Trusts, giving a response rate of 37%. This paper reports on 53 deceased from the survey who had lived at home during their last 3 months and who had been ill for more than 1 month. The data were analysed to explore the role of informal carers and the provision of community-based care in the last 3 months of life. Family and friends helped 82% of deceased with household tasks, 68% with personal care, 66% with taking medication and 54% with night-time care. By contrast, health and social services helped 30% with household tasks, 54% with personal care, 20% with taking medication and 6% with night-time care. Two-fifths (43%) of informants had to give up work or make major life changes to care for the deceased, and 26% of informants found looking after them 'rewarding'. Half (51%) reported that help and support from health services were excellent or good compared to 38% for social services. Results from the Regional Study of Care for the Dying indicated that people who died from a stroke in 1990 and their informal carers would have benefited from increased levels of community-based care and enhanced communication with care professionals. Our data suggest that informal carers continue to provide the majority of care for those who die from stroke, despite government initiatives to improve care for stroke patients and frail elderly people. Further research is required to explore best practice and service provision in caring for this group.     

Elderly care recipients in a Swedish municipality living in their own homes: their diseases, functional health status and care provided as reported by formal carers

The aim of this study was to investigate from the perspective of formal carers the care given to people aged 65 and over, who are cared for in their own homes by informal care. Thirty-three district nurses (DNs) and 20 home service assistants in a municipality with 13500 inhabitants (over 65 years old), were interviewed about the location of care recipients and 398 care recipients were located. Most of them were over 80 years old and had more than one disease (62%), mostly related to the circulatory system (27%). Dependence in three or more of the Katz ADL categories was seen in 30%, reduced mobility in 67%, reduced memory in 34% to a degree that restricted their everyday life and 34% of them could seldom or never be alone. Care had been given for three years or more for 57% of these people. The monitoring of the disabilities and reduced functional health status differed significantly between the diagnostic groups. Home help service was associated with the care recipients' ADL index but not with their need for continuous monitoring. The DNs' care did not relate to any of the variables. In conclusion, diagnoses, the care recipients ability to be alone and functional health status are important variables to include when assessing the demands for home care and when planning supplementary care for home care recipients and their informal caregivers.     

辽宁省农村独居失能老人长期照护模式选择意愿及其影响因素分析

目的 调查辽宁省农村独居失能老人长期照护模式选择意愿并分析其影响因素,为建立和发展农村独居失能老人长期照护体系提供理论依据。方法 采取便利抽样的方法选取辽宁省农村地区302名独居失能老人作为调查对象,采用一般情况调查表、老年人能力评估问卷、社会支持评定量表和自制长期照护模式调查表进行调查。结果 219例（72.5%）独居失能老人选择居家长期照护,83例（27.5%）选择机构长期照护,勉强能在家生活（76.3%）和没钱去养老机构（60.3%）是独居失能老人选择居家长期照护的2个主要原因,选择机构长期照护最重要的原因是有专人提供生活照料（73.4%）; Logistic回归分析表明月收入（OR = 4.156,P = 0.001）、社会支持（OR = 0.903,P = 0.036）和能力等级（中度失能:OR = 26.593,P = 0.001;重度失能:OR = 557.370,P＜0.001）是长期照护模式选择意愿的影响因素。结论 居家长期照护仍然符合大部分农村独居失能老人的长期照护意愿,应针对独居失能老人的不同特点,加强居家长期照护功能并发展机构长期照护服务。     

A randomised controlled trial of the Home Independence Program,an Australian restorative home‐care programme for older adults

A randomised controlled trial was conducted to test the effectiveness of the Home Independence Program (HIP), a restorative home‐care programme for older adults, in reducing the need for ongoing services. Between June 2005 and August 2007, 750 older adults referred to a home‐care service for assistance with their personal care participated in the study and received HIP or ‘usual’ home‐care services. Service outcomes were compared at 3 and 12 months. Subgroups of 150 from each group were also compared on functional and quality of life measures. Data were analysed by ‘intention‐to‐treat’ and ‘as‐treated’. The intention‐to‐treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [Odds ratio (OR) = 0.18, 95% CI = 0.13–0.26, P < 0.001; OR = 0.22, 95% CI = 0.15–0.32, P < 0.001]. Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as‐treated analysis. Contamination of the control group by an increased emphasis on independence across the home‐care agency involved, together with other methodological problems encountered, is thought to account for the few differences between groups in individual outcomes. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short‐term restorative programme appears to reduce the need for ongoing home care. The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in demand for home care associated with the five‐fold projected increase in numbers of the oldest old expected over the next 40 years.     

Carers' reflections on nursing home and NHS long-stay care for elderly patients

The aim of this study was to compare the perceptions of carers of elderly long-stay care patients who are now in nursing homes in three health districts in a former Regional Health Authority and in remaining long-stay geriatric National Health Service (NHS) wards. One hundred and ninety-eight nursing home carers (78%) and 128 NHS carers (83%) were interviewed by telephone, using a semi-structured questionnaire and open questions. The impact of caring at home was shown to be greater on NHS than on nursing home carers. Most were satisfied with the care, staff and atmosphere of the nursing home or hospital. Nursing homes were perceived to offer better ‘hotel’ facilities and a more pleasant environment. They were seen as better at respecting patients' privacy. The NHS was regarded as superior in offering clinical and rehabilitative services. Most participants thought the institution was the right place for their relative, although in general, it was thought to be better to care for elderly people at home. ‘Care in the community’ was supported, but carers were realistic about alternatives when informal care ceased to be a reasonable option. There was little ‘choice’ between public and private sector care. For many patients, entry into the institution followed directly from an acute hospital admission. The only choice was between care in a long-stay facility or remaining at home, with the patient becoming increasingly dependent and the carer becoming increasingly unable to cope. The formal aspect of community care should be to be organized rationally and accepted as a valid response to the needs of some dependent elderly patients and their carers.     

Lay carers of patients admitted to a hospice: how caring restricts their lives

The aim of this paper is to examine how caring for a terminally ill person in the domestic home restricts the lives of their lay carers. Fifty-nine lay carers of hospice patients were interviewed in the hospice approximately a week after the patient's admission using a structured and primarily closed choice schedule. Respondents were mainly the spouse or other close kin of terminally ill patients admitted to the hospice. Respondents reported that in the month prior to their admission, patients were highly symptomatic and required a great deal of help with activities of daily living. Forty per cent of patients required help. Three-quarters of the lay carers reported receiving help from one to three other lay carers in looking after the patient. Two thirds of the carers said that either the patient or they themselves, o both, would have benefited from moe help. Ove one thid of carers reported that in the month prior to the patient's hospice admission their own activities had been severely restricted, especially in the areas of visiting friends and relatives and going out to social activities. Activities least affected were looking after other members of the household and going out to paid work.     

A survey of those who care for the elderly at home: their problems and their needs

One thousand and sixty-six over 70s were interviewed in their own homes, 256 of the subjects had main carers who were non-statutory. These informal carers of the dependent elderly were then interviewed to examine the nature of the care that they provided, the assistance both formal and informal that they received and the consequences such caring had on their quality of life. The evidence from this study supports the view that the family is the main source of assistance to dependent elderly; usually the woman in the family. Very little assistance, either informal or formal, was received by the carers. Consequently there was a great deal of distress and psychological morbidity among the carers.     

Individual determinants of task division in older adults' mixed care networks

Older adults in need of long‐term care often receive help from both informal and formal caregivers. The division of tasks between these different types of caregivers may vary among such mixed care networks. Traditional models of task division suggest that formal and informal caregivers may either supplement each other or specialise in the care activities performed. Our study explores the determinants of various forms of task division in the Netherlands, using data collected in 2007 on 458 mixed care situations. Four types of task divisions of informal and formal care are distinguished: the complementation model [neither Activities of Daily Living (ADL) nor instrumental ADL (IADL) tasks shared, 14%], the supplementation model (both ADL and IADL tasks shared, 39%) and informal and formal specialisation (one type of task shared, one type of task not shared, 27% and 20% respectively). Marginal effects calculated with multinomial regression analyses show that the intensity of care provision, the informal caregivers' motives and the presence of privately paid help – more than care receiver's health – are related to type of task division with formal care. For example, when the informal caregiver provides more hours of help and out of a strong personal bond, the likelihood of informal specialisation increases, whereas the likelihood of formal specialisation decreases. When privately paid help is present, the complementation model is more likely, whereas the supplementation model is less likely to be found. Results are discussed regarding the differential consequences for co‐ordination and co‐operation in mixed care networks.     

Families' experiences of caring for technology-dependent children: a temporal perspective

In the present study, families' experiences of caring for a technology-dependent child were examined from a temporal perspective. This involved exploring the multiple 'technological', 'social' and 'natural' rhythms and routines around which the families' lives were variously structured. A purposive sample of 36 families with technology-dependent children who used one or more medical devices on a daily basis was recruited. Devices included feeding pumps, suction machines, dialysis machines and ventilators. Using mainly qualitative methods, children, parents and siblings were interviewed to establish what the care routines involved and how these impacted on family members. The authors found that the rhythms and routines of care varied across the sample, depending on the type and number of devices used, the individual child's needs, and who provided technical care during the day and/or at night at home and in other settings. While the children's health and quality of life benefited from the technology, the time demands of the care routines and lack of compatibility with other social and institutional timeframes had some negative implications for the children and their families, limiting their participation in school, employment and social life in general. The need to use and oversee the use of some medical technologies at night also meant that many parents suffered regular disruption to their sleep. In conclusion, the authors argue that the care of technology-dependent children at home places considerable time demands on families. Families have little or no access to suitably trained carers who can provide technical care required in the home or away from the home to give parents and the whole family a break from caring where required. More trained carers and short-term care provision, better coordination of services and improvements in the design of devices would all help to reduce the negative effects of the care routines on families.     

Patterns and Predictors of Home Care USe by the Elderly When Need Is the Sole Basis for Admission

Data from the Manitoba Longitudinal Study on Aging is used to describe thc 1975-78 home care utilization of a large probability sample of elderly interviewed in 1971. The predictors of home care use of these interviewers are identified by multiple logistic regression analysis. Findings indicate that a home care program based solely on professionally assessed need admits only a small minority of elderly and that, next to age, difficulty in coping with the instrumental activities of daily living is one of the best predictors of subsequcnt home care use. Differences between the determinants of home care and long-term institutional care are noted and the policy implications of the findings are discussed.     

Social and health services needs in a sample of elderly people in Catanzaro

The aim of this study is to analyze the general health state conditions of older people living in Catanzaro, using a multidimensional assessment instrument to determine their social and health needs. To this purpose, a sample of 544 individuals (344 women and 210 men) older than 65 years of age (mean age = 75.3) was selected from the general population. All subjects were administered the OARS (Older Americans Resources and Services) questionnaire that evaluates five areas: physical health, mental health, social resources, economic resources and Activities of Daily Living (ADL). The percentage of subjects with score 3 or more in each area, and therefore identified as partially or totally dependent, is higher in the area of physical health (17.9%) and ADL (16.6%). About 65% of the sample is not disabled in any of the different areas, while 8% is dependent in 3 or more areas. These subjects are partially or totally dependent elderly people, who stay at their own house in precarious conditions, and are able to remain there only because they are helped by informal caregivers. Probably these people are those for whom any domiciliary help is necessary and more urgent in order to support the existing stability and to avoid institutionalization.     

Gender differences in informal caring

Men have hitherto largely been invisible in research on informal care. This paper examines gender differences in informal caring, focusing on gender differences according to the relationship between the carer and care-recipient and the location of caring. The paper uses secondary analysis of the 1990–91 General Household Survey, which identified over 2700 adults as informal carers. Four per cent of men and women provide care for someone living in the same household. More women than men, 13% compared with 10%, provide care for someone living in another household. Men carers are less involved in care provision than women, providing fewer hours of care each week, and are less likely to be the main carer. However, gender differences are most marked among married carers, apart from those caring for their spouse, and least among unmarried carers. Married men can often rely on their wives to perform caring roles rather than performing them personally. Women carers are more likely to provide personal care than men carers, but the gender difference is least among those caring for their spouse or for disabled children. Cross-sex personal care is performed within the marital relationship and by parents caring for disabled children, but seldom by adult children caring for their parents or in more distant caring relationships. Evidence of cross-sex taboos in giving personal care is largely restricted to care provided in another household. Since the majority of elderly people in need of care are women, such cultural taboos may reinforce the pressure on mid-life women to care for mothers and mothers-in-law.