Diesfeldt H F, Jas K J, Merbis C P
Psychogeriatrische Dienst, Stichting Verpleeghuiszorg Nederland, SVN.
Tijdschr Gerontol Geriatr. 1993 Apr;24(2):45-50.
Residential homes were initially conceptualized to offer relatively independent elderly people room and board, rather than the nursing, medical, and rehabilitative care provided in nursing homes. Yet in the Netherlands an increasing number of frail elderly people are cared for in residential homes. By means of standardized rating scales data were collected in 1991 on the ability to perform 12 activities of daily living (ADL), cognitive disabilities, frequency of mood and behavioural problems, and social activities of all 1045 residents of 12 homes. The mean age of the 842 women (80.6%) and 203 men (19.4%) in this sample was 84.9 years (SD = 6.1). Using cutoff points that indicated the presence of serious impairment, we found that 11.9% of the residents were severely disabled in ADL. Severe cognitive impairments were detected in 10.2%, mood and behavioural problems in 13.7% and lack of social contacts in 11.6%. Multivariate cluster analysis revealed five patterns of care requirements, ranging from slight assistance (61.4%) to continuous skilled nursing care (4.9%). Residents are not homogeneous in their care requirements: 12.1% were found in a cluster that indicated a selective need of social contacts, 11.6% clustered together because of mood disorders, and 10.0% was found to have serious problems in three areas (ADL, cognition and social activity), except mood. This study suggests that about 15% of the elderly in residential homes need intensive and round-the-clock (psychogeriatric) nursing care. We conclude that residential homes have become a major component of the Dutch health care system for frail elderly patients.
最初，养老院的概念是为相对独立的老年人提供食宿，而非提供疗养院式的护理、医疗和康复护理。然而在荷兰，越来越多体弱的老年人在养老院中得到照料。1991年，通过标准化评分量表，收集了12所养老院中1045名居民在12项日常生活活动（ADL）方面的能力、认知障碍、情绪和行为问题的发生频率以及社交活动的数据。该样本中842名女性（80.6%）和203名男性（19.4%）的平均年龄为84.9岁（标准差 = 6.1）。使用表明存在严重损伤的临界值，我们发现11.9%的居民在ADL方面严重残疾。严重认知障碍的检出率为10.2%，情绪和行为问题的检出率为13.7%，社交联系缺乏的检出率为11.6%。多变量聚类分析揭示了五种护理需求模式，从轻微协助（61.4%）到持续的专业护理（4.9%）。居民在护理需求方面并非同质化：12.1%的居民属于表明有选择性社交联系需求的类别，11.6%因情绪障碍而聚集在一起，10.0%的居民在三个领域（ADL、认知和社交活动，不包括情绪）存在严重问题。这项研究表明，养老院中约15%的老年人需要强化的全天候（老年精神病学）护理。我们得出结论，养老院已成为荷兰体弱老年患者医疗保健系统的一个主要组成部分。
