城市老年人口中社區(qū)養(yǎng)老和機構(gòu)養(yǎng)老間的轉(zhuǎn)換外文翻譯

1、城市老年人口中社區(qū)養(yǎng)老和機構(gòu)養(yǎng)老間的轉(zhuǎn)換外文翻譯 本科畢業(yè)設(shè)計(論文)外 文 翻 譯原文: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. ne

2、arly half of this group were 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 nurs

3、ing homes; nearly two years 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. t

4、he short term stayers and 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 c

5、ommunity residents, in that 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.ba

6、ckground issues concerning 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 curr

7、ently reside in nursing homes, 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 various

8、ly estimated as upwards of 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 indi

9、viduals into poverty third, 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 el

10、derly persons or their 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-particularl

11、y in an era of budgetary 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

12、populations, determinants 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

13、 as well as populations 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

14、 homes indicate that 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, an

15、d have described variations 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

16、 to be closedlittle 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 pr

17、ovide community-based 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 representati

18、ve urban population of 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 p

19、resent first our findings 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

20、to determine whether 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,

21、 and medical care variables 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

22、significantly different 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

23、 source of health care 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 d

24、ifferences may not 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 variabl

25、es were more likely 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

26、 could distinguish 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 bet

27、ween the two community 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 characteristic

28、s that distinguished 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 cro

29、ss section of community 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 samp

30、le was limited to 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

31、of medical care, 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 t

32、han they did the 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

33、 and their counterparts 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 soci

34、al support prior 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 distingui

35、shing among nursing 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 hom

36、e resources or 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 base

37、line in the relevent 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

38、nursing home entry, 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

39、 following admission, 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 condition

40、s-coronary and 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

41、may be an appropriate 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,p1

42、05-121譯文:城市老年人口中社區(qū)養(yǎng)老和機構(gòu)養(yǎng)老間的轉(zhuǎn)換【摘要】在為期三年的觀察和研究中,在城市老齡人口中有6%的具有代表性的社區(qū)居民入住養(yǎng)老院。在觀察期內(nèi),這群人中有將近一半的人仍生活在養(yǎng)老院。三分之一的人在入住養(yǎng)老院后已經(jīng)逝世,剩余的人們已經(jīng)回到自己的家中。這三組人群在養(yǎng)老機構(gòu)中的所待的平均時間有著明顯的不同:那些仍住在養(yǎng)老院里的人所待的時間將近有兩年,短期的居住者有50天,那些在入住后去世的人們平均有153天。 在開始的時候,這三組人群在健康,功能和社會特征方面已經(jīng)有著不同方式。短期的居住者和已經(jīng)逝去的老年人在入住養(yǎng)老院后不同于那些不愿入住養(yǎng)老機構(gòu)的人?主要是前期生活安排和社會支持水平

43、這兩方面。長期居住的人們不同于其他兩組人群和社區(qū)居民,他們相比起來更加年長、機能和心智方面更加弱化。然而,在開始時他們表現(xiàn)得比那些在入住后死去的人們的死亡風(fēng)險率要低。 我們對這項發(fā)現(xiàn)的臨床研究進(jìn)行討論。背景 關(guān)于養(yǎng)老護(hù)理在長期護(hù)理中所扮演的角色一直被認(rèn)為是衛(wèi)生保健的規(guī)劃者、管理者、臨床醫(yī)師和研究者。這就是此案例中的一些原因。 首先,超過135萬的美國老年人入住養(yǎng)老機構(gòu),并且其床位已經(jīng)超過醫(yī)院里的急癥床位。雖然在任何一個時期只有5%的65歲及其以上的老年人入住養(yǎng)老機構(gòu),而終生待在養(yǎng)老機構(gòu)的幾率已經(jīng)估計達(dá)到40%。 其次,養(yǎng)老機構(gòu)護(hù)理的成本是巨大的。他們僅其次于醫(yī)院護(hù)理在衛(wèi)生保健方面的支出比例?養(yǎng)

44、老機構(gòu)護(hù)理的成本包括約40%的醫(yī)療補助成本,導(dǎo)致一些收入無依靠的老年人變得貧困。 第三,獲得養(yǎng)老機構(gòu)的床位和高品質(zhì)的醫(yī)護(hù)服務(wù)的有效性是比較低且分散的。最后,離開社區(qū)而進(jìn)行團(tuán)體生活是種急速的轉(zhuǎn)變,很少有老年人或者他們的家人愿意這樣做,除非是極其艱難或是病重,那些看護(hù)人員也被看作是最后的求助,或者是其他看護(hù)選擇不可行或是耗盡的時候才如此。 在提供機構(gòu)護(hù)理中最重要且迫在眉睫的事情是?尤其是在預(yù)算緊張的時候?老年人口的比例也隨時間的增長而增多,這將引起我們進(jìn)行大量的研究。這些努力包括機構(gòu)養(yǎng)老人群的特征信息,養(yǎng)老機構(gòu)的錄取、收入、花費、政策計劃和醫(yī)療條件的決定因素。本文研究也參考了許多此類文獻(xiàn)。 我們對

45、不同老年人群的研究包括部分具有代表性的人群以及虛弱或者殘疾的老年人,那些居住在特殊房或參加特殊項目的人,還有那些在機構(gòu)護(hù)理中年紀(jì)較長和有功能缺陷的人。對養(yǎng)老機構(gòu)里老年人的研究表明那些常駐人口已越來越年長,有更多的殘疾人,更高的住院率和死亡率。其他的研究在養(yǎng)老機構(gòu)及居住人員的數(shù)量和特征方面有顯著的地域差異,并且描述了機構(gòu)養(yǎng)老的差異性。 盡管我們在把養(yǎng)老院看成是社會和健康護(hù)理機構(gòu)的認(rèn)識上和提供老齡人口的使用上有了這樣和那樣的進(jìn)步,在認(rèn)識的準(zhǔn)確度和范圍上的明顯的差異仍然需要改變。所知甚少,舉個例子,從社區(qū)過渡到養(yǎng)老機構(gòu),一些人又回到社區(qū)生活。我們無法更精確地預(yù)測或識別養(yǎng)老機構(gòu)中高風(fēng)險的人,這就限制了

46、我們提供那些代替養(yǎng)老機構(gòu)的基本社區(qū)服務(wù)的一些能力。因為我們在縱向上對具有代表性的人群有了較多的研究,數(shù)據(jù)的覆蓋率也是有限的。 一項對具有代表性的住在社區(qū)的城市老年人的健康,健康護(hù)理和老齡化的縱向研究,提供了一個對那些養(yǎng)老機構(gòu)中參與本次研究的的老人在三年間探索過渡期變化程度、特征和收入等變化的機會。在本文中,我們在分析的基礎(chǔ)上進(jìn)一步提出了養(yǎng)老機構(gòu)的招人,根據(jù)對那些住過一個或多個養(yǎng)老機構(gòu)的人的分析結(jié)果。養(yǎng)老機構(gòu)組織的社會醫(yī)療特征 我們定義一個養(yǎng)老機構(gòu)和其他的有什么不同,通常是根據(jù)他們的社會醫(yī)療特征,這就需要幾個分析的步驟。我們首先計算各個組織社會基線、人口、經(jīng)濟(jì)、健康、功能、社會支持和醫(yī)療保健的多變因素的平均價值,這些因素都涉及到本文所提到的關(guān)于入住或久住養(yǎng)老機構(gòu)的問題。各變量間的顯著差異在表四中可以看出。 本文中比較重要的其他變量,并沒有在各個組織間顯示出顯著的不同,所以在表四中沒有表現(xiàn)出來。這些變量包括一些醫(yī)療條件的基本措施、住院前期、留住養(yǎng)老院和日間護(hù)理,接受一些正式而并不是非正式的社會支持,醫(yī)護(hù)的主要來源除了醫(yī)院(分組練習(xí)、私人醫(yī)生和其