以标准化老年综合评估为基础的居家养老研究：北京案例

【作者】 何帆；

【导师】 李培林；

【作者基本信息】 中国社会科学院研究生院 ， 公共管理（专业学位）， 2017， 硕士

【摘要】 老年人往往有功能受损、合并多种健康问题等多重叠加因素导致的照护需求具有高度的复杂性和特异性,需要科学的综合评估工具并由经过培训的评估员对老年人进行评估,才能准确掌握老年人的基本情况,从而开展更深入的需求分析。本次研究的目的是探索以标准化老年综合评估为基础的居家养老服务体系建设并为相关实践提供具有参考价值的结论和建议。本次研究使用interRAI居家照护评估工具对前往北京市东城区多福巷社区、海运仓社区、花园社区和南门仓社区卫生服务中心随诊的老年人进行综合评估,纳入其中年龄≥60岁,对本次研究知情同意,愿意参加本次研究的老年人,排除了患有老年痴呆、精神疾病、或处于疾病终末期的老年人,最终将166名老年人纳入统计分析。结果显示:在健康状况方面,55%的老年人存在尿失禁问题,21.7%的老年人有两种或以上疾病诊断,80.7%的老年人最近1年未测量过血压;在环境方面,53.6%的老年人住宅周围交通不便或家中活动不便,83.1%老年人表示紧急求助设施不可获取;在社会支持方面,78.3%的老年人无非正式照护者;在心理健康方面,24%老年人处于抑郁的高风险状态。老年人抑郁风险与患病种类、拥有其他健康问题数量、尿失禁程度以及社会活动降低程度呈正相关,与积极参加感兴趣的社会活动程度呈负相关,P值均小于0.05。基于本次研究结果建议政府建立以评估为基础的居家养老体系,完善居家养老服务人才培养计划,致力于提供整合养老服务,确立多维度长期照护保险受益资格评价标准。更多还原

【Abstract】 It is common to see that senior adults’ care needs are often highly complicated and peculiar to each other for the superposition of multiple factors,including function impairments and co-existing health problems and so on.That’s the reason why scientific comprehensive assessment instrument is needed to assess the seniors and should be operated by trained assessors.Only in this way,could we learn the accurate baseline situations of the seniors and make analysis of their care needs.This research aims at exploring the establishment of home care system for senior adults based on standardized comprehensive geriatric assessment and trying to reach the conclusions and make suggestions which could be referenced.interRAI Home care suit was used to assess the seniors who visited the community healthcare services centers in Duofuxiang Community,Haiyuncang Community,Huayuan Community and Nanmencang Community in Dongcheng District in Beijing for follow-up.Among them,166 seniors who were 60 years and older without senile dementia,mental disease or other end-stage disease and willing to participate after being well informed of this research were included.The results showed that in the aspect of health conditions,55% of the seniors had the problem of bladder incontinence,21.7% of them had the diagnoses of two or more diseases,80.7% of them did not measure the blood pressure in the past year;in the aspect of environment,53.6% of the seniors were living in the environment with limited access to home or rooms in home,83.1% of them claimed no emergency assistance was available;in the aspect of social supports,78.3% of the seniors had no informal helper;in the aspect of Psychosocial Well-Being,24% of the seniors had the high risk of depression.The risk of depression among the seniors is positively associated with the number of diagnoses of diseases and other health problems,the extent of bladder incontinence,the decline in level of participation in social activities,but negatively associated with the extent of participation in social activities of long-standing interest,with all the P values lower than 0.05.Based on the results of this research,the establishment of home care system for senior adults based on standardized comprehensive geriatric assessment,the improvement strategy of home care personnel training,the commitment of integrated senior care services and the multidimensional criteria for reimbursement of long term care insurance are proposed for the government.更多还原