护理院进入特殊医疗服务系统——可能改变病床增长的趋势

为了满足医院缩短住院日、降低住院费用的要求,美国许多州的护理院(NursingHome)开展了特殊医疗服务。这些服务包括老年性痴呆和脑外伤的康复治疗;透崭、呼吸疗法等。特殊医疗服务满足了社会人口老龄化的需要;集中了需要长期护理的病人;充分利用了空余床位,有可能改变病床增长的趋势。目前面临的问题是资金和专业人员短缺。     

为夕阳添彩 谱晚霞新曲——江桥红十字老年护理院介绍

江桥红十字老年护理院创办于1991年,是第一批由上海市总工会、市红十字会牵头,经市、区卫生局批准的一所集护理、医疗、康复、保健、临终关怀为一体的综合性养老护理院。现有床位140张,目前红十字老年护理院挂靠于江桥镇社区卫生服务中心。     

上海某中心城区老年护理院“入院难”问题的对策研究

通过对本区域老年人健康状况护理需求,以及老年医疗生活护理机构服务量的调查,提出建立以社区卫生服务为平台的老年康复护理社区分层管理模式,针对老年人不同层次的健康护理需求,提供相应适宜的健康护理服务,提高现有老年护理资源的服务效率和服务供应量,为缓解老年护理院"入院难"的矛盾提供科学依据。     

护理院病人的医护

美国的护理院(Nursing home)总计有150万张床,预算超过400亿美元。但很多护理院缺少技术和人员,治疗也不适当。由于院校护理院(Academic nursing home)和老年医学专业的产生和发展,将会提高所有护理院的医护质量。65岁以上的人,有5%住在护理院,平均住院时间2.9年。现今的护理院应具备有效能的护理设备和中等程度的治疗设施。50%的病人是由医院转来,由于老年医疗照顾制度的预先付款,使临终病人有所增加。大部分住入护理院的病人是由于功能性残疾,如步态异常、跌倒、痴呆、不能自制、自理能力下降及他们的家庭不能提供适当的照料等原因。医生及护理组成员要提高警惕,减少能避免的并发症,如给药过多、药物中毒、压迫性溃疡(Pressureulcers)、体重下降、食欲丧失、抑郁和感染。为提高生命质量,对长期治疗的病人应     

用服务创造感动 用诚信构建和谐——上海市宝山区老年护理医院介绍

宝山老年护理院是一所具有老年专科特色的公立非营利性医疗机构。护理院以康复训练为特色。辅以医疗诊治、临终关怀、生活护理、心理护理为一体的老年专科医院。作为区政府实事项目。在原宝山区传染病医院的基础上改建而成,实际开放床位260张。于2001年2月1日正式投入使用。主要承担老年患者的医疗护理服务。     

社区家庭病床现状与推行家庭医生制服务的思考

家庭病床是以家庭作为护理场所,选择适宜在家庭环境下进行医疗或康复的病种,让患者在熟悉的环境中接受医疗和护理,既有利于促进病员的康复,又可减轻家庭经济和人力负担。家庭病床的建立使医务人员走出医院大门,最大限度地满足社会医疗护理要求,服务的内容也从单一的医疗服务转变为将预防、基本医疗、保健康复、和健康教育有机结合起来的综合性服务。本文通过对家床服务现状分析,探讨开展家庭医生制服务的可行性。     

扬州市医养融合养老模式现状、问题及对策研究

本文通过分析扬州市医养融合的现状、存在的问题,提出要建立高水平的医养融合照护体系,必须整合服务内容、丰富服务层次、适当增加养老护理院数量、社区与三级医院开展紧密型合作、发掘社区卫生服务中心的康复功能、加强相关人才培养、逐步设立护理保险、加强对弱势群体医养照护问题关注。     

美国的医院外医疗服务走向企业化

在美国,近年来兴起的家庭医疗、急救医疗等医院外医疗服务正在逐步扩大。家庭医疗服务主要是派遣护理人员到病人家中进行康复指导、一般治疗等护理服务,主要服务对象是长期卧床或处于疗养期的病人。提供家庭医疗服务的组织,以政府机关、医     

苏州市解决老年人医疗护理问题的实践探索

为解决当地人口老龄化带来的老年AN疗护理问题,苏州市政府出台了一系列护理院发展扶持政策,形成了以民营护理院为主体的老年人医疗护理服务体系和一系列行业管理制度,为解决老年人医疗护理问题提供了实践经验及新的思路。     

基层医疗机构创办老年康复病房的实践与思考

绍兴市越城区东浦镇社区卫生服务中心以自身特有的医护条件,乘势而上,创办了集医疗、护理、康复、养老、临终关怀于一体的老年康复病房,把医疗卫生保障的覆盖面扩大到老人,让老年病人乃至弥留之际的垂危病人享有较好的医疗护理服务,赢得了老年人群的赞誉,同时为社区中心的发展走出了新的路子。     

Diagnosed Mental and Physical Health Conditions in the united States Nursing Home Population: Differences Between Urban and Rural Facilities

CONTEXT: There has been limited examination of the differences in health characteristics of the rural long-term care population. Recognizing these differences will allow policymakers to improve access to long-term care services in rural communities. PURPOSE: To determine whether differences in likelihood of diagnosis exist between urban and rural nursing home residents for 8 common medical conditions: 4 mental health conditions (depression, anxiety, Alzheimer's, and non-Alzheimer's dementia) and 4 physical health conditions (cancer, emphysema/chronic obstructive pulmonary disease, heart disease, and stroke/transient ischemic attack). METHODS: We used multivariate logistic regression to examine data derived from the 1996 Nursing Home Component of the Medical Expenditure Panel Survey, a multistage stratified probability sample of 815 nursing homes and 5899 residents, representing 3.1 million individuals in the United States who spent 1 or more nights in nursing homes during 1996. FINDINGS: Residents in rural homes were less likely to be diagnosed with depression compared to those in homes in large metropolitan areas, and residents in homes in small metropolitan areas were less likely to have cancer than those in large metropolitan areas. Diagnostic status between urban and rural residents was comparable for the other 6 conditions. CONCLUSIONS: Further research is necessary to determine whether and why depression is inadequately diagnosed in rural nursing homes and to ascertain which types of cancer are responsible for the observed differential. Such research is particularly important for elderly nursing home residents who are more likely to suffer from chronic conditions that require significant medical supervision.     

Patient outcome as a measure of quality of nursing home care.

One thousand males transferred from a general medical hospital into 40 community nursing homes were classified by their physicians as to expectations of outcome within six months and measured on physical functioning at the time of their transfer. They were followed up six months later and retested on functional status. Subjects were classified on follow-up as improved, the same deteriorated, or dead. They were also classified as discharged from the nursing home, still in the home, or readmitted to the hospital. Nursing homes were measured every six months on structural variables. Outcomes of the patients were related to the nursing home characteristics by multivariate analysis of variance, controlling for expected outcome, age, and diagnoses of cancer and chronic brain disease. Homes with more RN hours per patient were associated with patients being alive, improved, and discharged from the home. Better ratings on meal services were related to being alive and improved. A higher professional staff-to-patient ratio, better medical records, and more services were related to being discharged from the nursing home.     

Clinical decision making, risk and occupational therapy

Little is known about the processes involved in risk taking, and complex decision making of the type encountered on acute medical wards in general hospitals. The purpose of the present study was to examine certain of these processes in the context of decisions to discharge elderly inpatients from hospital. Vignettes of hypothetical frail and disabled elderly in-patients were presented to student and qualified occupational therapists (OTs). All the vignettes represented high risk discharges and each of the patients expressed the desire to return to their own home. The additional diagnosis of early dementia was manipulated within and between vignettes. Subjects were asked to decide on the appropriateness of discharging each patient to (a) home and (b) a residential or nursing home. In addition, subjects completed a short demographic questionnaire which also probed aspects of their knowledge about elderly people. Results indicated that qualified OTs were less likely to overrule patients' wishes by favouring discharge of patients to residential or nursing home, and more likely to favour discharge to patients' own homes than student OTs. There was no overall main effect of dementia on subjects' decisions. In addition to clinical experience, certain areas of knowledge about elderly people were significantly associated with different approaches to risk taking in response to the vignettes. Undergraduate syllabi may need to be modified to incorporate more information about elderly people, the prevalence of different diseases, and direct experience of clinical decision making in the context of uncertain and risky situations.     

The role of geriatric intermediate care facilities in long-term care for the elderly in Japan

Geriatric intermediate care facilities (GICFs) were first established in 1987 to help the hospitalized elderly return home within 3 months. Users of the GICFs are the elders who do not require hospitalization, but are mentally or physically impaired. Rather than providing unnecessary medical services, GICFs emphasize nursing care and rehabilitation so that users can carry out their daily tasks independently. Due to the limited supply of institutional and in-home services for the elderly in long-term care systems in Japan, only half of the discharged users were able to return home and a quarter stayed at GICFs for over 1 year, contrary to the initial purpose. This suggests that in addition to serving as an intermediate facility between institutions and private homes, GICFs should enlarge their role of home care supporting facilities in ways that would enable them to provide frail elderly patients at home with respite care and daycare services.     

Revealing regional differences in the institutionalization of adult patients in homes for the elderly and nursing homes: results of the Belgian network of sentinel GPs

OBJECTIVES: The aim of this study was, firstly, to determine the number of institutionalizations in homes for the elderly and nursing homes and, secondly, to learn about regional differences in the placement procedure and the pre-existing problems and diseases. METHODS: Data were recorded during 1994 by the 143 GPs of the network of sentinel practices, which is representative of Belgian GPs. All placements of adult patients in homes for the elderly and nursing homes were registered. RESULTS: During 1994, Belgian sentinel GPs placed 297 patients in a nursing home or a home for the elderly. Most of them were women and patients who lived alone. At the time of institutionalization, motor function impairment and dementia were the most common diseases. The institutionalizations were motivated mostly by a need for assistance with daily living activities and nursing assistance. An interim hospitalization was necessary in 60% of all institutionalizations. Two-thirds of all patients were on a waiting list. The average length of these waiting lists was shorter in the southern (Walloon) region than in the northern (Flemish) region. Home care services were consulted in 16% of all institutionalizations. In the southern region, home care services were consulted more often than in the northern region. CONCLUSIONS: Motor function impairment and dementia were the most common pre-existing impairments. Placements were often hampered by long waiting lists and interim hospitalization. In the southern region, waiting lists were shorter and home care services consulted more often. Some placements could be avoided or delayed by a better organization and promotion of the possibilities of professional home care services.     

Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population.     

Caring behaviours perceived by elderly residents and their associated factors in nursing homes in Zhengzhou City of China: A qualitative study

Caring is an evidence-supported behaviour or activity which can meet nursing home residents' needs. China has an ever-increasing number of care-dependent individuals in nursing homes. It is important to explore the caring behaviours and to understand the factors associated with the caring behaviours perceived by elderly residents in nursing homes. This will contribute to an evidence-based approach with which to assist healthcare services. This study aims to explore the perceived caring needs, associated behaviours, and their associated factors identified by elderly residents in nursing homes. Fourteen semi-structured interviews were conducted with elderly residents from five nursing homes in three districts across Zhengzhou City, China. Interviews were transcribed verbatim and analysed using the Colaizzi phenomenological method. Five themes and fourteen sub-themes were identified. The availability of health services, a livable environment, and social communication were the main caring needs identified. Nursing assistant factors and resident factors were the main influencers. This study provides valuable information on the need to carry out standardised training of nursing assistants and how to adjust the goal of care in nursing home residents. The medical support, psychological counselling, livable environment, recreational and cultural services as well as caring literacy about nursing assistants in the nursing homes, however, need to be further enhanced to meet the residents' diversified caring needs.     

医改前后重庆市城乡老年人住院服务利用状况分析

目的 比较医改前后重庆市城乡老年人的住院服务利用变化情况,评价医改政策在此方面的实施效果,为进一步完善相关卫生政策提供依据。 方法 利用第四次和第五次中国西部地区卫生服务调查资料,对重庆市2008年和2013年的城乡老年人住院服务利用数据进行分析。 结果 2008-2013年重庆市城市老年人的整体住院率从14.91%上升到19.18%,其中低收入人群的住院率从12.30%上升到20.29%,慢性病患者的住院率从17.96%上升到26.05%;城市老年人的应住院而未住院率从40.10%下降到17.35%。农村老年人的整体住院率从13.73%上升到18.02%,其中低收入人群的住院率从10.95%上升到18.59%,慢性病患者的住院率从18.40%上升到25.57%;农村老年人的应住院而未住院率从52.19%下降到27.00%。 结论 与2008年相比,2013年重庆市城乡老年人整体住院率上升,尤其是低收入人群和慢性病患者的住院率增加显著,应住院而未住院率大幅下降,但是城乡老年人在住院服务利用上仍然存在明显差距,说明医改政策对于提高重庆市城乡老年人整体住院服务利用的效果明显,但是仍有局限性。     

中国失能老人照护模式选择及其影响因素分析--基于非正式照护与正式照护的关系

基于2014年中国老年健康影响因素跟踪调查数据,实证分析相关因素对中国失能老人选择照护模式的影响。结果显示,中国失能老人选择非正式照护较多,养老院照护和家政服务利用率较低。低龄、夫妻分离、城镇、重度失能、少子、子女距离较远、社区照护体系完善的失能老人对正式照护的利用率更高;非正式照护对家政服务有较强替代作用。建议在医养结合的基础上,建立“家庭养老院”,实现非正式照护与正式照护的整合,推进健康老龄化。     

北京部分地区不同养老方式下老年期抑郁症发病情况的调查研究

目的 了解北京地区居家养老与养老院养老不同养老方式下老年期抑郁症的患病情况,为保护老年人群身心健康提供科学依据.方法 于2009年2-6月,在北京6个社区及2家养老院,分别调查了356名居家养老和171名养老院养老的老年人.采用自制问卷采集老年人婚姻、文化程度、职业等社会经济学特征,采用《中国精神疾病分类方案与诊断标准》第3版(CCMD-3)关于抑郁症的诊断标准,以及24项汉密尔顿抑郁量表(HAMD)进行老年期抑郁症筛查.结果 北京地区居家养老者老年期抑郁症的检出率为10.7％,其中轻中度占7.6％,重度占3.1％;养老院养老者老年期抑郁症的检出率为37.5％,其中轻中度占36.3％,重度占1.2％.养老院养老组的抑郁症检出率明显高于居家养老组,差异有统计学意义(x2=52.97,P＜0.01).居家养老组HAMD碍分为16.17±4.98,养老院养老组得分为18.48±5.47.对居家养老组与养老院养老组抑郁症患者HAMD7项因子进行比较,养老院养老组焦虑和阻滞因子得分高于居家养老组,差异有统计学意义(P＜0.05).结论 居家养老方式有益于防治老年期抑郁症的发生.