医养理念导向下的城市社区适老化设施营建体系与策略

发布时间：2018-04-13 18:33

本文选题：医养理念 + 城市社区　；参考：《浙江大学》2015年博士论文

【摘要】：在人口老龄化进程加快并深度发展的大背景下,高龄化和失能化趋势显著,而“421”倒金字塔家庭结构的大量出现,又衍生出家庭空巢化、小型化等现实问题。老年人口严重的“四化叠加”现象,对传统养老模式提出巨大挑战。单纯的家庭养老模式已难以为继,必须推进社会化养老,支撑完善养老保障体系。但考虑到社会养老服务供给不足、相关资源配置不均、经济发展水平有限以及传统孝道文化深入人心等现实国情,若在我国实行完全社会化养老也是不切实际的,这就需要发展多元养老模式,发挥各自优势和潜能,在原有基础平台上加以优化和调整。本文基于对我国养老服务环境的发展和研究现状的分析以及对国外养老服务体系建设经验的总结,阐述了以医养结合为导向的研究视角、目的、意义和框架等基础平台问题。其次,对国内外养老设施的演变特征、养老意识形态与需求、物质形态与干预进行了解读,结合相关学科的理论支撑,探讨了养老设施“医养”模式发展的可行性。接下来,在类型学理论方法的指导下,通过文献调查、实地调研和访谈的基础研究,由表及里,提炼出目前我国医养设施发展的雏形,并在此基础上进行归纳整合与分类,进而确立本研究的区域范畴——城市社区。实现从问题到方法的转化。随后,通过前期深入的文献调查和案例研究,参考老年综合评估和养老服务评估的评价机制,在定性判断的基础上抽取适老化设施营建的影响要素,形成较为系统的医养体系数据库。通过权重分析的量化研究进而验证和调整,建构“医养”体系模型。以合理化、规范化的政策体系为导向,以“整体统一、局部灵活”的方法为原则,针对适老化设施运营的保障政策、社区内的规划布局以及建筑整体和各单元空间的深化设计三个层面提出相应的营建策略和方法,形成多层次、多元化的服务体系,从而实现由理论探讨至实践操作的转变。以期研究成果对今后实践提供一定参考依据。本文力图以一种开放和融合的方式创新性转变“居家养老和设施养老”其内涵,通过对社区居家老人提供健康管理、上门服务及技术支持,将狭义的“居家”转变为新形势、新理念下的“养老床位”,提出以“适老化设施”为核心,向社区全面辐射的养老服务体系。从宏观层面建立医养保障政策和运营管理体系,从中观层面完善多元复合型适老化设施的规划布局,从微观层面制定医养设施的功能需求和建设目标。以此为平台,进而提出城市社区新型养老模式下的发展对策与方法。本文尚有诸多不足,有待今后进一步深入研究,但本文的根本目的在于开拓医养理念下的新型养老模式,引发对我国老龄化问题的思考与探索。
[Abstract]:Under the background of accelerated and deep development of population aging process, the trend of aging and disability is obvious, while the emergence of "421" inverted pyramid family structure has given rise to practical problems such as family empty nest and miniaturization.The phenomenon of "four ways superposition" in the elderly population poses a great challenge to the traditional old-age model.The simple family pension model has been difficult to continue, we must promote the socialized pension, support and improve the pension security system.However, considering the insufficient supply of social services for the aged, the uneven allocation of related resources, the limited level of economic development and the fact that traditional filial piety culture is deeply rooted in the hearts of the people, it is impractical to implement a completely socialized old-age pension system in our country.This requires the development of multiple pension model, play to their respective advantages and potential, in the original basic platform to optimize and adjust.Based on the analysis of the development and research status of the pension service environment in China and the summary of the experience of the construction of the pension service system in foreign countries, this paper expounds the basic platform problems, such as the perspective, purpose, significance and framework of the research guided by the combination of medicine and support.Secondly, it interprets the evolvement characteristics, the ideology and demand, the material form and the intervention of the old-age facilities at home and abroad, and discusses the feasibility of the development of the "medical care" mode of the old-age facilities combined with the theoretical support of related disciplines.Then, under the guidance of typology theory and method, through literature investigation, field investigation and basic research of interview, from the surface to the inside, extract the embryonic form of the development of medical and nursing facilities in our country, and on this basis, summarize, integrate and classify.And then establish the regional category of this study-urban community.Realize the transformation from problem to method.Then, through the previous in-depth literature investigation and case study, referring to the evaluation mechanism of the comprehensive assessment of the aged and the assessment of the old-age service, the influence factors of the construction of the suitable aging facilities are extracted on the basis of qualitative judgment.To form a more systematic database of medical and nursing system.Through the quantitative study of weight analysis to verify and adjust, the system model of "medical nourishment" is constructed.Guided by a rational and standardized policy system, and based on the principle of "unity as a whole, partial flexibility", and in view of the safeguard policies for the operation of aging facilities,The planning and layout of the community, as well as the deepening design of the whole building and each unit space, put forward the corresponding construction strategies and methods to form a multi-level and diversified service system, so as to realize the transformation from theoretical discussion to practical operation.With a view to the research results for the future practice to provide a certain reference basis.This paper tries to change the connotation of "home old-age care and facility old-age care" in an open and integrated way. By providing health management, home service and technical support to the elderly living in the community, the narrow sense of "home" is transformed into a new situation.Under the new concept of "old-age bed", the old-age service system with "suitable aging facilities" as the core and a comprehensive radiation to the community is put forward.The policy and management system of medical maintenance security should be established from the macro level, the planning and layout of the multi-element compound suitable aging facilities should be perfected from the meso level, and the functional requirements and construction objectives of medical and nursing facilities should be formulated from the micro level.Taking this as the platform, this paper puts forward the development countermeasures and methods under the new pension model of urban community.There are still many deficiencies in this paper, which need to be further studied in the future, but the fundamental purpose of this paper is to develop a new pattern of old-age support under the concept of medical care, which will lead to the thinking and exploration of the aging problem in China.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：TU984.12

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