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In order to cope with the challenges of an aging society,the construction and implementation of a policy system about integrated elderly care and medical services is an important measure to protect the health rights and interests of the elderly.By integrating medical care with elderly care services,the policy aims to provide comprehensive and continuous support for elderly care and health,and meet the diversified needs of the elderly in terms of medical treatment,rehabilitation,nursing,and life care.The construction and implementation of this policy system will not only help to improve the quality of life of the elderly,but also help to improve the service efficiency of the medical and health system and promote sustainable social and economic development.This paper reviews the policy of integrated elderly care and medical services from multiple perspectives such as its development history,policy level,classification and characteristics.
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Objective To explore the experience and causes of self-neglect of elderly diabetic patients in community,so as to provide references for community nursing workers to identify and intervene the self-neglect behavior of elderly diabetic patients.Methods An interpretative phenomenological method was used to collect data from elderly diabetic patients registered in 3 community health service centers in Hangzhou,Zhejiang Province through semi-structured interviews.Van Manen's method was used to analyze qualitative data.Results The experience and reasons of self-neglect of elderly diabetic patients in community were summarized into 4 themes and 10 sub-themes,including neglecting personal health(low sense of self-worth,high level of self-esteem,being afraid of compromising the family),neglecting blood glucose management(weak health awareness,difficulty in blood glucose management),inadequate self-care capacity(poor financial situation,insufficient personal time,diminished mobility)and inadequate perceived support(low social support,insufficient emotional support).Conclusion The experience and reasons of self-neglect of elderly diabetic patients in community are diversified.Community health services and nursing workers should pay attention to the performance of self-neglect behavior of elderly diabetic patients and actively explore effective prevention and intervention measures.
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Objective:To construct an evaluation indicator system for the efficiency of nursing human resources in integrated medical and elderly care institutions using Data Envelopment Analysis (DEA) and subsequently evaluate its effectiveness.Methods:This cross-sectional survey utilized literature review and investigative methods to initially establish a library of evaluation indicators for nursing human resource efficiency. The Delphi method was employed in two rounds of consultations with 17 experts from various fields, including nursing management, elderly care institution management, integrated medical and elderly care institution management, health economics management, and public health. The reliability of the indicator system was assessed based on factors such as expert enthusiasm, authority, concentration of opinions, and coordination. Adjustments, modifications, and improvements were made to the indicators based on expert opinions to establish the final indicator system. From August to December 2022, the DEA model was applied to evaluate the efficiency of 12 integrated medical and elderly care institutions in Haikou city based on this indicator system.Results:The constructed evaluation indicator system comprised 68 items divided into three levels: 9 primary indicators, 19 secondary indicators, and 40 tertiary indicators. The positive coefficients of the two rounds of expert consultations were 100% and 94.1%, with authority coefficients of 0.88 and 0.92, Kendall harmony coefficients of 0.471 and 0.348, and mean coefficients of variation of 0.16 and 0.12 ( P<0.001). DEA evaluation results for the 12 integrated medical and elderly care institutions showed that 5 were DEA effective institutions with comprehensive efficiency (OE), technical efficiency (TE), and scale efficiency (SE) values all equal to 1.000, while 7 were non-DEA effective institutions, including 4 with SE <1.000 but TE=1.000 and 3 with both SE and TE<1.000. Conclusions:The constructed evaluation indicator system demonstrates high enthusiasm, authority coefficients, and coordination in expert consultations, indicating high acceptability and comprehensive content with distinct levels and strong specialty characteristics. The DEA model′s evaluation results objectively and effectively reflect the efficiency of nursing human resources in integrated medical and elderly care institutions, demonstrating practical utility.
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ObjectiveTo analyze the satisfaction of service recipients with the preliminary assessment service of the unified elderly care needs evaluation in Shanghai， so as to provide reference for further optimization of the service system. MethodsA multi-stage random sampling method was employed to recruit participants. A total of 110 individuals who had received unified elderly care needs evaluation service in six districts of Shanghai were investigated using a structured questionnaire. SPSS 25.0 was used to analyze the data. Univariate analyses were conducted using the Chi-square test and Fisher’s precision probability test， while multivariate analysis was performed using ordinal regression. ResultsThere were differences in satisfaction with various aspects of the preliminary assessment process among participants from different areas， with those from outer suburbs generally exhibiting lower satisfaction （P<0.01）. Multivariate analysis results indicated that satisfaction with the timing of the preliminary assessment was related to the service recipients’ residential area and their primary source of income； satisfaction with the service attitude and capability of the assessment personnel was only related to the residential area. Satisfaction with the preliminary evaluation results was related to the participants’ marital status， educational level， income level， and the specific rating results. ConclusionThe satisfaction level with the preliminary assessment of the unified elderly care needs assessment in Shanghai is relatively high. In the process of evaluation， a deeper analysis and exploration of individual needs based on various personal information are essential to ensure the appropriateness of the provided elderly care services， and thereby effectively enhancing recipient satisfaction.
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ObjectiveTo clarify the perception of the work and satisfaction levels among personnel conducting unified elderly care needs assessment in Shanghai， to analyze the factors influencing their job satisfaction， and to provide references for optimizing the job satisfaction of unified elderly care needs assessment personnel in Shanghai. MethodsA survey was conducted among 93 assessment personnel randomly selected from 29 elderly care needs assessment agencies in Shanghai. The personnel’s perception of their work and their levels of job satisfaction were examined. Chi-square test and Fisher’s precision probability test were used to compare regional differences， while the two-factor theory was employed to analyze the factors influencing job satisfaction. ResultsRegarding perception of the work， 92.5% of the surveyed personnel believed their work was important. Moreover， 87.1% were interested in their assessment tasks， and 84.9% believed they made a positive contribution to the assessment work and the assessment position was in line with their personal preferences. Regarding job satisfaction， 83.9% of the participants were satisfied with their assessment work， 78.5% considered the workload appropriate， and 74.2% found the working hours suitable. Additionally， 65.6% expressed satisfaction with the level of cooperation from the assessment subjects， while 94.6% and 91.4% of the personnel were satisfied with the support provided by the assessment agencies and had a sense of belonging， respectively. Furthermore， 65.6% of the personnel expressed satisfaction with their job compensation and benefits. Hygiene factors affecting job satisfaction included salary and compensation， workload， time spent on the job and institutional support related to external assistance， job suitability， teamwork， and client cooperation （P<0.05）， while motivational factors included recognition of the significance of the job， sense of achievement， interest in the job， sense of belonging， and opportunities for personal growth （P<0.05）. ConclusionThe overall work cognition and satisfaction of unified elderly care needs assessment personnel in Shanghai towards their work are relatively positive. Main issues include the heavy workload and actual job subsidies not meeting expectations. It is recommended to improve the standardization of the assessment process， establish a professional team of assessment personnel， and enhance the compensation and incentive mechanisms to continuously increase staff satisfaction.
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The proportion of the elderly population in China is increasing.How to truly achieve elderly care and medical services through medical-nursing combined care is an important problem that urgently needs to be solved.Taking Beijing as an example,this paper analyzed the development situation of medical-nursing combined care in Beijing,conducted field research on the three main models of medical-nursing combined care in Beijing,as well as summarized the difficulties and challenges faced by different models from the perspective of organizations and institutions.It suggested to further integrate and coordinate the Beijing-Tianjin-Hebei policies of medical-nursing combined care,accelerate the implementation of long-term care insurance,strengthen the professional training of elderly care talent teams,enhance the standardized construction and supervision of elderly care institutions,and vigorously develop technological and intelligent elderly care.
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Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program’s implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home‑based care, and integrating digital health technologies and other existing welfare schemes.
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The COVID-19 has had a profound impact on human society, the elderly, as a vulnerable group, are the most affected. Based on two cases of disease narrative collected by the department of neurology of a hospital in Guiyang, this paper analyzed the shortcomings of elderly care in the context of epidemic prevention and control. The overall health information literacy of the elderly was low, which made it difficult to obtain correct epidemic related information. The lifestyle of the elderly has changed during the epidemic prevention and control stag. The long time isolation at home has reduced their constitution and made them prone to illness, thus affecting the quality of healthy elderly care. In this stage, the psychological burden of the middle-aged and elderly people has been increasing, which reduced the life satisfaction and subjective well-being of the elderly, and increased the risk of depression. In view of these outstanding problems, this paper proposed corresponding measures, aiming to improve the quality of life and physical and mental health of the elderly during the epidemic prevention and control stage, and provide reference for realizing healthy aging in China.
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With aging population becoming increasingly prominent, more intelligent, integrated, and anthropomorphic nursing robots are becoming an important option for future home-based elderly care. However, a series of ethical dilemmas may arise when nursing robots that provide long-term services participate in the social life of the elderly as social entities. For example, the encroachment of low-level interaction between humans and nursing robots on the high-level interaction between humans, as well as the dispute over the definition of responsibility caused by unclear moral subjects. The value sensitive design theory advocates incorporating value into technical design, and based on its conceptual research, empirical research, and iterative approach, it can be found that the fundamental reason for the above-mentioned ethical dilemma lies in the confusion and dislocation of the ternary nursing relationship among human caregivers, the elderly, and nursing robots. Accordingly, this paper proposed to clarify the user status of the elderly and human caregivers, while nursing robots serve as auxiliary tools to meet the nursing needs of the elderly, protect and enhance the well-being of the elderly.
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At present, China’s response to the aging population situation is unprecedentedly urgent, and the construction and planning of the pension system face great challenges. Home-based elderly care services stand out in institutional-based elderly care and family-based elderly care due to their unique advantages in meeting the individual needs of the elderly. By sorting out the main types, policy lines, and supply and demand status of home-based elderly care service, this paper indicated that there are five aspects of problems in home-based elderly care service, including weak professional talent team construction, relatively insufficient capital investment, weak supply-demand matching, imperfect operating mechanism, and imperfect supporting facilities. It was proposed that in the future home-based elderly care services should strive to strengthen the construction of professional talent teams, widen financing channels, fully play the leading role of the government, perfect the operational mechanism and the construction of supporting facilities of home-based elderly care services, so as to provide reference for the optimization of the home-based elderly care service system in China.
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Objective To investigate the prognosis of middle-aged and elderly patients with aspiration pneumonia and related influencing factors in integrated medical and elderly care institutions. Methods A total of 604 elderly patients with aspiration pneumonia were selected from integrated medical and elderly care institutions from January 2016 to December 2020. The prognosis of the patients was counted, and the prognostic factors were analyzed by univariate and multivariate logistic regression equations. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to analyze the predictive value of logistic regression model for the prognosis of elderly patients with aspiration pneumonia. Results Univariate analysis showed that Alzheimer's disease, severe pneumonia, ability of daily living (ADL), and the number of rescues were related to the prognosis of elderly patients with aspiration pneumonia (P12.97), the predictive value was the best, with the predictive sensitivity being 83.87%, and the specificity being 84.15%. Conclusion Alzheimer's disease, severe pneumonia, moderate and severe dependence in the ability of daily living and rescue times ≥ 2 are related to the prognosis of middle-aged and elderly patients with aspiration pneumonia in the integrated medical and elderly care institutions, which can be used as a prognostic plan for clinical treatment and nursing management. At the same time strengthening the intervention of patients with the above characteristics will help to promote the improvement of prognosis.
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Objective@#To investigate the willingness to pay integrated medical and elderly care services and identify the influencing factors among the elderly in Hohhot City, Inner Mongolia, so as to provide insights into promoting integrated medical and elderly care services.@*Methods@#The elderly at ages of 60 years and older were sampled using a convenient sampling method from public venues in four districts of Huimin, Saihan, Yuquan and Xincheng in Hohhot City from June to December 2021. Basic characteristics, health and disease burdens, social support and willingness to pay integrated medical and elderly care services were collected, and factors affecting the willingness to pay integrated medical and elderly care services were identified among the elderly using a multiple linear regression model. @*Results@#A total of 1 008 valid questionnaires were recovered, with an effective recovery rate of 96.74%. The respondents included 519 men (51.49%) and 489 women (48.51%), and had a mean age of (69.47±6.42) years. The monthly average fees of willingness to pay integrated medical and elderly care services were (2 076.49±36.79) Yuan, and there were 636 participants with 2 000 Yuan and less monthly average fees of willingness to pay integrated medical and elderly care services (63.10%). Multiple linear regression analysis showed that place of residence (β=180.832), satisfaction with housing (satisfied, β=-140.760), physical self-care ability (completely self-care: β=-238.244; mostly self-care: β=-254.557), burdens of disease diagnosis and treatment (able to afford: β=452.488; partly afford: β=228.626), monthly income (β=347.144), expenses of medications (β=0.019) and total score of social support (β=17.116) were factors affecting the willingness to pay integrated medical and elderly care services among the elderly. @*Conclusions@#The willingness to pay integrated medical and elderly care services among the elderly in Hohhot City is associated with place of residence, monthly income, satisfaction with housing, physical self-care ability, burden of disease diagnosis and treatment, expenses of medications and social support.
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Objective This study aims to explore the formation of the dilemma of"giving care"for disabled elderly people in nursing homes from the perspective of active health.Methods Purposive sampling was used to select caregivers and disabled elderly people from a nursing home in Chongqing as research subjects from July 2022 to December 2022.One-on-one in-depth interviews were conducted and Colaizzi's 7-step thematic analysis method was employed to collect and analyze the interview data.Results 4 themes were identified:①the dominance of the"giving"care concept,including the cultural thoughts of filial piety,passive acceptance of care characteristics and consumer psychology regarding paid services;②insufficient"participation"care ability,including lack of knowledge regarding active health and a weakening of skills to promote participation;③the hindrance to"transformation"of care models,including objective limitations in terms of human resources and delays in adapting aging environments;and ④the decline in"utilization"of internal abilities,including excessive avoidance of potential risks,a heavy workload of care and poor quality of individual care.Conclusion The formation of the dilemma of"giving care"for disabled elderly people in nursing homes is affected by multiple factors such as social background,service system,supply resources,and management mode.Transforming disabled elderly individuals from a state of"passive giving care"to"active participation in their health"is an important measure to realize the concept of positive aging and healthy aging.
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Objective:To build a practical strategy set for outpatient elderly care station, for references for improving the quality of outpatient elderly care services in hospitals.Methods:From January to December 2022, based on the 4Ms model and in view of needs of elderly outpatients, this study developed preliminary screening items of the practical strategy set for outpatient elderly care station by means of document analysis and semi-structured interviews. Two rounds of Delphi methods were used to construct the practice strategy set.Results:The effective response rates of the two rounds of Delphi methods were both 100%, and the expert authority coefficients were both 0.86. The practical strategy set for outpatient elderly care station included 4 first level items (what patients consider important, medication safety, activity safety and mental care), 10 second level items (friendly culture, friendly management, friendly service, friendly environment, including fall assessment, preventive measures, medication assessment, medication education, psychological assessment and psychological care), and 37 third level items. The importance and feasibility scores for all first and second level items were 5.00 points, while the third level items were all greater than 4.50 points.Conclusions:The practical strategy set for outpatient elderly care stations was led by nurses, reflecting the connotation of friendly services and covering the entire process of outpatient visits for elderly patients, with high feasibility.
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OBJECTIVE To understand the current status of the research on rational drug use among the elderly population in Chinese elderly care facilities， and to provide ideas for future related research. METHODS Retrieved from PubMed， Web of Science， Embase， CNKI， Wanfang database and VIP， relevant literature about the research on rational drug use among the elderly population in Chinese elderly care facilities were collected to evaluate the current status of research on the rational drug use among the elderly population in elderly care facilities. RESULTS A total of 14 cross-sectional studies were included. All included studies were completed before 2019 and focused on the eastern coastal areas of China. The AXIS quality scores of the included studies showed a mean score of 11.14±2.25， with six studies having a quality score ＞10. The 14 studies examined a total of 5 770 older adults in elderly care facilities， involving 181 elderly care facilities. Eight studies reported the type of chronic disease in the older adult population of the elderly care facilities； seven studies reported the type of medication used. Nine studies had medication compliance as an outcome， among which seven studies used different analytical methods to analyze the factors influencing medication compliance. The results showed that age， education， duration of illness， type of elderly care facilities， and level of staff attention had significant influence on medication compliance in the elderly population in the elderly care facilities. CONCLUSIONS There is insufficient research related to rational drug use among the elderly population in the elderly care facilities in China， and there is a lack of interventional studies to assess the effectiveness of the rational drug use service in the elderly population in the elderly care facilities. Most of the current research is based on cross-sectional studies， focusing on medication compliance.
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Objective:To explore the mechanism of factors affecting the long-term care needs of disabled elderly in elderly care institutions, and provide basis for taking targeted nursing intervention.Methods:From July to November 2018, convenience sampling method was used to conduct cross-sectional survey of the current situation and influencing factors of long-term care needs of 508 disabled elderly people in 10 elderly care institutions in Baoding City by general information questionnaire, Barthel index, the Long-term Care Needs of the Disabled Elderly in elderly care institutions, the Questionnaire on the Factors Affecting the Long-term Care Needs of the Disabled Elderly in elderly care institutions. SPSS 21.0 was used for correlation analysis and multiple regression analysis, and AMOS 24.0 was used for model fitting, path and mediation effect analysis.Results:The score of long-term care needs of the disabled elderly in elderly care institution was (105.04 ± 21.68) points; the scores of intra-personal, interpersonal, and extra-personal factors were (16.93 ± 5.20) points, (10.51 ± 3.39) points, (19.80 ± 6.24) points, respectively. Intra-individual factors, interpersonal factors, extra-individual factors and care needs were all positively correlated ( r values were 0.222-0.645, P<0.05). Intra-individual, inter-personal and extra-individual factors could directly affect the long-term care needs of the disabled elderly ( β=0.455, 0.527, 0.403); intra-individual and inter-personal factors had independent mediating effects and chain mediating effects between extra-individual factors and the long-term care needs of the disabled elderly, and the effects were significant, with effect value of 0.078, 0.095 and 0.023, accounting for 15.15%, 18.45% and 4.47% of the total effect, respectively. Conclusions:Each influencing factor has a strong ability to predict and explain the long-term care needs of the disabled elderly, and nursing staff could meet the care needs of the disabled elderly according to different influencing factors.
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Objective:To explore the factors that affect the participation of elderly care nurses in home-based elderly care services, in order to provide reference for the targeted improvement of human problems in home-based elderly care services.Methods:The phenomenological research method of qualitative research was used to conduct semi-structured in-depth interviews, on-site recordings and transcripts with 14 nurses in the geriatrics department of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical College from September to October, 2021. The collected data were analyzed and the theme was refined by using the 7-step analysis method of Colaizzi phenomenology.Results:Through sorting and analysis, four themes and six sub themes were extracted as follows: language behavior factors including environmental discomfort and differences in living habits, freedom was limited; psychological and emotional factors including high psychological pressure and loneliness, not respected; career development factors; social security factors including the definition of work scope is unclear, the division of responsibility for the accident was unclear and the protection of relevant rights and interests was insufficient.Conclusions:The intention of elderly care nurses to participate in home-based elderly care services is affected by many factors. These factors need to be accurately identified and targeted support measures should be taken to improve their enthusiasm to participate in home-based elderly care services and improve the human problems in home-based elderly care services.
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Objective:To analyze the utilization of traditional Chinese medicine (TCM) services and its influencing factors among home-based elderly care population in Zhejiang Province.Methods:A multi-stage stratified cluster random sampling method was used to enroll 2 300 home-based elderly care population aged 65 years and over and lived in the local area for 6 months and above in Zhejiang Province. The basic characteristics, health status and behavior, TCM cultural literacy, TCM cognitive beliefs and TCM service usage of the subjects were collected by face-to-face questionnaires from July 15 to August 15, 2021, and 2 123 valid questionnaires were recovered. Unconditional logistic regression was applied to analyze the influencing factors of TCM service usage among home-based elderly care population.Results:The overall utilization rate of TCM services among home-based elderly care population in Zhejiang Province was 36.46% (774/2 123). The utilization rates of the 6 types of TCM from high to low was oral administration of traditional Chinese medicine (22.00%), external treatment with traditional Chinese medicine (15.12%), acupuncture treatment (11.96%), medicated diet conditioning (7.44%), constitution identification (7.40%) and exercise conditioning (4.57%). Home-based elderly care population lived in urban areas, had never been to school, with education of primary school or high school and above, suffered from chronic diseases, moderate activities or physical exercise, believed in TCM and had attended lectures on TCM knowledge were more inclined to use TCM services (all P<0.05); agricultural laborers, production and transportation workers and family laborers before retirement were less inclined to use TCM services (all P<0.05); women, those with medical insurance, those drinking alcohol and those with better TCM cultural literacy were more inclined to use 2 and more kinds of TCM services (all P<0.05). Conclusions:The utilization rate of TCM services among home-based elderly care population in Zhejiang Province is relatively high; gender, place of residence, education level, occupation before retirement, medical insurance, belief in TCM, and participation in TCM knowledge lectures are the main influencing factors of the use of TCM services among home-based elderly care population.
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The construction of elderly care needs assessment system is conducive to realize the reasonable matching between care services and needs of the elderly， and to promote the effective allocation of pension resources. It is the basis and premise of the development of long-term care insurance system. Questions such as "Who is responsible for the assessment？ Who can apply for the assessment？ What is the assess tool？ How to pay the assessment fee？" are the core issues that need to be addressed in the construction of the evaluation system. This study compared the current situation of the elderly care needs assessment systems in China， the Netherlands， Germany， Japan and the United States from four aspects： assessment subject， assessment object， assessment cost source， and assessment tools’ dimensions. It has been a trend to entrust a third party for the evaluation work in pilot cities in China. Compared with foreign countries， domestic appraisers’ discipline and professional background are simpler. In foreign countries， the evaluation objects of elderly care needs are more extensive； the legal and financial support system of needs evaluation is more mature； and the evaluation dimensions are more objective and comprehensive. Based on this study， we suggest China to establish a national unified elderly care needs assessment system， cultivate professional assessment teams， expand the coverage of care needs assessment objects， improve the standards of assessment objects and assessment dimensions， and improve the law and financial support regulations related to needs assessment.
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Objective:To investigate status quo of smart elderly care needs of community older adults in main urban areas of Chongqing, and to analyze the influencing factors.Methods:A survey, using convenience sampling method, involving 452 community older adults in 9 districts in urban areas of Chongqing, was conducted by the General questionnaire and Smart Elderly Care Needs questionnaire from October to December, 2021. And analyze the influencing factors of the demand for smart elderly care needs.Results:In the demand for smart elderly care needs of the community elderly in the main urban area of Chongqing, the scores of needs for daily life care, social and emotional support, daily medical care and emergency medical assistance were 3.39 ± 1.45, 3.60 ± 1.28, 3.80 ± 1.19 and 3.87 ± 1.27, respectively. The results of ordinal Logistic analysis showed that gender, age, living alone and education level were the influencing factors of daily life care needs( P<0.05). Age and living alone were the influencing factors of social and emotional support and emergency medical assistance needs( P<0.05). Daily medical care needs were influenced by living alone( P<0.05). Conclusions:Community older adults in main urban areas of Chongqing have high level of needs for smart elderly care. Smart elderly care should focus on the ones with higher demand, namely those living alone, older, male and poorly educated, so as to promote active aging.