社区老年人躯体健康损害及死亡的预测因子分析

[目的 ]　探讨老年人躯体健康损害及死亡的预测因子 ,为老年保健服务计划的制定提供信息。　 [方法 ]　对 145 3名社区老年人近 3年的纵向观察资料 ,应用Logistic回归模型进行分析。　[结果 ]　基线时年龄 ,患心脏病、高血压病 ,疾病严重程度及躯体健康状况可预测近 3年内躯体健康的高损害。基线时年龄、职业、疾病严重程度、日常活动能力损害可预测近 3年内死亡的发生。　 [结论 ]　社区老年保健的重点对象为高龄老人、无职业者、患严重疾病尤其是患心血管疾病者。社区老年保健的首要任务是预防和阻止躯体健康和日常活动能力的损害 ,加强老年心血管疾病的人群防治。     

上海市某社区老年人精神健康及影响因素分析

[目的 ]　对社区老年人的精神健康状况进行评估。　 [方法 ]　对 2 0 0 5名老年人采用OARS量表结合我国国情修改而成的调查评估表 ,由调查员入户调查。　 [结果 ]　社区老年人中 91.6 %精神健康状况良好 ,8.4%的老人有精神障碍 ,6 .1%的老人有抑郁倾向。单因素分析显示影响老年人群精神健康的因素除年龄、性别、文化程度、婚姻、职业等基本特征外 ,主要为躯体健康状况、社会交往情况、经济情况及日常生活能力等。　 [结论 ]　老人精神健康应受到重视 ,宜针对影响因素采取相应措施 ,改善老年人群精神健康状况 ,促进老年人群的综合健康。     

社区老年人身体健康损害及死亡的预测因子分析

目的：探讨老年人躯体健康损害及死亡的预测因子，为老年保健服务计划的制定提供信息。方法：对1453名社区老年人近3年的纵向观察资料，应用Logistic回归模型进行分析。结果：基线时年龄，患心脏病，高血压病，疾病严重程度及躯体健康状况可预测近3年内躯体健康的高损害，基线时年龄，职业，疾病严重程度，日常活动能力损害可预测近3年内死亡的发生。结论：社区老年保健的重点对象为高龄老人，无职业者，患严重疾病尤其是患心血管疾病者，社区老年保健的首要任务是预防和阻止躯体健康和日常活动能力的损害，加强老年心血管疾病的人群防治。     

应用OARS问卷对社区老年人ADL功能的调查

目的：了解上海城市社区60岁以上老年人的日常活动能力（ADL）并探索其影响因素。方法：应用OARS问卷对上海某城区两个里委902名社区老年人日常活动能力（ADL）进行调查。结果：老年人各项ADL功能均不需帮助者占64．3％，至少有一项ADL功能下降者占34．2％，有7人（0．8％）完全丧失ADL功能。生理性ADL（PADL）中下降率最高的是沐浴（7．2％），最低的是进食（3．0％），PADL下降率随年龄增加而上升，但无性别差异。工具性ADL（IADL）中下降率最高的是打电话（28．5％），最低的是理财（7．5％）。结论：IADL下降率随年龄增加的趋势更加明显，是PADL的3．9倍，且有性别差异，女性下降率显著高于男性。影响ADL功能的因素主要有年龄、性别，ADL评分与老年人社会资源、经济状况、躯体健康及精神健康评分呈正相关，并有显著统计学意义。     

银川地区城市社区老年人群日常生活活动能力及影响因素分析

目的了解银川市城市社区老年人日常生活活动能力及影响因素,以便为社区卫生服务中心制定良好的、针对性卫生保健服务计划提供依据。方法采用ADL问卷和有关的影响因素调查问卷,对银川地区城市社区年龄≥60岁5399例老年人进行了入户调查。结果6项活动丧失率从38.2%~78.6%,在6项活动中有5项活动随着年龄上升而上升,除吃药外均有统计学意义。在控制年龄影响因素后,性别间在做饭、家务女性丧失率低于男性,邮寄女性丧失率高于男性且有统计学意义,其它两项无统计学意义;在控制年龄影响因素后,患病是影响老年人日常生活活动能力主要因素;吸烟、饮酒及锻炼与否都是影响老年人群日常功能的因素。结论银川市老年人群日常生活活动能力不容乐观,患病与否是影响老年人日常生活活动能力重要因素,应加强慢性病的防治和管理,改善健康状况,提倡戒烟、戒酒及经常参加体育锻炼,提高老年人生活质量。     

上海市静安区老年人健康期望寿命及影响因素

[目的 ]　计算静安区 60岁以上老年人的健康期望寿命 ,分析健康期望寿命的主要影响因素。　 [方法 ]　杜克法评价日常活动能力 ,Sullivan法计算健康期望寿命与期望寿命损失率。　 [结果 ]　本地区男、女性 60～ 65岁老年人的健康期望寿命分别为 14 .5 7岁和 14 .67岁 ,期望寿命损失率分别为 3 3 .3 %和 40 .7%。 60岁以上女性的期望寿命损失率高于男性。家庭经济收入、文化程度、是否合理体育锻炼、家庭居住条件、是否得到及时帮助可影响健康期望寿命。中风导致的期望寿命平均损失率最大 ,其他依次为精神障碍、糖尿病、高血压、慢性支气管炎和肺气肿、视力障碍和心脏病。　 [结论 ]　本地区 60岁以上老年人的健康期望寿命高于我国其他一些地区。为了提高老年人的健康期望寿命 ,应加强老年人尤其是女性老年人的健康保健服务和改善老年人的社会经济状况     

老年人躯体健康与抑郁症状发病的相关研究

目的 探讨社区老年人群躯体健康状况与抑郁症状发病之间的关系.方法 采用分层随机整群的抽样原则,在北京市城乡社区老年人群中抽取有效样本2506人,分别于2000年和2004年采用综合问卷进行人户调查.结果 北京市社区老年人抑郁症状的4年累积发病率是10.58%.单因素分析结果显示,文化程度越低抑郁症状发生率越高(文盲组、小学组和初中以上文化组的发生率分别为15.2%、10.5%和5.1%;χ2=26.587,P=0.000);居住在农村的老年人抑郁症状发生率明显高于城市的老年人(15.4%、6.1%;χ2=31.163,P=0.000).健康自评差的老年人抑郁症状的发生率明显增加(健康自评为良好、一般和差的各组老年人抑郁症状的发生率分别为7.3%、13.2%和38.0%;χ2=23.385,P=0.000);有认知功能障碍的老年人抑郁症状的发生率明显高于认知功能正常的老年人(19.3%、9.6%;χ2=11.947,P=0.001);生活不能自理的老年人抑郁症状的发生率也明显高于能够自理的老年人[基本日常生活自理能力(ADL):37.5%、10.1%;χ2=15.930,P=0.000;操作性日常生活自理能力(IADL):17.5%、9.6%;χ2=9.501,P=0.002].logistic回归分析结果显示,文化程度、居住地区、健康自评和ADL是老年抑郁症状发病的独立影响因子.结论 文化程度低、居住在农村、健康自评差以及ADL不能自理的老年人抑郁症状发病风险增高.     

哈密市老年人日常活动能力及健康期望寿命研究

目的 了解哈密市（伊区两县）≥60岁老年人日常活动能力及健康期望寿命,分析ADL的影响因素。方法 通过多阶段抽样抽取调查对象,收集≥60岁老年人的人口学特征、慢病患病情况以及日常活动能力情况。不同人群ADL依赖率的比较采用χ2检验,ADL影响因素筛选采用二分类Logistic回归分析。结果 共抽样调查880人,哈密市60岁及以上老年人ADL依赖率为13.18%。男性60岁及以上老年人ADL依赖率为10.21%,女性为16.59%;不同性别、民族、文化程度、婚姻状况、户籍类型、社会医疗保险,是否患有慢性病、是否吸烟,是否饮酒,是否进行体育锻炼分组的≥60岁老年人ADL依赖率有统计学差异（P＜0.05）;二分类Logistic回归分析显示,民族为哈萨克族、文盲、丧偶、患有慢性病的老年人ADL依赖率更高,参加体育锻炼的老年人ADL依赖率更低。哈密市60～64岁组老年人期望寿命为25.58岁,期望寿命随年龄增加而呈现下降趋势。60～64岁组老年人健康期望寿命为20.17岁,ADL依赖健康期望寿命为5.41岁。结论 在老年人健康问题中,应更加关注易发生ADL损失的高危人群,重点关注独居,丧偶老年人。鼓励老年人多参加体育锻炼或社区活动,增强身体健康。     

农村老年人日常生活活动能力现状及影响因素分析

[目的]调查山东省农村老年人的日常生活活动(ADL)能力状况,分析其影响因素。[方法]采用分层随机抽样方法抽取山东省9个地市的60岁以上老年人600例,应用日常生活活动(ADL)能力量表和自制影响因素问卷对他们进行面对面访谈,测评其ADL现状并对可能影响农村老年人日常生活活动能力的因素进行分析。[结果]山东省农村老年人的日常生活活动能力丧失率为8.8%,影响农村老年人日常生活活动能力的因素包括年龄、躯体健康状况、慢性病、饮食习惯等。[结论]高龄、患有慢性病是农村老年人日常生活活动能力的危险因素,躯体健康、均衡饮食是保护性因素。     

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.     

Activities of daily living, cognitive impairment and other psychological symptoms among elderly recipients of home help

Previous studies have shown a relationship between physical functioning and having home help. The hypothesis behind this study, carried out on a random community sample of 168 subjects aged 75 years and above, was that having home help would also be associated with cognitive impairment and psychological symptoms. Bivariate analysis showed that cognitive impairment was significantly more frequent among home help clients, whereas indicators of anxiety and depression were not. After multivariate adjustment, living alone, poor perceived health, problems in performing primary activities of daily living (ADL), instrumental ADL and, in particular, experiencing difficulties in cleaning the house remained the only variables independently related to having home help. Of these, difficulties with cleaning the house was the most powerful predictor. The home help seems to be used mainly to compensate for impaired mobility. An association between cognitive functioning and the provision of home help is related to a limitation in the ability to perform ADL associated with cognitive impairment.     

社区老年人健康功能多维评价及影响因素

目的 评价福州市社区老年人的健康状况，并探讨影响健康的有关因素。方法 对1767名65岁及以上的老年人进行问卷调查，从日常生活功能、躯体健康、精神健康、社会健康和经济状况等5个基本方面对老年人健康功能状况进行多维评价。结果 研究对象中综合健康状况优良、一般和较差分别占总人数的47．1％，44．6％和8．3％。5项单维健康损害发生率介于37．7％和74％之间，其中躯体健康损害发生率最高。影响老年人健康水平的主要慢性病为高血压、心脏病和糖尿病。结论 慢性病防治、婚姻家庭生活、适度体育锻炼、科学膳食营养以及参与社会活动等均有益于社区老年人健康水平的提高。     

The impact of somatic and cognitive disorders on the functional status of the elderly

To estimate the relative effects of coexisting nondementia illnesses on the probability of functional disability, depending on the presence of cognitive impairment or dementia, we used data from the baseline case-control assessment of a longitudinal study of aging and dementia. Our study included 668 subjects (345 nondemented, 98 cognitively impaired, and 225 demented), aged 75 and older. Demented subjects had greater disability prevalence on all specific instrumental activities of daily living (IADL) and activities of daily living (ADL) items than cognitively impaired subjects who, in turn, had greater disability than nondemented subjects. Somatic illnesses were found to be associated with particular tasks in item specific models; decreasing MMSE was strongly associated with the probability of IADL and ADL disability, which increased dramatically in the presence of somatic illnesses among cognitively impaired as well as demented subjects. Attention to illnesses among cognitively impaired and demented people may shed light on remediable factors crucial to their daily functioning.     

Functional Impairment in Youth Three Years after Detention

PurposeThis article examines functional impairment across global and specific dimensions among youth 3 years after their detention.MethodsFunctional impairment was assessed using the Child and Adolescent Functional Assessment Scale (CAFAS) in a large, stratified, random sample of formerly detained youth (N = 1653).ResultsMore than one-fifth of the individuals in the sample were scored as having marked impairment that required, at minimum, “multiple sources of care” (CAFAS Total Score of ≥100); 7.0% required “intensive intervention” (CAFAS Total Score ≥140). Most of the sample had impairment; only 7.5% had “no noteworthy impairment” (CAFAS Total Score ≤10). Significantly more males were impaired than females. Among males living in the community at follow-up, African Americans and Hispanics were more likely to be impaired than non-Hispanic whites. In comparison to males living in the community, males who were incarcerated at follow-up were significantly more likely to have impaired thinking and impaired functioning at home (if incarcerated, “home” is the correctional facility) but less likely to have substance use problems.ConclusionsThree years after detention, most youth struggle in one or more life domains; more than one in five have marked impairment in functioning. These findings underscore the ongoing costs, to both youth and society, of our failure to provide effective rehabilitation to youth after detention.     

抑郁症状对社区亚老龄及老龄人群心身健康结局影响的随访研究

目的 探索抑郁症对社区老年人群健康结局的影响。方法 对上海市静安区同一批非痴呆55岁以上人群应用中文版流行病学调查用抑郁自评量表（CES-D）等调查工具，进行5年随访。按当年抑郁症状的严重程度，对5年后多项心理和躯体健康结局指标进行多因素分析。结果 （1）2次面访者2927名。按照首次CES-D得分将有无抑郁症状分为4个等级，基线分布除年龄外、性别、教育程度、中文版简易智能状态检查（MMSE）、日常生活活动能力量表（ADL）差异均存在显著性。（2）以首次CES-D分数、年龄、性别、教育程度、MMSE、ADL为自变量，进行多元回归分析发现，CES-D得分与5年后MMSE、ADL、生活满意度指数A（LSIA）得分无显著性相关。（3）在控制基线变量后，首次CES-D得分与5年自我健康评价、记忆力自我评价呈显著性正相关。（4）分别以5年后躯体疾病指数、是否死亡为因变量，以首次CES-D得分等级、年龄、性别、教育程度、MMSE、ADL为自变量，进行多元logistic回归分析。在躯体疾病影响指数和死亡的风险预测中，5年前抑郁症状影响最大，其OR值分别为1.52(95%CI:1.19-1.95)和2.68(95%CI:1.41-5.06)。结论 抑郁症状是影响社区老年人心身健康结局的主要因素之一。     

Association between early methylmercury exposure and functional health among residents of the Shiranui Sea communities in Japan

The objective of this study was to evaluate the effect of estimated historical methylmercury exposure on the functional health of residents living in the Shiranui Sea communities in Japan. Functional health was measured by self-reported activities of daily living (ADL). Study areas were categorized into high, medium and low methylmercury exposure areas according to their location or distance from the Shiranui Sea. We estimated the adjusted prevalence odds ratios of impaired ADL in relation to exposure using a logistic regression model. Compared with residents in the low-exposure area, residents in the high-exposure area were significantly associated with a higher prevalence odds ratio (OR) for impaired ADL after adjustment for confounding factors (adjusted ORs = 2.8, 95% CI: 1.3–6.2). These results showed strong dose-response relationships (p for trend = 0.0050). Our findings suggest that historical methylmercury exposure might cause functional impairment in later in life depending on the exposure level.     

Outcomes after stroke: Basic and instrumental activities of daily living, community reintegration and generic health status

This study describes the discharge destination, basic and instrumental activities of daily living (ADL), community reintegration and generic health status of people after stroke, and explored whether sociodemographic and clinical characteristics were associated with these outcomes. Participants were 51 people, with an initial stroke, admitted to an acute hospital and discharged to the community. Admission and discharge data were obtained by chart review. Follow-up status was determined by telephone interview using the Modified Barthel Index, the Assessment of Living Skills and Resources, the Reintegration to Normal Living Index, and the Short-Form Health Survey (SF-36). At follow up, 57% of participants were independent in basic ADL, 84% had a low risk of experiencing instrumental ADL difficulties, most had few concerns with community reintegration, and SF-36 physical functioning and vitality scores were lower than normative values. At follow up, poorer discharge basic ADL status was associated with poorer instrumental ADL and community reintegration status, and older participants had poorer instrumental ADL, community reintegration and physical functioning. Occupational therapists need to consider these outcomes when planning inpatient and post-discharge intervention for people after stroke.