Attitudes and knowledge of medical and nursing staff toward elder abuse

Although physicians and nurses are best positioned to recognize and diagnose cases of elder abuse, the level of reporting these cases is much lower than its true incidence. Our aim was to assess and compare knowledge and attitudes of physicians and nurses toward this phenomenon. Two hundred and thirty-five nurses and physicians were asked to participate in the study. One hundred nurses and 57 physicians ultimately completed the questionnaires. The main finding was that participants had a low level of knowledge of elder abuse issues and the relevant laws and regulations (mean correct answers 5.36 ± 1.45 of 10 and 4.67 ± 1.34 of 8, respectively). No significant differences were found in the physicians’ knowledge according to medical specialty, hospital type, years in the profession and geriatric experience. Licensed practical nurses knew less than registered and academic nurses relating to the abuse issue and state reporting laws (p = 0.003 and 0.02, respectively). No significant differences relating to the knowledge of elder abuse were found between nurses and physicians nor between general and geriatric hospital employees. Both physicians and nurses tended to have neutral attitudes regarding this issue. However, employees of geriatric hospitals had better attitudes than general hospital workers (p = 0.008). Most responders believed that the unwillingness to get legally involved had been the main reason of not reporting suspected cases. This study emphasizes the need to take more efficient measures to improve the knowledge of the medical and nursing staff concerning elder abuse and to encourage medical personnel to be more concerned and involved in the safeguarding of the elderly.     

针刺配合康复训练对老年脑卒中患者吞咽障碍的影响

目的：探讨针刺配合康复训练对老年脑卒中患者吞咽障碍的疗效。方法：90例70岁以上老年脑卒中后吞咽障碍的患者采用针刺与康复训练相结合的治疗方法。治疗前后采用洼田氏饮水试验、吞咽障碍程度评分和吞咽能力评价方法进行评价。结果：疗程结束后患者的洼田氏饮水试验、吞咽障碍程度评分和吞咽能力评价均有显著改善（P〈0．001）。结论：针刺结合康复训练可以明显改善老年脑卒中患者吞咽障碍的功能。     

毒素清颗粒治疗老年下呼吸道感染的疗效观察及对患者生活质量的影响

目的:评价中药复方制剂毒素清颗粒治疗老年下呼吸道感染的临床疗效及对患者生活质量的影响。方法:老年下呼吸道感染患者200例,中医辨证属痰热壅肺和(或)气阴两虚,随机分为治疗组和对照组,两组均给予抗生素及对症治疗,治疗组同时口服毒素清颗粒2周,观察两组治疗前后中医证候、临床症状、体征、生活质量等变化。结果:①中医证候:治疗后总有效率提示治疗组明显高于对照组(P<0.05)。②症状、体征和胸部正位片:两组治疗后症状、体征、胸部正位片积分均降低,咳嗽、咯痰症状改善治疗组优于对照组(P<0.05,P<0.01)。③生活质量:两组治疗后生活质量综合评分和各领域评分均较治疗前显著提高(P<0.01或0.05);但治疗组各项评分均较对照组改善明显(P<0.05)。结论:毒素清颗粒对老年下呼吸道感染具有明显的治疗作用,可改善患者症状体征、提高患者生活质量,临床疗效显著。     

拉西地平联合贝那普利治疗老龄高血压患者的效果分析

目的探讨拉西地平联合贝那普利治疗老龄高血压患者的临床效果。方法 388例老龄高血压患者随机分为实验组194例和对照组194例。对照组给予拉西地平治疗,实验组在对照组上加用贝那普利。两组疗程均为3个月。结果实验组和对照组SBP和DBP均有显著性改善(均P<0.01),但实验组比对照组改善更为显著(均P<0.01)。实验组副反应率高于对照组,但无统计学意义(P>0.05),两组均未发生严重副反应。结论拉西地平联合贝那普利治疗老龄高血压,具有较好的安全性和有效性,值得临床考虑。     

Domestic Violence in Later Life: An Overview for Health Care Providers

ABSTRACT

Domestic violence is a significant problem that adversely affects the health and safety of millions of women throughout their life-span. Most cases of what is considered elder abuse occurs at home rather than in institutions, and the evidence suggests that only 1 in 5 cases are recognized. Frequently the perpetrator is a spouse, adult child, or other family member. Given the demographics of aging women and their longer life expectancies, clinicians are increasingly likely to see patients whose injuries or poor health status are caused or affected by abusive relationships. Improving the ability of physicians to identify domestic violence is an important skill needed for establishing comprehensive intervention and prevention efforts. In addition to conducting universal screening of all female patients, using clinical and behavioral indicators is a critical component of the intervention.     

Factors influencing decision-making by social care and health sector professionals in cases of elder financial abuse

This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals’ certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person’s mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person’s mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.     

管状胃在高龄食管癌和贲门癌根治术中的应用

目的 总结70岁以上高龄食管癌、贲门癌根治手术中应用管状胃代食管的手术操作方法, 分析术后肺部并发症的发生及术后生存的情况。方法 回顾分析30例70岁以上高龄食管癌和贲门癌患者临床资料, 术中应用管状胃代替食管, 统计分析术后发生的肺部并发症和随访资料。结果 术中保留胃右动脉及分支的管状胃制作成功, 23例术后无明显肺部并发症发生, 4例出现明显肺部感染, 积极治疗后康复出院;2例术后气管切开, 呼吸机辅助呼吸, 1周后顺利脱离呼吸机;1例较长时间呼吸机辅助呼吸, 出现吻合口瘘, 最终死亡。术后随访21例, 无明显反流性食管炎发生, 术后1月后生活基本自理。1、3年生存率分别为42.8%(9/21)和19.0%(4/21)。结论 应用管状胃代食管, 对高龄食管癌和贲门癌患者, 可以有效预防吻合口瘘, 减少胸腔胃对心肺功能的影响, 减少反流性食管炎的发生, 提高患者术后生存质量。     

晚发型抑郁症伴轻度认知损害患者脑白质胆碱能通路的对照研究

目的：对伴轻度认知损害（ MCI）的晚发型抑郁症（ LOD）患者脑白质胆碱能通路的改变进行对照性研究,并分析其与患者认知功能各领域受损的关系。方法：对伴MCI的LOD患者（研究组,n＝25）磁共振成像的胆碱能通路高信号评分（ CHIPS）,同时评定蒙特利尔认知评估量表（ MoCA）,分析CHIPS评分与MoCA各认知领域的关系;并与不伴MCI的LOD患者（对照组,n＝25）进行对照。结果：①研究组MoCA总分、视空间与执行功能、延迟记忆、注意及工作记忆得分,均显著低于对照组,差异有统计学意义（t＝2．091～2．398,P＝0．041～0．028）;②研究组CHIPS显著高于对照组,差异有统计学意义（t＝2．097,P＝0．042）;③研究组CHIPS评分与MoCA总分、视空间与执行功能、延迟记忆得分显著负相关（r＝－0．434,－0．398,－0．483;P＜0．05）。结论：脑白质胆碱能通路受损,在LOD患者MCI的发生中可能起了一定的作用,尤其与其视空间与执行功能、记忆及延迟记忆的损害有关。     

Hospital Elder Life Program in the Real World: The Many Uses of the Hospital Elder Life Program Website

The Hospital Elder Life Program (HELP) can prevent delirium, a common condition in older hospitalized adults associated with substantial morbidity, mortality, and healthcare costs. In 2011, HELP transitioned to a web‐based dissemination model to provide accessible resources, including implementation materials; information for healthcare professionals, patients, and families; and a searchable reference database. It was hypothesized that, although intended to assist sites to establish HELP, the resources that the HELP website offer might have broader applications. An e‐mail was sent to all HELP website registrants from September 10, 2012, to March 15, 2013, requesting participation in an online survey to examine uses of the resources on the website and to evaluate knowledge diffusion related to these resources. Of 102 responding sites, 73 (72%) completed the survey. Thirty‐nine (53%) had implemented and maintained an active HELP model. Twenty‐six (35%) sites had used the HELP website resources to plan for implementation of the HELP model and 35 (50%) sites to implement and support the program during and after launch. Sites also used the resources for the development of non‐HELP delirium prevention programs and guidelines. Forty‐five sites (61%) used the website resources for educational purposes, targeting healthcare professionals, patients, families, or volunteers. The results demonstrated that HELP resources were used for implementation of HELP and other delirium prevention programs and were also disseminated broadly in innovative educational efforts across the professional and lay communities.     

老年急性下壁心肌梗死溶栓后冠状动脉介入治疗安全性研究

目的 探讨老年急性下壁心肌梗死急诊溶栓后经皮冠状动脉介入治疗的有效性和安全性。方法 对由外院首诊后转运接受溶栓治疗的50例老年急性下壁心肌梗死患者按简单随机化分为两组,每组25例。对照组患者使用常规药物（阿司匹林300mg,氯吡格雷300mg）后直接行经皮冠状动脉介入治疗,研究组患者使用尿激酶150万U,再行急诊经皮冠状动脉介入治疗。观察患者胸痛缓解情况及动脉开通率,术后并发症发生率。结果所有接受治疗的老年急性下壁心肌梗死的患者均成功行血运重建,研究组患者来院后胸痛缓解率为80.0%,对照组为40.0%;研究组患者梗死相关动脉总开通率达88.0%,对照组为32.0%;研究组术后并发症主要有心律失常,严重出血,一过性窦性心动过缓、房室传导阻滞及低血压,经药物治疗后可恢复。结论需要急诊转运的老年急性下壁心肌梗死患者,在溶栓后转运再行急诊血运重建治疗的临床疗效及安全性较好,可考虑作为基层医院转运急性心肌梗死患者的首选处理方法。