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学科主题: 护理学
题名:
北京市痴呆患者照顾现状及照顾成本的研究
作者: 李小卫
答辩日期: 2014-05-26
导师: 王志稳
专业: 护理学
授予单位: 北京大学
授予地点: 北京大学护理学院
学位: 硕士
关键词: [痴呆] [居家] [机构] [生活质量] [照顾成本]
其他题名: Study on the cost and caring status of dementia patients in Beijing
分类号: R473.74
摘要: 目的:人口老龄化的加速使痴呆老人逐年增多,给家庭和社会带来沉重的照顾及经济负担。因此,本研究对居家、老人院及医院照顾痴呆患者的基本特征、照顾现状及照顾成本进行调查与比较,并分析痴呆患者照顾成本的影响因素,为有针对性地提高不同照顾场所痴呆患者的照顾质量,并探索适于我国国情的痴呆患者照顾支持服务及管理模式提供建议与思考。方法:本研究采用横断面研究方法,选取131对痴呆患者及其照顾者(居家样本48对、老人院样本46对、医院样本37对)进行问卷调查。问卷内容包括痴呆患者人口社会学资料、疾病信息(痴呆类型、痴呆严重度、伴随慢性疾病、患者日常生活能力、精神行为问题)、照顾现状(照顾者特征、照顾环境、活动安排、照顾者困难、患者生活质量、不良事件)及照顾成本。所得资料运用SPSS 17.0统计软件进行分析。结果: 1. 痴呆患者基本特征:①与居家及医院患者相比,老人院患者年龄较大,以无配偶、轻中度痴呆居多,并伴随较多的慢性疾病;居家患者痴呆严重度分布较均匀,医院患者以中重度为主,日常生活能力最差(P均<0.01);②老人院患者精神病性症状多于居家及医院患者(P均<0.05),医院患者攻击行为及身体非攻击行为多于居家及老人院患者(P均<0.05)。 2. 痴呆患者照顾现状:①居家照顾者以配偶为主,年龄相对较大(P<0.001),老人院及医院照顾者主要为中学/中专学历的护理员;②三组照顾者均报告较多的日常生活照料及与患者沟通交流方面的困难;此外,居家照顾者异常行为应对困难的报告率高于老人院及医院照顾者(P<0.01);③老人院及居家环境在照顾环境总分、稳定性/可预测性、个体化刺激维度好于医院环境(P均<0.001),老人院及医院环境安全性维度均分高于居家环境(P<0.001),居家环境隐私性与社交性维度均分高于老人院(P=0.011)及医院环境(P<0.001);④居家患者活动水平最高,老人院患者次之,医院患者活动水平最低(P<0.01);⑤老人院患者生活质量总体上优于居家及医院患者(P<0.01),居家及医院患者生活质量除自尊维度之外基本无差异;⑥不良事件方面,三组患者跌倒、坠床、肺炎、压疮、走失、急诊及住院的发生率存在差异。老人院患者跌倒发生率高于医院患者(P<0.05),居家患者肺炎、急诊及住院发生率高于老人院患者(P均<0.05),居家患者跌倒、急诊及住院发生率高于医院患者(P均<0.05)。 3. 痴呆患者照顾成本及影响因素:①每名痴呆患者的照顾成本平均为7303元/月(87636元/年)。其中,居家患者照顾成本平均为3522元/月(42264元/年),老人院为5380元/月(64560元/年),医院为14598元/月(175176元/年);医院患者照顾成本最高,老人院患者次之,居家患者最低(P均<0.001);②照顾场所、患者文化程度、月收入及日常生活能力是照顾成本的影响因素;患者文化程度、月收入越高、日常生活能力越差,照顾成本越高。结论:在不同场所接受照顾的痴呆患者在年龄、婚姻状况、文化程度、医疗付费方式、疾病严重度、伴随慢性疾病、日常生活能力、精神行为问题、照顾者特征、照顾困难等方面均存在差异。在照顾环境方面,居家环境在安全性、社交性、定向线索、大的时钟/日历及感官刺激方面有待改进,老人院环境在隐私性、活动区噪音、定向线索方面有待改进,医院环境在隐私性、定向线索、大的时钟/日历、患者熟悉物品及感官刺激方面存在不足;且老人院及医院患者的活动安排有待丰富,应针对其不足及照顾者的困难,提供相应指导及痴呆照顾支持服务;痴呆患者照顾成本受照顾场所、患者文化程度、月收入及日常生活能力的影响,应进一步加强痴呆照顾成本的研究,以合理利用有限的社会资源,发展痴呆患者最节约成本且最优的照顾与管理模式。
英文摘要: Objective:With the rapid progress of population aging, the number of dementia patients is increasing year by year, which brings great caring and economic burden to patients’ families and the whole society. The present study aimes to investigate and compare the basic characteristics, caring status and cost of dementia patients lived in communities, elderly homes and hospitals, and to analyze the influencing factors of caring costs, so as to improve caring quality of dementia patients in different settings targetedly, and provide basis for the development of caring support services and management model of dementia patients suitable for China's actual conditions. Methods: A cross-sectional study method was adopted. Totally 131 dementia patients and their primary caregivers (48 cases in communities, 46 cases in elderly homes and 37 cases in hospitals) were recruited in this study. Data on patients’ and caregivers’ demographic information, disease information (dementia type, dementia severity, accompanying chronic diseases, activities of daily living, behavioral and psychological symptoms), caring status (environment and activity arrangement, caring difficulties, patients’ quality of life and adverse events) and caring costs were collected by questionnaires. Results: 1. Basic characteristics of dementia patients: (1) Compared with patients from community and hospital, elderly home patients had older age, more with no spouse, more of mild to moderate severity, and accompanying more chronic diseases. While patients from hospital were mainly moderately severe dementia, had worst activtities of daily living (P<0.01). (2) Elderly home patients had more psychotic symptoms (P<0.05), while hospital patients showed more aggressive behaviors and physically non-aggressive behaviors (P<0.05). 2. Caring status of dementia patients: (1) Caregivers of community patients were mainly spouses of older age (P<0.001), while caregivers of elerly home and hospital patients were mostly nursing assistants with milddle school/technical school education background. (2) Caregivers of all three groups reported difficulties in caring for daily life and communication with dementia patients, while community caregivers reported more difficulties in coping with disrupted behaviors. (3) Environment arrangement in elderly homes and communities were better than hospital environment in total score, dimension scores of stability/predictability and individualized stimulus (P<0.001); environment in elderly homes and hospitals were better than community environment in safety dimension (P <0.001); dimension score of privacy in community environment was the higest (P<0.05). (4) The activity level of community patients was the highest (P<0.01), followed by elderly home patients and hospital patients. (5) The total score of quality of life (QOL) in elderly home patients was highest (P<0.01), while no significant difference was found in the QOL score between hospital and community patients. (6) The incidence of falls in elderly home patients was higher than that of hospital patients (P<0.05), while incidences of pneumonia, emergency treatment and hospitalization of community patients were higher than those of elderly home patients (P<0.05); incidences of falls, emergency treatment and hospitalization of community patients were higher than those of hospital patients (P < 0.05). 3. Cost of dementia: (1) The average cost of one dementia patient was 7303 RMB per month (87636 RMB per year). Among them, average cost of community patients was 3522 RMB per month (42264 RMB per year), and 5380 RMB per month (64560 RMB per year) for elderly home patients, 14598 RMB per month (175176 RMB per year) for hospital patients. Hospital patients had the highest cost, followed by elderly home patients, community patients ranged the lowest (P<0.001). (2) Caring settings, patients’ activitites of daily living, educational level and monthly income were influencing factors of caring costs.The higher the educational level, the higher the monthly income, the lower the activitites of daily living, the higher the caring costs. Conclusion: Dementia patients receiving care in different settings are different in age, marriage status, educational level, disease severity, accompanying chronic diseases, activitites of daily living, behavioral and psychological symptoms, etc. The orientation cues in environment of all seetings need to be improved. In addtition, community environment needs to be improved in terms of safety, sociability, big clock/calendar and sensory stimulation, elderly home environment needs to be improved in privacy, noise in activity area and hospital environment needs to be strengthened in privacy, big clock/calendar, familiar objects of patients and sensory stimulation. Activity arrangement in the elderly homes and hospitals needs to be enriched, and professional guidance and dementia caring support services are needed. The cost of dementia is influenced by caring place, patients’ activities of daily living, educational level and monthly income. Further studies on cost of dementia are needed to provide basis for development of cost-saving and optimal dementia care and management mode.
语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/108191
Appears in Collections:北京大学护理学院_学位论文

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作者单位: 北京大学护理学院

Recommended Citation:
李小卫. 北京市痴呆患者照顾现状及照顾成本的研究[D]. 北京大学护理学院. 北京大学. 2014.
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