Uvod: Napredovala stopnja demence je terminalna stopnja v kliničnem poteku demence, za katero sta poleg kognitivnih, telesnih, vedenjskih in psiholoških okvar značilna izguba samostojnosti pri ...izvajanju osnovnih dnevnih opravil ter visoko tveganje za podhranjenost. Namen raziskave je predstaviti pristope za zagotavljanje optimalne prehranjenosti pri osebah z napredovalo stopnjo demence v institucionalni oskrbi. Metode: Narejen je bil integrativni pregled literature, objavljene med letoma 2014 in 2019. Za identifikacijo relevantne literature smo uporabili iskalni niz dementia OR alzheimers OR cognitive impairment OR memory loss AND feeding OR eating OR nutrition, pregledani sta bili podatkovni bazi CINAHL in MEDLINE. V končno analizo je bilo vključenih 19 člankov. Rezultati: Izsledki pregleda literature so bili razporejeni v štiri kategorije: (1) spodbujanje samostojnosti pri hranjenju, (2) uporaba prilagojene prehrane, (3) obvladovanje motenj požiranja in (4) na posameznika usmerjena oskrba. Diskusija in zaključek: Pristopi pri zagotavljanju kakovosti življenja oseb z napredovalo stopnjo demence so usmerjeni k spodbujanju samostojnosti pri hranjenju. Slednje se lahko dosega z intervencijami na področju obvladovanja upada umskih in telesnih sposobnosti, motenj požiranja, z zagotavljanjem prehranskega vnosa per os ter izvajanjem oskrbe, usmerjene k posamezniku.
Več kot 90 % starostnikov bi se rado postaralo tam, kjer živijo. To idejo podpirajo tudi strateški načrti Evropskega semestra za dolgotrajno oskrbo (ang. European semesters on long-term care) za ...države članice, vendar ne vključujejo dovolj inovacij, da bi resnično izboljšali življenjske razmere starejših z ustrezno opremljenim okoljem in vzdržnim financiranjem. Prostorsko razpršenost bivališč in gostoto poselitve v funkcionalnem območju bi morala pri načrtovanju grajenega okolja in drugih objektov za starejše posebej upoštevati vodstva ustanov, ki starejšim zagotavljajo namestitev, zdravstveno oskrbo in druge storitve, saj so cene logistike (prevoz materiala, delovna sila, prevoz starostnikov v dnevne programe …) precej odvisne od teh dveh dejavnikov. Na podlagi podatkov doma za ostarele v eni od madžarskih občin smo ocenili in optimizirali načrtovanje poti ter razporejanje za potrebe oskrbe starostnikov na domu glede na različne možne prostorske razpršitve in z različno gostoto strank. Poti negovalnega osebja, ki oskrbuje starostnike, smo simulirali po modelu multiple travelling salesman problem, rešitve pa navajajo potrebno delovno silo in časovne zahteve za opravljanje storitev. Orodje, ki nam je omogočilo proučiti izide različnih možnosti, bi lahko tudi stroki pomagalo pri predvidevanju in načrtovanju prihodnjih sprememb pri stroških dolgotrajne oskrbe zaradi vse večjega števila starejših, ki bodo pri ohranjanju samostojnosti potrebovali pomoč, spreminjata pa se tudi gostota in razpršenost gospodinjstev.
The populations of rural areas across Europe, especially Slovenia, are ageing rapidly and the areas themselves are becoming depopulated. Therefore, this study aims to contribute to our understanding ...of the population dynamics and provide a method for forecasting housing and other long-term care needs.
The surveys questioned those responsible for long-term care, the caretakers in institutional care, and current and potential homecare users in rural areas of Slovenia. We wanted to discover what they considered as crucial in the process of long-term care deinstitutionalization. Our 2020-2050 projections are based on the surveys conducted across 38 municipalities in the Eastern Slovenian region and an in-depth empirical study in Posavje. The results are embedded in the demographic projections and the multistate transition model of the declining functional capacities to forecast the needed housing facilities and human resources.
The results are the time series of required capacities. Around 60% of respondents in Slovenian rural areas believe that even a better organization of homecare would not allow them to stay at home until death due to inadequately built housing and the absence of a continuous presence of caregivers. These findings were included in the projections. Therefore, community care in the network of Smart Silver Villages was proposed.
Investments are needed to renovate the housing stock of older adults and construct sheltered, assisted living housing and specialized households in the community. Moreover, proper education and training of human resources would increase the output. In addition, financial solutions are advised to develop Smart Silver Villages.
The quality of long-term care services has an important effect on the quality of life of their users and their informal carers. By identifying gaps between provision of services and users' needs we ...can suggest adjustments of the long-term care services and advance their development.
The data from the first Slovenian national survey of social homecare (SHC) users and their informal carers was utilised. Linear regression analysis was used to evaluate factors that affect assessments of five-dimensional concept of access.
On average, affordability was rated the lowest (mean=2.9) and acceptability the highest (4.0), with availability, accessibility and accommodation (mean=3.6) in the middle. Regression analysis explains 15% of variability in affordability, while for other dimensions much less. Caregiver's needs are the most influential predictor of access, negatively influencing the rating of access (availability B=.127, accommodation B=-.113, acceptability B=-.120, affordability B=-.155). Care recipients' needs also affect the rating of affordability (B=-.132). Family income negatively influences the rating of availability (B=-.115), accessibility (B=-.076) and affordability (B=-.270). Residents of rural areas rate availability (B=-.070) and affordability (B=-.067) less favourable.
This study showed that affordability is rated the least favourable among components of access. Adjustment in private out-of-pocket co-payment mechanism is suggested.
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