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老年人、风险与康复:拓宽我们的思维。

Seniors, risk and rehabilitation: broadening our thinking.

作者信息

Egan Mary Y, Laliberte Rudman Debbie, Ceci Christine, Kessler Dorothy, McGrath Colleen, Gardner Paula, King Judy, Lanoix Monique, Malhotra Ravi

机构信息

a School of Rehabilitation Sciences, University of Ottawa , Ottawa , Canada.

b School of Occupational Therapy, Western University , London , Canada.

出版信息

Disabil Rehabil. 2017 Jun;39(13):1348-1355. doi: 10.1080/09638288.2016.1192227. Epub 2016 Jun 13.

Abstract

PURPOSE

Conceptualizations of risk in seniors' rehabilitation emphasize potential physical injury, functional independence and cost containment, shifting rehabilitation from other considerations essential to promoting a satisfying life. In a two-day multidisciplinary planning meeting we critically examined and discussed alternatives to dominant conceptualizations.

METHOD

Invitees reflected on conceptualizations of risk in stroke rehabilitation and low vision rehabilitation, identified and explored positive and negative implications and generated alternative perspectives to support rehabilitation approaches related to living a good life.

RESULTS

Current risk conceptualizations help focus rehabilitation teamwork and make this work publically recognizable and valued. However, they also lead to practice that is depersonalized, decontextualized and restrictive. Further research and practice development initiatives should include the voices of clinicians and seniors to more adequately support meaningfully living, and foster safe spaces for seniors and clinicians to speak candidly, comprehensively and respectfully about risk. To ensure that seniors' rehabilitation targets a satisfying life as defined by seniors, increased focus on the environment and more explicit examination of how cost containment concerns are driving services is also necessary.

CONCLUSION

This work reinforced current concerns about conceptualizations of risk in seniors' rehabilitation and generated ways forward that re-focus rehabilitation more on promoting a satisfying life. Implications for rehabilitation In seniors' rehabilitation, considerations of risk focus on physical injury, functional dependence and cost containment. Focus on provider-defined risk of physical injury limits examination of patient goals and patients' histories of judging and dealing with risk. Focus on functional dependence and cost containment may lead to practice that is depersonalized and decontextualized. Abandonment of ableist and ageist thinking and an explicit focus on person-centered definitions of risk and a satisfying life are recommended.

摘要

目的

老年人康复中对风险的概念化强调潜在身体损伤、功能独立性和成本控制,使康复偏离了对促进满意生活至关重要的其他考虑因素。在为期两天的多学科规划会议上,我们对主流概念化的替代方案进行了批判性审视和讨论。

方法

受邀者反思了中风康复和低视力康复中风险的概念化,识别并探讨了其积极和消极影响,并产生了支持与美好生活相关康复方法的替代观点。

结果

当前的风险概念化有助于集中康复团队的工作,并使这项工作得到公众认可和重视。然而,它们也导致了非个性化、脱离背景和限制性的实践。进一步的研究和实践发展倡议应纳入临床医生和老年人的声音,以更充分地支持有意义的生活,并为老年人和临床医生营造安全的空间,让他们能够坦诚、全面和尊重地谈论风险。为确保老年人康复以老年人定义的满意生活为目标,还需要更多地关注环境,并更明确地审视成本控制问题如何推动服务。

结论

这项工作强化了当前对老年人康复中风险概念化的关注,并产生了使康复更侧重于促进满意生活的前进方向。对康复的启示 在老年人康复中,对风险的考虑集中在身体损伤、功能依赖和成本控制上。关注提供者定义的身体损伤风险限制了对患者目标以及患者判断和应对风险历史的审视。关注功能依赖和成本控制可能导致非个性化和脱离背景的实践。建议摒弃能力主义和年龄主义思维,明确关注以个人为中心的风险定义和满意生活。

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