Characteristic Autonomic Nervous Activity of Institutionalized Elders with Dementia

This study clarified the characteristic autonomic nervous activity of institutionalized elders diagnosed with dementia using Hasegawa’s Dementia Scale-Revised. Twenty-six healthy adult persons (HPs) in their 20 s - 40 s met the inclusion criteria, and 16 persons (27.6 ± 8.2 years old) completed the research procedure. Of 70 persons with dementia (PDs) residing at the one geriatric health services facilities, only 24 persons met the inclusion criteria, and only nine (N = 9, 83.44 ± 9.45 years old) completed the procedure. Actigraph and ambulatory electrocardiographic instruments measuring autonomic nervous activity were attached to the subjects for 24 hours. Activities and behaviors of PDs and HPs were observed by clinically experienced staff nurses and care workers. High frequency (HF) power indicating parasympathetic activity and LF/HF ratio indicating sympathetic activity were calculated. When awake, PDs’ LF/HF ratio was significantly lower than HP’s (Z = -2.60, p < 0.01), showing significant differences in the LF/HF ratios between waking and sleeping, more than those of the PDs (p < 0.001). Similarly, when awake, significant positive correlations were observed in the LF/HF ratio and actigraph activity count (AC) in 11 HPs and 3 PDs (range r = 0.17 to 0.49, p < 0.05);however, significant negative correlation was found in HF and AC of 12 HPs and 3 PDs (range r = -0.55 to -0.18, p < 0.05). While sleeping, significant positive correlations were observed in LF/HF and AC of 3 HPs and 1 PD (range r = 0.35 to 0.42, p < 0.05) and significant negative correlation was found in the HF and AC of 1 HP (r= -0.32, p < 0.001) and 1 PD (r = -0.32, p < 0.05). The mean value of LF/HF in a wakeful state was significantly lower for PDs than HPs. Combined results of behavioral observation, actigrapy and heart rate variability (HRV) analyses suggested that PDs showed positive correlations between LF/HF and AC in a wakeful state. Compared to those who showed no positive correlation, they did not require much nursing care.

失能失智老人医疗服务需求满足及其影响因素

目的 调查失能失智老人医疗服务需求满足情况,分析其影响因素,为进一步完善失能失智老人医疗服务提供决策依据。方法 按分层整群抽样方法,在上海市杨浦和奉贤两区抽取60岁及以上失能失智老人402名,采用自制问卷调查。运用单因素分析比较不同状况下失能失智老人医疗服务需求满足情况,运用多因素分析失能失智老人医疗服务需求满足的影响因素。结果 失能失智老人医疗服务需求满足程度偏低,为41.0%。老年人日常生活是否能自理、是否有高血压病、是否需要慢性疾病日常配药和治疗、是否需要老年综合征治疗服务、是否有长期便秘、家人没空送老年人上医院、日常配药便利程度、选择在何处接受药物注射、选择在何处接受食物或尿液插管服务以及社区医生治疗水平不高等是影响失能失智老人医疗服务需求满足的主要因素。结论 失能失智老人医疗服务需求满足度不高,受多因素影响。应进一步加强失能失智老人慢性疾病、老年综合征治疗服务,积极推动多病共治的整合式医疗服务。加强社区和养老机构医疗服务设施建设,方便失能失智老人慢性疾病日常管理和医疗护理服务,不断提高失能失智老人医疗服务需求满足程度。