外文翻譯----城市老年人口中社區(qū)養(yǎng)老和機(jī)構(gòu)養(yǎng)老間的轉(zhuǎn)換（節(jié)選）

1、<p>　　中文3120字,1880單詞，1萬(wàn)英文字符</p><p>　　出處:Howard R. Kelman，Cynthia Thomas，Journal of Community Health ，1990，P105－121</p><p><b>　　原文：</b></p><p>　　Transitions between

2、community and nursing home residence in an urban elderly </p><p>　　Howard R. Kelman，Cynthia Thomas</p><p>　　Abstract: Over the course of a three year observation and study period, some 6% of a r

3、epresentative community residing urban elderly population were admitted to nursing homes. Nearly half of this group were still living in nursing homes at the end of this observation period. One third had died after enter

4、ing the nursing home, and the remaining people had returned to their own homes in the community. These three groups had significantly different mean lengths of stay in nursing homes; nearly two </p><p>　　At

5、baseline, the three groups also tended to have different patterns of health, functional and social characteristics. The short term stayers and those who died following admission to a nursing home differed from respondent

6、s who did not enter nursing homes--primarily in terms of prior living arrangements and levels of social support. The permanent stayers differed from the two other nursing home sub-groups, and from community residents, in

7、 that they tended to be older and more functionally and m</p><p>　　Clinical and research implications based on these findings are discussed.</p><p>　　Background</p><p>　　Issues conc

8、erning the place of nursing home care in a continuum of long term care services continue to occupy the attention of health care planners, administrators, clinicians, and researchers.' This has been the case for a num

9、ber of reasons.</p><p>　　First, more than 1,350,000 elderly Americans currently reside in nursing homes, and the number of nursing home beds now exceeds the number of acute care hospital beds. While at any o

10、ne moment in time only 5% of the population 65 years old, or older, are nursing home residents, the life-time risk of being admitted to a nursing home has been variously estimated as upwards of 40%. </p><p>

11、　　Second, costs for nursing home care are substantial. They are second only to hospital care as a proportion of all expenditures for health care? Nursing home costs encompass approximately 40% of all Medicaid costs and f

12、orce many otherwise income independent elderly individuals into poverty. </p><p>　　Third, the availability of and access to nursing home beds and to quality care in nursing homes is poorly and unevenly distr

13、ibuted. Finally, having to relinquish residence in the community for institutional living is an abrupt and radical transition that is seldom welcomed by elderly persons or their family members except in cases of extreme

14、hardship or sickness among care givers and is accepted only as a last resort or when other care options are either not available or have been exhausted. </p><p>　　The magnitude and urgency of the problem of

15、providing nursing home care--particularly in an era of budgetary stringency--and its likely growth over time due to the graying of the population and increase in the proportion of the oldest segment of that population, c

16、ontinues to give rise to a large body of research. These efforts included information on characteristics of nursing home populations, determinants of nursing home admissions and outcomes, costs, policies and planning, an

17、d the treatment </p><p>　　Studies of diverse elderly populations ranging from those few that include broadly representative groups as well as populations of frail or disabled individuals, those living in spe

18、cial housing environments, or participants in special programs, have commonly identified advanced age and functional deficits as high risk factors for nursing home placement. Studies of elderly populations living in nurs

19、ing homes indicate that the resident populations have become older, more disabled, and have high ra</p><p>　　Despite these and other advances in our knowledge of the nursing home as a social and health care

20、institution, and its use by elderly populations, significant gaps in the precision and range of this knowledge remain to be closed. Little is known, for example, of the dynamics of the transition from community to nursi

21、ng home residence and, for some, return to living in the community. Our inability to predict or to identify more accurately persons at high risk of nursing home placement has limited</p><p>　　A longitudinal

22、study of health, health care and aging in a representative urban population of elderly persons residing in the community provided an opportunity to explore certain of the transitional dynamics, characteristics, and outc

23、omes of study participants who were admitted to nursing homes during the course of a three year period of observation. In this paper we present first our findings from analyses of the occurrences of nursing home admissi

24、ons followed by the results of analyses of th</p><p>　　Sociomedical Characteristics of the Nursing Home Subgroups </p><p>　　The effort to determine whether these nursing home groups could be dis

25、tinguished from one another, according to their sociomedical characteristics, required several analytic steps. We first calculated for each group the mean values for baseline social, demographic, economic, health, funct

26、ional, social support, and medical care variables that the literature suggested were related either to admission or to length of stay in nursing homes. The variables which were significantly different among the</p>

27、<p>　　Other variables, suggested as important in the literature, had means that were not significantly different across the groups and therefore are not shown in Table 4. These variables included baseline measures

28、 of the number of reported medical conditions, prior hospitalizations, nursing home stays and ambulatory care visits, receipt of formal but not informal social support, primary source of health care other than a hospital

29、 (group practice, private physician, other or none), ethnic and education</p><p>　　Multivariate Analyses </p><p>　　While there were a number of significant distinctions among these outcome group

30、s as shown in Table 4, these univariate differences may not hold up when other possibly confounding or correlated variables are systematically controlled in a multivariate analysis. Since our analytic goals were more des

31、criptive than etiologic and the background literature suggested that clusters of variables rather than individual variables were more likely to be relevant in distinguishing between these groups, we ch</p><p&g

32、t;　　We first formulated a series of questions and then developed sets of analytic comparisons between groups. The first question was whether we could distinguish all those admitted to nursing homes--whether they returne

33、d to community or not, or even whether they died or not--from community residents who were not admitted to nursing homes and survived, and from community residents who died. Second, we asked whether there were distincti

34、ons between the two community resident groups--those who remaine</p><p>　　Summary and Conclusions </p><p>　　The findings of this study can be summarized as follows: </p><p>　　1. Ove

35、r a three year period 6% of the cross section of community residing older persons were admitted to nursing homes. A third of those admitted died, nearly half continued to reside in nursing homes, and the remainder return

36、ed to their homes. While the number of nursing home entrants may seem small, it should be noted that the study sample was limited to those elderly persons residing in their homes and excluded those in hospitals or in nur

37、sing homes at the time the sample was selected. The 6%</p><p>　　2. Nursing home subgroups were identified that differed from each other sociomedically and in length of stay. Those admitted for short stays in

38、 nursing homes resembled community residents not admitted to nursing homes more than they did the permanent nursing home stayers. Similarly, those who died subsequent to a nursing home admission resembled those who died

39、in the community. In both instances, prior levels of social support and living arrangements were the primary distinction between these tw</p><p>　　3. The permanent nursing home stayers, in contrast to the co

40、mmunity residents and the other two nursing home subgroups were more likely to be older, more disabled, and mentally impaired, sustained strokes more often, and received more informal and formal social support prior to t

41、heir admission. The characteristics of this latter nursing home subgroup have come to typify the nursing home population identified in most prior cross sectional studies. </p><p>　　4. The relative importance

42、 of health, functional, social support and demographic characteristics in distinguishing among nursing home subgroups varies as does their duration of stay in a nursing home. This suggests that there may be different rea

43、sons for admission to nursing homes among these groups.</p><p>　　Caution is suggested in generalizing these findings to communities differing in their supply of nursing home resources or in the composition o

44、f their elderly populations, or to studies with follow up periods of different durations. Also, greater precision and improvement in accounting for the unexplained variance in the findings might have been achieved were i

45、t possible to have measured changes from baseline in the relevent social, health and functional variables closer in time to the actual tra</p><p><b>　　譯文：</b></p><p>　　出處：霍華德·寇曼

46、，辛西亞·托馬斯，《社區(qū)衛(wèi)生雜志》，1990，P105－121</p><p>　　城市老年人口中社區(qū)養(yǎng)老和機(jī)構(gòu)養(yǎng)老間的轉(zhuǎn)換</p><p>　　【摘要】在為期三年的觀察和研究中，在城市老齡人口中有6%的具有代表性的社區(qū)居民入住養(yǎng)老院。在觀察期內(nèi)，這群人中有將近一半的人仍生活在養(yǎng)老院。三分之一的人在入住養(yǎng)老院后已經(jīng)逝世，剩余的人們已經(jīng)回到自己的家中。這三組人群在養(yǎng)老機(jī)構(gòu)中的所待的

47、平均時(shí)間有著明顯的不同：那些仍住在養(yǎng)老院里的人所待的時(shí)間將近有兩年，短期的居住者有50天，那些在入住后去世的人們平均有153天。</p><p>　　在開(kāi)始的時(shí)候，這三組人群在健康，功能和社會(huì)特征方面已經(jīng)有著不同方式。短期的居住者和已經(jīng)逝去的老年人在入住養(yǎng)老院后不同于那些不愿入住養(yǎng)老機(jī)構(gòu)的人——主要是前期生活安排和社會(huì)支持水平這兩方面。長(zhǎng)期居住的人們不同于其他兩組人群和社區(qū)居民，他們相比起來(lái)更加年長(zhǎng)、機(jī)能和心智方

48、面更加弱化。然而，在開(kāi)始時(shí)他們表現(xiàn)得比那些在入住后死去的人們的死亡風(fēng)險(xiǎn)率要低。</p><p>　　我們對(duì)這項(xiàng)發(fā)現(xiàn)的臨床研究進(jìn)行討論。</p><p><b>　　背景</b></p><p>　　關(guān)于養(yǎng)老護(hù)理在長(zhǎng)期護(hù)理中所扮演的角色一直被認(rèn)為是衛(wèi)生保健的規(guī)劃者、管理者、臨床醫(yī)師和研究者。這就是此案例中的一些原因。</p><

49、;p>　　首先，超過(guò)135萬(wàn)的美國(guó)老年人入住養(yǎng)老機(jī)構(gòu)，并且其床位已經(jīng)超過(guò)醫(yī)院里的急癥床位。雖然在任何一個(gè)時(shí)期只有5%的65歲及其以上的老年人入住養(yǎng)老機(jī)構(gòu)，而終生待在養(yǎng)老機(jī)構(gòu)的幾率已經(jīng)估計(jì)達(dá)到40%。</p><p>　　其次，養(yǎng)老機(jī)構(gòu)護(hù)理的成本是巨大的。他們僅其次于醫(yī)院護(hù)理在衛(wèi)生保健方面的支出比例？養(yǎng)老機(jī)構(gòu)護(hù)理的成本包括約40%的醫(yī)療補(bǔ)助成本，導(dǎo)致一些收入無(wú)依靠的老年人變得貧困。</p>&l

50、t;p>　　第三，獲得養(yǎng)老機(jī)構(gòu)的床位和高品質(zhì)的醫(yī)護(hù)服務(wù)的有效性是比較低且分散的。最后，離開(kāi)社區(qū)而進(jìn)行團(tuán)體生活是種急速的轉(zhuǎn)變，很少有老年人或者他們的家人愿意這樣做，除非是極其艱難或是病重，那些看護(hù)人員也被看作是最后的求助，或者是其他看護(hù)選擇不可行或是耗盡的時(shí)候才如此。</p><p>　　在提供機(jī)構(gòu)護(hù)理中最重要且迫在眉睫的事情是——尤其是在預(yù)算緊張的時(shí)候——老年人口的比例也隨時(shí)間的增長(zhǎng)而增多，這將引起我們進(jìn)行

51、大量的研究。這些努力包括機(jī)構(gòu)養(yǎng)老人群的特征信息，養(yǎng)老機(jī)構(gòu)的錄取、收入、花費(fèi)、政策計(jì)劃和醫(yī)療條件的決定因素。本文研究也參考了許多此類文獻(xiàn)。</p><p>　　我們對(duì)不同老年人群的研究包括部分具有代表性的人群以及虛弱或者殘疾的老年人，那些居住在特殊房或參加特殊項(xiàng)目的人，還有那些在機(jī)構(gòu)護(hù)理中年紀(jì)較長(zhǎng)和有功能缺陷的人。對(duì)養(yǎng)老機(jī)構(gòu)里老年人的研究表明那些常駐人口已越來(lái)越年長(zhǎng)，有更多的殘疾人，更高的住院率和死亡率。其他的研究

52、在養(yǎng)老機(jī)構(gòu)及居住人員的數(shù)量和特征方面有顯著的地域差異，并且描述了機(jī)構(gòu)養(yǎng)老的差異性。</p><p>　　盡管我們?cè)诎佯B(yǎng)老院看成是社會(huì)和健康護(hù)理機(jī)構(gòu)的認(rèn)識(shí)上和提供老齡人口的使用上有了這樣和那樣的進(jìn)步，在認(rèn)識(shí)的準(zhǔn)確度和范圍上的明顯的差異仍然需要改變。所知甚少，舉個(gè)例子，從社區(qū)過(guò)渡到養(yǎng)老機(jī)構(gòu)，一些人又回到社區(qū)生活。我們無(wú)法更精確地預(yù)測(cè)或識(shí)別養(yǎng)老機(jī)構(gòu)中高風(fēng)險(xiǎn)的人，這就限制了我們提供那些代替養(yǎng)老機(jī)構(gòu)的基本社區(qū)服務(wù)的一些能力

53、。因?yàn)槲覀冊(cè)诳v向上對(duì)具有代表性的人群有了較多的研究，數(shù)據(jù)的覆蓋率也是有限的。</p><p>　　一項(xiàng)對(duì)具有代表性的住在社區(qū)的城市老年人的健康，健康護(hù)理和老齡化的縱向研究，提供了一個(gè)對(duì)那些養(yǎng)老機(jī)構(gòu)中參與本次研究的老人在三年間探索過(guò)渡期變化程度、特征和收入等變化的機(jī)會(huì)。在本文中，我們?cè)诜治龅幕A(chǔ)上進(jìn)一步提出了養(yǎng)老機(jī)構(gòu)的招人，根據(jù)對(duì)那些住過(guò)一個(gè)或多個(gè)養(yǎng)老機(jī)構(gòu)的人的分析結(jié)果。</p><p>　

54、　養(yǎng)老機(jī)構(gòu)組織的社會(huì)醫(yī)療特征</p><p>　　我們定義一個(gè)養(yǎng)老機(jī)構(gòu)和其他的有什么不同，通常是根據(jù)他們的社會(huì)醫(yī)療特征，這就需要幾個(gè)分析的步驟。我們首先計(jì)算各個(gè)組織社會(huì)基線、人口、經(jīng)濟(jì)、健康、功能、社會(huì)支持和醫(yī)療保健的多變因素的平均價(jià)值，這些因素都涉及到本文所提到的關(guān)于入住或久住養(yǎng)老機(jī)構(gòu)的問(wèn)題。各變量間的顯著差異在表四中可以看出。</p><p>　　本文中比較重要的其他變量，并沒(méi)有在各個(gè)

55、組織間顯示出顯著的不同，所以沒(méi)有表現(xiàn)出來(lái)。這些變量包括一些醫(yī)療條件的基本措施、住院前期、留住養(yǎng)老院和日間護(hù)理，接受一些正式而并不是非正式的社會(huì)支持，醫(yī)護(hù)的主要來(lái)源除了醫(yī)院（分組練習(xí)、私人醫(yī)生和其他），民族和教育背景和與配偶一起居住。</p><p><b>　　多元化的分析</b></p><p>　　盡管在表四中各組的結(jié)果有著挺多不同，在多元化的分析中當(dāng)其他可能混淆

56、或相關(guān)的變量被系統(tǒng)地控制時(shí)，這些不同的單變量模型就會(huì)被阻礙。由于我們的分析目前更注重描述性而不是原因，而且本文的背景也主要是不同變量群而不是單個(gè)變量，這些都和我們所討論的群體有關(guān)。</p><p>　　我們首先制定了一系列問(wèn)題，并且對(duì)各組人群做了進(jìn)一步的比較分析。第一個(gè)問(wèn)題就是我們是否能區(qū)別出這些進(jìn)入養(yǎng)老機(jī)構(gòu)的老年人——不管他們是否又回到社區(qū)，也不管他們是否逝世——那些來(lái)自社區(qū)的居民哪些不愿意入住養(yǎng)老機(jī)構(gòu)，哪些已

57、經(jīng)逝去。第二，我們問(wèn)到是否能區(qū)別出這兩組社區(qū)居民——在養(yǎng)老機(jī)構(gòu)的分組中，哪些人還活著那些人已近死去——那些長(zhǎng)期的和短期的居住者，還有進(jìn)入養(yǎng)老院后死去的老年人。最后，我們?cè)囍卸ㄔ谶@養(yǎng)老機(jī)構(gòu)的三個(gè)分組里是否有不同的社會(huì)醫(yī)學(xué)特征——除了區(qū)別那些在社區(qū)居住群體中比較年長(zhǎng)的人。</p><p><b>　　總結(jié)</b></p><p>　　本文研究結(jié)果可歸納如下：</p

58、><p>　　在這三年期間有6%的社區(qū)老年人住入養(yǎng)老機(jī)構(gòu)。他們中三分之一的人已經(jīng)死亡，接近二分之一的人繼續(xù)居住在養(yǎng)老院，剩下的老年人都已經(jīng)回家。雖然參加此次研究的住入養(yǎng)老機(jī)構(gòu)的老年人看起來(lái)似乎很少，我們應(yīng)該注意到所選取的樣本也是局限于那些居住在家里的老年人，排除了在選取樣本期間那些居住在醫(yī)院和已經(jīng)住在養(yǎng)老院的老年人。這6%的數(shù)字可以被看作是這三年期間一個(gè)養(yǎng)老院的入住率，在一個(gè)具有不錯(cuò)醫(yī)療保健、健康相關(guān)的、長(zhǎng)期看護(hù)和醫(yī)

59、療設(shè)備的城市。</p><p>　　養(yǎng)老機(jī)構(gòu)的分組是根據(jù)不同的社會(huì)醫(yī)療特征和在養(yǎng)老院居住的長(zhǎng)短。那些在養(yǎng)老院里的短期居住者和社區(qū)中不愿住入養(yǎng)老機(jī)構(gòu)的老年人的相似程度要比長(zhǎng)期住在養(yǎng)老院里的老年人要噠。同樣的，那些在入住養(yǎng)老院后死去的人類似于那些居住在社區(qū)死去的老年人。在兩個(gè)實(shí)例中，前期的社會(huì)支持程度和生活安排是區(qū)別養(yǎng)老機(jī)構(gòu)的兩個(gè)分組和與他們相類似的住在社區(qū)里的人的主要因素。</p><p>

60、　　那些長(zhǎng)期居住在養(yǎng)老院里的人，與那些住在社區(qū)中的和養(yǎng)老機(jī)構(gòu)的其他兩個(gè)組相比看起來(lái)要更加年長(zhǎng)、殘疾人更多、心智受損程度更大、中風(fēng)率更大，并且在入住前期受到更多的正式的、非正式的社會(huì)支持。</p><p>　　隨著老年人在養(yǎng)老機(jī)構(gòu)的時(shí)間的變化，健康、機(jī)能、社會(huì)支持和社會(huì)醫(yī)療特征在區(qū)別養(yǎng)老院分組的重要性也是相對(duì)的。這也意味著各組老年人入住養(yǎng)老院的原因也是各不相同的。</p><p>　　值得注

61、意的是在向社區(qū)推廣這些研究時(shí)，他們所提供的養(yǎng)老機(jī)構(gòu)資源或是老年人口的結(jié)構(gòu)，或是對(duì)不同時(shí)間段的研究都是不同的。</p><p>　　向那些在養(yǎng)老院資源應(yīng)用和老年人成分不同的社區(qū)以及之后不同持續(xù)時(shí)間的研究普及這些調(diào)查結(jié)果時(shí)需謹(jǐn)慎。并且，只有在這些調(diào)查結(jié)果中未解釋的差異得到了更加精確和改進(jìn)的解釋后，從社會(huì)相關(guān)衡量，健康和功能參數(shù)到進(jìn)入和離開(kāi)養(yǎng)老院的過(guò)渡上的變化才有可能。調(diào)查結(jié)果表明不同的和更加集中的臨床和綱領(lǐng)性的策略需

62、要干預(yù)那些避免進(jìn)入養(yǎng)老院年老的社區(qū)居民，如果這的確是一個(gè)迫切的社會(huì)目標(biāo)的話。對(duì)于一個(gè)和CNN居住者有相似特征的小組，干預(yù)應(yīng)更加強(qiáng)調(diào)中風(fēng)的復(fù)發(fā)和減少在功能和精神上的障礙。其它小組的特征，比如那些進(jìn)入養(yǎng)老院之后去逝的人，建議強(qiáng)調(diào)加入額外的社會(huì)支持并給予設(shè)當(dāng)?shù)尼t(yī)療照顧，這是防止進(jìn)入養(yǎng)老院的一個(gè)方法。那些和短期居住養(yǎng)老院的人有相似特征的人，那些患冠狀動(dòng)脈和心血管的疾病對(duì)醫(yī)療條件更具挑戰(zhàn)的人，那些認(rèn)為自己的健康是好的或不好的人以及那些表現(xiàn)出不同社