Research On Social Support System Of Elders With Dementia In Shanghai

1. Systematically review the current situation of social support system of elders with senile dementia2. Study and develop social support system of elders with senile dementia in Shanghai3. estimates and recommendations of social support system of elders with senile on the operational level.First, systematically evaluate the condition of elders with dementia and their social support system through literature analysis. Meantime, Get knowledge of the current condition for demands of elders with senile dementia and institution service on the demands in Shanghai through the stratified random cluster sampling method and investigation to institutions.Furthermore, according to the existing social support system, combining with the characteristics of patients with dementia, develop social support system framework. Trough the literature analysis and field investigations broadly collect the existing typical care pattern under the different level of the framework, then develop the care patterns and enrich the connotation of the framework. Based on the framework and typical care pattern, the research group launched a demand-side argument and Delphi discussion by experts to ensure the results being scientific, rational and workable and to optimize results. On that basis, clear the framework for the service pack. According to literature analysis, typical institution investigation, insider interviews to get collection of a broad list of services and combing with expert services demonstration project to create an operational basic services package for senile dementia care. Finally, using sensitivity analysis, Formatting different assumptions according to the different levels of community service and estimating appropriate staffing and labor costs to format policy recommendations for the social support system and provide the basis for decision makers.(1) there is not yet a clear medical cause, nor an effective treatment for senile dementia. There is no specific study area for senile dementia, no adequate or in-depth social support system.(2) The sample survey contains a total of 15 158 elderly people over age 65 at three streets in Shanghai and finally diagnose of 1271 cases of senile dementia. The survey showed the crude dementia rate was 8.1% for people over age 65,9.9% over 70 years old,12.9% over 75 years old,18.3% over 80 years old. Based on the standard population age structure at the end of 2008 in Shanghai, the age standardized prevalence rates were 6.1%,8.8%,12.9% and 19.4%.(3) NPI test results show that: there are 620 cases with NPI total score of 0 points,406 cases with clinically significant symptoms and 238 cases between the two. The several composition of the elderly are:I grade mild 49.05%, II grade moderate 18.83% andâ…¢grade severe 32.12%.(4) There are 4757 cases of elder with senile dementia in 339 out 513 of pension institutions and 5215 cases in 197 health care institutions. According to a rough projection of the survey data, Shanghai has 170,000 patients with dementia, of which 50,000 people have serious psychiatric symptoms. This shows the supply and demand contradiction of care in Shanghai.(1) The social support frame system including: home care which is a combination of social and family care approach; community care which refers to community day-care services; Rest home care which mainly provides life care at centralized boarding; medical institution care which mainly provides medical care at centralized boarding.(2) Delphi method showed that: the activeness coefficient of Delphi experts is more than 80%, which shows the expert support and concern to this study; the authority coefficient of 0.59, which indicates the results of expert advice is authoritative; the variation coefficient is greater than 0.25 for small part in the first round and in the second round all is less than 0.25, which indicates the convergence of the second round of expert opinion. After two rounds, the co-ordination coefficient are 0.15,0.18 and 0.17 (all with P<0.05) for system framework, principles of and care pattern, which shows expert evaluation results are reliable.(1) The supporting facilities, assistant materials, dominant service and hidden services constitute. Economic support, life care, health maintenance and spiritual comfort constitute the second level elements. The two together constitute the framework of the package services for the elder with dementia.(2) On above basis, combining the practice, format a service pack containing home care, community care, rest home care and medical institution care.(1) It is estimated that there are totaling 170,372 cases of patients with dementia in Shanghai. The component according to severity is:I grade mild with 83,567 cases, II grade moderate with 32,081 cases and III grade severe with 54,723 cases.(2) The basic care cost under the lowest conditions:home care needs 34,611 home nursing workers,115 management personnel,93 psychiatrists,93 general practitioners,93 rehabilitation physicians,279 nurses, with total labor costs more than 50 million Yuan; community care needs 401 psychiatrists,401 physicians,3,208 crew and 401 management personnel, with total labor costs nearly 7 million Yuan; rest home care needs 18,240 nursing workers,274 doctors including 91 psychiatrists,274 nurses,912 logistics personnel and 274 management personnel, with total labor costs about 30 million Yuan; medical institution care needs 7,285 doctors,14,570 nurses,7,285 other health technicians,11,902 administrative and support service personnel, with total labor cost about 150 million Yuan.(3) For per person per month human cost, the highest is medical institution care, up to 5,334 Yuan per person per Month, followed by the rest home care, community care. Home care has the lowest 212 Yuan per person per month.(1) Shanghai has high incidence rate of senile dementia and prevalence is severe. The current condition of service is strait and building social support system for the elderly dementia is necessary and urgent.(2) Social Support System, not only to ensure that dementia sufferers access to basic and appropriate services, but also can liberate family care givers to enable them to develop their potential, achieve their personal values and create benefits for society.(3) Suggestions for construction of the social service system: government leading; community participating; completing series matching system; enriching the care giver team; combing volunteer service with low compensation payment; promoting demand-side to seek community help; safeguarding the rights of dementia sufferers to achieve equal rights and obligations; formatting specialized dementia care resources based the existing pension system, designing at overall level and progressing steadily.