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