城市老年人口中社区养老和机构养老间的转换[外文翻译]

《城市老年人口中社区养老和机构养老间的转换[外文翻译]》由会员分享，可在线阅读，更多相关《城市老年人口中社区养老和机构养老间的转换[外文翻译]（10页珍藏版）》请在装配图网上搜索。

1、本科毕业设计（论文）外 文 翻 译原文：Transitions between community and nursing home residence in an urban elderly Abstract: Over the course of a three year observation and study period, some 6% of a representative community residing urban elderly population were admitted to nursing homes. Nearly half of this group w

2、ere still living in nursing homes at the end of this observation period. One third had died after entering the nursing home, and the remaining people had returned to their own homes in the community. These three groups had significantly different mean lengths of stay in nursing homes; nearly two yea

3、rs for those whose stays were more permanent, 50 days for those whose stays were shortterm, and 153 days on average for those who died following admission. At baseline, the three groups also tended to have different patterns of health, functional and social characteristics. The short term stayers an

4、d those who died following admission to a nursing home differed from respondents who did not enter nursing homes-primarily in terms of prior living arrangements and levels of social support. The permanent stayers differed from the two other nursing home sub-groups, and from community residents, in t

5、hat they tended to be older and more functionally and mentally impaired. However, at baseline they appeared at less risk to expire than those people who later died following admission to nursing homes. Clinical and research implications based on these findings are discussed.BackgroundIssues concerni

6、ng the place of nursing home care in a continuum of long term care services continue to occupy the attention of health care planners, administrators, clinicians, and researchers. This has been the case for a number of reasons.First, more than 1,350,000 elderly Americans currently reside in nursing h

7、omes, and the number of nursing home beds now exceeds the number of acute care hospital beds. While at any one moment in time only 5% of the population 65 years old, or older, are nursing home residents, the life-time risk of being admitted to a nursing home has been variously estimated as upwards o

8、f 40%. Second, costs for nursing home care are substantial. They are second only to hospital care as a proportion of all expenditures for health care? Nursing home costs encompass approximately 40% of all Medicaid costs and force many otherwise income independent elderly individuals into poverty. Th

9、ird, the availability of and access to nursing home beds and to quality care in nursing homes is poorly and unevenly distributed. Finally, having to relinquish residence in the community for institutional living is an abrupt and radical transition that is seldom welcomed by elderly persons or their

10、family members except in cases of extreme hardship or sickness among care givers and is accepted only as a last resort or when other care options are either not available or have been exhausted. The magnitude and urgency of the problem of providing nursing home care-particularly in an era of budgeta

11、ry stringency-and its likely growth over time due to the graying of the population and increase in the proportion of the oldest segment of that population, continues to give rise to a large body of research. These efforts included information on characteristics of nursing home populations, determina

12、nts of nursing home admissions and outcomes, costs, policies and planning, and the treatment of medical conditions. Much of this literature is beyond the scope of this paper. Studies of diverse elderly populations ranging from those few that include broadly representative groups as well as populatio

13、ns of frail or disabled individuals, those living in special housing environments, or participants in special programs, have commonly identified advanced age and functional deficits as high risk factors for nursing home placement. Studies of elderly populations living in nursing homes indicate that

14、the resident populations have become older, more disabled, and have high rates of hospitalization and death. Other studies have documented significant local and regional variations in both the numbers and characteristics of referrals to nursing homes and resident populations, and have described vari

15、ations in length of stay among those admitted to nursing homes.Despite these and other advances in our knowledge of the nursing home as a social and health care institution, and its use by elderly populations, significant gaps in the precision and range of this knowledge remain to be closed. Little

16、is known, for example, of the dynamics of the transition from community to nursing home residence and, for some, return to living in the community. Our inability to predict or to identify more accurately persons at high risk of nursing home placement has limited our ability to provide community-base

17、d services that could substitute or prevent nursing home placement. Because we have infrequently studied representative community populations longitudinally, data on incidence and prevalence are also limited.A longitudinal study of health, health care and aging in a representative urban population o

18、f elderly persons residing in the community provided an opportunity to explore certain of the transitional dynamics, characteristics, and outcomes of study participants who were admitted to nursing homes during the course of a three year period of observation. In this paper we present first our find

19、ings from analyses of the occurrences of nursing home admissions followed by the results of analyses of the health and social characteristics of respondents who experienced one or more nursing home admissions.Sociomedical Characteristics of the Nursing Home Subgroups The effort to determine whether

20、these nursing home groups could be distinguished from one another, according to their sociomedical characteristics, required several analytic steps. We first calculated for each group the mean values for baseline social, demographic, economic, health, functional, social support, and medical care var

21、iables that the literature suggested were related either to admission or to length of stay in nursing homes. The variables which were significantly different among the groups are shown in Table 4. Other variables, suggested as important in the literature, had means that were not significantly differ

22、ent across the groups and therefore are not shown in Table 4. These variables included baseline measures of the number of reported medical conditions, prior hospitalizations, nursing home stays and ambulatory care visits, receipt of formal but not informal social support, primary source of health ca

23、re other than a hospital (group practice, private physician, other or none), ethnic and educational background, and living with ones spouse.Multivariate Analyses While there were a number of significant distinctions among these outcome groups as shown in Table 4, these univariate differences may not

24、 hold up when other possibly confounding or correlated variables are systematically controlled in a multivariate analysis. Since our analytic goals were more descriptive than etiologic and the background literature suggested that clusters of variables rather than individual variables were more likel

25、y to be relevant in distinguishing between these groups, we chose to use stepwise discriminant function analysis as the multivariate procedure. We first formulated a series of questions and then developed sets of analytic comparisons between groups. The first question was whether we could distinguis

26、h all those admitted to nursing homes-whether they returned to community or not, or even whether they died or not-from community residents who were not admitted to nursing homes and survived, and from community residents who died. Second, we asked whether there were distinctions between the two comm

27、unity resident groups-those who remained alive and those who died and the nursing home sub- groups-the short term and the long term stayers and those who died following a nursing home admission. Finally, we sought to determine whether there were different sociomedical characteristics that distinguis

28、hed the three nursing home subgroups from one another-apart from whatever distinctions emerged from their earlier comparisons with the community resident groups.Summary and Conclusions The findings of this study can be summarized as follows: 1. Over a three year period 6% of the cross section of com

29、munity residing older persons were admitted to nursing homes. A third of those admitted died, nearly half continued to reside in nursing homes, and the remainder returned to their homes. While the number of nursing home entrants may seem small, it should be noted that the study sample was limited to

30、 those elderly persons residing in their homes and excluded those in hospitals or in nursing homes at the time the sample was selected. The 6% figure can be viewed as the rate of nursing home admission over a three year period in an urban community with a reasonably adequate supply of medical care,

31、health related, and long term care services and facilities. 2. Nursing home subgroups were identified that differed from each other sociomedically and in length of stay. Those admitted for short stays in nursing homes resembled community residents not admitted to nursing homes more than they did the

32、 permanent nursing home stayers. Similarly, those who died subsequent to a nursing home admission resembled those who died in the community. In both instances, prior levels of social support and living arrangements were the primary distinction between these two nursing home subgroups and their count

33、erparts in the community. 3. The permanent nursing home stayers, in contrast to the community residents and the other two nursing home subgroups were more likely to be older, more disabled, and mentally impaired, sustained strokes more often, and received more informal and formal social support prio

34、r to their admission. The characteristics of this latter nursing home subgroup have come to typify the nursing home population identified in most prior cross sectional studies. 4. The relative importance of health, functional, social support and demographic characteristics in distinguishing among nu

35、rsing home subgroups varies as does their duration of stay in a nursing home. This suggests that there may be different reasons for admission to nursing homes among these groups.Caution is suggested in generalizing these findings to communities differing in their supply of nursing home resources or

36、in the composition of their elderly populations, or to studies with follow up periods of different durations. Also, greater precision and improvement in accounting for the unexplained variance in the findings might have been achieved were it possible to have measured changes from baseline in the rel

37、event social, health and functional variables closer in time to the actual transition into or out of the nursing home. The findings indicate that different and more focussed clinical and programmatic strategies may be required to intervene with elderly community residents at risk for nursing home en

38、try, if this is indeed a desirable social goal. For one group-those whose characteristics resemble the permanent stayers CNN-intervention might emphasize rehabilitation for strokes and reduction in functional and mental disability. Characteristics of the other subgroups-those who died following admi

39、ssion, for example, suggest that additional social supportive efforts might be emphasized along with appropriate medical care-as a way to prevent admission to a nursing home. Persons whose characteristics resemble the short stayers-those with more acutely threatening medical conditions-coronary and

40、cardiovascular disease, and who define their health as fair or poor-present yet a different cluster of socio medical characteristics that may require intervention approaches different from those described above. However, it is possible that a temporary or short stay in a nursing home may be an appro

41、priate site for their care. Beyond these clinical implications, prediction studies might improve their precision by targeting the scope of their prediction to one or another of the at risk population subgroups.Source:Howard R. Kelman，Cynthia Thomas，Journal of Community Health ，1990，P105121译文：城市老年人口中

42、社区养老和机构养老间的转换【摘要】在为期三年的观察和研究中，在城市老龄人口中有6%的具有代表性的社区居民入住养老院。在观察期内，这群人中有将近一半的人仍生活在养老院。三分之一的人在入住养老院后已经逝世，剩余的人们已经回到自己的家中。这三组人群在养老机构中的所待的平均时间有着明显的不同：那些仍住在养老院里的人所待的时间将近有两年，短期的居住者有50天，那些在入住后去世的人们平均有153天。在开始的时候，这三组人群在健康，功能和社会特征方面已经有着不同方式。短期的居住者和已经逝去的老年人在入住养老院后不同于那些不愿入住养老机构的人主要是前期生活安排和社会支持水平这两方面。长期居住的人们不同于其他两

43、组人群和社区居民，他们相比起来更加年长、机能和心智方面更加弱化。然而，在开始时他们表现得比那些在入住后死去的人们的死亡风险率要低。我们对这项发现的临床研究进行讨论。背景关于养老护理在长期护理中所扮演的角色一直被认为是卫生保健的规划者、管理者、临床医师和研究者。这就是此案例中的一些原因。首先，超过135万的美国老年人入住养老机构，并且其床位已经超过医院里的急症床位。虽然在任何一个时期只有5%的65岁及其以上的老年人入住养老机构，而终生待在养老机构的几率已经估计达到40%。其次，养老机构护理的成本是巨大的。他们仅其次于医院护理在卫生保健方面的支出比例？养老机构护理的成本包括约40%的医疗补助成本，

44、导致一些收入无依靠的老年人变得贫困。第三，获得养老机构的床位和高品质的医护服务的有效性是比较低且分散的。最后，离开社区而进行团体生活是种急速的转变，很少有老年人或者他们的家人愿意这样做，除非是极其艰难或是病重，那些看护人员也被看作是最后的求助，或者是其他看护选择不可行或是耗尽的时候才如此。在提供机构护理中最重要且迫在眉睫的事情是尤其是在预算紧张的时候老年人口的比例也随时间的增长而增多，这将引起我们进行大量的研究。这些努力包括机构养老人群的特征信息，养老机构的录取、收入、花费、政策计划和医疗条件的决定因素。本文研究也参考了许多此类文献。我们对不同老年人群的研究包括部分具有代表性的人群以及虚弱或者

45、残疾的老年人，那些居住在特殊房或参加特殊项目的人，还有那些在机构护理中年纪较长和有功能缺陷的人。对养老机构里老年人的研究表明那些常驻人口已越来越年长，有更多的残疾人，更高的住院率和死亡率。其他的研究在养老机构及居住人员的数量和特征方面有显著的地域差异，并且描述了机构养老的差异性。尽管我们在把养老院看成是社会和健康护理机构的认识上和提供老龄人口的使用上有了这样和那样的进步，在认识的准确度和范围上的明显的差异仍然需要改变。所知甚少，举个例子，从社区过渡到养老机构，一些人又回到社区生活。我们无法更精确地预测或识别养老机构中高风险的人，这就限制了我们提供那些代替养老机构的基本社区服务的一些能力。因为我

46、们在纵向上对具有代表性的人群有了较多的研究，数据的覆盖率也是有限的。一项对具有代表性的住在社区的城市老年人的健康，健康护理和老龄化的纵向研究，提供了一个对那些养老机构中参与本次研究的的老人在三年间探索过渡期变化程度、特征和收入等变化的机会。在本文中，我们在分析的基础上进一步提出了养老机构的招人，根据对那些住过一个或多个养老机构的人的分析结果。养老机构组织的社会医疗特征我们定义一个养老机构和其他的有什么不同，通常是根据他们的社会医疗特征，这就需要几个分析的步骤。我们首先计算各个组织社会基线、人口、经济、健康、功能、社会支持和医疗保健的多变因素的平均价值，这些因素都涉及到本文所提到的关于入住或久住

47、养老机构的问题。各变量间的显著差异在表四中可以看出。本文中比较重要的其他变量，并没有在各个组织间显示出显著的不同，所以在表四中没有表现出来。这些变量包括一些医疗条件的基本措施、住院前期、留住养老院和日间护理，接受一些正式而并不是非正式的社会支持，医护的主要来源除了医院（分组练习、私人医生和其他），民族和教育背景和与配偶一起居住。多元化的分析尽管在表四中各组的结果有着挺多不同，在多元化的分析中当其他可能混淆或相关的变量被系统地控制时，这些不同的单变量模型就会被阻碍。由于我们的分析目前更注重描述性而不是原因，而且本文的背景也主要是不同变量群而不是单个变量，这些都和我们所讨论的群体有关。我们首先制定

48、了一系列问题，并且对各组人群做了进一步的比较分析。第一个问题就是我们是否能区别出这些进入养老机构的老年人不管他们是否又回到社区，也不管他们是否逝世那些来自社区的居民哪些不愿意入住养老机构，哪些已经逝去。第二，我们问到是否能区别出这两组社区居民在养老机构的分组中，哪些人还活着那些人已近死去那些长期的和短期的居住者，还有进入养老院后死去的老年人。最后，我们试着判定在这养老机构的三个分组里是否有不同的社会医学特征除了区别那些在社区居住群体中比较年长的人。总结本文研究结果可归纳如下：1 在这三年期间有6%的社区老年人住入养老机构。他们中三分之一的人已经死亡，接近二分之一的人继续居住在养老院，剩下的老年

49、人都已经回家。虽然参加此次研究的住入养老机构的老年人看起来似乎很少，我们应该注意到所选取的样本也是局限于那些居住在家里的老年人，排除了在选取样本期间那些居住在医院和已经住在养老院的老年人。这6%的数字可以被看作是这三年期间一个养老院的入住率，在一个具有不错医疗保健、健康相关的、长期看护和医疗设备的城市。2 养老机构的分组是根据不同的社会医疗特征和在养老院居住的长短。那些在养老院里的短期居住者和社区中不愿住入养老机构的老年人的相似程度要比长期住在养老院里的老年人要哒。同样的，那些在入住养老院后死去的人类似于那些居住在社区死去的老年人。在两个实例中，前期的社会支持程度和生活安排是区别养老机构的两个

50、分组和与他们相类似的住在社区里的人的主要因素。3 那些长期居住在养老院里的人，与那些住在社区中的和养老机构的其他两个组相比看起来要更加年长、残疾人更多、心智受损程度更大、中风率更大，并且在入住前期受到更多的正式的、非正式的社会支持。4 随着老年人在养老机构的时间的变化，健康、机能、社会支持和社会医疗特征在区别养老院分组的重要性也是相对的。这也意味着各组老年人入住养老院的原因也是各不相同的。值得注意的是在向社区推广这些研究时，他们所提供的养老机构资源或是老年人口的结构，或是对不同时间段的研究都是不同的。同样，更加明确和晚上的账单在未经解释的变量向那些在养老院资源应用和老年人成分不同的社区以及之后

51、不同持续时间的研究普及这些调查结果时需谨慎。并且，只有在这些调查结果中未解释的差异得到了更加精确和改进的解释后，从社会相关衡量，健康和功能参数到进入和离开养老院的过渡上的变化才有可能。调查结果表明不同的和更加集中的临床和纲领性的策略需要干预那些避免进入养老院年老的社区居民，如果这的确是一个迫切的社会目标的话。对于一个和CNN居住者有相似特征的小组，干预应更加强调中风的复发和减少在功能和精神上的障碍。其它小组的特征，比如那些进入养老院之后去逝的人，建议强调加入额外的社会支持并给予设当的医疗照顾，这是防止进入养老院的一个方法。那些和短期居住养老院的人有相似特征的人，那些患冠状动脉和心血管的疾病对医疗条件更具挑战的人，那些认为自己的健康是好的或不好的人以及那些表现出不同社会医疗特征的人，需要的干预方法不同以上所描述的两种。但是，暂时性的和短期的居住，养老院对他们的健康来说是一个合适的地址，这是可能发生的。脱离这些临床应用，通过把其中“处于危险”的一组或另一组作为预测范围目标，预测的研究才能提高精确度。出处：霍华德寇曼，辛西亚托马斯，社区卫生杂志，1990，P105121