慢性病老年人养老方式选择的影响因素研究

目的 了解慢性病老年人养老方式选择的影响因素,为其提供合适的养老方式。方法 通过多阶段分层抽样调查厦门市60岁及以上常住老年人的人口学资料、养老方式选择及慢性病患病情况等,采用χ2检验和多分类Logistic回归分析慢性病老年人养老方式选择的影响因素。结果 1 276名老年人中慢性病患病率为61.4%,慢性病老年人（相比未患慢性病老年人）选择社区居家养老和机构养老的比例均较高。以家庭养老为参照,慢性病老年人选择社区居家养老与机构养老的影响因素分别是与子女关系、居住地、文化程度、婚姻、孤独感,独居、与子女关系、文化程度、年龄、居住地。结论 慢性病老年人养老方式选择仍以家庭养老为主,但较未患慢性病老年人低。独居、年龄、婚姻、居住地、孤独感是慢性病老年人养老方式选择特有的影响因素。     

Transforming clients into experts-by-experience: A pilot in client participation in Dutch long-term elderly care homes inspectorate supervision

As experts-by-experience, clients are thought to give specific input for and legitimacy to regulatory work. In this paper we track a 2017 pilot by the Dutch Health and Youth Care Inspectorate that aimed to use experiential knowledge in risk regulation through engaging with clients of long-term elderly care homes. Through an ethnographic inquiry we evaluate the design of this pilot. We find how the pilot transforms selected clients into experts-by-experience through training and site visits. In this transformation, clients attempt, and fail, to bring to the fore their definitions of quality and safety, negating their potentially specific contributions. Paradoxically, in their attempts to expose valid new knowledge on the quality of care, the pilot constructs the experts-by-experience in such a way that this knowledge is unlikely to be opened up. Concurrently, we find that in their attempts to have their input seen as valid, experts-by-experience downplay the value of their experiential knowledge. Thus, we show how dominating, legitimated interpretations of (knowledge about) quality of care resonate in experimental regulatory practices that explicitly try to move beyond them, emphasizing the need for a pragmatic and reflexive engagement with clients in the supervision of long-term elderly care.     

护理质量管理在高龄患者手术护理中的应用

目的观察护理质量管理应用于高龄患者手术护理的临床效果,探讨分析其应用价值。方法回顾性分析我院2012年5月--2013年6月的高龄手术患者182例,患者按照自主和随机原则分为对照组和观察组。其中对照组患者行常规护理,而观察组则按照护理质量管理方法,在传统护理基础上行护理干预。比较分析两组患者的临床情况,分析其护理效果。结果对照组和观察组患者的手术时间、手术成功率、护理满意度、手术配合度以及医疗纠纷发生率相比较．均具有显著性差异（P〈0．05）。结论护理质量管理对于提升高龄患者手术护理的护理满意度具有重要作用,是提高医院护理水平的重点。     

上海建立老年护理制度的分析与探讨

上海已进入老龄化社会,老年护理需求增加,如何保证“老有所养”成为一个急迫的问题。与此同时,家庭结构的变迁、人口流动性的加大,传统的家庭照顾模式又面临挑战。医疗护理与生活护理的边界不清,带来过度住院问题,造成医疗保险基金的严重压力。建立老年护理制度,成为探索解决这一系列问题的一种途径。     

北京市老年人卫生服务需求研究

目的　了解北京地区老年人的健康现状及卫生服务需求 ,为政府及相关部门制定老年人保健政策和有针对性地开展老年人卫生服务提供依据。方法　抽样调查北京不同地区 (城区、城乡结合部、郊区农村 ) 6 0岁及以上老年人群 2 4 87人。调查内容涉及老年人的健康状况 ,医疗、护理、康复及保健需求 ,以及社区卫生服务。分析不同地区及人群的老年人健康现状与卫生服务需求的差异。结果　慢性病是老年人的主要卫生问题 ,罹患的前 4种慢性病是高血压、冠心病、骨关节病、脑血管病 ,糖尿病患病率增加较快。约 10 %的老人躯体功能有障碍 ,日常生活能力下降 ,生活需要他人帮助。老年人增多对医疗及护理照料服务的需求量增大。社区卫生服务的优势日益显出 ,得到老年人的认可。经济困难是影响老年人就医行为的主要原因。结论　老年人群是健康的弱势群体 ,随着人口老龄化 ,老年人卫生服务的需求增加。健康是影响老年人生活质量的重要因素 ,大力加强慢性病的防治应列为老年保健的中心任务 ,也是提高老年人生活质量的关键。     

优质护理对老年高血压患者生活质量的影响

目的：探讨优质护理对老年高血压患者生活质量的影响。方法：选取88例老年高血压患者作为研究对象,将其随机分成对照组和护理干预组,每组44例,并对所有患者实施医疗护理,给予对照组按照常规方法进行治疗及护理,护理干预组则在常规护理的基础上实施优质护理干预;对两组患者的生活质量改善情况加以观察。结果：护理干预组的护理有效率为90.91%,对照组护理有效率为79.55%,两组数据差异有统计学意义（P〈0.05）;护理干预组患者的生活质量良好率为86.36%,对照组则为70.45%,差异有统计学意义（P〈0.05）。结论：对老年高血压患者实施优质护理,可有效的提高患者的治疗依从性,使临床症状得到改善,有力的促进了患者生活质量的提高。     

An estimate of post-acute intermediate care need in an elderly care department for older people

There is an expectation that intermediate care services for older people will be widely introduced in England. The planning of such services should be based on an understanding of required capacity. The present study provides a needs estimate for post-acute intermediate care. Older patients admitted acutely to an elderly care department in a district general hospital serving a large city in northern England were followed prospectively by a research team until medical stability had occurred in the opinion of the senior ward nurses and the responsible consultant. The clinical staff then determined if the patient had continuing post-acute care needs or if imminent discharge was possible. Out of 1211 acutely admitted patients, 997 became medically stable and 312 [25.8% of admissions; 95% confidence interval (CI) = 23.3-28.2%] were considered to require post-acute care, and of these, 251 (20.7% of admissions; 95% CI = 18.4-23.0%) needed post-acute rehabilitation care. In conclusion, the present authors suggest that intermediate care services providing post-acute care for older people should have a capacity to address the needs of up to one-quarter of acute admissions to a district general hospital elderly care department.     

The effectiveness of preventive care at reducing curative care risk for the Taiwanese elderly under National Health Insurance

Whether provision of free preventive care for the elderly under National Health Insurance has reduced the risk for curative care use raises much concern in Taiwan. This study analyzes the relationship by examining the impact of health examination utilization on the utilizations of outpatient care and inpatient care. Data come from the 2005 National Health Interview Survey and National Health Insurance Research Database. A two-stage method is used in the estimation. We found a negative relationship between the utilization of preventive care and hospitalization care in terms of length of stay and medical expenditures. On average, the elderly people who used preventive care tended to have 16 shorter hospitalization stays and NTD64,220 lower hospitalization expenditures than their counterparts. In order to improve the health of the elderly and reduce the escalation of medical expenditures due to aging, including preventive care in the health insurance is a very effective strategy.     

Relationship between regulatory status,quality of care,and three-year mortality in Canadian residential care facilities: a longitudinal study

OBJECTIVES: To compare the mortality rate in regulated and unregulated facilities, controlling for confounding variables, and investigate the effect of care quality on residents' length of survival. DATA SOURCES/STUDY SETTING: At baseline, subjects were assessed in their living environment with respect to their functional autonomy, cognitive abilities, and quality of care. Vital status, disease-related information, and hospitalization data were retrieved three years later from the subjects' medical files. STUDY DESIGN: A three-year follow-up study of 299 residents from 88 long-term care facilities located in the province of Quebec, Canada. The effect of regulatory status and quality of care on length of survival was investigated by means of multivariable Cox proportional hazards regression models, from both traditional and competing risks perspectives. PRINCIPAL FINDINGS: Controlling for age, comorbidity, and baseline functional abilities, a resident's length of survival is not significantly influenced by the regulatory status of the facility in which he or she lived at baseline. However, residents with poor quality ratings at baseline had shorter survival times than those provided with good care. Median survival was 28 months among residents classified as receiving inadequate care compared to 41 months for those adequately cared for (p = 0.0217). CONCLUSIONS: The study suggests that quality of care has a much stronger influence on resident outcomes than regulation per se. This finding underscores the relevance of testing innovative interventions aimed at improving the quality of care provided in long-term care facilities, regardless of their regulatory status.     

Privatization of social services: quality differences in Swedish elderly care

One of the major policy trends in recent decades has been the privatization of social services. This trend has also reached Sweden, a welfare state with health care and social service sectors that previously had almost no private providers. One of the most affected areas is elderly care, i.e. home-help services and residential care provided to citizens older than 65 years, where the proportion of private providers increased from 1% in 1990 to 16% in 2010. The ongoing privatization in Sweden and many other countries has raised important questions regarding the consequences of this policy transformation. In this paper, we present a cross-sectional study comparing the quality of services in private and public elderly care. Using statistics from 2007 displaying a variety of quality dimensions covering over 99% of all elderly care residents in Sweden, we were able to show that privatization is indeed associated with significant quality differences. Structural quality factors such as the number of employees per resident was significantly smaller (-9%) in private elderly care. On the other hand, the proportion of residents participating in the formulation of their care plan (+7%), the proportion of elderly with a reasonable duration between evening meal and breakfast (+15%), and the proportion of elderly offered different food alternatives (+26%) were significantly in favour of private contractors. Our conclusion is that private care providers seem to emphasize service aspects rather than structural prerequisites for good care.     

A Multilevel Analysis of the determinants of emergency care visits by the elderly in France

BackgroundRising numbers of visits to emergency departments (EDs), especially amongst the elderly, is a source of pressure on hospitals and on the healthcare system. This study aims to establish the determinants of ED visits in France at a territorial level with a focus on the impact of ambulatory care organisation on ED visits by older adults aged 65 years and over.MethodsWe use multilevel regressions to analyse how the organisation of healthcare provision at municipal and wider ‘department’ levels impacts ED utilisation by the elderly while controlling for the local demographic, socioeconomic and health context of the area in which patients live.ResultsED visits vary significantly by health context and economic level of municipalities. Controlling for demand-side factors, ED rates by the elderly are lower in areas where accessibility to primary care is high, measured as availability of primary care professionals, out-of-hours care and home visits in an area. Proximity (distance) and size of ED are drivers of ED use.ConclusionHigh rates of ED visits are partly linked to inadequate accessibility of health services provided in ambulatory settings. Redesigning ambulatory care at local level, in particular by improving accessibility and continuity of primary and social care services for older adults could reduce ED visits and, therefore, improve the efficient use of available healthcare resources.     

养老机构养老护理员职业认同现状及影响因素分析

目的 探讨养老机构养老护理员职业认同现状及其影响因素,为提升养老护理员职业认同水平提供参考依据。方法 采用整群随机抽样法,于2020年9—12月在遵义市城区内的95所养老机构中随机抽取24所,对24所养老机构中符合纳入标准的所有养老护理员采用一般情况调查表、养老护理员职业认同量表、人文关怀能力评价量表进行调查,本次调查共发放问卷351份;应用SPSS 21.0进行数据分析,其中一般情况采用描述性统计分析,职业认同的影响因素采用单因素分析、多元线性逐步回归等方法进行分析。结果 养老护理员职业认同平均得分为（104.95±18.39）分,多元线性回归分析结果显示:养老护理员职业认同影响因素有年龄（t=-2.398,P=0.017）、月收入（t=3.695,P＜0.001）、文化程度（t=2.544,P=0.011）、职业技能证书（t=2.072,P=0.039）、培训机会（t=4.704,P＜0.001）、工作时长（t=-4.254,P＜0.001）、照护老人数量（t=-3.336,P=0.025）、家庭支持情况（t=4.608,P＜0.001）、人文关怀能力（t=9.576,P＜0.001）。结论 养老护理员职业认同处于中等水平,建议有关部门针对以上影响因素提出整改措施,提高养老护理员职业认同水平,促进养老机构护理队伍的建设。     

少数民族地区老年妇女健康保健服务需求

目的:了解少数民族地区老年妇女的健康保健服务需求,为社区卫生服务发展提供参考依据。方法:采用整群随机抽样的方法选取调查对象,用自行设计的问卷进行入户调查。结果:29.5%的老年妇女在自感病情较轻时选择社区、街道卫生服务中心就诊,90.5%在突发重病时能及时赶到医院或急救中心治疗,大部分老年妇女希望获得自助呼救、健康教育等健康保健服务,仅有少部分人希望这些服务由社区卫生服务机构提供。结论:少数民族地区老年妇女健康保健服务需求高,但对社区卫生服务认识不足,社区卫生服务中心需提供各种形式的健康保健服务。     

Using queue to signal quality in primary care: The need for further empirical investigation

In recent times, signalling quality via queues for generic services has received significant attention. However, the literature till date on primary care services has focussed on the optimal speed-quality trade-off to ensure higher service times and lower waiting times for the patients. Borrowing from the queue management literature on generic services, we aim to understand whether the hypothesis that queue is a signal of physician's quality is reasonable. Based on theoretical arguments, we justify the need to investigate this hypothesis on queue acting as a signal of quality in primary care. Although we conjecture that the queue length on arrival may act as a signal of quality, the waiting experienced after joining the queue is still considered expensive.     

家庭医生责任制延续性管理方式对社区老年脑卒中患者的影响

目的探讨家庭医生责任制延续性管理方式对社区老年脑卒中患者的影响。方法选取本院2014年1月~2015年6月随访登记的100例社区老年脑卒中患者,随机分为干预组(50例)和对照组(50例),对照组采用传统的脑卒中患者管理方案,干预组实施家庭医生责任制延续护理模式,分别观察干预前后的药物与治疗的依从性、脑卒中复发危险因素以及复发率。结果经过6个月的干预,比较两组患者的药物和治疗依从性,差异有统计学意义(P0.05);干预组患者血压(BP)、空腹血糖(FB)、血脂、同型半胱氨酸水平(HCY)、颈动脉斑块的性质、戒烟、限酒、体质量指数(BMI)的达标率均高于对照组(P0.05);脑卒中复发率低于对照组,差异有统计学意义(2%vs 14%,P0.05)。结论家庭医生责任制延续性管理方式对社区老年脑卒中患者能够更好的提高患者药物与治疗的依从性,控制脑卒中复发危险因素,从而降低脑卒中患者的复发率,值得临床进一步推广。     

The Chinese health care regulatory institutions in an era of transition

The purpose of this paper is to contribute to a better understanding of Chinese health care regulation in an era of transition. It describes the major health care regulatory institutions operating currently in China and analyzes the underlying factors. The paper argues that in the transition from a planned to a market economy, the Chinese government has been employing a hybrid approach where both old and new institutions have a role in the management of emerging markets, including the health care market. This approach is consistent with the incremental reform strategy adopted by the Party-state. Although a health care regulatory framework has gradually taken shape, the framework is incomplete, with a particular lack of emphasis on professional self-regulation. In addition, its effectiveness is limited despite the existence of many regulatory institutions. In poor rural areas, the effectiveness of the regulatory framework is further undermined or distorted by the extremely difficult financial position that local governments find themselves in. The interpretations of the principle of 'rule of law' by policy makers and officials at different levels and the widespread informal network of relations between known individuals (Guanxi) play an important role in the operation of the regulatory framework. The findings of this paper reveal the complex nature of regulating health care in transitional China.     

养老机构老年人睡眠信念与态度现况及影响因素研究

目的 探讨养老机构老年人睡眠信念与态度现况及其影响因素。方法 2021年10月—2022年3月,采用便利抽样法选取河北省内6所养老机构的445位老年人为研究对象,采用一般资料调查表,匹兹堡睡眠质量指数量表（Pittsburg sleep quality index scale, PSQI）,简式睡眠信念与态度量表（brief version of dysfunctional beliefs and attitudes about Sleep, DBAS-16）,焦虑自评量表（self-trating anxiety scale, SAS）收集调查资料。结果 养老机构老年人睡眠信念与态度总分为（42.99±3.47）分。多元线性回归结果显示,年龄、性别、自述睡眠质量、学历、PSQI、焦虑情绪为机构老年人睡眠不良信念的影响因素（均P<0.05）,可解释总变异的67.7%。且焦虑情绪在睡眠质量与睡眠信念与态度之间存在部分中介效应。结论 中高龄、学历偏低、存在睡眠障碍、焦虑情绪的老年人睡眠不良信念更严重,养老机构医护人员应重点关注此类人群,采取有效措施改善对睡眠的不良信念;且医护人员应重...     

城市老年人社区护理服务需求与影响因素调查

目的调查城市社区老年人健康需求,提出老年人健康管理对策。方法采取问卷调查和深入访谈相结合的方式收集相关数据,运用SPSS16.0进行数据分析。结果老年人两周患病与患病而未就诊比例高,在健康项目管理中有87%的老年人同时选择了健康教育、健康咨询和定期体检3项,老年人就诊受多种因素的影响。结论城市社区应以老年人需求为导向开发适宜技术,建立适宜性老年社区护理模式。     

Pathways to care: how superdiversity shapes the need for navigational assistance

The recently developed sociological concept of superdiversity provides a potentially interesting and useful way of developing an understanding of life in contemporary Europe. Here we report on research based on individual narratives about access to health care, as described by a range of people from very different sociocultural backgrounds in four European countries. This article notes the frequent appearance in first‐person narratives of the need for navigational assistance in the form of knowledge, cultural competence and orientation that facilitate the identification and use of pathways to health care. Our dataset of 24 semi‐structured interviews suggests that, in the context of needing health care, the feeling of being a ‘stranger in a strange land’ is common in people from a wide range of backgrounds. In social settings characterised by transnationalism and cultural heterogeneity, it is important to understand the need for navigational assistance, particularly at times of uncertainty, in the design and delivery of health services. The relationship between the inhabitants of contemporary Europe and the healthcare systems available in the places where they live is dominated by both complexity and contingency – and this is the cultural field in which navigation operates.