试论1965年《美国老年人法》的诞生及对我国老龄政策的启示

在美国老龄政策的发展历史上,1965年《美国老年人法》的诞生具有划时代的意义。20世纪60年代美国经济的飞速发展,老年人的迫切需要,老年社会学理论的发展,代表老年人的利益集团施加的压力都是促使其最终诞生的重要因素。1965年《美国老年人法》颁布后,老年人获得了全方位的保障,美国逐步构建起老龄工作的行政网络。1965年《美国老年人法》对我国的老龄政策也有着重要的启示作用。

“PPS”法在社区老年人护理服务需求调查中的应用

目的:减少抽样调查工作量;方法:为等概率容量比抽样调查;结果:抽样30个初级抽样单位,大于或等于210个调查对象;

我国老年教育政策法规:回顾、反思与建议

改革开放近四十年,我国老年教育政策法规的发展经历了探索起步期、确立稳步期和转型发展期三个阶段,虽然其数量初见规模,体系初具雏形,但在立法根据、体系和内容上依然存在着一定的缺陷;同时,在法学研究和司法实践中,老年教育政策法规也一直处于被忽视的地位,这势必会阻碍我国老年教育事业可持续发展的进程.因此,完善我国老年教育政策法规的建议有:加强老年教育及其政策法规的理论研究,推进《终身教育法》/《成人教育法》单独立法,发挥老年教育政策促进法律完善及科学立法的功能,健全老年教育政策法规落实的法律监督体系等.

韩国老年教育相关法律、政策的考察及启示

韩国老年教育相关法律、政策的出台覆盖了扫除文盲阶段、社会福利阶段、终身教育阶段和社会公正阶段四个时期,其内容主要体现在《老年人就业促进法》《老年人福利法》《少子化·高龄化社会基本法》《终身教育法》《老年教育专家培训计划》五部法律或政策中。主要特色表现为:以产出性老龄化理念为立法取向;福利政策法规与终身教育政策法规互为补充;完善的老年教育专家培训制度。我国可借鉴韩国经验,坚持以优势视角的老龄化理念为立法取向,依据老年教育发展规律和法律、政策自身发展规律,对现有老年教育法律、政策体系进行修订与完善,以推动我国老年教育的发展。

日本老年教育相关政策、法律的考察及启示

日本老年教育相关政策、法律的出台经历了准备期、实施期、成长期与扩张期四个阶段,其内容主要体现在《宪法》《教育基本法》《终生学习振兴法》和《社会教育法》等教育法和《老年福利法》《高龄社会对策基本法》和《老龄者雇佣安定法》等老年人法中。主要特色有:以社会参与、福利社会和终身教育为取向的立法理念;以保障人权、教育机会均等和向国民直接负责为核心的立法原则;福利政策法规、老龄政策法规与终身教育政策法规共同构建完备的政策法律体系;顺应时势修改,灵活机动修订。我们可借鉴日本经验,用福利社会和社会参与思想丰富老年教育立法理念;在教育基本法中明确向人民直接负责的立法原则;与时俱进地修改现有法律,完善老年教育法律体系,以推动我国老年教育的发展。

日本老年人雇佣政策及其对中国的启示

日本已进入人口减少及超老龄社会,劳动力不足问题将会制约日本经济未来的发展。为了解决劳动力不足问题,促进老年人就业,日本政府修改了《老年人雇佣稳定法》,制定了继续雇佣制度。这些法律和政策的实施在一定程度上缓解了劳动力短缺问题,基本保障了日本老年人的收入及就业稳定。但也存在大多数企业与职工签订短期非正式雇佣合同等问题。这些经验和问题可为中国进一步完善《老年人权益保障法》及促进老年人再就业提供借鉴。

日本开发老年人力资源的经验及启示

在人口老龄化不断加剧的情况之下,社会发展将更多地依赖于老年人的积极参与。而且随着长寿社会的到来,老年人的参与愿望和参与能力都在提升。日本是世界上人口老龄化程度最高的国家,已进入人口减少和超老龄社会。人口下降和老龄化将带来劳动力减少问题,对日本整个社会的均衡和可持续发展产生严重影响。为了应对劳动力不足问题,日本不仅修改《老年人就业稳定法》逐渐延长退休年龄,保障老年人继续工作,而且开展老年志愿者活动积极为退休的老年人创造再就业的环境。

中日老年教育服务体系对比研究

人口老龄化已成为21世纪一个世界性难题。作为世界上人口最多的国家,早在上世纪90年代,我国就进入了老龄化国家的行列,那时60岁以上的老年人口就超过1.3亿,到了2014年60岁以上的老人已达到2.1亿,占全国总人口的15.6%。面对中国老龄化趋势的严峻挑战,老年教育在建设学习型社会、构建终身教育体系中发挥的作用有了更高的要求。如何提高中国老年人的生活质量,老年教育体系的建设至关重要。此文通过对日本老年教育服务体系的初探,引发对中国老年教育服务体系的对比与思考。

1994～2004年中国老年人的生活自理预期寿命及其变化

本文应用2004年和1994年国家统计局全国人口变动抽样调查中有关老年人生活自理能力的数据，采用Sullivan法对老年人的生活自理预期寿命进行了分析，并且比较了1994年到2004年生活自理预期寿命的变化。研究发现，2004年中国男性老年人平均有1．5年生活不能自理，女性老年人平均为2．5年。随着年龄的增长，中国老年人的生活自理预期寿命占余寿的比重也在逐渐下降。女性老年人的预期寿命比男性高，生活自理预期寿命在60～80岁也高于男性，但是85岁及以上女性的生活自理预期寿命低于男性，而且女性老年人生活自理预期寿命占余寿的比重在整个老年阶段均低于男性老年人。从10年间的变化看，中国老年人的预期寿命和生活自理预期寿命都有所增长，但是生活自理预期寿命在余寿中的比重反而下降了，而且随年龄的增长，下降得也越来越快，男性和女性均呈现同样的态势。就平均水平而言，健康状况改善的程度低于寿命的延长，高龄女性老年人在这个方面尤其处于劣势。

Management of constipation in the elderly: Emerging therapeutic strategies

A number of new, novel strategies for managing constipation in the elderly have emerged over the past few years. Prucalopride is one such new agent that is highly effi cacious in managing chronic constipation. In fact, Camilleri et al in a recent study reported that the average number of bowel movements increased by at least one in nearly 47% of the patients who were administered a dose of 4 mg. Lubiprostone is another new agent recently approved by the FDA that shows efficacy in managing the symptoms of constipation. Neostigmine has also been successfully used for the management of recalcitrant constipation. Most of these studies have used subcutaneous neostigmine. Symbiotic yogurt containig components, such as Bifidobacterium and fructoligosaccharide, have also been recently shown to be highly effective in improving symptoms of constipation. Elderly patients especially those in hospices and nursing homes are often on opiods for pain management. Constipation secondary to opioid use is extremely common in nursing homes. Subcutaneous methylnaltrexone has recently been shown to be highly effective in the management of opioid-related constipation, and was recently approved by the FDA. Sacral nerve stimulation is another emerging strategy. A recent analysis by Mowatt et al supports the eff icacy of this technique. Botulinum toxin is another agent that has already been successfully used for the management of chronic, refractory constipation in children and may be very effective for elderly constipation. Further larger studies are needed to confi rm the fi ndings noted in these studies. Constipation is clearly a major issue in the elderly and these new, emerging strategies will hopefully improve the quality of life and relieve the symptoms of constipation in this population.

Outcome of laparoscopic cholecystectomy is not influenced by chronological age in the elderly

AIM:To evaluate the outcome of laparoscopic cholecystectomy(LC)in patients aged 80 years and older. METHODS:A total of 353 patients aged 65 to 79 years(group 1)and 35 patients aged 80 years and older(group 2)underwent LC.Patients were further classified into two other groups:those with uncomplicated gallbladder disease(group A)or those with complicated gallbladder disease(group B). RESULTS:There were no significant differences between the age groups(groups 1 and 2)with respect to clinical characteristics such as age,gender,comorbid disease,or disease presentation.Mean operative time,conversion rate,and the incidence of major postoperative complications were similar in groups 1 and 2.However,the percentage of high-risk patients was significantly higher in group 2 than in group 1 (20.0%vs 5.7%,P<0.01).Group A comprised 322 patients with a mean age of 71.0±5.3 years,and group B comprised 51 patients with a mean age of 69.9±4.8 years.In group B,mean operative time (78.4±49.3 min vs 58.3±35.8 min,P<0.01),mean postoperative hospital stay(7.9±6.5 d vs 5.0±3.7 d, P<0.01),and the incidence of major postoperative complications(9.8%vs 3.1%,P<0.05)were significantly greater than in group A.The conversion rate tended to be higher in group B,but this difference was not significant. CONCLUSION:Perioperative outcomes in elderly patients who underwent LC seem to be influenced by the severity of gallbladder disease,and not by chronologic age.In octogenarians,LC should be performed at an earlier,uncomplicated stage of the disease whenever possible to improve perioperative outcomes.

Appropriate prescribing in the elderly: Current perspectives

Advances in medical therapeutics have undoubtedly contributed to health gains and increases in life expectancy over the last century. However, there is growing evidence to suggest that therapeutic decisions in older patients are frequently suboptimal or potentially inappropriate and often result in negative outcomes such as adverse drug events, hospitalisation and increased healthcare resource utilisation. Several factors influence the appropriateness of medication selectionin older patients including age-related changes in pharmacokinetics and pharmacodynamics, high numbers of concurrent medications, functional status and burden of co-morbid illness. With ever-increasing therapeutic options, escalating proportions of older patients worldwide, and varying degrees of prescriber education in geriatric pharmacotherapy, strategies to assist physicians in choosing appropriate pharmacotherapy for older patients may be helpful. In this paper, we describe important age-related pharmacological changes as well as the principal domains of prescribing appropriateness in older people. We highlight common examples of drugdrug and drug-disease interactions in older people. We present a clinical case in which the appropriateness of prescription medications is reviewed and corrective strategies suggested. We also discuss various approaches to optimising prescribing appropriateness in this population including the use of explicit and implicit prescribing appropriateness criteria, comprehensive geriatric assessment, clinical pharmacist review, prescriber education and computerized decision support tools.

Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data

AIM： To assess the association of measured gait speed with hemodialysis （HD） patients’ hospitalization, in conjunction with, and apart from, recent fall history.METHODS： Gait speed was measured by a standard protocol and falls during the past 12 mo were ascertained for a prevalent multi-center HD cohort （n = 668） aged 20-92. Hospitalization during the past 12 mo was identified in the patient’s clinic records, and the first hospitalization after gait speed assessment （or the competing event of death） was identifed in the 2013 United States Renal Data System Standard Analysis Files.characterized 34.7% of the patients, and 27.1% had experienced a recent fall. Patients with slow gait speed but without a history of recent falls were 1.79 times more likely to have been hospitalized during the past 12 mo （OR = 1.79, 95%CI： 1.11-2.88, P = 0.02）, and patients with slow gait speed and a history of recent falls were over two times more likely to have been hospitalized （OR = 2.10, 95%CI： 1.19-3.73, P = 0.01）, compared with patients having faster gait speed and no recent fall history. Prospective examination of gait speed/fall history status in relation to frst hospitaliza-tion （or death） incurred by the end of follow-up Decem-ber 31, 2011 also showed that slow gait speed was as-sociated with these events in conjunction with a history of falls （HR = 1.54, 95%CI： 1.04-2.30, P = 0.03）.CONCLUSION： The International Task Force on Nutri-tion and Aging reported that gait speed is a powerful predictor for older adults of adverse outcomes such as hospitalization. In our data, gait speed-apart from, as well as in conjunction with, recent fall history-was as-sociated with HD patients’ hospitalization for multiple causes. Gait speed may be a sensitive health indicator among HD patients across the age spectrum.

Role of chemotherapy and novel biological agents in the treatment of elderly patients with colorectal cancer

Patients older than 65 years are the fastest growing segment of the cancer population. It is estimated that within 20 years over 75% of cases and 85% of deaths from colorectal cancer (CRC) will be in this setting. Concerns about cancer treatment in the elderly relate to comorbidities, which increase proportionally with age, physiological changes associated with aging which may influence drug metabolism and toxicity, and diminishing life expectancy, which particularly impacts decisions surrounding the benefits of adjuvant therapies. Over the last 10 years, significant improvements in the treatment of advanced CRC with combination therapy have been made. The randomized trials which have defined these improvements did not exclude elderly patients. However, the median age of patients in these trials has generally been approximately 60 years. Thus, it appears that some degree of selection is involved with younger and presumably fitter patients being the subjects in most of the pivotal trials. The availability of new molecularly targeted agents and newly improved existing agents has expanded the range of treatment options available. This variety gives greater flexibility in dealing with different subsets of patients, such as the elderly. However, some fit elderly patients seem to tolerate combination therapy reasonably well, while studies on unfit elderly subjects are needed.

Effects of equine-assisted interventions on older adults’health:A systematic review

Objective:Equine-assisted interventions(EAI)can improve a variety of health problems in older adults and thus promote their well-being.This systematic review aimed to synthesize studies on EAI to understand better their effects on the health of older adults.Method:A systematic search guided by the PRISMA 2020 approach was performed on specific databases:Medline(PubMed),EMBASE,PsycINFO,and Cochrane Library.Peer-reviewed articles published in the English language from inception to June 2022 were retrieved.Methodological quality was established using the modified version of the Downs and Black checklist.Results:A total of 244 studies were retrieved,and 13 eligible studies were finally included.Three health domains were investigated:physical(balance,gait,and muscular strength),psychological(quality of life and cognitive assessment),and physiological(hormonal measures,cerebral and muscular activity).Among the eight studies investigating the physical dimension,four studies highlighted a positive effect of EAI on balance,four for gait,and three for strength.Regarding the three studies investigating the psychological dimension,two studies showed a positive effect of EAI on quality of life.Lastly,the four studies investigating the physiological dimensions all demonstrated a positive effect of EAI on hormonal measures and cerebral and muscular activity.Conclusion:Nevertheless,this systematic review provides promising findings regarding the positive effects of EAI on physical,psychological,and physiological health in older adults.Research on EAI should therefore be pursued rigorously to promote this non-pharmacological intervention in an older adult population.

Effectiveness of fire needle combining with moist healing dressing to promote the growth of granulation tissue in chronic wounds:A case report

In this case study,we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment,and we tracked the coverage of granulation tissue and decrease of slough and exudate.An 85-year-old man had repeated right shoulder and back pain,itching,and skin festering for more than 1.5 years.A fire needle was administered combined with moist dressing once every 5 days to promote wound healing.After six rounds of fire needle treatment,granulation tissue formed over the surface of the wound base,the depth of the wound had become shallow,and the wound area was reduced.No complications occurred during the intervention.Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.

Effects of creative expression program on the event-related potential and task reaction time of elderly with mild cognitive impairment

Objectives:This study aimed to evaluate the effects of a 16-week creative expression intervention program(CrExp)on the event-related potential(ERP)and task reaction time in older individuals with mild cognitive impairment(MCI).Methods:This study is a randomized controlled clinical trial conducted in the Memory Center of Fujian Provincial hospital.Thirty-six MCI patients were randomly distributed into two groups.One group underwent a 16-week creative expression program(CrExp,n=18)and the other performed as a control group(CG,n=18)by general social activities.The amplitude and latency of ERP-P300 from the central(Cz),parietal(Pz),frontal(Fz)cortices and task reaction time(RT)were assessed at baseline,postinterventi on,and 24-week follow-up.Results:The CrExp group showed greater differences than CG of P300 latency in Cz(F=4.37,P=0.015),Pz(F=2.78,P=0.009),Fz(F=6.45,P=0.031)brain area after 16 weeks of intervention and in Fz(F=3.23,P=0.028),Cz(F=3.79,P=0.024),and Pz(F=5.60,P=0.036)at 24 weeks follow-up.Also,we analyzed the task reaction time between two groups and found that a shorten reaction time at postintervention(F=4.47,P=0.011)and 24 weeks follow-up(F=3.12,P=0.007)in the CrExp group.However,there was no difference in P300 amplitude in either brain area between the two groups.Conclusion:The electrophysiological results of the creative expression cognitive therapy group were more obvious than those of the general cognitive therapy group,and the latency and task reaction time may be considered as supported parameters in diagnosing the effects during non-drug therapy intervention in clinical practice.

Art making and expressive art therapy in adult health and nursing care:A scoping review

Objectives:While receptive art engagement is known to promote health and wellbeing,active art engagement has not been fully explored in health and nursing care.This review is to describe the existing knowledge on art making and expressive art therapy in adult health and nursing care between 2010 and 2020.Methods:Relevant studies and grey literature were searched and identified between March 17 and April 10,2020 from EBSCO,CINAHL,Medline and ERIC databases and a general Internet search.Following data charting and extraction,the data(n=42 papers)were summarized and reported in accordance with PRISMA-ScR guidelines.Results:In the included papers,both art making and expressive art therapy were seen in different health care and nursing contexts:yet not the home care context.The emphasis of art activities were group activities for chronically or terminally ill residents,adults aged 65 years or older.A focus on personal narrative was often seen,which may explain why art activities appear to be linked to acknowledging and building new strengths and skills,making meaning of experiences,personal growth,symptom alleviation,and communication;all used to foster collaboration between patients,patients’near-ones and health care professionals.Conclusions:Art activities appear to be suitable for every context and can promote personcenteredness and the measurement of nursing outcomes,and they should be considered an essential part of health and nursing care,nursing education and care for health care personnel.

BENEFICIAL EFFECTS OF CAPTOPRIL ON PROGNOSIS IN ELDERLY PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective. This study sought to investigate the effects of early and long-term intervention with an- giotensin-converting enzyme(ACE) inhibitor captopril on the elderly patients with acute myocardial in farc- tion(AMI), and observe its in-hospital and post-hospital outcomes during serial follow-up of 54 months. Methods. 631 elderly patients(60～75 years old) with AMI and without cardiogenic shock were hospi- talized within 72 hours of symptoms and were randomly allocated to captopril (n = 361;treatment group) and conventional treatment (n = 270; control group). The survival and cardiac events (congestive heart fail- ure, reinfarction, severe arrhythmias and cardiac death)of each group were determined during hospitaliza-tion and follow-up. Results. During hospitalization, the survival was higher in treatment group than in control group(p< 0. 0001 ). On the other hand, in treatment group lower mortality was true for patients with anterior my- ocardial infarction(p < 0. 001 ) or with anterior+inferior myocardial infarction (P= 0. 026 ), but not statis- tically significant in ones with inferior myocardial infarction (P= 0. 061 ). During follow-up, the occurrence of cardiac death, heart failure, reinfarction and severe arrhythmias were lower in treatment group (P = 0. 0001, P = 0. 05, P = 0. 0004 and P = 0. 027). So higher survival (P = 0. 005 ) and lower total cardiac events(p= 0. 0008) could be seen in treatment group over this period. Conclusions. Early and long-term treatment with captopril in the elderly patients with AMI has bene-ficial outcomes in both in-hospital and follow-up periods.

Teaching Gallo at School

This study explores the origins and current status of the Gallo language at school--a minority language spoken in the eastern part of Brittany--among older speakers （group 1-41 informants） and students of Gallo （group 2-17 informants）. The paper discusses different pedagogical methods, learning materials, and learners＇ status. The most important mission of schools is to increase public awareness about their linguistic environment which helps reassert minority identity through language acquisition and linguistic maintenance. Implementing an educational language curriculum for regional languages constitutes a main step towards the preservation of linguistic minorities. According to the informants interviewed during the fieldwork, both groups express positive reactions towards the presence of Gallo at school （group 1--80%; group 2--92.9%）. However, in follow-up discussions, a certain number of older speakers seem to be more reluctant, because the variety of Gallo taught at school is different from the one which was transmitted to them. In conclusion, bilingual and immersion programs are increasingly successful in Brittany and could lead to a wider recognition of Eastern Brittany＇s language and culture.