Changes and Development of Home and Community Based Elderly Care Service Policies in China

This paper analyzes the current situation of the development of home and community based elderly care service in China,points out the existing problems,and puts forward improvement measures,aiming to deepen the understanding of HCBS and promote the theoretical research and practice of community home-based elderly care service.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

To Die at Home or to End Life in an Institution

In the Western world, 60%-80% of all deaths occur in an institution. This study aimed to determine the main causes for the low proportion of deaths at home in Norway. A retrospective cohort study was conducted in six Norwegian municipalities. The study employed official statistics and structured interviews with key staff individuals (spring 2012). We included 41 individuals that received palliative home care;21 died at home. The rate of deaths at home may be increased by an acceptance of death and confidence that home is a good, safe place to die. This study showed how challenging it was for the family and health personnel to be a fellow Pellegrino in the last steps of life. However, when physical distress is under control, and when a dying patient and his significant other genuinely wish for death at home, it is necessary to control physical distress. Greater holistic well-being may then be achieved at home than in the hospital.

Consensus on the health education of home-based negative pressure wound therapy for patients with chronic wounds:a modified Delphi study

Background:The study aimed to develop consensus on the components of health education of home-based negative pressure wound therapy(NPWT)for patients with chronic wounds.Methods:A Delphi method was used to achieve consensus on the components of health education and 75%agreement and coefficient of variation(CV)<0.25 were used as cutoff.Sixteen experts were recruited purposefully to finish this study.Results:Two rounds of consultation were implemented.Consensus was achieved on 36 of the 42 statements.The final agreed list of statements represented three domains:health education before carrying out home-based NPWT,health education for the treatment day of NPWT at hospital and health education for NPWT at home.Conclusions:This study was the first attempt to develop consensus on the comprehensive components of health education of home-based NPWT for patients with chronic wounds.According to the established framework and components of health education,wound professionals can safely and effectively implement health education of home-based NPWT for patients with chronic wounds and improve their self-care ability and treatment experience at home.