Neck injuries among the elderly in Sweden

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patient.     

Consumer Preferences for Health Care Reform Options

This study uses the 1992 Health and Retirement Study to examine consumer preferences for four health care reform options: tax-financed national health insurance, personally subsidized Medicare extensions, publicly subsidized nursing home insurance, and tax credits for health insurance purchases. Males, non-Caucasians, the self-employed, those in excellent health, and those who reside in the Northeast favor national health insurance, while those with high levels of liquid and non-liquid assets tend to disfavor it. Males and those with higher expectations of living in nursing homes tend to favor personally subsidized Medicare extensions to cover nursing homes and home health care. Those with higher expectations of living in nursing homes also favor publicly subsidized nursing home insurance. Relatively little support for subsidized nursing home insurance is found among males and those with high levels of liquid and non-liquid assets. The self-employed tend to support tax credits for health insurance premiums.     

人口老龄化背景下回归家庭养老的路径选择

随着我国人口老龄化进程的加快,养老模式与路径选择问题日益成为社会关注的主要问题。当前,家庭养老功能弱化,社会养老保障体系尚未完全形成,养老问题面临着新的困境。虽然养老模式开始逐渐趋于社会化和多元化,但家庭养老在我国有着很深的根基和不可替代的优势,在应对老龄化的过程中仍有着重要的支撑作用。家庭养老不仅有利于家庭关系的稳定和人力资本的投资,还能节约公共财政和社会资源。家庭养老的困难和危机不仅源于自身,还产生于社会和国家,政府应加大对家庭养老的支持力度,完善家庭养老保障的相关制度,强化家庭养老的社会关系网络,加大"孝"文化的宣传和教育。     

Methodological challenges in hip fracture registration: the Harstad Injury Registry

The aim of the study was to evaluate a hospital-based injury recording system on hip fracture registration in elderly persons aged?+?65 years from 1994 through 2008, and to examine the agreement between the number of validated fractures and the number of fractures reported to the Norwegian Patient Registry using three different sources: (1) Medical records, (2) Patient administrative system and (3) The hospital's hip fracture record to the Norwegian Patient Registry from 2002 through 2008. The injury recording system included 582 hip fracture events and 535 (92%) were confirmed through the medical records. Reasons for non-verification were different coding failures. Searching the patient administrative system using ICD codes identified 16 hip fractures not included in the fracture registry between 2002 through 2008. The total number was the same as the number of hip fractures reported to the Norwegian Patient Registry using ICD codes alone for identification. The conclusion is that on well-defined diagnosis like hip fractures, local fracture registries may obtain a high degree of reliability if different sources are available for quality control. Well-functioning patient administrative systems may be used to study numbers of hip fractures.     

Clothing for the elderly at home and in nursing homes

Age-related changes and clothing problems of elderly people at home and in nursing homes have been systematically studied in both an objective and a subjective way with medical literature studies, interviews and user studies. There are certain demands which the clothing design must meet in order to fulfil the requirements specified by the functional ability of the ageing individual. The consequences of the age-related changes on the construction of clothing are analysed and some clothing examples described.     

Short reports

The aim of the study was to evaluate a hospital-based injury recording system on hip fracture registration in elderly persons aged + 65 years from 1994 through 2008, and to examine the agreement between the number of validated fractures and the number of fractures reported to the Norwegian Patient Registry using three different sources: (1) Medical records, (2) Patient administrative system and (3) The hospital's hip fracture record to the Norwegian Patient Registry from 2002 through 2008. The injury recording system included 582 hip fracture events and 535 (92%) were confirmed through the medical records. Reasons for non-verification were different coding failures. Searching the patient administrative system using ICD codes identified 16 hip fractures not included in the fracture registry between 2002 through 2008. The total number was the same as the number of hip fractures reported to the Norwegian Patient Registry using ICD codes alone for identification. The conclusion is that on well-defined diagnosis like hip fractures, local fracture registries may obtain a high degree of reliability if different sources are available for quality control. Well-functioning patient administrative systems may be used to study numbers of hip fractures.     

居家养老服务体系财税政策空间及顶层设计--基于上海市的实证研究

财税政策是养老服务财政责任的重要工具变量;政策路径与财力支持能力是核心,直接关系服务体系建设与发展。上海是中国老龄化最突出的地区。本文以问题为导向,基于实际调查与老龄人口服务需求预测;通过居家养老服务财税政策空间及财政支持能力关联分析,从“财税、社保、民政福利”财力统筹及“养、医、康、护、住”服务融合的全局,设计与经济社会发展相适应、满足老年服务需求以及发挥财税政策效能三者相协调的财税支持政策顶层框架,并进行政策效果模拟,制定财税政策分步实施路线。     

Out-of-Pocket Home Care Expenditures for Disabled Elderly

Levels and predictors of out-of-pocket home care expenditures for the disabled elderly are examined using a sample of users of home care with out-of-pocket expenditures from the 1984 National Long Term Care Survey (N = 856). Multiple regression results indicate need, specifically functional ability, adds the most explanation to out-of-pocket home care expenditures. Education, marital status, asset availability, prior nursing home use, and population density, while significant, add relatively little explanation to the total variance. Implications for prevention education and long-term care policy are discussed.     

Injuries sustained during snow removal from roofs resulting in hospital care

Clearing snow from roofs causes serious injuries annually. The aim of this study was to describe injury mechanisms, injury panorama, and injury incidence in connection to this activity. A specific aim was to study the association between snow depth and injury incidence. A total of 95 people were injured during four study periods. The risk of injury is strongly associated with snow depth, and the incidence varied up to 10-fold between the studied winter seasons. The majority of injuries (91; 96%) occurred during leisure time and only four people were injured in the occupational setting. The most common injury mechanism was falling off roofs or ladders of residential homes. Nearly 60% sustained moderate or serious injuries (Maximum Abbreviated Injury Scale [MAIS] 2–3), and fractures accounted for almost half of all injuries. Because roofs of single-family homes in Sweden usually do not require snow removal for heavy snow loads, these injuries may have been both unnecessary and avoidable. Further education is required to advise the public on the risks associated with snow removal from roofs.     

养老护理人员胜任素质指标体系构建与应用——基于396名养老护理人员的调查

随着我国人口老龄化步伐的加快,如何完善养老服务体系,提供社会化、多层次养老服务成为我国当前亟待解决的社会热点问题。提高养老护理人员素质和保障服务水平,是推进我国养老服务体系发展的关键。构建养老护理人员胜任素质指标体系,能够为政府部门制定养老护理人员培育政策及其职业生涯发展提供指导、为加强养老服务人力资源开发与管理提供科学的依据。以胜任素质模型为理论依据,运用文献回顾、行为事件访谈法编制养老护理人员调查量表,针对济南、青岛6家养老机构396名养老护理人员的问卷调查数据,采用探索性因子分析和结构方程模型,构建并检验了养老护理人员的胜任素质指标体系。研究结果表明:养老护理人员胜任素质指标体系主要由护理基本知识、照护技能、个人特质、职业道德与认同感4个维度的26项胜任素质特征构成。从每个维度的影响效应分析,影响最大的是照护技能,其后依次为护理基本知识、个人特质、职业道德与认同感。基于该指标体系,分别从完善养老护理人员的招聘选拔机制、培训机制、考核激励机制三方面提出了拓宽招聘渠道扩大招聘群体、设置合理选拨标准、加强培训内容开发、增设培训可选择方案及实景模拟评价方式等养老护理人员胜任素质提升路径。     

Linking service climate to customer loyalty

The present study evaluates the effect of service climate on customer loyalty by incorporating resident perceptions of service quality regarding their interaction with staff members in a nursing home. The study also explores the mediating role of service quality between service climate and customer loyalty. A conceptual two-level model linking service climate to customer loyalty was developed and analyzed using data collected from 197 nursing staff members and 477 residents in 44 nursing homes in Taiwan. The results show that service climate improves service quality and customer loyalty and provide empirical support for the mediating role of service quality between service climate and customer loyalty. Both theoretical and practical implications are discussed as well as future research directions.     

Measuring physical access to ‘healthy foods’ in areas of social deprivation: a case study in Cardiff

This paper examines some characteristics of ‘food deserts’– areas of social deprivation which have poor physical access to food shopping – in a large British city, Cardiff. The stereotype of the ‘food desert’ is critically examined, emphasizing the importance attached by residents of such areas to easy access to food shopping, especially in multiple supermarkets. The case study of Cardiff briefly discusses the identification of potential ‘food deserts’, and then examines the structures of ‘healthy food’ availability and prices in four areas of the city (two in the inner city, two in the outer city) where physical access to large multiple supermarkets is poor. The analysis shows that the local shops in these areas cannot compete generally with large supermarkets on either availability of items or their prices, but that the local shops in the inner city areas are rather more competitive than those in the outer areas. Implications for research and policy formulation are finally discussed.     

整合照料视角下的老年家庭照护床位政策研究

作为嵌入式养老的创新模式，家庭照护床位是解决当前养老服务困境，推动养老服务体系高质量发展、精细化治理的重要举措。然而，当前的试点仍存在需求不足、供给乏力的双重困境。究其原因，主要在于对家庭照护床位认识不清、理解错位；政策实施中尚未有效解决社区居家养老服务资源碎片化问题，资源整合定位不准、整合层次低。基于此，本文提出回归家庭照护床位政策本色，强调其准市场化服务属性，明确其补充、协调、整合的功能定位，探索以街镇-社区为基点、以“养老管家”为媒介、以智能科技为支撑、以老年人住所为场域、以老年人个体为中心的服务终端功能性整合路径，完善配套激励相容机制、支付保障机制，推动实现 “医-养-康-护”一体化居家养老。     

上海市少子老龄化与可持续发展

在概述21世纪上半叶上海市户籍少子老龄化主要特点的基础上,从实施可持续发展战略高度,建议探讨充分发挥少子老龄化的正面效应,尽可能把负面效应转化为正面效应的政策措施;采取既有利于更多吸纳年轻人才,又不使未来老龄化水平过高的替代性人口流迁战略;制定既不使未来中国总人口过多,又有利干减缓老龄问题的现行生育政策调整方案;寻求既不会加重失业问题,又有利于减缓城镇职工基本养老保险基金压力的推迟职工退休年龄的最佳时机;切实推进以“终身保健”为基础、大病保障为重点的医疗卫生服务体系;不断完善以居家养老为主,按适度比例加快养老设施发展的生活照料体系。     

Evaluation of a home injury prevention program in a WHO Safe Community

The objective of this study was to evaluate the effect of a community-based injury prevention program on home injuries. Unintentional injuries occurring in private homes and during leisure time account for 70-80% of injuries treated in public health care. A quasiexperimental design was used for the study, with cross-sectional preand post-implementation measurements in the program area and in a neighboring control community. Children and the elderly were two main target groups of the intervention program, which was based on a participative strategy for community involvement. The study was based on defined total populations. The total relative risk for home injury occurrence decreased in the study area, whereas it increased in the control area. Regarding age and gender, there was a decrease for females and males in the study area and a slight increase in the control area. For males, the youngest and oldest age groups showed no decrease, whereas females showed a decrease among the youngest and those aged 60-79. No decrease was observed in the control area. The study showed that the Safe Community approach had a general effect on the incidence of home injuries.     

New directions in injury surveillance: Development of a model for continuous monitoring of direct medical costs

Information on the costs of injuries is an important additional instrument in setting priorities for injury prevention. The importance of this instrument is increasingly being recognized by health policy makers. The objective of this study was to develop a model which continuously monitors the direct medical costs of injuries in The Netherlands. This model should provide information on the direct medical costs of injuries at any time and for any selection of injury categories. It is an incidence-based model according to the ‘bottom up’ principle. Homogeneous patient groupings with respect to health care use are defined. The groupings are based on existing classifications from the literature and the experience of medical experts, and are defined by means of seven criteria: nature of care provided, body region of the injury, type of injury, severity of injury, age, complications, and sex of the patient. Several cost elements are distinguished (e.g., general practitioner help, hospital care, nursing home care). For each cost element, relevant patient groupings are determined. The new Dutch Injury Surveillance System (LIS) for injuries treated in an A&E department is an important source for incidence data. This article presents the design of the model as adopted by the Working Group on the Costs of Injuries of the European Consumer Safety Association (ECOSA).     

PURPOSE-BUILT RETIREMENT HOUSING FOR SALE

Sheltered housing for the elderly has traditionally been provided by local authorities and charitable organizations but it seems that they can no longer meet the housing needs of this group. In the last few decades, there has been a significant rise in home-ownership amongst retired people. Two features of this are important. First, those retired people who have been used to owning their own homes may be unwilling to consider somewhat institutional types of housing. Second, as a group, although eligible for specialist retirement housing provided by local authorities and charitable agencies, elderly owner-occupiers find it nearly impossible to qualify for such accommodation as they are not considered to be in need. Recently there has been a move by the private sector to provide purpose-built accommodation for sale to the elderly. How far the needs of the elderly can be met by this type of housing was investigated in two related studies. The first involved interviewing a sample of residents living in sheltered accommodation, while the second study surveyed respondents of retirement age at present living in ordinary housing. The investigation has shown that a considerable demand exists for purpose-built housing for sale to the elderly.     

Mortality in elderly injured patients: the role of comorbidities

Home injuries in older people are an important cause of morbidity, disability and death. In addition, the presence of a pre-existing disease has generally been shown to be associated with higher mortality in this population. The objective of the study was to evaluate the association between pre-existing chronic conditions and risk of death among older trauma patients. A retrospective study was conducted in the Lazio Region, including the city of Rome. The study included all the people aged 65 years or older who were admitted to emergency departments in the year 2000 for home or road injuries, which was followed by hospitalisation within 24 hours. Comorbidities are quantified according to the Charlson Comorbidity Index (CCI). The outcome of interest was 30-day mortality. To measure the association between comorbidities and the probability of death, logistic regression was used, adjusting for triage code, sex, age and place of injury. An analysis stratified by triage was also performed. It was found that 17.9% of the injured subjects (8145) were affected by one or more chronic conditions. The probability of death was higher among males, older people, more severe patients and in cases of home accident. Risk of death for non-urgent and urgent patients increased with the increasing of the CCI score. Mortality among very urgent injured elderly was not affected by the presence of chronic conditions. It was concluded that chronic conditions are strong determinants of mortality, particularly for mild injuries.     

北京市城镇居民消费结构的实证分析

采用扩展的线性支出系统(ELES)模型对北京市城镇居民家庭的消费结构进行了实证分析,结果显示,目前北京市城镇居民家庭在消费结构上呈现出吃、教育、行、医、穿、住、用的消费格局,居民的消费已从基本生存型商品消费为主的阶段转到以享受型、发展型消费为主的阶段。     

空巢老人的养老意愿及其影响因素——基于苏州的实证研究

以2008年苏州城乡老年空巢家庭养老状况的调查资料为基础,对城乡空巢老人的养老意愿及其影响因素进行了分析。超过半数的空巢老人不愿意与子女共同居住,而机构养老也并非空巢老人的最爱。在影响空巢老人是否愿意与子女共同居住的因素中,户籍因素最为重要,其次是与子女关系因素,最后是房屋建筑面积因素;而在影响空巢老人是否愿意入住养老机构的众多因素中,文化程度、儿子数量和养老金(养老补贴)数量这三个变量尤为重要。