Næss Gro, Kirkevold Marit, Hammer Wenche, Straand Jørund, Wyller Torgeir Bruun
CHARM Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
BMC Health Serv Res. 2017 Sep 12;17(1):645. doi: 10.1186/s12913-017-2600-x.
In Norway, as in many Western countries, a shift from institutional care to home care is taking place. Our knowledge is limited regarding which needs for nursing interventions patients being cared for in their home have, and how they are met. We aimed at assessing aspects of health and function in a representative sample of the most vulnerable home-dwelling elderly, to identify their needs for nursing interventions and how these needs were met.
In this observational study we included patients aged 75+ living in their own homes in Oslo, who received daily home care, had three or more chronic diagnoses, received daily medication, and had been hospitalized during the last year. Focused attention and cognitive processing speed were assessed with the Trail Making Test A (TMT-A), handgrip strength was used as a measure of sarcopenia, mobility was assessed with the "Timed Up-and-Go" test, and independence in primary activities of daily living by the Barthel Index. Diagnoses and medication were collected from electronic medical records. For each diagnosis, medication and functional impairment, a consensus group defined which nursing service that the particular condition necessitated. We then assessed whether these needs were fulfilled for each participant.
Of 150 eligible patients, 83 were included (mean age 87 years, 25% men). They had on average 6 diagnoses and used 9 daily medications. Of the 83 patients, 61 (75%) had grip strength indicating sarcopenia, 27 (33%) impaired mobility, and 69 (83%) an impaired TMT-A score. Median amount of home nursing per week was 3.6 h (interquartile range 2.6 to 23.4). Fulfilment of pre-specified needs was >60% for skin and wound care in patients with skin diseases, observation of blood glucose in patients taking antidiabetic drugs, and in supporting food intake in patients with eating difficulties. Most other needs as defined by the consensus group were fulfilled in <10% of the patients.
We identified a very frail group of home-dwelling patients. For this group, resources for home nursing should probably be used in a more flexible and pro-active way to aim for preserving functional status, minimize symptom burden, and prevent avoidable hospitalisations.
与许多西方国家一样，挪威正在从机构护理向家庭护理转变。我们对居家接受护理的患者的护理干预需求以及这些需求如何得到满足的了解有限。我们旨在评估最脆弱的居家老年人代表性样本的健康和功能状况，以确定他们对护理干预的需求以及这些需求是如何得到满足的。
在这项观察性研究中，我们纳入了奥斯陆75岁及以上的居家患者，他们接受每日家庭护理，有三种或更多慢性诊断，每日服药，且在过去一年中曾住院治疗。用连线测验A（TMT-A）评估注意力集中程度和认知处理速度，用握力作为肌肉减少症的指标，用“定时起立行走”测试评估活动能力，用巴氏指数评估日常生活主要活动的独立性。从电子病历中收集诊断和用药信息。对于每种诊断、用药和功能障碍，一个共识小组确定特定情况需要哪种护理服务。然后我们评估每位参与者的这些需求是否得到满足。
150名符合条件的患者中，83名被纳入研究（平均年龄87岁，25%为男性）。他们平均有6种诊断，每天服用9种药物。83名患者中，61名（75%）握力表明存在肌肉减少症，27名（33%）活动能力受损，69名（83%）TMT-A评分受损。每周家庭护理的中位数时长为3.6小时（四分位间距为2.6至23.4小时）。皮肤病患者的皮肤和伤口护理、服用抗糖尿病药物患者的血糖监测以及进食困难患者的食物摄入支持等预先确定的需求满足率>60%。共识小组确定的大多数其他需求在不到10%的患者中得到满足。
我们确定了一组非常虚弱的居家患者。对于这组患者，家庭护理资源可能应以更灵活、更积极的方式使用，以维持功能状态、减轻症状负担并预防可避免的住院治疗。
