外文翻译城市老年人口中社区养老和机构养老间的转换Word文档下载推荐.docx

外文翻译城市老年人口中社区养老和机构养老间的转换Word文档下载推荐.docx

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本科毕业设计（论文）

外文翻译

原文：

Transitionsbetweencommunityandnursinghomeresidenceinanurbanelderly

Abstract:

Overthecourseofathreeyearobservationandstudyperiod,some6%ofarepresentativecommunityresidingurbanelderlypopulationwereadmittedtonursinghomes.Nearlyhalfofthisgroupwerestilllivinginnursinghomesattheendofthisobservationperiod.Onethirdhaddiedafterenteringthenursinghome,andtheremainingpeoplehadreturnedtotheirownhomesinthecommunity.Thesethreegroupshadsignificantlydifferentmeanlengthsofstayinnursinghomes;

nearlytwoyearsforthosewhosestaysweremorepermanent,50daysforthosewhosestayswereshortterm,and153daysonaverageforthosewhodiedfollowingadmission.

Atbaseline,thethreegroupsalsotendedtohavedifferentpatternsofhealth,functionalandsocialcharacteristics.Theshorttermstayersandthosewhodiedfollowingadmissiontoanursinghomedifferedfromrespondentswhodidnotenternursinghomes--primarilyintermsofpriorlivingarrangementsandlevelsofsocialsupport.Thepermanentstayersdifferedfromthetwoothernursinghomesub-groups,andfromcommunityresidents,inthattheytendedtobeolderandmorefunctionallyandmentallyimpaired.However,atbaselinetheyappearedatlessrisktoexpirethanthosepeoplewholaterdiedfollowingadmissiontonursinghomes.

Clinicalandresearchimplicationsbasedonthesefindingsarediscussed.

Background

Issuesconcerningtheplaceofnursinghomecareinacontinuumoflongtermcareservicescontinuetooccupytheattentionofhealthcareplanners,administrators,clinicians,andresearchers.'

Thishasbeenthecaseforanumberofreasons.

First,morethan1,350,000elderlyAmericanscurrentlyresideinnursinghomes,andthenumberofnursinghomebedsnowexceedsthenumberofacutecarehospitalbeds.Whileatanyonemomentintimeonly5%ofthepopulation65yearsold,orolder,arenursinghomeresidents,thelife-timeriskofbeingadmittedtoanursinghomehasbeenvariouslyestimatedasupwardsof40%.

Second,costsfornursinghomecarearesubstantial.Theyaresecondonlytohospitalcareasaproportionofallexpendituresforhealthcare?

Nursinghomecostsencompassapproximately40%ofallMedicaidcostsandforcemanyotherwiseincomeindependentelderlyindividualsintopoverty.

Third,theavailabilityofandaccesstonursinghomebedsandtoqualitycareinnursinghomesispoorlyandunevenlydistributed.Finally,havingtorelinquishresidenceinthecommunityforinstitutionallivingisanabruptandradicaltransitionthatisseldomwelcomedbyelderlypersonsortheirfamilymembersexceptincasesofextremehardshiporsicknessamongcaregiversandisacceptedonlyasalastresortorwhenothercareoptionsareeithernotavailableorhavebeenexhausted.

Themagnitudeandurgencyoftheproblemofprovidingnursinghomecare--particularlyinaneraofbudgetarystringency--anditslikelygrowthovertimeduetothegrayingofthepopulationandincreaseintheproportionoftheoldestsegmentofthatpopulation,continuestogiverisetoalargebodyofresearch.Theseeffortsincludedinformationoncharacteristicsofnursinghomepopulations,determinantsofnursinghomeadmissionsandoutcomes,costs,policiesandplanning,andthetreatmentofmedicalconditions.Muchofthisliteratureisbeyondthescopeofthispaper.

Studiesofdiverseelderlypopulationsrangingfromthosefewthatincludebroadlyrepresentativegroupsaswellaspopulationsoffrailordisabledindividuals,thoselivinginspecialhousingenvironments,orparticipantsinspecialprograms,havecommonlyidentifiedadvancedageandfunctionaldeficitsashighriskfactorsfornursinghomeplacement.Studiesofelderlypopulationslivinginnursinghomesindicatethattheresidentpopulationshavebecomeolder,moredisabled,andhavehighratesofhospitalizationanddeath.Otherstudieshavedocumentedsignificantlocalandregionalvariationsinboththenumbersandcharacteristicsofreferralstonursinghomesandresidentpopulations,andhavedescribedvariationsinlengthofstayamongthoseadmittedtonursinghomes.

Despitetheseandotheradvancesinourknowledgeofthenursinghomeasasocialandhealthcareinstitution,anditsusebyelderlypopulations,significantgapsintheprecisionandrangeofthisknowledgeremaintobeclosed.Littleisknown,forexample,ofthedynamicsofthetransitionfromcommunitytonursinghomeresidenceand,forsome,returntolivinginthecommunity.Ourinabilitytopredictortoidentifymoreaccuratelypersonsathighriskofnursinghomeplacementhaslimitedourabilitytoprovidecommunity-basedservicesthatcouldsubstituteorpreventnursinghomeplacement.Becausewehaveinfrequentlystudiedrepresentativecommunitypop