Sotile W M, Miller H S
Wake Forest University Cardiac Rehabilitation Program, Winston-Salem, North Carolina, USA.
J Cardiopulm Rehabil. 1998 Mar-Apr;18(2):124-8. doi: 10.1097/00008483-199803000-00005.
Family challenges, depression, and age-related developmental and psychological issues must be considered when structuring interventions for elder cardiopulmonary patients. Elderly patients tend to have difficulty coping when they face novel, unpredictable circumstances and are left to flounder in suspenseful anticipation. Furthermore, if support is not forthcoming during such times--or if they are treated in ways that strip them of control rather than in ways that bolster their sense of control--elderly patients are at great risk of quickly developing a passive, learned helplessness that can significantly complicate their rehabilitation. The overall well-being of elderly cardiopulmonary patients is affected by more than the actions of health-care providers. Poverty, pension and health-care plans, institutionalization, concomitant diseases, family issues, and other factors have a profound and, frequently, an overriding effect on the functional status of the elderly population. However, it is also true that the provision of spirit-enhancing care can make a tremendous difference in quality of life for elderly patients, independent of factors such as residential circumstance or health status. The most valued and valuable sources of social support for elderly patients come from family, church, and health-care providers. Our interventions either enhance or diminish an elderly patient's sense of autonomy and control. Our task-driven health-care system, replete with its growing emphasis on brevity of treatments and cost-effectiveness, can create a style and pace of delivering care that demoralizes an elderly patient. The results can be devastating: "When the spirit is broken, one has no will to marshall coping skills". But health-care providers who are attuned to the psychosocial issues relevant to the later life stages can make a profound difference in enhancing both rehabilitation and quality of life for elderly cardiopulmonary patients and their loved ones.
在为老年心肺疾病患者制定干预措施时，必须考虑家庭挑战、抑郁症以及与年龄相关的发育和心理问题。老年患者在面对新奇、不可预测的情况且处于悬念重重的期待中而不知所措时，往往难以应对。此外，如果在这些时候得不到支持——或者如果他们受到的治疗方式剥夺了他们的控制权，而不是增强他们的控制感——老年患者极有可能迅速产生一种被动的、习得性无助感，这会显著使他们的康复变得复杂。老年心肺疾病患者的整体幸福感受到的影响不仅仅来自医疗保健提供者的行为。贫困、养老金和医疗保健计划、机构化、伴随疾病、家庭问题以及其他因素对老年人群的功能状态有着深远且往往是决定性的影响。然而，提供振奋精神的护理确实可以极大地改善老年患者的生活质量，而与居住环境或健康状况等因素无关。老年患者最珍视且最有价值的社会支持来源来自家庭、教会和医疗保健提供者。我们的干预措施要么增强要么削弱老年患者的自主感和控制感。我们以任务为导向的医疗保健系统，越来越强调治疗的简短性和成本效益，可能会营造出一种提供护理的方式和节奏，使老年患者士气低落。结果可能是毁灭性的：“当精神崩溃时，一个人就没有意愿去调动应对技能”。但是，关注与晚年阶段相关的社会心理问题的医疗保健提供者，能够在提高老年心肺疾病患者及其亲人的康复效果和生活质量方面产生深远影响。
