Samson Institute for Ageing Research, University of Cape Town, 234 Upper Buitenkant St, Cape Town, 8001, South Africa.
BMC Geriatr. 2019 Apr 4;19(1):98. doi: 10.1186/s12877-019-1116-0.
As older people age, they have different health needs compared to younger people. South African elder care policy places a strong emphasis on ageing in community rather than institutional settings, but the primary healthcare system is not geared to address the health needs of older people living in community settings.
This paper presents findings of nine focus groups conducted with community-dwelling older adults in three areas (high, medium and low-income) in Cape Town, South Africa over 2 months in 2017. These discussions addressed primary health services available to older persons, their ability to access these services and their expectations and experiences of care.
Findings showed that while participants in the high-income area had few challenges accessing quality care or support services, services available in lower-income areas were much less responsive and participants displayed low trust in the healthcare system, feeling that their needs were overlooked. Participants who experienced poor doctor-patient communication often failed to comply with treatment, while those who experienced patient-centered communication, either through the private sector or NGO-public sector partnerships had better perceptions of care.
Older persons' complex health needs cannot be adequately addressed by a process-driven approach to care. Supporting patient-centered communication and care may help health workers to understand older persons health needs and improve patient understanding, trust and co-operation. This paper suggests the importance of community support services in enhancing health access and developing systems that enable healthcare providers to better understand and respond to older persons' needs in resource-constrained settings.
随着老年人年龄的增长，他们的健康需求与年轻人不同。南非的老年护理政策强调在社区中而不是在机构中老龄化，但初级卫生保健系统并没有针对居住在社区环境中的老年人的健康需求进行调整。
本文介绍了 2017 年在南非开普敦的三个地区（高、中、低收入）进行的 9 次焦点小组讨论的结果，这些讨论涉及老年人可获得的基本医疗服务、他们获得这些服务的能力以及他们对护理的期望和体验。
研究结果表明，高收入地区的参与者在获得高质量的护理或支持服务方面几乎没有遇到挑战，但在低收入地区，服务的响应能力要差得多，参与者对医疗保健系统的信任度也较低，他们觉得自己的需求被忽视了。那些经历过不良医患沟通的参与者往往不遵守治疗方案，而那些经历过以患者为中心的沟通的参与者，无论是通过私营部门还是非政府组织-公共部门伙伴关系，对护理的看法都更好。
单纯依靠以流程为导向的护理方法无法充分满足老年人复杂的健康需求。支持以患者为中心的沟通和护理可能有助于卫生工作者了解老年人的健康需求，并提高患者的理解、信任和合作。本文提出了社区支持服务在增强健康获取和发展系统方面的重要性，使医疗保健提供者能够更好地理解和应对资源有限环境下老年人的需求。
