重庆市三区县社区老年人轻度认知障碍的患病现状与社区管理策略研究

发布时间：2018-02-23 11:43

本文关键词： 轻度认知障碍患病现状影响因素社区管理策略　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过对重庆市三区县社区老年人轻度认知障碍患病现状的问卷调查,发现其患病率和患病的影响因素;其次通过定性访谈考察目前对轻度认知障碍患者进行社区管理过程中存在的主要问题和原因,从而提出针对重庆市社区老年人轻度认知障碍的社区管理策略,为从社区角度加强轻度认知障碍的防治及管理提供科学依据,同时为政府及相关部门制定卫生政策、改善卫生服务利用提供科学依据。方法采用文献分析法,对收集到的国内外轻度认知障碍患病现状及社区管理策略领域的相关文献、书籍和政策文件等进行整理、分类、归纳和总结。在文献分析的基础上,结合专家咨询及反复论证,编制《重庆市社区老年人轻度认知障碍调查问卷》和《重庆市社区老年人轻度认知障碍患病现状及社区管理策略访谈提纲》。采用多阶段随机整群抽样的方法,在重庆市40个区县中按照经济发展水平的高、中、低和地理位置特征随机抽取巴南区、垫江县和奉节县作为样本区(县);在所抽取的样本区(县)中分别随机抽取1个街道和1个乡镇,再分别从3个街道和3个乡镇下属的居委会和村委会中各随机抽取2个居委会和6个村委会,全市共抽取了3个街道的6个居委会,3个乡镇的18个村委会;对所纳入的各居委会和村委会中的研究对象进行轻度认知障碍的调查及影响因素的收集,并对样本区(县)卫生行政部门领导、社区医护人员、轻度认知障碍患者及其家属进行半结构式访谈。通过对回收的问卷进行编码和数据输入,采用Epi Data3.1建立数据库,应用SPSS 21.0统计软件进行数据分析,对重庆市三区县社区老年人轻度认知障碍的患病现状、影响因素、社区管理现状等进行分析。结果1.重庆市三区县社区老年人轻度认知障碍的患病现状与影响因素方面:(1)重庆市三区县社区老年人轻度认知障碍的患病率为11.73%(209/1781);(2)轻度认知障碍的患病率在不同地区、年龄、婚姻状况、文化程度、职业、是否吸烟、饮酒、锻炼、肥胖、高血压、糖尿病、脑卒中及抑郁等组间的差异有统计学意义(P0.05)。轻度认知障碍的患病率在不同性别、居住状况、经济状况、常吃海鲜、亲友邻居交往、宗教信仰、冠心病及高血脂等组间的差异无统计学意义(P0.05),多因素Logistic回归分析显示居住在农村、增龄、独身、肥胖、高血压及抑郁是重庆市三区县社区老年人轻度认知障碍的危险因素;文化程度初中及以上、脑力劳动者、戒烟、常吃海鲜、禽蛋、锻炼、每天从事大强度劳动和小强度劳动、每天及有时从事家务劳动、每天及每周至少参加一次户外活动、每天打麻将棋牌、每天看电视或听广播或读报纸是重庆市三区县社区老年人轻度认知障碍的保护因素。2.重庆市三区县社区老年人轻度认知障碍患者的社区管理现状方面:(1)从事轻度认知障碍患者的管理工作的一般都是由社区公共卫生人员担任,缺少认知功能训练、日常生活管理技巧等专业知识;(2)社区公共卫生人员无法对轻度认知障碍患者进行规范化管理;(3)目前社区老年人普遍认为轻度认知障碍是衰老过程中的自然现象,缺乏正确认识;(4)轻度认知障碍患者及家属对轻度认知障碍的关注少,缺乏对该病的认识;(5)轻度认知障碍患者及家属缺乏相应的知识,无法进行有效的自我管理及家庭护理;(6)轻度认知障碍患者的社会保障制度不完善。结论重庆市三区县社区老年人轻度认知障碍的患病率较高,应尽早针对轻度认知障碍的相关因素采取有效措施,延缓或阻止轻度认知障碍向老年痴呆的发展;政府对轻度认知障碍重视程度不够,欠科学管理且该类人群社保制度不完善;目前对轻度认知障碍患者进行社区管理过程中存在以下问题:(1)社区公共卫生人员专业技术水平低,对于轻度认知障碍的识别、筛查、处理及管理都停留在一个相当低的水平;(2)社区公共卫生人员对轻度认知障碍患者的管理能力有限;(3)目前社区老年人对轻度认知障碍缺乏认识;(4)目前轻度认知障碍患者及家属对轻度认知障碍的关注少,缺乏对该病的认识;(5)轻度认知障碍患者在确诊患病后无法进行有效的自我管理及家庭护理等;(6)轻度认知障碍患者的社会保障制度不完善等。因此,为了完善对轻度认知障碍患者的社区管理策略,提高轻度认知障碍患者的生活质量,提出应加强认知障碍卫生人才建设,增强全社会对轻度认知障碍的关注和支持、完善对轻度认知障碍患者及家属的健康知识指导、完善对轻度认知障碍患者的医疗保障制度、同时联合各单位,完善对轻度认知障碍患者的社区管理。
[Abstract]:The purpose of this research through the questionnaire survey on the prevalence of mild cognitive impairment in three counties of Chongqing city community, found that the factors affecting the prevalence and prevalence; secondly through qualitative interviews on the current study of patients with mild cognitive impairment were the main problems and causes in the process of community management, community management and puts forward strategies for mild cognitive impairment in Chongqing aged people in the community, provide scientific basis for strengthening the prevention and management of mild cognitive impairment from the community perspective, while the development of health policy for the government and relevant departments, improve and provide scientific basis for health services. Using the method of literature analysis, the collected domestic and foreign literature related to mild cognitive impairment prevalence status and community management strategy in the field of books and policy documents were collected, classified and summarized. Based on the literature analysis, combined with expert consultation Consultation and demonstration, investigation of the < Chongqing city community elderly people with mild cognitive disorder questionnaire "and" Chongqing city community elderly people with mild cognitive disorder status and community management strategy. The outline of interview by multistage random cluster sampling method in 40 counties of Chongqing city in accordance with the level of economic development, high and low and geographic characteristics were randomly selected from Banan District, Dianjiang county and Fengjie County as a sample area (county); in the samples from the district (county) were randomly selected from 1 streets and 1 townships, 2 neighborhood committees were randomly selected each subordinate to respectively from 3 streets and 3 Township neighborhood committees and village committees and in the 6 Village, a total sample of 6 residents of 3 Street, 18 village 3 villages and towns; collect and influence factors of mild cognitive impairment on the study included various committees and village committees in, and the The sample area (county) health administrative departments, community medical staff, patients with mild cognitive impairment and their families conducted semi-structured interviews. Encoding and data input through the recovery of the questionnaire, using Epi Data3.1 to establish a database, using SPSS 21 statistical software for data analysis, factor status, prevalence of mild cognitive impairment in elderly community three districts people in the city of Chongqing, the community management status were analyzed. The results of mild cognitive impairment in three counties of Chongqing city in 1. community elderly prevalence status and influencing factors: (1) three counties of mild cognitive impairment among the elderly in Chongqing city the prevalence rate was 11.73% (209/1781); (2) the prevalence of mild cognitive impairment in different regions, age, marital status, education level, occupation, smoking, drinking, exercise, obesity, hypertension, diabetes mellitus, there were statistically significant differences in stroke and depression and other groups (P0 .05). The prevalence of mild cognitive impairment in different gender, living conditions, economic conditions, eat seafood, friends and neighbors exchanges, religious beliefs, no statistically significant difference between coronary heart disease and hyperlipidemia groups (P0.05), Logistic regression analysis showed that living in the countryside, increasing age, obesity, celibacy, hypertension and depression are risk factors of mild cognitive impairment in three counties of Chongqing city community; junior high school education and above, mental workers, quit smoking, eat seafood, eggs, exercise every day in the big and small labor intensity of labor intensity, and sometimes do housework every day, every day and every week to attend at least one outdoor activities every day, every day playing mahjong chess, watch TV or listen to the radio or reading a newspaper is the three district community elderly patients with mild cognitive impairment protective factors of mild cognitive impairment in three districts of Chongqing city community.2. community of Chongqing City The present situation of the management of areas: (1) in patients with mild cognitive impairment management are generally served by the community public health personnel, the lack of cognitive training, professional knowledge, daily life management skills; (2) community public health personnel to carry on the standardized management of patients with mild cognitive impairment; (3) the community elderly people generally think that mild cognitive impairment is a natural phenomenon in the aging process, the lack of correct understanding; (4) patients and families of mild cognitive impairment in mild cognitive impairment less attention, lack of awareness of the disease; (5) patients with mild cognitive impairment and their families lack of knowledge, not self management and effective home care; (6) patients with mild cognitive impairment of the social security system is not perfect. The mild cognitive impairment in community elderly three counties Chongqing conclusion high prevalence of mild cognitive impairment should be as early as possible for the phase The relevant factors and take effective measures to delay or prevent the development of mild cognitive impairment to dementia; mild cognitive impairment of government pay enough attention to the scientific management and the people under the social security system is not perfect; the patients with mild cognitive impairment in community management process exist the following problems: (1) community public health professional and technical personnel for the low level of recognition, mild cognitive impairment screening, treatment and management remained at a fairly low level; (2) community public health personnel limited to patients with mild cognitive impairment and management ability; (3) the elderly mild cognitive impairment on the lack of understanding; (4) the patients and their relatives with mild cognitive impairment of mild cognitive impairment, less attention, lack of awareness of the disease; (5) patients with mild cognitive impairment can not be effective self management and family care in the diagnosis of illness; (6) identify mild To know patients with disorders of the social security system is not perfect. Therefore, in order to improve the community management strategy in patients with mild cognitive impairment, improve the quality of life of patients with mild cognitive impairment, cognitive impairment, and proposes that we should strengthen the construction of health personnel, enhance the whole society attention and support to the patients with mild cognitive impairment, improve the patients and their families with mild cognitive impairment health knowledge guidance, improve the patients with mild cognitive impairment of the health care system, and the joint units, improve the community management of patients with mild cognitive impairment.

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.1;D669.3

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