|
The 21st century is the era of the aging of the population since 1999, China entered the aging society since the elderly population is increasing, continued to increase the degree of aging. According to a 5% average prevalence, there are 5.5 million Alzheimer's sufferers. With a further increase of the aging, senile dementia prevalence crowd as common diseases of the elderly population will be further expanded. Senile dementia general course was progressive development of early symptoms of memory impairment, then multiple cognitive deficits, common appear aphasia, apraxia, agnosia, and abstract thinking abilities decline, patients living skills poor body complications. About 70% -90% of patients with dementia will appear at some stage in the course of the behavioral and psychological symptoms of dementia, depression, stolen paranoia, suspicion killed, behavior disorders, personality changes, wandering behavior, loud noise, paranoid idea social misconduct, sloppy and so on. Caregivers not only have to bear the heavy manual labor, but also to cope with the patient's bizarre behavior consequences, the care process is long and arduous. For a long time, the demented social support system by the home care and institutional care. The professionalism of the vast majority of our elders with dementia is still home care, long-term home care model to bring a heavy burden to family caregivers, and care services needs to be improved. Provide social support services, has become the caregiver's needs. As society changes, changes in family structure, this demand has become increasingly urgent. Institutional care as the main form of social care is also facing a dilemma: Unlike the demented elderly, cure rehabilitation is almost impossible, and can only live in institutions for a long time until death, which resulted in the beds in a very low turnover rate exacerbated a difficult \This aging movement, Shanghai walking in the forefront of the country. Shanghai took the lead as early as in 1979 entered the aging society, the degree of aging has been ranked highest in the country. Accumulation of aging of 30 years, 10 years of negative population growth, resulting in the aging rate year after year soared, the aging degree of escalation, accompanied by students dementia long-term care for the elderly has become an unavoidable problem. At the same time, Shanghai dementia elderly social care service system is extremely weak. Alzheimer's sufferers as vulnerable groups of the elderly, care requirements and the burden is much higher than for the elderly in general, the existing old-age care policy, however, does not have any tilt. Government as an overall and comprehensive planning, resulting in the dementia elderly long-term care services lack the institutional resources and nursing force shortage, lack of focus on dementia services groups. The face of this grim situation, it is necessary first to take positive responses from the multiple perspectives of strategic positioning, policy preferences, social and resource allocation. This study is targeted at the long-term care and management of the demented, combined with the actual situation of Shanghai, prospectively from the needs of social development, the development of the social support system of the elderly with dementia, and calculated on the basis of the basic elements required to build the system provide the basis for the dementia the elderly field of scientific decisions. First, the use of literature judging of systematic reviews of elders with dementia and social support system of the status quo, while the use of stratified random cluster sampling method and institutional surveys, overview of the prevalence of Alzheimer's sufferers, Shanghai requirement status and agency services . Furthermore, based on the existing system of social support for the elderly, the characteristics of Alzheimer's sufferers, social support framework developed Alzheimer's sufferers. Typical care model already exists widely collected through literature and field survey, in accordance with the framework of different care level, thus the formation of dementia care models for the elderly, deepening the implications of the framework. Successfully developed in the framework and the model of care on the basis of the research team to carry out demand-side argument and Delphi expert panel discussion, the demonstrated results of science, rationality and operability, in order to adjust and optimize the results. On this basis, through the Documentation Systems Review, forming the framework of the service pack, and around the elements of the service pack, the use of literature analysis, the typical agency survey and key informant interviews extensive collection list, combined with the expert panel discussion and Shanghai actual form of Alzheimer's sufferers care basic service pack. Finally, the theoretical study the application of sensitivity analysis, in accordance with the different levels of the service level of socialization to the formation of different assumptions, estimates staffing and human costs of building a social support system, and policy recommendations formed on the basis of the social support system built to a period of The decision makers operation to provide the basis. 1, of the demented limited attention not to a specific field. Cause of senile dementia is not yet clear, the lack of effective treatment, a serious shortage of social support system research, to be in-depth. 2 to Shanghai street (town) a total of 15,158 elderly people aged 65 and over as a sample survey, 1271 cases of patients with the final diagnosis of senile dementia, the Shanghai community aged 65 and over crowd senile dementia crude prevalence was 8.1%, over the age of 70, 9.9%, 12.9% over the age of 75, more than 80 years of age was 18.3%. The standard adjustment of the end of 2008, the population age, the age-standardized prevalence of 6.1%, 8.8%, 12.9% and 19.4%, respectively. 3, NPI test results: senile dementia in patients with NPI total score of 0 620 cases, clinically significant symptoms 406 cases; 238 cases in between. Composition of elders with dementia severity of the disease: Stage I grade mild 49.05%, 32.12% of the grade II moderate 18.83% and grade Ⅲ severe. 4, the city's pension agency admitted to the demented 4757 cases; health care institutions were treated in 5215 with dementia, both less than 1 million people. 1 frame system of social support of the elderly with dementia include: home care is a social and family combined way of care, family support and home services; community care refers to a community day-care service; pension institutions care refers to the centralized boarding care mainly life care; medical institutional care to belong to the same social-oriented boarding care, the main provider of medical care. Delphi method results: positive coefficient of the the two Delphi method experts in more than 80% of the experts on the study is to support and concern; expert authority coefficient of 0.59, indicating that the results of the expert advice from the authoritative; coefficient of variation The first round of the parts is greater than 0.25, the second round, all less than 0.25, indicating that the second round of expert opinion consistent. After two rounds of consultation expert system framework, principles of care model, model of care the opinions coordination coefficient were 0.15,0.18 and 0.17 (P lt; 0.05), expert advice and good coordination, experts have demonstrated reliable results. , A of the demented service package framework elements of support facilities, aids, dominant, recessive service; two elements by economic support, life care, health maintenance and solace composition. 2, the result of discussion by experts as the main basis for the formation of basic services, with Shanghai based on the actual form of home care, community care, pension institutional care and medical institutions care service pack. According to the projections, Shanghai elders with dementia a total of 170,372 cases, the disease is divided into: the class Ⅰ mild 83,567 cases, 54,723 cases of grade II moderate 32,081 cases of grade Ⅲ severe minimum conditions under the care costs: home the way care need 34,611 name Home Economics care workers, 115 management staff responsible for the lives of the elderly care; 93 psychiatrists, 93 general practitioners, 93 rehabilitation doctors, 279 nurses home beds to meet the medical needs of the elderly, the human cost of five thousand multi-million; community care need to configure the 401 psychiatrists and 401 physicians, 3,208 attendants and 401 management staff, the human cost of nearly seven million yuan; pension institutions need to be equipped with 18,240 nurses, 274 physicians, including 91 psychiatrists, 274 nurses and 912 support staff and 274 management staff, the human cost of about thirty million yuan; medical institutions need to configure the 7285 doctors, 14,570 nurses and 7,285 other health technicians, 11,902 administrative workers and service personnel, a total of 41,042 staff, the human cost of one hundred and fifty million yuan. 3, from the per person monthly the human cost estimates results, the highest medical institutions care, up to 5334 yuan / person. Months, followed by the pension agency, in home care; minimum of community care, only 212 yuan / month. (A) of Shanghai for senile dementia in the high incidence and prevalence of the degree of weight, the demented social services faced with the dilemma of social support system for the elderly is very necessary and urgent to build Shanghai dementia. (B) social support system, not only to ensure the demented basic, appropriate services, and can be a great liberation of family caregivers, so that they can give full play to their abilities, personal values ??and create benefits for society. (C) Construction of the demented social support system policy recommendations include: government-led; social participation; perfect series matching system; team enrich caregivers; unpaid combination of low reimbursement payment; intensify propaganda to promote demand-side initiative seeking social assistance; rights of Alzheimer's sufferers, rights and obligations on; existing pension system as the basis for the formation of a specialized dementia care resources for the elderly; overall design, steady progress.
|