Matthews Fiona E, Bennett Holly, Wittenberg Raphael, Jagger Carol, Dening Tom, Brayne Carol
MRC Biostatistics Unit, Cambridge Biomedical Campus, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, England.
Newcastle University Institute of Health & Society, Newcastle University, Edwardson Building, Campus for Ageing and Vitality, Newcastle upon Tyne, England.
PLoS One. 2016 Sep 2;11(9):e0161705. doi: 10.1371/journal.pone.0161705. eCollection 2016.
There have been fundamental shifts in the attitude towards, access to and nature of long term care in high income countries. The proportion and profile of the older population living in such settings varies according to social, cultural, and economic characteristics as well as governmental policies. Changes in the profiles of people in different settings are important for policy makers and care providers. Although details will differ, how change occurs across time is important to all, including lower and middle income countries developing policies themselves. Here change is examined across two decades in England.
Using the two Cognitive Function and Ageing Studies (CFAS I: 77% response, CFAS II: 56% response), two population based studies of older people carried out in the same areas conducted two decades apart, the study diagnosis of dementia using the Automated Geriatric Examination for Computer Assisted Taxonomy, health and wellbeing were examined, focusing on long term care. The proportion of individuals with three or more health conditions increased for everyone living in long term care between CFAS I (47.6%, 95% CI: 42.3-53.1) and CFAS II (62.7%, 95% CI: 54.8-70.0) and was consistently higher in those without dementia compared to those with dementia in both studies. Functional impairment measured by activities of daily living increased in assisted living facilities from 48% (95% CI: 44%-52%) to 67% (95% CI: 62%-71%).
Health profiles of residents in long term care have changed dramatically over time. Dementia prevalence and reporting multiple health conditions have increased. Receiving care in the community puts pressure on unpaid carers and formal services; these results have implications for policies about supporting people at home as well as for service provision within long term care including quality of care, health management, cost, and the development of a skilled, caring, and informed workforce.
高收入国家对长期护理的态度、获取途径和性质发生了根本性转变。生活在这类环境中的老年人口比例和特征因社会、文化、经济特征以及政府政策而异。不同环境中人群特征的变化对政策制定者和护理提供者而言至关重要。尽管细节会有所不同，但变化如何随时间发生对所有人都很重要，包括正在自行制定政策的低收入和中等收入国家。本文考察了英格兰二十年期间的变化情况。
利用两项认知功能与老龄化研究（CFAS I：应答率77%，CFAS II：应答率56%），这两项针对老年人的基于人群的研究在相隔二十年的同一地区开展，采用计算机辅助分类的自动老年检查法对痴呆进行研究诊断，同时对健康和幸福状况进行了考察，重点关注长期护理。在CFAS I（47.6%，95%置信区间：42.3 - 53.1）至CFAS II（62.7%，95%置信区间：54.8 - 70.0）期间，居住在长期护理机构中的每个人患有三种或更多健康问题的个体比例都有所增加，并且在两项研究中，没有痴呆的人这一比例始终高于患有痴呆的人。通过日常生活活动衡量的功能障碍在辅助生活设施中从48%（95%置信区间：44% - 52%）增加到了67%（95%置信区间：62% - 71%）。
长期护理机构居民的健康状况随时间发生了巨大变化。痴呆患病率和报告患有多种健康问题的情况有所增加。在社区接受护理给无偿护理者和正规服务带来了压力；这些结果对居家支持政策以及长期护理服务的提供具有影响，包括护理质量、健康管理、成本以及培养一支技能娴熟、富有爱心且信息灵通的劳动力队伍。
