本文關(guān)鍵詞： 輕度認(rèn)知障礙 患病現(xiàn)狀 影響因素 社區(qū)管理策略　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本研究通過對重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙患病現(xiàn)狀的問卷調(diào)查,發(fā)現(xiàn)其患病率和患病的影響因素;其次通過定性訪談考察目前對輕度認(rèn)知障礙患者進(jìn)行社區(qū)管理過程中存在的主要問題和原因,從而提出針對重慶市社區(qū)老年人輕度認(rèn)知障礙的社區(qū)管理策略,為從社區(qū)角度加強(qiáng)輕度認(rèn)知障礙的防治及管理提供科學(xué)依據(jù),同時(shí)為政府及相關(guān)部門制定衛(wèi)生政策、改善衛(wèi)生服務(wù)利用提供科學(xué)依據(jù)。方法采用文獻(xiàn)分析法,對收集到的國內(nèi)外輕度認(rèn)知障礙患病現(xiàn)狀及社區(qū)管理策略領(lǐng)域的相關(guān)文獻(xiàn)、書籍和政策文件等進(jìn)行整理、分類、歸納和總結(jié)。在文獻(xiàn)分析的基礎(chǔ)上,結(jié)合專家咨詢及反復(fù)論證,編制《重慶市社區(qū)老年人輕度認(rèn)知障礙調(diào)查問卷》和《重慶市社區(qū)老年人輕度認(rèn)知障礙患病現(xiàn)狀及社區(qū)管理策略訪談提綱》。采用多階段隨機(jī)整群抽樣的方法,在重慶市40個區(qū)縣中按照經(jīng)濟(jì)發(fā)展水平的高、中、低和地理位置特征隨機(jī)抽取巴南區(qū)、墊江縣和奉節(jié)縣作為樣本區(qū)(縣);在所抽取的樣本區(qū)(縣)中分別隨機(jī)抽取1個街道和1個鄉(xiāng)鎮(zhèn),再分別從3個街道和3個鄉(xiāng)鎮(zhèn)下屬的居委會和村委會中各隨機(jī)抽取2個居委會和6個村委會,全市共抽取了3個街道的6個居委會,3個鄉(xiāng)鎮(zhèn)的18個村委會;對所納入的各居委會和村委會中的研究對象進(jìn)行輕度認(rèn)知障礙的調(diào)查及影響因素的收集,并對樣本區(qū)(縣)衛(wèi)生行政部門領(lǐng)導(dǎo)、社區(qū)醫(yī)護(hù)人員、輕度認(rèn)知障礙患者及其家屬進(jìn)行半結(jié)構(gòu)式訪談。通過對回收的問卷進(jìn)行編碼和數(shù)據(jù)輸入,采用Epi Data3.1建立數(shù)據(jù)庫,應(yīng)用SPSS 21.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析,對重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙的患病現(xiàn)狀、影響因素、社區(qū)管理現(xiàn)狀等進(jìn)行分析。結(jié)果1.重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙的患病現(xiàn)狀與影響因素方面:(1)重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙的患病率為11.73%(209/1781);(2)輕度認(rèn)知障礙的患病率在不同地區(qū)、年齡、婚姻狀況、文化程度、職業(yè)、是否吸煙、飲酒、鍛煉、肥胖、高血壓、糖尿病、腦卒中及抑郁等組間的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。輕度認(rèn)知障礙的患病率在不同性別、居住狀況、經(jīng)濟(jì)狀況、常吃海鮮、親友鄰居交往、宗教信仰、冠心病及高血脂等組間的差異無統(tǒng)計(jì)學(xué)意義(P0.05),多因素Logistic回歸分析顯示居住在農(nóng)村、增齡、獨(dú)身、肥胖、高血壓及抑郁是重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙的危險(xiǎn)因素;文化程度初中及以上、腦力勞動者、戒煙、常吃海鮮、禽蛋、鍛煉、每天從事大強(qiáng)度勞動和小強(qiáng)度勞動、每天及有時(shí)從事家務(wù)勞動、每天及每周至少參加一次戶外活動、每天打麻將棋牌、每天看電視或聽廣播或讀報(bào)紙是重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙的保護(hù)因素。2.重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙患者的社區(qū)管理現(xiàn)狀方面:(1)從事輕度認(rèn)知障礙患者的管理工作的一般都是由社區(qū)公共衛(wèi)生人員擔(dān)任,缺少認(rèn)知功能訓(xùn)練、日常生活管理技巧等專業(yè)知識;(2)社區(qū)公共衛(wèi)生人員無法對輕度認(rèn)知障礙患者進(jìn)行規(guī)范化管理;(3)目前社區(qū)老年人普遍認(rèn)為輕度認(rèn)知障礙是衰老過程中的自然現(xiàn)象,缺乏正確認(rèn)識;(4)輕度認(rèn)知障礙患者及家屬對輕度認(rèn)知障礙的關(guān)注少,缺乏對該病的認(rèn)識;(5)輕度認(rèn)知障礙患者及家屬缺乏相應(yīng)的知識,無法進(jìn)行有效的自我管理及家庭護(hù)理;(6)輕度認(rèn)知障礙患者的社會保障制度不完善。結(jié)論重慶市三區(qū)縣社區(qū)老年人輕度認(rèn)知障礙的患病率較高,應(yīng)盡早針對輕度認(rèn)知障礙的相關(guān)因素采取有效措施,延緩或阻止輕度認(rèn)知障礙向老年癡呆的發(fā)展;政府對輕度認(rèn)知障礙重視程度不夠,欠科學(xué)管理且該類人群社保制度不完善;目前對輕度認(rèn)知障礙患者進(jìn)行社區(qū)管理過程中存在以下問題:(1)社區(qū)公共衛(wèi)生人員專業(yè)技術(shù)水平低,對于輕度認(rèn)知障礙的識別、篩查、處理及管理都停留在一個相當(dāng)?shù)偷乃?(2)社區(qū)公共衛(wèi)生人員對輕度認(rèn)知障礙患者的管理能力有限;(3)目前社區(qū)老年人對輕度認(rèn)知障礙缺乏認(rèn)識;(4)目前輕度認(rèn)知障礙患者及家屬對輕度認(rèn)知障礙的關(guān)注少,缺乏對該病的認(rèn)識;(5)輕度認(rèn)知障礙患者在確診患病后無法進(jìn)行有效的自我管理及家庭護(hù)理等;(6)輕度認(rèn)知障礙患者的社會保障制度不完善等。因此,為了完善對輕度認(rèn)知障礙患者的社區(qū)管理策略,提高輕度認(rèn)知障礙患者的生活質(zhì)量,提出應(yīng)加強(qiáng)認(rèn)知障礙衛(wèi)生人才建設(shè),增強(qiáng)全社會對輕度認(rèn)知障礙的關(guān)注和支持、完善對輕度認(rèn)知障礙患者及家屬的健康知識指導(dǎo)、完善對輕度認(rèn)知障礙患者的醫(yī)療保障制度、同時(shí)聯(lián)合各單位,完善對輕度認(rèn)知障礙患者的社區(qū)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.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.1;D669.3

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