1 / 25

Home health

Home health. 報告 者：陳彥予 指導 老師：毛慧芬 老師 2012.11.8. Outline. Introduction History ( USA & Taiwan) Personal qualities of the practitioner Team members OT’s work Research Study Evaluate the long-term mortality effect of a home-based intervention

robert-price
Télécharger la présentation

Home health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Home health 報告者：陳彥予 指導老師：毛慧芬 老師 2012.11.8

  2. Outline • Introduction • History (USA & Taiwan) • Personal qualities of the practitioner • Team members • OT’s work • Research Study • Evaluate the long-term mortality effect of a home-based intervention • Home environment v.s. day hospital settings • 居家護理照顧提供者工作壓力與自覺健康狀況 • Maintenance of Effects of the Home Environmental Skill-Building Program for Family Caregivers

  3. Introduction • Home • Part of a person’s identity • Potential as a therapeutic environment • OT role • return people to functional independent • Reclaim their identity

  4. History • Social Security Act(Medicare & Medicaid) • Diagnosis-related groups(DRGs) • Deinstitutionalization

  5. 長期照顧十年計畫 (2007) • 服務對象 （一）65歲以上老人。 （二）55至64歲的山地原住民。 （三）50至64歲的身心障礙者。 （四）僅IADLs失能且獨居之老人。 • 依據上述服務對象之界定，推估長期照顧服務需求人口數： • 2007年：245,511人 • 2010年：270,325人 • 2015年：327,185人 • 2020年：398,130人

  6. Unique aspects of home-based care

  7. Personal qualities of the practitioner

  8. Safety

  9. Family as the caregiver • Spouse / female • The loss of role fulfillment by the client • Personal sacrifices

  10. Team members Client

  11. 職能治療師的工作 • 評估個案 • ADL, IADL→執行日常生活活動的最大限制 • 設定及執行治療計畫 • 在實際情境中練習 • 環境改造 • 輔具諮詢及建議 • 指導家屬日常活動照顧技巧 • 參與團隊溝通會議 • 定期記錄治療進度

  12. RESEARCH Study

  13. Long-Term Effect on Mortality of a Home Intervention that Reduces Functional Difficulties in Older Adults: Results from a Randomized TrialLaura N. Gitlin, WalterW. Hauck,wMarie P. Dennis, EdM, LaraineWinter,Nancy Hodgson, and Sandy SchinfeldJournal of the American Geriatrics Society. 57:476–481, 2009 • Purpose • To evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.

  14. Method • Participants: 319 adults aged 70 and with difficulties performing daily activities. • Two-group randomized trial with survivorship followed up to 4 years • Control group (n=159) • Intervention group (n=160)

  15. Result • Conclusion • The intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. • Subjects at moderate mortality risk derived the most intervention benefit. • The intervention could be a low-cost clinical tool to delay functional decline and mortality

  16. Comparing the experience of outpatient therapy in home and day hospital settings after traumatic brain injury: patient, significant other and therapist perspectivesEMMAH DOIG, JENNIFER FLEMING, PETREA CORNWELL & PIM KUIPERSDisability and Rehabilitation, 2011; 33(13–14): 1203–1214 • Purpose • To explore how therapy in a home and day hospital setting impacts on rehabilitation processes and outcomes • Method • 14 severe traumatic brain injury • Aone-to-one, goal-directed, client-centredoutpatient occupational therapy program (a) in their home for 6 weeks (b) in a day hospital clinic for 6 weeks. (1 hr/week, random assigned) • Use semi-structured interviews with the participants, their significant others and their treating occupational therapists.

  17. Result • Home-based therapy perceived as more relaxing, normal, satisfying and effective • Conclusion • The experience of home-based therapy was perceived as more convenient, positive and preferred by patients and their family members. • Therapists described more therapeutic benefits and the ability to work more effectively on activity and participation level goals in the client’s real-life environment.

  18. 分析居家護理照顧提供者工作壓力與自覺健康狀況相關性之研究楊惠芳、王鐘慶、吳立偉、江昇達、高東煒、羅慶徽、陳韋良中華職業醫學雜誌 19(3)：135-145, 2012 • 目的 • 針對其照顧者進行工作壓力與健康狀況的調查並且分析與健康生活品質的關聯性。 • 方法 • 以自擬式結構式問卷為主要研究工具(ADL量表、PSTR壓力量表、SF-36 健康量表) • 研究對象為於2011年1月1日至2011年12月31日期間接受居家照護的個案照顧者(n=165)。

  19. 結果 • 在照顧者健康狀態(SF-36)的8個構面中，親屬關係之照顧者分數，顯著低於台灣常模健康族群。 • 在照顧者對壓力因素分析中，發現照顧者的壓力指數與其自覺健康狀況的各個範疇，均呈現顯著負相關。

  20. 結論 • 居家照護照顧者壓力越大，其健康生活品質越差。 • 照顧者與病人關係若為親屬，其壓力分數顯著大於非親屬關係之照顧者 • 照顧合併2 種或3種疾病以上病人的照顧者壓力指數均大於照顧合併1種疾病病人的照顧者壓力指數。

  21. Maintenance of Effects of the Home EnvironmentalSkill-Building Program for Family Caregivers andIndividuals With Alzheimer’s Disease and Related DisordersLaura N. Gitlin, Walter W. Hauck, Marie P. Dennis, and LaraineWinterJournal of Gerontology: MEDICAL SCIENCES2005, Vol. 60A, No. 3, 368–374 • Purpose • This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for family caregivers who participated in an occupational therapy intervention

  22. Method • Participant: caregiver • To Caregive for at least 6 months, and provide at least 4 hours of daily care to person with one or more activity limitations and MMSE<24 • A randomized two-group design • usual care control group (n=65) • Intervention: six occupational therapy sessions & maintenance (n=65) baseline 6 months 12 months Help families modify the environmentto support daily functionof the person with dementia and reduce caregiver burden. one home and three brief telephone sessions to reinforce strategy use and obtain closure

  23. Result • Intervention group • Conclusion • An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year. • More frequent professional contact and ongoing skills training may be necessary to maintain other clinically important outcomes such as reduced upset with behaviors.

  24. Discussion

More Related