老年人社区嵌入式养老服务需求及影响因素研究

目的 了解老年人社区对嵌入式养老服务的需求意愿，分析影响因素，为满足老年人多元化的养老需求提供参考。方法 方便抽取832名老年人进行问卷调查。结果 老年人对社区嵌入式养老服务需求率为19.2%。logistic回归分析显示，文化程度、就医频率、子女数量、自理能力、对现阶段养老方式的满意度及社区嵌入式养老是否满足自身养老需求，是老年人社区嵌入式养老需求的影响因素(P<0.05,P<0.01)。结论 老年人对社区嵌入式养老服务的需求意愿较低，受多方面因素的影响。需提高老年人对社区嵌入式养老的认识。     

基于养老服务管理者及老年人视角的社区嵌入式养老服务的SWOT分析

目的 分析社区嵌入式养老服务优劣势、机遇及威胁,为社区嵌入式养老服务持续健康发展提供参考。 方法 采用目的抽样法及滚雪球抽样法抽取天津市6名社区嵌入式养老服务管理者及6名接受服务的老年人,对其进行半结构式深入访谈,使用内容分析法分析资料,基于SWOT模型从优势、劣势、机会、威胁4个维度对社区嵌入式养老服务进行分析评价。 结果 社区嵌入式养老优势包括提供服务多元、满足情感需求、统筹整合优质资源、开放式养老;劣势为场地资源受限、盈利困难;机遇有服务需求量大、政府有力支持、信息技术发展日益成熟;威胁包括功能定位模糊、护理员短缺、老年人缺乏自主消费观念。 结论 在积极推进“互联网+社区养老”的背景下,天津市社区嵌入式养老因其服务多元,形式灵活,兼具地缘优势,具有良好的社会反响。未来,需在运营中进一步加强政府引导及监督,细化功能定位、稳定护理员队伍,以切实满足社区老年人多元化养老服务需求。     

呼和浩特市蒙古族老年人社区居家养老服务需求研究

目的探究蒙古族老年人社区居家养老服务的现状及具体需求。方法采取整群抽样方法,选取呼和浩特市蒙古族老年人232名,对养老模式选择需求、社区居家养老需求情况及目前对社区养老服务满意情况进行问卷调查。结果蒙古族老年人选择社区居家养老服务模式最多,占89.7%,其次为选择养老院(7.8%)。蒙古族老年人在社区居家养老的需求中,生活照顾类需求较多的是开设"老年餐桌"(38.5%);医疗保健类对水平较高的社区蒙医医院需求最大(占29.3%);精神文化类对增设棋牌社需求量最大(占25.0%)。对社区居家养老服务的需求受文化程度、月收入、身体健康状况、有无配偶、有无子女以及居住方式的影响(P0.05,P0.01)。结论呼和浩特市蒙古族老年人青睐社区居家养老,对社区居家养老服务需求较高,且受多种因素影响。应以蒙古族老年人的实际需求情况为导向,提供有针对性、多元化的社区居家养老服务,以满足老年群体的个体化需求。     

养老机构自立支援实施影响因素的质性研究

目的 探讨影响养老机构实施自立支援的因素,为制订针对性管理策略提供依据。 方法 以健康服务领域研究成果应用的行动促进综合框架（i-PARIHS）为指导,采用描述性质性研究方法,通过目的抽样法选取养老机构的工作人员13人和老年人6人,对其进行半结构深入访谈,应用归纳和演绎相结合的方法进行资料分析。 结果 呈现出3个主题和8个子主题,包括变革（优势、风险）、组织环境（照护理念、护理员配比、设施设备及用物配备、领导者支持）、接受者（护理员的实施能力、老年人及其家属的接受意愿）。 结论 养老机构实施自立支援受多个因素的影响,增强机构实施自立支援的意愿、完善机构的组织环境、提升护理员的实施能力、增强老年人及其家属的接受意愿,有助于推动自立支援在养老机构的开展。     

四川城区老年人养老方式选择及其影响因素调查

目的了解四川城区老年人养老方式选择及其影响因素。方法在四川省6个地区,采用自行设计问卷方便抽样640名城区老年人进行调查,分析老年人养老方式选择及相关影响因素。结果 640名老年人中,8.1%选择社区居家养老,10.3%选择机构养老,81.6%选择家庭养老。单因素分析中,性别、文化程度、个人月收入、与子女关系满意度、子女个数、养老费用来源个数对老年人养老方式选择有影响;多因素Logistic回归分析中,文化程度越高、与子女关系越不满意的老年人越愿意接受机构养老和社区居家养老;养老费用来源个数越多的老年人更愿意接受社区居家养老。结论家庭养老仍然是城区老年人养老方式的主要选择,合适的养老方式对满足老年人需求、合理利用养老资源,实现"健康四川2030"健康老龄化有积极作用。     

社区低龄老年人对互助养老认知和参与动机的质性研究

目的了解社区低龄老年人对互助养老的认知和参与动机,为提高社区低龄老年人互助养老参与度提供参考。方法采用目的抽样法,按照资料饱和原则,选择15名社区低龄老年人进行半结构式访谈,运用内容分析法对资料进行整理、分析。结果共提取2个主题,即对互助养老的认知和参与动机(包括互利互惠、价值表达、经验学习和利他主义)。结论社区低龄老年人对社区互助养老的接受度较高,但对社区互助养老的认知度较低;参与互助养老的动机明确,有其人群特异性。社区需加大宣传力度,强调“内在性报酬”的作用,以促进社区互助养老模式的发展。     

社区中老年居民养老护理服务的需求调查

目的了解社区中老年居民对养老护理需求现状,为满足其护理服务需求的干预提供参考。方法对东莞市456名社区中老年居民采用自行编制的护理服务需求调查表进行调查。结果社区中老年居民所希望的养老方式首选家庭养老(53.07%),最担心的养老问题为"失去生活自理能力"(占52.63%),护理服务需求总分(71.33±8.57)分;护理服务需求较高的条目为干重活、紧急救助和体育锻炼场地。结论我国老年人的养老方式仍然以家庭养老为主,对养老护理服务需求表现为多样性,对生活照顾、医疗保健及精神及活动需求较高。政府和养老机构应进一步完善养老政策和保险及医疗保障体系,满足老年人的养老护理服务需求。     

低龄老年人时间银行互助养老模式的参与意愿调查

目的了解城市低龄老年人对时间银行互助养老模式的参与意愿,探讨促进低龄老年人参与时间银行的激励政策。方法采用自设时间银行互助养老模式参与意愿问卷,调查杭州市397名60~69岁低龄老年人的参与意愿。结果 79.6%低龄老年人愿意尝试时间银行互助养老模式;回归分析结果显示,政治面貌为中共党员、有宗教信仰、自评健康状况较好、无主要疾病的低龄老年人更愿意参与时间银行互助养老模式(P0.05,P0.01)。低龄老年人愿意提供的服务类型排名前3位的是陪伴服务(65.2%)、家政服务(36.8%)、生活照料服务(32.2%);愿意兑换的服务内容需求最强烈的是家政服务(39.5%)、陪伴服务(36.8%)、医疗卫生服务(28.7%)。结论杭州市低龄老年人的参与意愿较高,在时间银行目前的发展形势下,可优先发展中共党员、自评健康状况较好的低龄老年人参与时间银行互助养老模式;设置多样性的服务内容和兑换形式以供老年人选择,促进时间银行互助养老模式的发展完善。     

老年人正式入住医养结合养老机构前服务沟通方式的改进

目的探讨老年人入住医养结合养老机构前服务沟通方式的改进策略。方法将115例预约试住医养结合养老机构的老年人随机分为观察组58例和对照组57例。对照组采用传统方法,于老年人试住当天讲解《试住期合同》内容后,为老年人提供2周的试住期服务。观察组以团队服务模式行分阶段服务与沟通为老年人提供试住期照护。结果试住期满后,观察组对试住期满意度、对《试住期合同》主要内容知晓程度、正式入住率显著优于对照组(P0.05,P0.01)。结论对有入住医养结合养老机构意愿的老年人,采取团队式分阶段服务沟通的方式,有利于提高老年人试住期满意度和正式入住率。     

盐城市不同养老模式高龄老年人的护理需求分析

目的了解盐城市不同养老模式高龄老年人的护理需求,从而提出改进对策,以提高高龄老年人的生活质量。方法采用自行编制的调查表对盐城市家庭养老(282人)、机构养老(234人)和社区居家养老(139人)的≥80岁老年人的疾病护理、疾病预防和健康促进三方面需求进行调查。结果3种养老模式下高龄老年人的护理需求比较,差异有统计学意义(均P<0.01),其中社区居家养老高龄老年人健康促进的需求最高,家庭养老对疾病护理的需求最高,机构养老对疾病预防需求最高;影响高龄老年人护理需求的主要因素有对护理服务的认识和患病数目(均P<0.01)。结论不同养老模式高龄老年人的护理需求不同,在我国多种养老模式并存的情况下,护理人员需针对性满足高龄老年人的护理需求,提高其生活质量。     

Polytrauma in the elderly

Twenty-seven patients over 70 years old in a consecutive series of 300 patients (mean age 75.1 years) who had sustained polytrauma were compared to a group of 27 younger patients of that series (mean age 36.1 years) and were matched for similar patterns of injuries. The injury severity scores (ISS) were nearly equal in both groups. The amount of blood transfused, the shock index on arrival, the number of peritoneal lavages performed, and the number of chest drains inserted were similar in both groups. In general, the trauma-causing injury in the older patients was substantially less severe than in the younger age group. Nearly all fractures were treated operatively in the younger patients, while equivalent fractures in the older group were more often treated conservatively. The greater mortality in the older patients was due to preexisting handicaps, which are disregarded by the ISS. Most of the older patients who survived could be satisfactorily rehabilitated. What causes and what are the injuries of the elderly polytrauma patient? How aggressive should the treatment be and to what degree is rehabilitation of survivors possible?     

Tumors in the elderly

The prevalence and incidence of cancer are age related; increased longevity thus increases the number of elderly patients with cancer. Only a few data suggest that en bloc radical cystectomy in patients with bladder cancer and radical prostatectomy in patients with prostate cancer can be safely performed on properly selected elderly patients (aged 70 years or older) with results comparable to those for younger patients. Due to the physiologic decline in renal function and hepatic drug metabolism in old age, chemotherapeutic agents show increasing toxicity in the elderly. The elderly remain underrepresented in clinical trials. In the absence of comprehensive data on treatment in the elderly, the belief persists that the elderly derive less benefit and suffer greater toxic effects from chemotherapy than younger patients.     

Trauma in the elderly

One hundred geriatric patients who suffered injury severe enough to necessitate hospitalization were compared retrospectively to a random group of 100 younger patients. The elderly suffered different types of injury and died six times as often as their younger peers, even when controlled for injury severity. The PRE method was employed to examine outcome in both groups and was found to be strongly predictive of death in young patients. Age stratification aided significantly in predicting mortality in elderly patients. Regression analysis was employed to examine the data set to determine the relative importance of several variables in the prediction of ultimate mortality. By incorporating all the data from the entire data set, curves describing the contribution of age and shock to mortality corrected for all factors is possible. Increasing age after 65 increases mortality and this effect is dramatically increased by the presence of shock. This information may be useful in counselling the injured elderly and their families.     

Pharmacodynamics in the elderly

An overview is given of the influence of age on the pharmacodynamics of drugs used during general and locoregional anaesthesia. For some groups of agents a distinct separation into age-related changes in the pharmacokinetics and pharmacodynamics is possible, whereas for others the literature indicates only that responses in the elderly are enhanced. I start with an overview of the influence of age on cardiovascular and neuroendocrine function and include a short account of the state-of-the-art in pharmacodynamic modelling. The physiological changes that occur with age are associated with an increased sensitivity to the effects of anaesthetic agents. For most intravenous hypnotic agents, and inhalational anaesthetic agents, the increased sensitivity with age is, at least in part, explained by altered pharmacodynamics. For opioids and local anaesthetics applied for blockade of the central nervous system, the pharmacodynamic involvement is not always clear. For neuromuscular blocking agents, pharmacodynamic involvement appears to be nearly absent in the reduced dose requirements seen with age--so that the latter appear to be caused by altered pharmacokinetics. Future studies, using pharmacokinetic-pharmacodynamic (PK-PD) mixed-effects modelling, should further explore this area to obtain clinically applicable data for improving our insight into the delivery of anaesthetics to the elderly and improving the quality of anaesthesia in this fast-growing population.     

Sexuality of the elderly

Partial androgen deficiency of the aging male is associated with symptoms collectively accepted as the andropause syndrome. The underlying hormonal changes, the definition of age-dependent cofactors for changing sexuality, and the data on decreasing erectile function are the main topics of this critical analysis. Alterations in libido, ejaculation and sperm quality also have to be considered in order to define a change in male sexuality as part of the natural process of aging.     

Pharmacokinetics in the elderly

The elderly are an expanding population of patients presenting for anaesthesia. The pharmacokinetics of anaesthetic agents in the elderly deserves special attention because the normal ageing process and the effect of age-related diseases affect organ systems in a heterogeneous way with unpredictable consequences. The pharmacokinetics of each drug is also affected by these changes in a specific way and, together with the pharmacodynamic consequences, makes drug use and drug dosing challenging in this population. Although a decrease in bolus and infusion rates is a common theme, only pharmacokinetic modelling of drug disposition in the elderly will provide accurate dosing guidelines and increase the margin of safety.