Informal caregiving for frail older people at home and in long-term care institutions: who are the key supporters?

This paper describes the extent of the informal caregiving unit for older people who are physically or mentally frail living in private households or resident in long-term care institutions using cross-sectional analysis of survey data. A total of 1444 people aged 65 years or more registered with a general practitioner (GP) in four areas in England and, consenting to the study, were screened for mental or physical frailty. Of 1127 older subjects living at home 7% reported receiving no informal support, 15% had a paid supporter only and 78% nominated a key informal supporter who helped with defined activities of daily living of whom 650 (74%) were interviewed. Only 13% nominated more than one informal supporter. Key supporters were spouses (38%), daughters (30%), sons (9%), daughters-in-law (4%), other relatives (11%) and friends and neighbours (8%). Of 317 frail older people resident in long-term care institutions 175 (55%) received a main visitor at least once a week of whom 132 (75%) were interviewed. Main visitors were spouses (11%), daughters (36%), sons (23%), daughters-in-law (2%), other relatives (24%) and friends (4%). Qureshi & Walker's (1989) hierarchical, decision-making model for selecting informal caregivers was applied to the data and correctly identified 85% of key informal supporters and 79% of main visitors interviewed. This large-scale comprehensive survey of informal care for frail older people supports earlier small-scale localized studies highlighting the key role of spouses and daughters in the provision of informal support. Families of frail older people provide the support to maintain people at home.     

Pilot study of a visitor volunteer programme for community elderly people receiving home health care

There is a need to evaluate community support programmes for elderly people. In this randomized control trial (RCT), we determined the effectiveness of 'friendly visitors' in a volunteer programme of a visiting nurses organization in Southern Ontario, Canada. The Volunteer Friendly Visitor Programme was developed to support elderly people receiving homemaking and nursing care in the community. Volunteers are screened, trained, interviewed and matched to homebound elderly clients for general interest, visit expectations and personality. Volunteers spend three to four hours on average per week with clients socializing in mutually agreed-upon ways. The nursing staff identified clients who were lonely for this additional support. These newly-referred clients were randomly allocated to receive a friendly visitor or not for six weeks. Those receiving the volunteer visitor improved in life satisfaction and two social support measures: worth and social integration. Thus, the addition of volunteer visitors to planned homemaking and nursing care made a difference for elderly in the community.     

More than just a health issue: a review of current issues in the care of enterally-fed children living in the community

There are increasing numbers of children with a disability living in the community who require enteral tube feeds to optimize their nutritional status. Whilst there appears to be evidence of health gains, for some children there may also be serious and unintended social deprivations resulting from the need to be tube fed. This paper reviews the literature on support for children who are tube fed and makes a case for more coordinated and effective support services for families who are tube feeding a child at home. It is argued that national guidance should be developed which clarifies the position of all non-parent carers and staff who are willing to administer enteral tube feeds. Such guidance should also ensure that enterally-fed children have the same rights to educational and social services as other children and that families are given the opportunity to make informed decisions about the implications of enteral feeding prior to it being established.     

Redefining community care social work: needs or risks led?

This reflective paper assesses whether the focus of community care social work is shifting from responding to needs to reducing or containing risks. Whilst public response to unacceptable risk has instigated major developments in health and welfare services and an overt concern with risk management is a key feature in elder abuse and mental health work, notions of risk have featured less explicitly in the community care literature. This paper suggests that community care assessment is increasingly concerned with risk management, as containing risks becomes a means of rationing scarce resources, when situations of high risk attract more resources than those where the risk is less. In addition, this emphasis on only the negative connotations of risk and the need for protection may constrain empowering service users to define their own positive risks.     

Total purchasing, community and continuing care: lessons for future policy developments in the NHS

The introduction of total purchasing pilots (TPPs) into the National Health Service (NHS) gave general practitioners (GPs) significant new opportunities to take responsibility for the development of community and continuing care (CCC) services. Based on five case studies of TPPs involved in developing CCC this paper asks three questions: (1) to what extent were the TPP’s involvement in CCC informed by an awareness of CCC policy?; (2) were TPPs involved in joint commissioning to develop integrated purchasing or provision which was informed by population based needs assessment?; (3) were TPPs seeking to involve users, carers and voluntary agencies in their plans? The findings indicate that TPPs showed little awareness of national or local policy for CCC, although their project initiatives did address some of the policy issues (in particular a recognition of the need for joint working at the practice level). At the time of fieldwork, four of the case study TPPs had begun to investigate the potential for integrated purchasing, and three of them had relatively sophisticated models of both horizontally and vertically integrated provision of care. However, the TPPs developments were not based on systematic population based needs assessment. The paper concludes that there is potential for the primary care led groups proposed in the recent white papers in England, Scotland and Wales to improve integration of care both horizontally and vertically. However, they may need policy guidance and push to: encourage them to put CCC high on their agenda for action; to work with people with expertise in population based, prevention focused, needs assessment; and to find innovative ways to include users, carers and voluntary agencies. Incentives or levers (such as control over budgets) may be needed to promote joint working between staff in different agencies.     

营养干预对社区几种慢性疾病的效果评价

选取８７名家住成都市有血糖、血压、血脂异常者为研究对象,经过配制食谱、营养教育咨询等干预措施,观察了以下指标的变化：１．空腹血糖和餐后２小时血糖;２．血清胆固醇和甘油三酯;３．血压和体重;４．症状评分。用配对ｔ检验、相关和逐步回归分析对资料进行处理。结果表明,采用营养干预措施１０周以后,以上各项指标均有显著降低。可以认为合理饮食是控制社区这几种慢性病简便有效的措施。     

相似系数法在川贝母群落分类中的应用研究

目的　探讨数值分类方法应用于川贝母分布群落类型的划分。方法　以群落相似系数百分率划分川贝母分布的群落类型。结论　应用相似系数法可将川贝母野生抚育的适宜群落划定为窄叶鲜卑花灌丛、理塘杜鹃灌丛、硬叶柳灌丛、金露梅 +绣线菊灌丛、香柏灌丛、珠芽蓼 +圆穗蓼草甸等 6种类型     

社区也要开展药学服务

目的：调查社区居民家中备用药的保管和使用情况。方法：向社区居民发放家庭备用药自查表90份．收到有效表78份。调查内容包括有无家庭备用药；有无固定容器放置，是否避光、避热、避潮，是否放在儿童拿不到的地方．是否定期清理药品，是否存有无用法的药．有无过期药；备用药的种类；备用药来源和用法指导；比较不同文化程度的家庭备用药保管情况。结果：94．9％的家庭有备用药。有专用容器放置的占21．6％，注意避光、避热、避潮的家庭占29．7％，放在儿童拿不到的地方占28．4％。51．4％的家庭定期清理药品。不清理的家庭占31．1％。存有未标明有效期的药品的家庭占68．9％．存有无用法的药的家庭占74．3％，52．7％的家庭有过期药。备用药以感冒药(89．2％)和抗生素(77．0％)居多。87．8％的居民根据医师介绍用药，有药师指导的仅6．76％。文化程度高的家庭对药品的保管较文化程度相对低的家庭要好。结论：居民对家庭备用药的保管和使用存在一定问题，社区也应开展药学服务。     

广州市社区居民吸烟现状分析

[目的]了解广州市社区居民的吸烟状况,为制定控制吸烟的相应措施提供依据.[方法]在2004年,采用随机抽样入户问卷调查方式,调查广州市越秀区洪桥街和东风街20～60岁居民1006名.[结果]人群吸烟率为28.4%,男性吸烟率为52.2%,女性为6.5%;61.9%吸烟者在20岁以前开始吸烟;吸烟率随年龄增长而增高;文化程度低者吸烟率较高;运输业人员吸烟率最高;大部分吸烟者通常在家里、工作场所或娱乐场所吸烟;受访者对吸烟可能引起的呼吸系统以外的疾病认知不足;大多数认为从公共传媒获得吸烟危害健康的知识.[结论]吸烟仍是一个严重的公共卫生问题,须加强宣传教育,动员全社会力量,控制吸烟,以减少烟草对健康的危害.     

社区获得性肺炎3种治疗方案的成本-效果分析

目的评价氨苄西林-舒巴坦组（A组）、头孢哌酮组（B组）、左氧氟沙星组（C组）三种方案对治疗社区获得性肺炎药物经济学成本与效果。方法采用回顾性研究方法，运用成本-效果分析法对三种治疗方案进行成本与效果分析。结果三种治疗方案中，A组、B组、C组总成本分别为1770．96元、1896．00元、1153．86元，治愈率分别为46．2％，61．5％，69．2％，每增加1个单位效果A组与B组比C组需多花成本分别为28．49元和52．45元。结论C组为治疗社区获得性肺炎的较佳治疗方案，通过成本-效果分析能优化治疗方案、指导合理用药，提高临床疗效。