不同养老方式老年人心理健康状况及心理需求的比较研究

目的 比较养老院与居家老人心理健康现状及心理需求,为提高机构服务及老人生活质量提供依据.方法 随机抽取60岁以上、思路清晰、智能正常的老人,应用《老年人心理健康问卷》评估心理健康水平,应用《老年人心理需求问卷》了解老年人的心理需求.回收有效问卷:社区养老院或敬老院中的老人(社会组)150名,家庭养老的老人(居家组)155名.结果 社会组的心理健康总分及自我、情绪、适应分量表分均高于居家组(P＜0.05);心理需求方面:社会组与居家组的需求排序一致,表现为生理需求最高,其次是交往需求、自我实现需求、认同需求.社会组的交往需求大于居家组(P＜0.05),自我实现需求小于居家组(P＜0.05).结论 社会养老的老人心理健康状况优于居家养老,但要注意满足他们的交往需求,社会养老机构是可取的养老方式.     

家居和老年公寓老人生活质量对比分析

目的了解家居和老年公寓老年人的生活幸福度和生活质量。方法采用整群抽样的方法,随机抽取城市社区和老年公寓60岁以上老人300人,用总体幸福感量表、生活质量综合评定问卷进行调查。结果居住于社区家庭的老年人个人和家庭的经济收入、人均住房面积明显高于老年公寓的老人(p=0．00);老年公寓老人的精神紧张度和情绪波动明显高于居住于社区者(p=0．00);生活质量总体评价、总体幸福感等方面两者无显著性差异。结论老年公寓是一种可取的社会化养老方式,但仍有多项因子分显示老年公寓的老人低于社区老人,老年人的养老观念和养老方式仍趋向于社区家庭。     

不同养老方式的上海城区老人心理状态和生活质量的比较（英文）

背景国内大型城市中老年人口迅速增加,常见的养老方式有3种：传统居住家中由家人照料的方式（传统养老）,以家庭为核心结合社区养老服务的方式（居家养老）以及居住养老院的方式（机构养老）。不同养老方式对城区老人生活质量、社会支持和心理状况影响的系统评估,目前尚缺乏。假设与传统养老或机构养老的老人相比,居家养老老人的生活质量较好,获得的社会支持较多,心理问题较少。方法采用整群抽样方法 ,抽取3种养老方式,即传统养老、居家养老和机构养老,年龄在65岁及以上的老人各100名,进行生活质量综合评定问卷（36-item Medical Outcome Study Short Form health survey,SF-36）、社会支持评定量表（Social Support Rating Scale,SSRS）和90项症状清单（Symptom Checklist90,SCL-90）的评定。结果 3组间性别构成、婚姻状态、月收入以及受教育程度均无显著意义的差异,但是传统养老组的平均年龄稍大。居家养老组和传统养老组SF-36中8个纬度的平均得分均高于机构养老组。居家养老组（A）的社会支持评定量表（SSRS）的评分也高于传统养老组（B）和机构养老组（C）[依次为36.8（4.4）分、25.3（6.7）分以及20.0（30.4）;F2,297=12.78,P〈0.001;A〉B〉C]。根据SCL-90评分,居家养老组和传统养老组老人的心理症状比机构养老组的程度轻[依次为129.9（38.7）分、131.6（28.4）分以及139.0（31.2）分,F2,297=8.98,P=0.004;A,B〈C]。传统养老组中SCL-90中躯体化、人际关系、偏执、精神病性的分量表得分高于居家养老组。校正人口学资料后,上述差异仍有统计学显著意义。结论与传统养老或机构养老方式的老人相比,居家养老方式的老人自我报告的稳固的社会支持更多。与养老机构者比,居住家中的老人（居家养老和传统养老）生活质量好,心理症状轻。今后需要前瞻性队列研究来验证实这些横断面研究的结果 。     

社区干预对精神分裂症患者社会功能及生存质量的影响

目的探讨以患者为中心的“患者-家属-社区居民”模式的社区干预对精神分裂症患者社区康复的影响。方法将精神分裂症患者随机分成干预组和对照组,对干预组患者及其家属、社区居民实施群体干预和个别指导,对照组只给予一般健康指导,共干预1年。采用家庭社会关怀度指数问卷（APGAR）、社会功能缺陷量表（SDSS）和生活质量综合评定问卷（GQOL1～74）对干预效果进行评定。结果实施干预后,干预组患者的社会功能缺陷程度明显降低,与干预前及两组间比较,均有显著性意义（P〈0．01）。患者得到较多的家庭、社会支持,家庭社会关怀度显著提高（P〈0．01）。患者生活质量与家庭社会支持度的相关性分析,除物质生活维度,其余3个维度即躯体功能（r=0．34、P〈0．01）、心理功能（r=0．36P〈0．01）、社会功能（r=0．28,P〈0．05）均与家庭社会关怀度呈正相关,患者生活质量明显提高（P〈0．01）。结论及时的社区干预可有效提高精神分裂症患者的社会功能和生活质量。     

首发精神分裂症患者家庭干预的效果

目的观察家庭干预在首发精神分裂症患者康复中的效果。方法选取2017年7月～2019年6月在我院住院治疗后病情稳定且正在服用药物的72例首发精神分裂症患者用随机数字表法将他们分为两组。其中对照组36名患者不采用家庭干预,研究组36例患者采取家庭干预。采用阴性和阳性量表(PANSS)、世界卫生组织生存质量测定量表(WHOQOL-BREF)、个体和社会功能量表(PSP)对两组患者治疗效果以及治疗前后社会功能、生活质量进行比较,并统计两组的复发率。结果家庭干预6月后,研究组36例患者PANSS减分较明显,疗效优于对照组,对比差异有统计学意义(P0.05);研究组患者WHOQOL-BREF评分、PSP评分明显优于对照组,差异有统计学意义(P0.05);研究组复发率明显低于对照组,差异有统计学意义(P0.05)。结论家庭干预能提高首发精神分裂症患者的疗效,可进一步改善患者生活质量及社会功能,降低复发率。     

家庭干预对分裂情感性精神障碍患者生活质量的影响研究

目的探讨家庭干预对分裂情感性精神障碍患者生活质量的影响。方法于2012年1月-2013年12月在苏州市广济医院精神科选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的135例分裂情感性精神障碍患者为研究对象,按照最小不平衡指数法分为对照组(n=67)和研究组(n=68),两组均采用盐酸氯丙嗪片治疗并进行常规处理,研究组同时进行每3个月1次的家庭干预,共8次。采用躁狂评定量表(YMRS)和汉密尔顿抑郁量表(HAMD)评定患者的不良情绪,采用生活质量综合评定问卷(GQOLI-74)评定患者的生活质量情况。结果干预后,两组YMRS评分和HAMD评分均较干预前下降(t=4.24~12.35,P均0.05),且研究组优于对照组(t=5.47,9.37,P均0.05);研究组躯体功能、心理功能、社会功能和总体生活质量评分均高于对照组(t=7.23~13.01,P均0.05)。结论家庭干预可改善分裂情感性精神障碍的症状,提高生活质量。     

社区老龄人群的生命质量的初步研究——成功老龄、常态老龄和轻度认知功能损害的比较

目的 调查社区老人；成功老龄，常态老龄和轻度认知功能损害（MCI）者的生命质量及其相关因素。方法 （1）调查对象为社区中≥65岁以上的老人，共1516名；成功老龄组700名，常态老龄608名；MCI147名；（2）应用生活满意度指数A（LSIA）和简化36医疗结局研究量表（MOS SF－36）评估老人的生活质量；（3）分析三组老人的生活质量，并分析成功老龄组影响SF－36结果的相关因素。结果 （1）成功老龄组，常态老龄组和轻度认知功能损害组LSIA总分，SF－36的8个分量表分三组间有着显著性差异，成功老龄组生命质量最，次为常态老龄，MCI最差。（2）成功老龄者生命质量与诸多心理社会因素相关。结论 成功老龄者生命质量高于常态老龄及轻度认知功能损害者，其相关因素伙进一步实施成功老龄化干预提供了客观依据。     

内观心理疗法对慢性精神分裂症患者社会人际关系、社会功能及生活质量的影响

目的探讨内观心理疗法对慢性精神分裂症患者社会人际关系、社会功能及生活质量的影响。方法选取2013年2月~2015年6月我院收治的120例慢性精神分裂症患者为研究对象,随机数字表法均分为研究组和对照组,对照组给予抗精神病药物治疗,研究组在对照组基础上加用内观心理疗法,治疗后评估两组社会人际关系、社会功能及生活质量并进行比较,同时随访两组患者治疗后1年复发情况。结果治疗前两组社会人际关系、社会功能及生活质量评估指标相较均无统计学意义(P0.05),治疗后研究组人际关系敏感因子、敌对因子评分及社会人际关系各因子得分分别均较治疗前显著降低(P0.05);治疗后1个月、2个月、3个月研究组住院精神患者社会功能评定量表(Social-Skills for Psychiatric Inpatients,SSPI)总评分均显著高于对照组(P0.05);研究组躯体健康、心理健康、社会功能评分均显著高于对照组(P0.05);研究组治疗后1年复发率(3.33%)及再住院率(1.67%)均显著低于对照组(复发率20.00%,再住院率11.67%)(P0.05)。结论内观心理疗法可显著改善慢性精神分裂症患者社会人际关系、社会功能及生活质量,有效降低复发率及再住院率,在临床中有较广泛的应用价值。     

社区健康老人综合认知训练1年随访观察

目的:探讨综合认知训练对社区健康老人认知功能的长期影响效果. 方法:151名上海市某街道社区年龄≥70岁的老人参加研究.按先后顺序分为认知训练干预组90名和对照组61名.对干预组进行12周(共24次)的综合认知训练,采用中国老年成套神经心理测验(NTBE)及自编健康问卷,分别于干预前、干预结束、干预后1年对两组进行测评. 结果:干预前,干预组NTBE中有1项优于对照组,1项低于对照组(P≤0.05),其他项目两组差异无显著性(P>0.05);1年后随访两组内比较,干预组NTBE分测验有19项(推理训练等)提高,4项下降(P≤0.05);对照组NTBE分测验有11项提高,3项下降(P≤0.05);1年后随访两组间比较,干预组NTBE分测验有3项(推理训练等)优于对照组(P≤0.05). 结论:综合认知训练对社区健康老人多项认知功能在1年后仍有一定影响,其中推理能力较为明显.     

积极式个案管理模式对精神分裂症患者生活质量影响的研究

目的探讨积极式个案管理模式对精神分裂症患者生活质量的影响。方法选取800例精神分裂症患者随机分为两组,分别接受积极式个案管理治疗（研究组,入组400例,完成380侧）和普通康复治疗（对照组,入组400例,完成350例）,应用阳性与阴性症状量表（PANSS）、Camberwell需求评价量表（CAN）、生活质量量表（QOLS）、家庭负担量表（FBI）和WHO-精神残疾评价量表简化版（DAS—S）分别于入组前、入组后1年、2年末对患者的精神症状、生活质量变化等进行评定。结果（1）治疗后,PANSS总分和阴性症状评分,两组比较差异有统计学意义（P〈0．05）;（2）CAN帮助栏目分量表中基本生活、家庭和社会职能及社会救助因子分研究组较前均有下降,两组比较差异有统计学意义（P〈0．05）,cAN帮助来源分量表中社会帮助因子分研究组较前升高,两组比较差异有统计学意义（P〈0．01）;（3）生活质量量表中日常生活、家庭生活及安全感因子分,研究组均有提高,对照组无变化,两组比较差异有统计学意义（P〈0．05）;（4）家庭负担量表评分,家庭经济和心理健康因子分,研究组明显下降,对照组无变化,两组比较差异有统计学意义（P〈0．05）;（5）精神残疾评价量表评分,研究组DAS—S评分有下降,两组比较差异有统计学意义（P〈0．05）。结论积极式个案管理模式能提高精神分裂症患者社会功能及生活质量。     

社区老年轻度认知损害者自我效能的研究

目的探索社区老年轻度认知损害者的自我效能特点及其与躯体状况、个性的关系。方法调查对象为社区中60岁以上的老人，共168名，其中，正常认知功能组93名，轻度认知功能损害组（MCI）75名。分别采用自编问卷（包括人口学资料）、躯体疾病清单、自我效能量表、个性指数问卷和MMSE进行测评。结果①两组间自我效能总分及保持健康、乘车、生活安排、生产力能力等项目均有显著性差异。②自我效能分别与躯体疾病指数及个性指数各不同分项显著相关。结论轻度认知功能损害者具有较低水平的自我效能，其可能受到躯体状态及个性特征的影响。     

Leaving home: the experience of people with a mental handicap

ABSTRACT. Open-ended interviews were conducted with 12 people with a mental handicap who had left parental homes in order to live as tenants in community residential hostels. Parents and hostel staff were also interviewed. The nature of life in the family home, and the tenant's role in the move, reasons for leaving home and expectations for the future were explored. It was found that social life, autonomy and opportunities to develop self-help skills had been limited at home. The tenants who had the widest social experience and the greatest use of self-help skills at home were the most active in changing their situation. Tenants hoped to gain more freedom by leaving home, although they were also in agreement with parents and staff about the value of learning new skills.     

Support and Companionship in Virtual Communities: Establishing a COVID-19 Counseling Network for Soldiers and the Collective Healing Phenomenon

Counseling people, particularly those in the military engaged in group living, who are in quarantine during the COVID-19 pandemic is a challenge. Therefore, supporting the people in quarantine who are experiencing psychological and interpersonal problems has become a new challenge in military mental health. This study’s primary concern was how to overcome the problems caused by physical quarantine. The study subject was a virtual counseling network and its operating experience during the quarantine period in Taiwan amidst the global COVID-19 pandemic. For soldiers who mainly live in groups, this study discussed how the virtual counseling network combined with the existing military support group to determine what influence the network had on people in quarantine. This study found that this group exhibited four types of experiences: togetherness, empathy, confidence, and belonging and cohesion. Such experiences are beneficial for group healing through mutual support and companionship. Collective cohesion and psychological healing can be achieved through a virtual community. This is worthy of attention, particularly in the pandemic or post-pandemic era. Physical isolation has become a fact of life, and such isolation is not just isolation from disease but also between regional boundaries. Counseling and support systems in virtual space or the operation of virtual teams must be considered for the future.     

Service support to people in Wales with severe intellectual disability and the most severe challenging behaviours: processes, outcomes and costs

A survey of people with severe intellectual disability and the most severe challenging behaviour in Wales identified five adults living in family homes, 17 in new specialist community housing and 19 in traditional services. With the omission of two people from the latter group and with a restricted collection of data for people living in the family home, the present study explored service input, outcome and costs across the three setting types. Process and outcome indicators for the family home group, who received little service input, were better than those for the traditional service group, although less good than those for the community house group. The specialist community home model produced significant gains over the traditional services in virtually all areas. Across the residential data set as a whole, there was no association between staff:resident ratios and severity of disability or between costs and severity of disability. This was largely true of the service types separately. There was a relationship between costs and service quality. However, this association was underpinned by gross differences between community houses and traditional settings. Costs, processes and outcomes ceased to be related when the two residential types were considered separately. Although higher costs of new community services compared to traditional services may be set against improved outcomes, high costs within the former could not be related to benefit. Outcome indicators were generally related to each other, suggesting that high quality in one sense was matched by high quality in other senses. Outcome was significantly associated with the ability of residents. Outcome indicators also tended to be related to observed staff performance, which was independent of resident ability. Therefore, outcome may be considered as dually determined by differences in resident ability and in what staff did.     

Supported living in residential homes for the elderly: impact on patients and elder care workers

To enable older people with severe and persistent mental illness to live in the community, the Dutch mental health sector has developed a program for supported living in residential homes for the elderly. It provides for the permanent stationing of mental health workers (MHWs) in elder care facilities to support both the resident patients and the elder care staff. The authors examined associations between the number of MHW staff and the degree to which (1) patients were integrated into the community and (2) elder care workers had developed effective working alliances with their patients. Participants included 110 patients participating in 18 supported living programs in the Netherlands. Community integration was assessed in face-to-face interviews with the patients about their perceived influence over daily life, involvement in social activities, and social network size. The quality of the worker-patient relationship was assessed using the Dutch Working Alliance Questionnaire for Community Care, completed by the elder care worker primarily responsible for each patient. After differentiation of the MHW staff into medically trained and nurse-trained professionals, associations with outcome measures were found only for the nurse-trained staff. The more hours of nurse-trained staff capacity per patient, the more influence perceived by the patients, and the more directiveness shown by the elder care workers in their contacts with patients. The impact of supported living programs in residential homes for the elderly appears to be determined in part by the caseloads of the on-site MHWs.     

Three years after in-patient stroke rehabilitation: A follow-up study

A 3-year follow-up study was performed aimed at describing the outcome for severely affected stroke survivors who had undergone geriatric in-patient rehabilitation. Living conditions, psychological well-being, and changes in functions were assessed in 55 survivors. Twenty-five people were living in the community, 15 in apartment hotels or homes for the aged and 15 in nursing homes. From discharge to follow-up 11 people had had to move to an accommodation offering more support. Living alone, recurrent strokes and functional decline were associated with moving. Many of those living in the community were supported by relatives or home help services. Home adjustments and assistive devices were common and in most cases were aimed at facilitating transfers and bathroom activities. Motor function had deteriorated from discharge to follow-up, otherwise no statistically significant changes were seen in the survivors' abilities and functions. Most survivors had in fact been able to maintain their functions or to make further improvements. Also, their psychological well-being seemed quite good. These results should encourage rehabilitation efforts for elderly people severely affected by stroke.     

History of past sexual abuse in married observant Jewish women

OBJECTIVE: The authors examined instances of past sexual abuse and related demographic characteristics in the self-reports of a select group of married observant Jewish women. METHODS: Orthodox Jewish married women (N=380) ages 19 to 58 responded to advertisements asking them to complete an anonymous questionnaire about sexual experiences, including sexual abuse. RESULTS: Sexual abuse was reported by 26% of the respondents surveyed, with 16% reporting abuse occurring by the age of 13. More ultra-Orthodox Jews reported abuse than modern-Orthodox Jews. Women who were raised observant reported significantly less childhood sexual abuse than those who became observant later in life. Sexual abuse was associated with increased treatment-seeking for depression, marital counseling, or other emotional or psychological problems. CONCLUSION: While observant Jewish women live in a culture defined by a high degree of adherence to specific laws of conduct, including rules designed to regulate sexual contact, sexual abuse of various types still exists among them.     

A longitudinal study of the quality of life of older people with intellectual disability after leaving hospital

A study was made of the quality of life of 29 older people with intellectual disability who left hospital to live in ordinary three- or four-bedroom houses. A short version of the Questionnaire on Quality of Life was used to measure quality of life before moving and at three points in the first 53 months after changing residence. Results showed that there were improvements in quality-of-life subscales in the first 41 months with an eventual levelling out after 53 months. Social and leisure activity have been identified as particular important in the quality of life of older people. Therefore, items from the scale that measure participation in community leisure activities, contact with people without intellectual disability during these activities and engagement in leisure activities within the home were selected for detailed analysis. These data also showed increased activity and contacts in the first 41 months with a levelling out after 53 months.     

The distribution of services to demented elderly people living in the community

One hundred and sixty demented, community-resident elderly people were identified by means of a community survey. Subjects who lived alone received home helps and meals-on-wheels more often than those who lived with supporters but there were no differences between the two groups with respect to district nursing or day care. Services increased in line with the degree of mental infirmity and nearly all moderately and severely demented people who lived alone were known to at least one service. We suggest that the home help and meals-on-wheels services, as presently constituted, may have limited applicability to dependent old people who live with able-bodied supporters. If services are to provide effective assistance, they may need to adapt their provision to the actual needs of elderly people and their relatives.     

Moving out: an opportunity for friendship and broadening social horizons?

ABSTRACT. The study investigated the changes in social activities and social network of people with mild learning difficulties who moved from family home and from a long-stay hospital to live more independently in the cummunity, Twenty-five people with a learning difficulty, 12 mothers and 33 members of stuff participated in this siudy based on interviews before and alter the move to the community. It was found that people with a learning difficulty participated in more comrminity-bascd activities after the move but they had very few opportunities to meet non-handicapped people, Their segregation remained a main source of dissatisfaction with their social life.