精神养老难题待解——精神养老：养老新主题

随着人口老龄化进程的加快，迅速增加的老年人口对养老服务需求也提出了更新、更高的要求。在传统的经济供养、生活照料等养老需求基本满足之后，老年人的‘精神养老”问题日益凸显：他们不再满足于吃饱、穿暖的单调生活，而是期望能够同时满足情感交流．人际交往、文化娱乐、知识教育、政治参与等多样化的高层次需求，以体现自身价值，维护健康，实现积极老龄化。     

镇江人口老龄化发展及养老保障情况剖析

镇江自1986年进入人口老龄化以来,伴随着经济和社会的快速发展,已经迎来老年人口第一个高增长时期,并将于2025年出现第二个高增长时期,人口老龄化问题已日益突出。随着老年人口的逐年增加、少儿人口的大幅下降和家庭养老功能的不断弱化,高龄、“空巢”、独居、患病老年人越来越多,老年人对养老社会保障和服务的需求越来越大。与此形成鲜明对比的是,人们的社会养老意识还不强,社会养老服务投入有限、设施不足、服务欠缺,老年人社会保障机制不全、程度不高,尤其是占老年人总数七成左右的农村老年人缺乏养老社会保障,加上“未富先老”的国情,迫切需要各级政府高度重视,在加大养老服务设施建设投入的同时,引导和扶持社会力量发展养老服务业,大力发展居家养老社会服务,鼓励和支持老年人相互扶助,实施“以老治老”的积极老龄化战略,以从容应对人口老龄化挑战。     

慈溪市居家养老服务的三大突破

与全国其他城市一样，浙江省慈溪市也面临着人口结构老龄化和空巢家庭逐年增多的现实难题。如何促进养老服务健康、快速发展，满足老年人群日益提高的服务需求，成为政府高度关注的问题。近年来，我们把推行居家养老作为工作的重点，采取措施大力推进，取得了三大突破性发展。     

沈阳市居家养老服务问题研究

沈阳市老年人口逐年增多，老年人失能风险随年龄增大不断加重，受家庭养老思想影响，很多老人把居家养老作为养老最好的选择，老年人对居家养老服务的需求扩大。因此，为了满足老年人的养老服务需求，需要研究沈阳市居家养老服务问题。目前，沈阳市居家养老服务还存在生活服务中适老服务资源少、居家养老服务内容与服务对象需求不匹配等问题。对此，本研究对沈阳市居家养老服务提出相应对策建议。     

政策引导 整合资源 创新居家养老模式

云南省地处我国西南边陲，以地处去岭以南而得名。全省共设8个省辖市和8个自治州，129个县（市、区），是一个多民族的省份，有25个世居少数民族，是我国少数民族人口多、分布广的省份之一。截止2006年底，全省老年人口为483万人，占全省总人口的10．8％。随着人口老龄化的快速发展，使家庭结构、老年群体状况、代际利益关系和城乡老年人口分布发生了新的变化，“空巢家庭”和“四二一”结构家庭的数量增加，高龄老年人口急剧增长，直接导致社会供养系数上升，家庭的养老服务功能弱化，社会负担加重，给经济社会发展带来广泛深远的影响。对此，省委、省政府十分关注养老服务工作，通过政策引导，加大扶持，采取公建民营、民办公助、政府补贴、购买服务的办法，初步建立了以居家养老为基础、社区养老服务为依托、机构养老为补充的养老服务体系，为老年人安享晚年提供了良好的生活环境，提高了老年人的生活生命质量，促进了社会的和谐与稳定。     

探索适合自己的居家养老模式

上海在1973年成为全国最早进入人口老龄化的城市。而截至2010年底,上海户籍老年人口331．02了了,占总人弱的23．4％;80岁以上户籍老年人口59.83万,占老年人口的18．1％。在人口老龄化、高龄化日益严峻的形势下,上海开展了深入调研,并参考国外养老服务的经验,明确了老年人家庭照顾、社区居家养老服务与机构养老为一体的“9073”养老服务格局,     

吉林市“医养融合”创新养老模式问题研究

随着老年人口的不断增加,为了更好地适应老龄化社会的发展,保障老年人晚年生活的需要,党中央在十九大报告中明确指出,中国在应对人口老龄化问题上,要采取积极应对的方式,结合我国人口发展的实际情况,由政府主导、社会参与构建养老体系,营造良好的社会环境,逐步推进医养融合发展,加快养老产业配套设施的建设。本文选取吉林省吉林市为研究对象,结合吉林市的特点,深入走访调查,针对老年人对医疗保障的需求不断增加前提下,对吉林市养老模式及现状进行分析,提出在传统养老模式的基础上开展"医养融合"新型养老模式并给出相关建议,旨在构建以医养为中心的健康养老体系,真正做到老有所养,老有所医。     

如何构建社区精神养老服务体系

伴随人口老龄化速度的加快和老龄人口绝对数量的增多,老年人在物质需求得到一定程度的满足后,其精神需求问题日益凸显出来。社区日常提供的精神养老服务能否满足老年群体日趋旺盛的精神需求？如何通过构建社会化精神养老服务体系来改进和提高精神养老质量？这些都是亟待研究和解决的重大现实问题。     

创新居家养老模式提升养老服务水平

截至2012年底,江苏省南京市北仑区60岁及以上户籍老人达7.08万,占总人口的19.9％,高于全市、全省和全国的水平.到"十二五"末,全区老年人口将达到8万.近年来,北仑区着力构建"以居家为基础、社区为依托、机构为支撑"的社会养老服务体系,老年人的生活质量得到了明显改善.但随着人口老龄化趋势的进一步加剧和家庭结构小型化的日益凸现,家庭成员为老年人提供的养老支持已越来越不能满足老年人的需求,因此做好居家养老服务工作,显得日趋重要.     

开展互动养老 推动老龄产业发展

面对人口老龄化快速发展趋势下银色浪潮的汹涌冲击,全社会的老年人如何养老、谁来为他们养老、怎样更好地安度晚年,已经成为摆在各级政府和人们面前的一道重要课题,由此也催生了各种各样的养老服务机构、设施和场所,也不断开辟创新出许多新的养老渠道和养老方式,使为老服务的内容和形式更加多姿多彩。最初从老年旅游业引发和开展起来的异地互动式养老,近几年发展得很快,已经成为促进老年人旅游观光,丰富老年人的精神文化生活,同时解决老年人阶段性养老服务需求的一种重要的养老模式,     

Official conceptualizations of person-centered care: Which person counts?

Numerous studies have indicated that a “psycho-social” person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a “consumer-based” rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the “Fourth Age”. This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia.     

Meeting the mental health needs of elderly clients

1. Older individuals in both community and institutional settings have traditionally underused mental health services. Providers of such care devote a minimum of their professional time to those over 65 years of age. 2. Ageism and difficulty with diagnosis are the most frequent explanations for inadequate mental health care to the elderly. This study found that lack of referrals and failure of the aged to seek services partially accounted for underuse. 3. Legislative changes mandating that aged persons be screened for and receive appropriate mental health services will increase the demand for qualified providers. 4. Nursing's approach to care of the older adult, which focuses on both physiological and psychological needs, can facilitate the delivery of comprehensive effective mental health interventions in and out of the institutional setting.     

Older Lesbians and Work in the Australian Health and Aged Care Sector

While research has identified challenges lesbians face in the workplace, there is limited understanding of the particular experiences of older lesbians, especially those working in the health and aged care sector. This article draws on the stories of four women who participated in a narrative research project on lesbian and gay people's experiences of health and aged care. It highlights the need for future research to examine the complexity of identity expression and community affiliation, how people negotiate “coming out” in the workplace, the impact of discrimination, and the resources (such as friends) available to lesbians in the workplace.     

Health care,social care or both? A qualitative explorative study of different focuses in long-term care of older people in France,Portugal and Sweden

Challenges with an ageing population are increasingly becoming a reality in the Western world. Since cognitive impairment increases with age, we can expect an increasing number of older people in need of care. The aim of this article is to describe, analyse and compare different focuses on care of older people with dementia, using examples from France, Portugal and Sweden. The questions are principally focused on the participants’ view about their tasks, the organisation of work, the professional role and cooperation with other professions. Everyday care was studied through observations and participant observations and the staff's opinion was explored by means of interviews. Twenty-two care settings for older people were included. The findings showed that France provided mainly ‘health care’, Sweden ‘social care’ and Portugal an integrated ‘health care and social care’. In a comparative perspective the Portuguese general care of older people, which focuses on integration of health care, social care and social work, also seems to provide care for older people suffering from dementia which best corresponds to the previously developed group living model.     

Teaching pedagogies enhancing social work students’ perceptions and attitudes toward older age in an undergraduate course on working with older people

Approximately threefold increases in older age population groups (+65 years) are projected in the next 15 years. Demographic changes in society will mean greater numbers of older adults in proportion to the younger generation. In the current policy on older age groups, emphasis is placed on healthy aging warranting a multidisciplinary workforce to work with older people. Despite this need and increased demand in the aged care sector, a fewer social work students are willing to undertake aged care placements or to choose it as a career option.

An innovative teaching and learning pedagogy was used in designing the course curriculum titled ‘Social Work with Older People’, including the input of invited specialist guest speakers, an on-campus interactive workshop with older guests, and an assessment designed to evaluate the learning related to the workshop content. The paper reports changes in the attitudes of students studying gerontological social work after the course delivery, evaluated through an online survey with the purpose of improving the learning outcomes in the course and to gauge students’ interest, experiences, attitudes and motivation to work in the aged care sector. The paper contributes to building knowledge in addressing the needs of the changing social demographic.     

Do children in foster care receive appropriate treatment for asthma?

Asthma is the most common childhood chronic disease, and children in foster care have the highest rates of chronic conditions of any studied child population. The purpose of this study is to determine whether there are disparities in asthma management and health care utilization between children in foster care and other children covered by Medicaid in the state of Illinois. We use performance measures developed by the state child welfare system as well as those developed by the National Committee on Quality Assurance and used throughout the country. The study sample was drawn from linked administrative data on children in foster care and paid Medicaid claims. In order to determine the influence of living arrangement setting within the child welfare system, children in foster care were further grouped according to whether they lived in a stable home setting, a stable congregate care setting, or other living arrangement. We found that children living in home settings performed better on most performance measures than income-eligible Medicaid children. In contrast, children with asthma living in congregate care were particularly vulnerable as reflected in poor asthma care measurements and high utilization of hospitalizations despite positive performance on indicators of medication use. This population presents a significant challenge to the child welfare and health care delivery systems.     

Promoting reflective practice with older people: Learning and teaching strategies

Social work with older people is often characterised as low status employment and is dominated by medicalised constructions of old age. Consequently, there is a need for educational responses that address students' negative attitudes toward older people and enable the development of practice skills in this area. The present paper evaluates an elective course for third year social work students that challenged their perceptions of their own and others' ageing, and stimulated a reflective approach to practice with older people. Reflective learning techniques were employed in the course, including observations in aged care service settings. Students in the course showed a high degree of interest in working with older people in the future and, although this did not increase much throughout the course, they evaluated it positively, noting greater awareness of issues affecting older people.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.