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266条结果
  • 机译 痴呆症患者的综合护理-建立的痴呆症护理模型的社会科学评估结果
    摘要:Currently, approximately 46.8 million people worldwide and 1.47 million German people are affected by dementia. The rising numbers of cases of people with dementia, the need for complex care and the insufficient care available call for innovative and sustainable solutions both in Germany and many other countries. This article presents results of the social-scientific evaluation of an established care model for people with dementia developed by the professionals as a result of acute problems in care in north-east Germany. In addition to the central elements of the model, the conditions of intersectoral and interprofessional cooperation as well as the qualification profile requirements of the professional groups involved are presented in detail. The results can give suggestions for the organization of integrated care for people with dementia in other countries. Further, the author would hereby like to highlight the gain from the scientific examination of solutions to problems in the field.
  • 机译 医院设计对急性痴呆症患者的影响
    摘要:Increasing emphasis on patient privacy and satisfaction has seen more 100% single-room hospitals opened across the UK. Few studies have addressed the impact of these new hospital designs (single rooms) on clinical outcomes specifically for acutely unwell frail patients with dementia. The objective of this study was to profile and compare the clinical outcomes of acutely unwell patients with dementia admitted to two different hospital environments. This prospective observation study was conducted for 100 dementia patients admitted at Ysbyty Ystrad Fawr (hospital with 100% single rooms) and Royal Gwent Hospital (traditional multi-bed wards) under the same University Health Board. The length of stay (LoS) was significantly longer for patients admitted to single rooms. The clinical profile of the patients was similar in both hospitals and has no association with LoS. There was no significant difference in terms of incidence of inpatient falls, fall-related injury, discharge to a new care home, 30-day readmission, or mortality. The single room environment appears to influence LoS, as previously reported; however, following the introduction of quality improvement initiatives to prevent inpatient falls, single rooms do not appear to be associated with higher inpatient fall incidence. We propose more research to understand the relationship between single rooms and LoS.
  • 机译 疼痛的问题适应疗法(PATH疼痛):患有慢性疼痛和负性情绪的老年人在基层医疗中的社会心理干预
    摘要:Chronic pain is highly prevalent in older adults, contributes to activity restriction and social isolation, disrupts family and interpersonal relationships, and poses a significant economic burden to society. Negative emotions such as sadness, anxiety, helplessness, and hopelessness are associated with chronic pain and contribute to poor quality of life, impaired interpersonal and social functioning, and increased disability. Psychosocial interventions for older adults with chronic pain have been historically developed for, and are almost exclusively delivered to, cognitively intact patients. Therefore, many older adults with chronic pain and comorbid cognitive deficits have limited treatment options. Our multidisciplinary team developed Problem Adaptation Therapy for Pain in Primary Care (PATH-Pain), a psychosocial intervention for older adults with chronic pain, negative emotions, and a wide range of cognitive functioning, including mild-to-moderate cognitive impairment. In the current article, we describe the principles underlying PATH-Pain, review the steps taken to adapt the original PATH protocol, outline the treatment process, and present a case illustrating its potential value.
  • 机译 使用老年老年休闲女高尔夫球手和久坐控制的超声成像测量大腿前部组织厚度
    摘要:Physical activity is vital for the prevention of sarcopenia and frailty. The training effects of recreational golf on muscle function in older people are unknown. The present study examined quadriceps muscle and subcutaneous fat thickness in 66 older females. Thirty-one golfers (mean age 69.1 years, standard deviation ±3.4) were compared with 35 less active non-golfers (73.4 ± 4.2 years). Images of the dominant anterior thigh were obtained using real-time B-mode ultrasound imaging. Thickness of muscle (rectus femoris, vastus intermedius, and intermuscular fascia) and subcutaneous tissue (fat and perimuscular fascia) was measured, and percentage contributions calculated. Muscle thickness was significantly greater (p < 0.001) in golfers (mean 2.78 cm ± 0.73 cm) than non-golfers (2.18 cm ± 0.55 cm). Mean percentage contribution of muscle and non-contractile tissue was 64% ± 9% and 36% ± 9%, respectively, in golfers, compared to 58% ± 8% and 42% ± 8% in non-golfers (p = 0.013). Multiple linear regression analysis, controlling for age and BMI, showed that golfers still had higher total anterior thigh thickness (regression parameter for non-golfers B = −0.984, p = 0.004) and higher muscle thickness (B = −0.619, p = 0.002). This study indicates an association between recreational golf and greater relative thigh muscle thickness and lower subcutaneous fat than in less active controls. Training effects need to be examined in prospective controlled trials in males and females in different age groups.
  • 机译 住院老年患者的肌内脂肪组织和肌肉减少症的功能成分
    摘要:Intramuscular adipose tissue (IMAT) could be an important missing value in the assessment of sarcopenia. This study tries to determine the relation between IMAT, muscle strength, functionality and mortality. In addition, the relation with nutritional status is screened. For six months, all patients admitted to the University Geriatric Center of Antwerp were evaluated for strength (hand grip), functionality (short physical performance battery—SPPB) and nutritional status. After one year, patients/relatives were contacted to obtain a current health status (mortality). A total of 303 patients were included at a mean age of 83.0 ± 6.4 years. The mean percentage of IMAT was 29.2% ± 13.0% (range 3.2%–86.2%). There was a negative correlation between IMAT and both grip strength and SPPB. SPPB was positively correlated with both grip strength and muscle mass. There was a positive correlation between IMAT and mortality. There was a negative correlation between grip strength, SPPB and mortality. IMAT did not have a clear relation with nutritional status. IMAT should be addressed in the work-up of sarcopenia, as it is correlated with muscle strength, functionality and mortality. In this cohort of hospitalized geriatric patients, there is a mean of about one-third of measured muscle volume that appears to be adipose tissue.
  • 机译 80岁以上休闲女高尔夫球手和不太活跃的非高尔夫球手的肌肉力量和功能能力
    摘要:Muscle strength and functional ability decline with age. Physical activity can slow the decline but whether recreational golf is associated with slower decline is unknown. This cross-sectional, observational study aimed to examine the feasibility of testing muscle strength and functional ability in older female golfers and non-golfers in community settings. Thirty-one females over aged 80, living independently (golfers n = 21, mean age 83, standard deviation (±) 2.1 years); non-golfers, n = 10 (80.8 ± 1.03 years) were studied. Maximal isometric contractions of handgrip and quadriceps were tested on the dominant side. Functional ability was assessed using the Timed Up and Go (TUG) and health-related quality of life using the Short Form-36 questionnaire. Grip strength, normalised to body mass, was greater in golfers (0.33 ± 0.06 kgF/kg) than non-golfers (0.29 ± 0.06), however, the difference was not statistically significant (p = 0.051). Quadriceps strength did not differ (golfers 2.78 ± 0.74 N/kg; non-golfers 2.69 ± 0.83; p = 0.774). TUG times were significantly faster (p = 0.027) in golfers (10.4 ± 1.9 s) than non-golfers (12.6 ± 3.21 s; within sarcopenic category). Quality of life was significantly higher in golfers for the physical categories (Physical Function p < 0.001; Physical p = 0.033; Bodily pain p = 0.028; Vitality p = 0.047) but psychosocial categories did not differ. These findings indicated that the assessment techniques were feasible in both groups and sensitive enough to detect some differences between groups. The indication that golf was associated with better physical function than non-golfers in females over 80 needs to be examined by prospective randomised controlled trials to determine whether golf can help to achieve the recommended guidelines for strengthening exercise to protect against sarcopenia.
  • 机译 iPad在中风神经康复中的应用
    摘要:Neuro-rehabilitation services are essential in reducing post-stroke impairments, enhancing independence, and improving recovery in hospital and post-discharge. However these services are therapist-dependent and resource intensive. Patients’ disengagement and boredom in stroke units are common which adversely affect functional and psychological outcomes. Novel techniques such as use of iPads™ are increasingly researched to overcome such challenges. The aim of this review is to determine the feasibility, effectiveness, acceptability, and barriers to the use of iPads™ in stroke neuro-rehabilitation. Four databases and manual literature search were used to identify published studies using the terms “iPad”, “Stroke”, and “neuro-rehabilitation”. Studies were included in accordance with the review selection criteria. A total of 16 articles were included in the review. The majority of the studies focused on iPads use in speech and language therapy. Although of small scale, the studies highlighted that iPads are feasible, have the potential to improve rehabilitation outcomes, and can improve patient’s social isolation. Patients’ stroke severity and financial limitations are some of the barriers highlighted in this review. This review presents preliminary data supportive for the use of iPad technology in stroke neuro-rehabilitation. However, further research is needed to determine impact on rehabilitation goals acquisition, clinical efficacy, and cost-efficiency.
  • 机译 体弱和肌肉减少症的发生中的全身性炎症:运动的预防和治疗作用及其药物治疗潜力的概述
    摘要:The clinical, pathological and biological characteristics of frailty and sarcopenia are becoming better understood and defined, including the role of systemic inflammation. It is increasingly apparent that in older adults there is a tendency for the innate immune network to shift toward a pro-inflammatory setting, often due to the presence of chronic inflammatory diseases but also associated with age alone in some individuals. Furthermore, acute inflammation tends to resolve more slowly and less completely in many elderly people. Inflammation contributes to the pathogenesis of sarcopenia and other components of the frailty syndrome. Blood levels of inflammatory cytokines and acute phase proteins, are reduced by exercise, and there is a growing body of epidemiological, observational and intervention research that indicates that regular moderate exercise improves strength, function, morbidity and mortality in middle-aged and elderly adults. There is also an increasing awareness of the potential role of drugs to ameliorate inflammation in the context of frail old age, which might be particularly useful for people who are unable to take part in exercise programs, or as adjunctive treatment for those who can. Drugs that shift the innate immune biochemical network toward an anti-inflammatory setting, such as methyl-xanthines and 4-amino quinolones, could be of value. For example, theophylline has been shown to induce a 20 percent fall in pro-inflammatory tumor necrosis factor (TNF) and 180 percent rise in anti-inflammatory interleukin-10 production by peripheral blood monocytes, and a fall of 45 percent in interferon-gamma (IF-gamma) release. Such properties could be of therapeutic benefit, particularly to re-establish a less inflamed baseline after acute episodes such as sepsis and trauma.
  • 机译 中国痴呆症护理面临的挑战
    摘要:Dementia results in brain dysfunction, disability and dependency among affected people, causing an overwhelming burden for caregivers. China has the largest number of people with dementia worldwide and is facing severe challenges with respect to dementia care, including poor awareness of dementia in the public, inadequate knowledge of dementia for medical professionals and caregivers, an underdeveloped dementia service system, and high costs of dementia care. To address these challenges, China is taking action to increase dementia awareness and education among the public and care providers, and develop policies, services and resources for dementia care.
  • 机译 处理晚期神经退行性疾病的伦理困境
    摘要:Neurodegenerative diseases are chronic, progressive and incurable illnesses that ultimately lead to death. The patient deteriorates inexorably towards the terminal phase of the disease when he becomes mentally and physically incapacitated. This article discusses the many ethical and moral dilemmas faced by the clinician and family members as they care for patients with neurodegenerative illnesses approaching the end of life. Topics discussed will include steps on how to assess mental capacity and decision-making capability, advance care planning, withholding and/or withdrawing treatment, food refusal, the do-not-resuscitate order and euthanasia. An approach to ethical decision-making incorporating Jonsen’s 4-topic approach will also be discussed briefly.
  • 机译 身体虚弱,肌肉减少症和慢性肺疾病的老年人对肺康复的反应
    摘要:Frailty and sarcopenia are two important clinical syndromes associated with the ageing process, with a high risk of morbidity and mortality. Patients with chronic disease have been shown to have an accelerated decline into a frail state, with patients with both chronic lung disease and frailty having a higher mortality than those with frailty alone. Pulmonary rehabilitation has been found to be an effective intervention in patients with chronic obstructive pulmonary disease (COPD), yet the effect of frailty on this as intervention remains unclear. A narrative literature search of PubMed, Medline complete and the Cochrane library was performed by the reviewers using predefined criteria. Only 3 studies met the selection criteria and were reviewed. These studies highlighted that, although completion rates are lower in patients with both COPD and frailty, pulmonary rehabilitation remains effective as an intervention in this subgroup of patients, with up to 61% of frail patients no longer meeting frailty criteria after completion of a pulmonary rehabilitation programme.
  • 机译 女同性恋,男同性恋,双性恋和变性者(LGBT)老年人的医疗保健和生命终期需求:研究范围
    摘要:Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the purpose of this scoping review was to determine the healthcare needs of LGBT older adults nearing end-of-life as well as the factors that contribute to a good death experience among older adults who identify as LGBT. A systematic search of electronic databases for articles published between 2005 and 2016 as well as screening for relevance resulted in 25 results. The data were charted and grouped according to the themes of: social support and chosen family, intimacy, health status, fear of discrimination and lack of trust, lack of knowledge and preparedness, and cultural competence in the healthcare system. The results suggest a role for health and social service workers in contributing to a positive care experience for LGBT older adults by becoming knowledgeable about the unique needs of this population and being unassuming and accepting of individuals’ sexuality. Many of the articles reviewed collected data outside of Canada, limiting generalizability and highlighting a need for Canadian data on LGBT aging and end-of-life.
  • 机译 致2016年老年医学评论家的致谢
    • 作者:
    • 刊名:Geriatrics
    • 2017年第1期
    摘要:
  • 机译 使用定量和叙述性数据捕获居民痴呆症和心理健康环境中的互动职业和社会参与度
    摘要:Objectives: Despite an abundance of research acknowledging the value of interactive occupation and social engagement for older people, and the limits to these imposed by many residential settings, there is a lack of research which measures and analyzes these concepts. This research provides a method for measuring, analysing and monitoring interactive occupation and social engagement levels of residents in a secure residential setting for older people with mental health problems and dementia. It proposes suggestions for changes to improve the well-being of residents in residential settings. Method: In this case study design, the Assessment Tool for Occupational and Social Engagement (ATOSE) provided a ‘whole room’ time sampling technique to observe resident and staff interactive occupation and social engagement within the communal sitting room over a five-week period. Researchers made contemporaneous notes to supplement the ATOSE data and to contextualise the observations. Results: Residents in the sitting room were passive, sedentary, and unengaged for 82.73% of their time. Staff, who were busy and active 98.84% of their time in the sitting room, spent 43.39% of this time in activities which did not directly engage the residents. The physical, social and occupational environments did not support interactive occupation or social engagement. Conclusions: The ATOSE assessment tool, in combination with narrative data, provides a clear measurement and analysis of interactive occupation and social engagement in this and other residential settings. Suggestions for change include a focus on the physical, social, occupational, and sensory environments and the culture of care throughout the organization.
  • 机译 驾驶模拟器培训与降低老年驾驶员的抑制性工作量有关
    摘要:Background: In demanding cognitive tasks, older people mostly experience more problems than younger people, and their brain workload is higher. An overloaded or exhausted mental workload is frequently associated with unsafe driving behavior. In this paper, we hypothesize that 10 active training sessions in a driving simulator positively influence brain workload, which relates to a beneficial increase in on-road driving performance. Methods: Ninety-one healthy active drivers (62–87 years) were randomly assigned to: (a) a driving simulator-training group; (b) an attention-training group; or (c) a control group. The dependent variables of this training study were brain workload (theta Fz/alpha Pz), and performance in three tasks, for which inhibition of inadequate responses (Stroop, Negative Priming, and Flanker) is required. Seventy-seven participants (85% of the total sample) completed the training. Training gains were analyzed by using a multiple regression analysis with planned comparisons. Results: The results revealed that the driving simulator training reduced brain workload during performance of the inhibition tasks. The performance of the simulator group during the inhibition tasks did not improve, but the participants completed the tasks with less brain workload compared to the attention-training group. Conclusion: Adding to our first paper on the Drive-Wise project, this paper now focuses on the superiority of the driving simulator training, compared to attention-training in regards to reducing brain workload. The change in brain workload seems to be associated with a positive change in drivers’ behavior on the road. Hence, a driving simulator training lasting only ten sessions leads to beneficial neuroplastic changes. This demonstrates brain plasticity of older people and its possible positive influence in real driving behavior.
  • 机译 一项十二周的市政痴呆症预防计划对社区老年人的认知/运动功能的影响
    摘要:In a rapidly aging society, like that in Japan, it is imperative to establish strategies to prevent dementia. We investigated the effects of a dementia prevention program, conducted as part of a municipality’s long-term care prevention project, on cognitive/motor functions among the community-dwelling elderly. Participants underwent a physical activity program involving muscle training and aerobic exercise, once a week, for 12 weeks. Cognitive and motor tests were performed twice, before and after the intervention. Thirty participants, aged 75.7 ± 6.7 years, were included in the analysis. Scores from the immediate word memory task were significantly increased (23.0 ± 7.8 vs. 25.7 ± 6.5) after the program. Scores from the Yamaguchi Kanji Symbol Substitution Test were also significantly increased (36.2 ± 13.1 vs. 40.1 ± 14.1). Time spent during the 5 m maximum walking speed test was significantly shorter after the program (3.4 ± 0.8 vs. 3.0 ± 0.7 s), whereas the daily walking distance increased significantly (1.9 ± 1.5 vs. 3.1 ± 2.2 km). Participants showed improvement in some aspects of their cognitive/motor function and walking distance per day. Therefore, this program can be regarded as a practical community-based healthcare activity.
  • 机译 Hemianopia和Quadrantanopia人之间的汽车碰撞参与
    摘要:Persons with homonymous quadrantanopia and hemianopia experience driving restrictions, yet there is little scientific evidence to support driving prohibition among persons with these conditions. This retrospective cohort study compares motor vehicle collision (MVC) rates among 27 current licensed drivers with hemianopic and quadrantanopic field defects, who were ≥6 months from the brain injury date with that of 27 age-matched drivers with normal visual fields. Information regarding all police-reported MVCs that occurred over a period of nine years was obtained. MVC rates per year and per mile travelled were calculated and compared using conditional Poisson regression. Drivers with hemianopia or quadrantanopia had more MVCs per mile driven compared to drivers with normal visual fields; specifically their overall MVC rate was 2.45-times (95% confidence interval (CI) 0.89–3.95) higher and their at-fault MVC rate was 2.64-times (95% CI 1.03–6.80) higher. This study indicates that drivers with hemianopia or quadrantanopia have elevated MVC rates. This is consistent with previous research despite studies showing wide individual variability from excellent to poor driving skills. Future research should focus on the functional and driving performance characteristics associated with superior driving skills and/or those that may be amenable to improvement via behavioral and/or engineering interventions.
  • 机译 增强老年驾驶员的安全性:刻板印象威胁对老年人驾驶性能,工作记忆和自我调节的影响
    摘要:In a study concerned with driving behaviors of older drivers (mean age 70 years) in a driving simulator, our findings indicate that telling older drivers that they are more at risk of accidents because of their age and their driving performance-related decline (i.e., exposing them to a stereotype threat concerning older drivers) severely impairs their self-regulatory skills. Moreover, our results show that this is at least partly due to exhaustion of the executive resources (older drivers under stereotype threat tended to contradict the stereotype of being slow by driving faster), appearing also through working memory overload (older drivers under stereotype threat performed markedly less well in a modular arithmetic task than drivers in the control condition). We thus complete the existing evidence that older drivers’ performance may be affected by socially-grounded factors, suggesting that simply being investigated may be enough to tax many capabilities in older people. We also propose that stereotype threat might be at least a partial explanation for why older drivers sometimes have poorer self-regulation performances after attending rehabilitation programs designed to make older drivers safer ones.
  • 机译 在高需求驾驶情况下对阿尔茨海默氏病驾驶员的评估:应对驾驶模拟器中的交叉路口
    摘要:Intersections are one of the most complex and cognitively demanding driving situations. Individuals with dementia and, more precisely, Alzheimer’s disease (AD), may face additional challenges negotiating intersections given the nature of their cognitive decline, which often includes deficits of attention. We developed a comprehensive evaluation scheme to assess simulated driving performance at intersections. The evaluation scheme captured all types of errors that could occur during preparation (i.e., prior to the intersection), execution (i.e., during the intersection), and recovery (i.e., after the intersection). Using the evaluation scheme, intersection behaviour in a driving simulator among 17 drivers with mild AD was compared to that of 21 healthy controls. The results indicated that across all types of intersections, mild AD drivers exhibited a greater number of errors relative to controls. Drivers with mild AD made the most errors during the preparation period leading up to the intersection. These findings present a novel approach to analyzing intersection behaviour and contribute to the growing body of research on dementia and driving.
  • 机译 年龄在70岁以上的人的医疗严重和非严重自杀尝试
    摘要:High rates of suicide are observed among older adults in many countries worldwide. In clinical settings, those who make a medically serious suicide attempt are generally considered to be at higher risk of subsequent suicide than those who make less serious attempts. Medically serious attempts in older clinical cohorts are, however, relatively understudied. The aim was to compare older adult suicide attempters (70+) who did or did not make medically serious attempts. We hypothesized, in line with the Interpersonal Model of suicide, that social problems and feelings of being a burden would be associated with medical seriousness. Participants (n = 101) were recruited in hospitals in the aftermath of a suicide attempt; they took part in an interview with a research psychologist. Attempters with (n = 28) and without (n = 73) medically serious attempts were compared. Major depression was common in both groups, and scores on the Geriatric Depression Scale did not differ. However, older adults who made medically serious attempts scored higher on the Brief Scale of Anxiety and lower on the Mini Mental State Examination than their peers who made less serious attempts. Medically serious attempters more often attributed the attempt to social problems as well as problems with functioning and autonomy, but perceived burdensomeness was not associated with seriousness. Findings may help to inform clinicians who meet and treat older suicidal persons.

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