Effectiveness of Extended Care in Preventing Falls in Disabled Elderly and Its Impact on Quality of Life

Objective:To analyze the value of extended care interventions for disabled elderly in preventing falls and optimizing quality of life.Methods:A sample of 60 cases of disabled elderly in a tertiary hospital from May 2022 to May 2023 was selected and grouped by the random number table method.The observation group received extended care,while the control group adopted routine care.The differences in complication rate,fall rate,36-Item Short Form Health Survey(SF-36)score,health knowledge awareness score,and nursing satisfaction were compared.Results:The complication rate and fall rate of the disabled elderly in the observation group were lower than those in the control group,P<0.05;the SF-36 score,health knowledge score,and nursing satisfaction of the observation group were higher than those of the control group,P<0.05.Conclusion:Extended care for the disabled elderly can reduce the risk of falls and complications related to disability,as well as optimize their cognition and improve their quality of life,which is efficient and feasible.

Medical care and clinical practice for disabled elderly

At preasent,with the continuous development of the trend of population aging worldwide,more elderiy people are increasingly facing s-erious life disorders caused by physical and mental disability.In this study,the common symptoms and the nursing practice related to diseases of the disabled elderly are reviewed with reference to the basic concepts of disability care and the current situation of domestic and foreign research,which is expected to provide the basis for the construction of a new model of disability nursing.

Investigation and Countermeasures on the Health-Promoting Lifestyle of the Disabled Elderly in a Rural Area

Objective： To investigate the level of health-promoting lifestyle in the disabled elderly in a rural area and to provide useful countermeasures for health care workers and the government to improve the elderly＇ s lifestyle behaviors. Methods： A total of 446 disabled elderly people were recruited and examined using the General Questionnaire and Health-Promoting Lifestyle Profile II. Results： The mean score of the health-promoting lifestyle was 109.73（ SD = 16.80）, in which 90.6 percent of the disabled elderly demonstrated unhealthy lifestyle behaviors. The average score for each of the subscales includedthe following： interpersonal relations, stress management, nutrition, self-actualization, health responsibility, and sports activity. Conclusions： The health-promoting lifestyle of the disabled elderly needs to be improved; health care workers and the government should pay more attention to the countermeasures that can improve the lifestyle behaviors and promote the health of the disabled elderly.

Path Exploration for Long-term Care of Rural Disabled Elderly: A Case Study of G Town in South Shaanxi

Field survey of G Town in South Shaanxi indicates that current situations and existing problems of rural disabled elderly. According to these situations and problems,this paper analyzes difficulties in long-term care of rural disabled elderly. From the perspective of welfare pluralism,it comes up with development paths for long-term care of rural disabled elderly with joint participation of government,communities,non-profit organizations on the basis of the family endowment.

Disability and Quality of Life among Elderly Persons with Self-Reported Hearing Impairment: Report from the Ibadan Study of Aging

Background: Despite a high prevalence of hearing impairment (HI) among the elderly, the effect on their quality of life (QOL) has not been well studied in this environment. Aim: To determine the prevalence of disability and profile of QOL among elderly persons (aged ≥65 years) with HI. Design of Study: Cross-sectional. Setting: Eight contiguousYoruba-speaking states in Nigeria. Methods: Face-to-face interviews of respondents selected using a multi-stage, stratified area probability sampling of households;HI was based on self report and observer confirmation and the QOL was measured with the World Health Organization brief version (WHOQOL-Bref). Results: The prevalence of disability in Activities of Daily Living (ADL) was 35.4% while it was 10.1% in Instrumental ADL. Prevalence increased significantly with increasing age (P = 0.05). Disability in ADL (P = 0.01), poor family interaction (P = 0.01), poor community involvement (P = 0.01) cognitive impairment (P = 0.05) and poor report of overall health (P = 0.05) were significantly more common among the elderly with HI than those without. No significant differences were found in regard to current depression or the likelihood of experiencing verbal, physical or emotional abuses. Logistic regression analyses adjusting for age, sex, chronic medical conditions and disability confirmed the salient effect of HI on the decrement in the physical domains (P = 0.05). Conclusion: HI is associated with high prevalence of disability and has adverse effect on the quality of life. This observation strengthens the need for hearing rehabilitation in the policy formulation on the care of the elderly in resource-poor settings.

Long-term care policy simulation of disabled elderly

With the accelerating process of population aging in our country, the physical function of the elderly will decline, the possibility of suffering from acute and chronic diseases will increase, and the occurrence of disability will become more common and normal. The potential demand for elderly care is rapidly increasing. With the growth, the care of the disabled elderly has become increasingly acute. At the same time, due to the intensification of family miniaturization and population migration, the traditional family-based long-term care has been difficult to sustain. How to incorporate long-term care into our social security system as soon as possible has become the focus of the whole society. The thesis through the combination of public policy simulation methods and the research data, the long-term care insurance system implemented at the beginning of 2018 in Shanghai is a policy blueprint. It uses statistical software SPSS, MATLAB, etc. to achieve data collation, analysis and prediction, and at the same time integrates the pilot of the long-term care insurance system. The implementation of policies in cities such as Qingdao and Nantong has been simulated. Finally, on the basis of simulation results, suggestions have been made for the future development of China＇s long-term care insurance system.

Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

AIM： To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. METHODS： The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and de- mographic characteristics, function in the activities of daily living （ADL）, co-morbidities and drug use were collected by a structured interview. Upper gastroin- testinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters： （1） abdominal pain syndrome; （2） reflux syndrome; （3） indigestion syn- drome; （4） bleeding, and （5） non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. RESULTS： 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointes- tinal symptoms was 43.0%, i.e. cluster （1） 13.9%, （2） 21.9%, （3） 30.2%, （4） 1.2%, and （5） 4.5%. Upper gastrointestinal symptoms were more frequently re- ported by females （P 〈 0.0001）, with high number of co-morbidities （P 〈 0.0001）, who were taking higher number of drugs （P 〈 0.0001） and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex （OR = 1.39, 95% CI： 1.17-1.64）, dis- ability in the ADL （OR = 1.47, 95% CI： 1.12-1.93）, smoking habit （OR = 1.29, 95% C]： 1.00-1.65）, and body mass index （OR = 1.06, 95% CI： 1.04-1.08）, as well as the presence of upper （OR = 3.01, 95% C]： 2.52-3.60） and lower gastroenterological diseases （OR = 2.25, 95%CI： 1.70-2.97）, psychiatric （OR = 1.60, 95% CI： 1.28-2.01） and respiratory diseases （OR = 1.25, 95% C]： 1.01-1.54） were significantly associated with the presence of upper gastrointestinal symptoms. CONCLUSION： Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symp- toms in older subjects.

Factors associated with activities of daily living among the disabled elders with stroke

Objective:To determine the factors associated with activities of daily living(ADL)among the disabled elders post-stroke.Methods:A total of 158 patients were chosen from community health service stations in eighteen regions of Tianjin city by convenience sampling from March to November in 2013.The Barthel Index(BI)and the short-formmini-nutritional assessment(MNA-SF)were used to evaluate the ADL,the nutritional status respectively.Statistical analysis was performed using independent sample t-test,one-way ANOVA,Pearson correlation and multiple linear regression analysis.Barthel ADL index was the main outcome.Results:The mean score of ADL was 50.50±27.125.The multiple linear regression showed that the factors which had significant impact on ADL were stroke frequency,types of stroke,nutritional status,financial status,and age.Conclusions:Disabled elders with recurrent strokes,hemorrhagic stroke,dependent financial resources,older age,worse nutritional status and living with family had poorer strokerelated outcome.Healthcare providers can discover the high-risk groups of disability and implement individualized preventive interventions in accordance with the related factors.

中国老年人口健康状况及其家庭照料需求预测

中国人口老龄化快速发展,失能、半失能老年人口规模迅速扩大,老年照料需求快速增加。科学预测不同失能状况老年人口规模及其照料服务需求是推动老年照护服务体系建设的重要基础。文章基于中国老年健康影响因素跟踪调查(CLHLS)数据,使用Markov模型测算中国分性别、分年龄段老年人口健康状况转移矩阵,运用队列要素预测法、多元回归法等预测得到2020—2035年中国不同失能状况老年人口规模及其照料服务人员需求规模、家庭照料经济成本。预测结果显示:中国失能老年人口规模呈现增长态势,从2020年的1946万人增至2035年的3424万人,失能老年人口的比例从2020年的7.4%小幅增至2035年的7.9%,且中重度失能老年人口增幅更快,2035年时轻度失能老年人口规模相比2020年增加66%,中重度失能老年人口规模相比2020年增加92%。女性失能老年人口规模增速快于男性,80岁及以上老年人口失能比例增长更快,2035年男性70~79岁、80~89岁、90+岁三个年龄组失能老年人口规模分别为2020年的1.53倍、1.92倍、1.94倍;2035年女性三个年龄组失能老年人口规模分别为2020年的1.72倍、2.29倍、2.52倍。老年家庭照料需求将呈现快速增长态势,家庭照料服务人员需求量从2020年的2795万人增至2035年的4863万人,增长74%。2020—2035年健康老年人口的照料服务人员需求量占总需求量的比例在57%左右,中重度失能老年人口需求量占比在24%左右,轻度失能老年人口需求量占比在19%左右。60~69岁老年人口所需的照料服务人员占比最高,90岁及以上年龄组对照料服务人员的需求量增长更快。老年人口家庭照料经济成本从2020年的3027亿元增至2035年的11676亿元,将增长近3倍。中重度失能老年人口所需的家庭照料现金成本相比2020年增长3.1倍,轻度失能老年人口所需的家庭照料现金成本相比2020年增长2.6倍。男性老年人口所需家庭照料现金成本低于女性老年人口,且增速也低于女性老年人口。本研究基于定量预测结果提出积极推进健康老龄化,加大促进生育的政策支持力度,尽快推广长期照护保险制度,以赋能家庭为着力点加强失能老年人口的支持体系建设,大力发展老年护理服务业,大力发展养老护理职业教育等政策建议。

空巢老人失能状况及影响因素的城乡差异——基于2018 CLHLS数据的实证分析

[目的]分析我国空巢老人失能状况及影响因素的城乡差异,为预防老年人失能及完善老龄社会政策提供参考。[方法]基于2018年中国老年健康调查数据(CLHLS),选取≥65岁的空巢老人为研究对象,利用Katz指数量表及二分类Logistic回归模型对4488名空巢老人失能状况及影响因素进行分析。[结果]空巢老人总体失能率为13.4%,城市空巢老人失能率(14.6%)高于农村空巢老人(12.2%),轻度失能者占比最高(9.9%),洗澡困难是失能老人最易遇到的自理难题。高龄、自评健康差、患多种慢性病、参与社交活动频率低是城乡空巢老人失能的共同危险因素(P<0.05)。吸烟、过去从事体力劳动、未每年体检是农村空巢老人失能特有危险因素,受教育水平高则是其失能的保护因素(P<0.05)。[结论]与一般老年群体相比,我国空巢老人失能率较高,且失能状况存在显著城乡差异。应制定针对性预防和社会救助措施,完善老年照护服务支持体系,协同保障空巢老年人身心健康。

失能老人和配偶照顾者健康素养与自我效能对生活质量的交互作用

目的探讨失能老人和配偶照顾者的健康素养、自我效能与生活质量的关系。方法采用便利抽样法,于2020年12月—2022年6月对我国7个省(自治区)的1086对失能老人与配偶照顾者进行问卷调查,调查工具包括日常生活功能指数量表、慢性病病人健康素养量表、一般自我效能感量表、中文版生活质量量表,通过主客体互倚模型分析失能老人和配偶照顾者的健康素养、自我效能与生活质量的路径关系。结果失能老人和配偶照顾者的健康素养、自我效能与生活质量的中位数分别为79.00、20.00、378.33,85.00、20.00、548.11。模型结果显示,双方的健康素养与自我效能均能够正向预测自身的生活质量,即主体效应显著(β=0.389,β=0.267,β=0.340,β=0.222;均P<0.05);客体效应,失能老人的健康素养正向预测配偶照顾者的生活质量(β=0.138,P<0.001),配偶照顾者的健康素养对失能老人的生活质量预测作用不显著(β=0.050,P=0.078);双方的自我效能对对方生活质量的预测作用不显著(β=0.034,P=0.259;β=0.032,P=0.276)。结论失能老人和配偶照顾者的生活质量受自身健康素养和自我效能的影响,失能老人的健康素养与配偶照顾者的生活质量存在一定的交互作用。提示我们应将失能老人和配偶照顾者视为一个整体,进行“捆绑式”健康赋能以提升他们的健康素养和自我效能水平,提高他们的生活质量。

失能老年人长期照护服务社会支持体系研究

立足于我国人口老龄化进程加速的基本国情,对失能老年人长期照护服务的现状及存在的问题进行深入梳理与分析。运用社会支持理论,探索完善以政府、家庭、社区、机构为主体的失能老年人长期照护服务的社会支持体系,并提出对策建议,以期为失能老年人长期照护服务体系的建立和完善提供参考,助力健康中国建设目标的实现。

工具性日常活动能力对老年人抑郁影响机制与调节效应研究

我国人口老龄化日渐加剧,失能老年人成为社会养老体系中应重点关注的群体之一,而由失能所引发的老年人抑郁研究尚未深入。文章采用2018年中国家庭追踪调查数据,基于工具性日常活动能力评估失能对老年人抑郁的影响并分析其异质性,考察人格特质与认知能力的中介效应、社会支持及社会参与的调节效应。通过稳健性检验发现,工具性日常活动能力对老年人抑郁具有显著负向效应,且东部与西部、性别、受教育水平及年龄等因素存在显著的异质性,3种人格特质与数学推理能力有显著的中介效应。因此,建议完善失能与认知评估及监测机制,建立针对特定人格特质与认知能力等重点人群的心理健康预警机制,推进基层精神卫生服务体系的构建,从制度层面发挥长期护理保险体系对失能老人心理健康的促进作用,大力推进智慧养老,增强老年人的社会参与感。

基于Farran模型的失能老人照护者照护技能干预方案的构建与实施

目的构建失能老人家庭照护者照护技能干预方案并探讨其实施效果。方法以Farran照顾者技能模型为理论框架,构建失能老人家庭照护者照护技能干预方案。将80名失能老人家庭照护者随机分为对照组和干预组各40人。对照组实施常规住院护理和出院随访,干预组实施基于Farran模型的失能老人照护者照护技能干预,分别于干预前、干预后当天、干预后2周评估失能老人的生存质量以及家庭照护者的照护负担和照护技能。结果干预2周后,两组照护者照护负担得分、照护技能得分比较,差异有统计学意义;两组失能老人生存质量得分(除生理维度外)差异有统计学意义(均P<0.05)。结论失能老人家庭照护者照护技能干预方案可有效减轻家庭照护者照护负担,提高其照护技能水平,提高失能老人的生存质量。

Disability trajectories in activities of daily living of elderly Chinese before death

This study aims to analyze the changes in activities of daily living(ADL)of the Chinese elderly before death,and to explore the heterogeneity in this process.Using data from the Chinese Longitudinal Healthy Longevity Survey(CLHLS),we quantify disability trajectories of ADL using a group-based trajectory model and find that there are three types of disability trajectory for ADL.The elderly who differ by socioeconomic status,childhood experiences,health behaviors,ages and birth cohorts show significant differences in their disability trajectories.Long duration of disability is found to be more prevalent in older females and people with high socioeconomic status.Good and stable status of ADL is more common among males and people of low socioeconomic status,while the elderly in an early cohort who died at older ages were more likely to have experienced a long duration of disability.Selective and protective effects contribute to the observed differences in trajectories.

中国老年人口失能率及失能规模分析——基于第六次全国人口普查数据

依据2010"六普"长表中生活不能自理老年人数据,计算了分全国及分省区、年龄、性别、城乡的老年人口失能率,并推算其规模。结果表明,我国老年人口失能规模为522万,总失能率为2.95%,其中男性2.52%,女性3.35%,低于以往的文献报道。老年人口失能率随着年龄上升而快速上升,60岁组老年人口合计失能率为0.68%,70岁组为2.15%,80岁组为6.49%,90岁组为18.56%,百岁及以上的高达29.19%。老年人口失能率在城市、镇、乡村之间存在较大差距,城市失能率最低(2.35%),其次是镇(2.60%)、最高是乡村(3.33%)。

长沙市某区失能老人家庭照护者照护知识和技能现状及需求研究

目的了解长沙市某区失能老人家庭照护者照护知识和技能现状及需求。方法 2016年12月,采用滚雪球法选取长沙市某区失能老人家庭照护者96名为研究对象,采用中文版Barthel指数量表评定失能老人的日常生活能力,同时使用失能老人照护知识问卷和照顾者所需知识与技能表对照护者进行调查。结果家庭照护者照护知识平均得分为(17.87±6.92)分。不同年龄、文化程度以及与失能老人亲属关系不同的家庭照护者,其照护知识的掌握情况差异均有统计学意义(均P<0.05)。家庭照护者对照护知识和技能需求的平均得分为(62.76±12.15)分。高中及以下人员、失能者的配偶及子女和照护的失能者Barthel指数较低者,其照护知识的需求得分较高,与其他照护者相比,差异有统计学意义(P<0.05)。家庭照护者对照护知识技能的需求排在前5位为疾病知识、康复、用药、身体不适和预防处理褥疮知识。结论长沙市某区失能老人的家庭照护者照护知识和技能亟待加强,学习需求强烈,应对其开展照护知识和技能培训。

我国失能老人长期照料现状及影响因素——基于城乡差异的视角

利用2011-2012年中国健康长寿调查数据(CLHLS),实证分析了影响我国失能老人长期照料模式选择的因素。结果表明,90%以上的失能老人主要依靠家庭照料,社会化照料形式较少。总体上看,失能老人的家庭人均收入、社区起居照料服务的供给对其选择社会化照料具有正向影响。从城乡差异看,教育程度及社区照料服务的供给状况对农村失能老人照料模式的选择有正向影响,但在城市中并不显著;儿子数与女儿数对其照料模式的选择也有显著差异。因此,政府应加大农村社区照料服务建设,并对经济状况差、失能严重的老人提供财政补贴。

新疆哈萨克族失能老年人居家照护者的社会支持及其影响因素

目的:探讨新疆哈萨克族失能老年人居家照护者社会支持现况及其影响因素。方法:应用社会支持量表(SSRS)对315名研究对象进行调查。结果:居家照护者社会支持得分(33.24±8.97)分,三个维度中主观支持最高;年龄、家庭月收入、每日照护时间及照护负担是社会支持的影响因素;年龄≥60岁,文化程度为文盲,每日照护时间≥8h的照护者对支持的利用度最低;中度照护负担的照护者客观支持最低。结论:哈萨克族失能老年人居家照护者的社会支持较低,应开展有针对性的居家照护者支持服务。

关于失能老人状况与老年长期护理保险的研究综述

长期护理保险作为国际上解决失能老人护理需求的重要手段,已经成为老年社会保障领域研究的重点问题。文章梳理国内外关于我国失能老人的状况和老年长期护理保险的文献,研究目前相关研究的主流观点,包括失能老人基本状况、失能老人照料需求和服务供给、老年长期护理保险实现模式选择、老年长期护理保险制度制定、老年长期护理保险国际经验。研究结果表明,中国失能老人增多是中国人口老龄化过程中的必然趋势,存在失能老人照料供需失衡的状态,社会护理保险是解决老年护理问题的主要途径。