香港心理衞生期刊 三十八卷 第一期 二０一二年夏 Hong Kong Journal of Mental Health Volume 38 No.1 Summer 2012
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Prevention of Mental Disorders in late life - Perspectives from Hong Kong
Helen F K Chiu Department of Psychiatry, The Chinese University of Hong Kong Joshua M Y Tsoh Prince of Wales Hospital and Shatin Hospital S W Li Castle Peak Hospital |
Abstract
| In the last few decades, there have been significant advances in the path of prevention in some medical illnesses. Of note are some of the achievements of medicine in the field of infectious diseases, perinatal mortality and cardiovascular diseases in the developed countries. Apart from scientific advances in the etiology and treatment of the diseases and new technology, a focus on prevention and raising public awareness are some important factors associated with the downward trends of the afore-mentioned diseases (Beekman et al, 2010). In contrast, prevention of mental disorders is a young field (Beekman et al, 2010) , but fortunately, a growing field. In this paper, prevention of dementia, depression and suicide in late life will be discussed, in the context of Hong Kong. In Psychiatry, primary prevention means preventing the disease from occurring, i.e. reducing the incidence of a disease. Secondary prevention means early detection and screening, so it can lead to reduction of the prevalence of a disease. Tertiary prevention means preventing relapse or reducing dysfunction (Koplan et al, 2007). |
摘要
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香港地區的生命末期精神疾病之預防 在過去幾十年裏，一些疾病的預防得到了 長足的發展，比較有代表性的成就如，在 發達國家，傳染性疾病、圍產期死亡率、 心血管疾病的預防。除了在疾病的病因 學、治療學、新技術方面的進展外，主要 集中于對這些疾病發生有關的重要因素的 預防和引起公眾的關注。相比之下，精神 疾病的預防起步較晚，但幸運的是這是一 個新興領域。本文章，將對香港地區的癡 呆症、抑鬱症、生命末期自殺傾向的預防 進行討論。在精神病學領域，初級預防意 味著預防疾病的發生，如減少疾病的發 生；二級預防即早期發現和篩查，進而減 緩疾病的發展；三級預防即預防疾病的復 發和身體機能的減退。 |
Keywords
| Prevention, mental disorders in late life |
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Caring for Older People in Australia: Policy Challenges and Opportunities
Helen Bartlett
Monash University, Australia
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Abstract
| As the Australian population ages in line with other westernised countries, the health care needs of older people are becoming increasingly complex, with a growing emphasis on self-care management in diverse community settings. These changing needs have important implications for future care models and workforce planning. Policy attention is currently focused in Australia on exploring ways in which access to care and support can be improved for all older Australians, with ageing in place a clear policy goal where possible. While new solutions are sought to meet the needs of this growing older population, the current and potential contribution of nursing should be carefully considered. This paper explores some of the key challenges in community and aged care delivery in Australia, including the current issues experienced by the nursing profession in its contribution to aged care in this changing environment. While there are some examples of good practice and innovation, making this field of nursing more attractive is still a major challenge. The agenda for change is explored, along with the skills required for a new era in community and aged care nursing which prepares nurses for an enhanced scope of practice, greater collaborative working with clients and other care professionals, and improved career pathways. |
摘要
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為澳洲長者提供的照顧：政策挑戰及機會 澳洲跟其他西方國家同樣面對人口老化問題，長者的健康照顧需要變得愈來愈複雜，其中在多元社會環境下的個人護理管理更得到特別關注，這些改變需要對未來的護理模式及人手編排有很重要的影響。近來澳洲在政策制定上，注重如何令到長者的護理服務及支援得到改善，護理專業在這方面的幫助是不容忽視。這篇文章會探討澳洲在社區提供長者服務所面對的主要挑戰，包括護理專業人員在這個轉變環境中所作出的貢獻。當有一些良好的做法及創新意念出現後，如何令護理界更具吸引力仍然一項主要挑戰。由於改變的議題已產生，所需的長者服務新技能亦要相應配合，護理界需要增強訓練範圍，提升與病人及其他護理專業的合作，和改善事業發展的機會。 |
Keywords
| Ageing, Australia, policy |
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Healthy Ageing – Singapore’s Perspective
Y L Chow Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore |
Abstract
| Due to better health care and improved living conditions, people are living longer. It is a well-known fact that the world population is ageing fast although not at the same rate, some countries faster than others. Although a phenomenon worth celebrating, it is not without its challenges. Ageing population impacts on the socioeconomic, health and policy direction of a given country. In anticipation, some countries have put in place strategies to meet these challenges. This paper aims to examine the concept and dimensions of healthy ageing and measures taken to enable its ageing population to age in place in the Singapore context. |
摘要
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健康晚年 – 新加坡的情況 由於衞生護理及生活環境逐步改良，人類的壽命愈來愈長。全球的人口正在快速老化，個別國家的情況更見急速。雖然這個現象值得慶賀，但並非沒有為我們帶來挑戰。人口老化對一個國家的社會經濟、衛生及政策方向均有影響，有些國家會制定策略以面對這些挑戰。這篇文章會研究健康晚年的概念及範圍，及新加坡在這方面施行的措施。 |
Keywords
| Healthy ageing, physical activity, diets, mental health. |
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Integrated health and social care for people with mental illness in Hong Kong – Who will lead us into the future?
Claudia K Y Lai School of Nursing, The Hong Kong Polytechnic University |
Abstract
| People and especially older people with mental illness have complex healthcare needs. Globally, the basic tenet that mentally ill patients need to be supported by an integrated health and social model of care for rehabilitation is upheld by various advanced countries. Documentation from the Legislative Council of the Hong Kong Government shows that our Administration also adopts this position. More often than not in Hong Kong, the discipline of social work may seem to equate to case management in community care. Nursing has been advocating holistic care for those under our care. Within the framework of promoting a better integration model of health and social care, could this be the time for nurses to consider how we could take the lead in instigating changes? This paper attempts to discuss the worldwide trend of health and medical care integration in the community care of mentally ill patients and their families. Hong Kong is behind in terms of this development in community mental health care. Nurses need to play a more proactive role in facilitating changes for the future. |
摘要
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為香港精神病患者提供綜合健康和社區護理 ﹣由誰引導我們步進未來？ 精神病患者，尤其是老年精神病患者，有複雜的醫療保健需求。很多先進國家都以一個綜合醫療和社區康復護理的模式為支援精神病患者的服務發展原則。從立法會文件中顯示，香港政府也採用了這一種立場。在本港，社區護理的個案經理一般均是社會工作者。護理專業一直提倡全人護理，在推行整合醫療和社區康復護理模式的框架下，現在正好讓我們思考護士如何能夠帶領改變。本文討論精神病患者和家屬的社區綜合醫療和保健服務發展的全球趨勢。香港正在朝著建立一個綜合醫療和社區康復護理的服務發展，護士需要承擔更主動的倡導者角色去推動日後的轉變。 |
Keywords
| Community, mental health nursing, case management, mental health policy |
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Satisfaction of patients towards the elderly suicide prevention programme of the Castle Peak Hospital and their attitude towards medical treatment for their depressive illnesses
Mimi M C Wong S W Li C F Chan Y M Lau Castle Peak Hospital |
Abstract
| Objectives: This study aims to explore how patients perceived the Elderly Suicide Prevention Programme of the Castle Peak Hospital and to examine their attitude towards their medical treatment in order to facilitate further improvement of service and to improve their medication adherence. Participants and Methods: Focus group interviews were conducted. Data collected were sorted and analysed and relevant themes were generated from each focus group. Findings: Twenty seven participants attended the focus groups. All of them found the programme effective in the treatment of their illness and they were satisfied with the service. Among all the factors, the short waiting time, helpful attitude of staff, regular home visits and medication treatment were most appreciated. They would like home visits to be continued even after they had recovered. Most of them were aware of the importance of medical treatment after receiving psychoeducation from the team members. Conclusion: This qualitative study provides evidence on the effectiveness of the Elderly Suicide Prevention Programme. Although this intensive community support involves a significant amount of manpower and resources, it is worthwhile as the service is perceived by the patients to be an important contributing factor towards their recovery. |
摘要
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青山醫院病人對預防長者自殺計劃的滿意程度及他們對藥物治療的態度 老人精神科速治服務自二零零二年成立以來，為有自殺傾向的長者提供快捷和適當的診斷和治療。青山醫院乃其中提供此服務的醫院，在二零零二至二零一零年間，一共醫治了一千零九十七名長者。我們邀請了其中二十七名接受老人精神科速治服務的長者參與焦點小組，希望了解他們對服務的滿意程度，以及他們對藥物治療的態度，從而繼續提高服務質素。結果發現每一位受訪者都滿意我們的服務。他們最滿意的，是新症輪候時間短、工作人員熱心的服務態度、家訪以及有效的藥物治療。他們更希望病情好轉後仍能繼續安排家訪。經過醫護人員的講解後，大部分長者都明白藥物治療的重要性。這質性研究肯定了老人精神科速治服務對病人的幫助。雖然密集的社區支援，如家訪是需要額外的人力資源。但由於它在病人心目中相當重要，我們應盡量安排這類型服務以協助他們盡早康復。 |
Keywords
| Focus group, Elderly, Depression, Suicide prevention |
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Functional activity and depression in elderly people over 70 years of age visiting Accident and Emergency Departments
Kristiina Kariniemi-Ormala Katri Venviläinen-Julkunen Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland |
Abstract
| Purpose: The purpose of this study was to investigate the functional home activity and depression incidence in the elderly people (over 70 years of age) after an Accident and Emergency Department visit. It is well known that elderly people commonly use emergency services; however, elderly patients have been less studied in acute care settings than other age groups. Sample and materials: Data were collected by interviewing 141 elderly people aged 70 years and older from one university hospital district in Finland and by analysing the person’s medical records. The interview included the Lawton Instrumental Activities of Daily Living, Social Activity Measures and the Geriatric Depression Scale. Results: Elderly people 70 years and older who were living at home had predominantly independent activities of daily living statuses, and their self-reported ability to manage their life was good despite their functional characteristics. However, unidentified depression, continuous melancholy and the lack of assistance in activities of daily living were identified problems for this group of elderly people. Conclusions: In acute care settings, it is of utmost importance for advanced nursing practitioners to pay attention to elderly patients’ ability to function at home and to identify depression symptoms in these patients. It is a challenge for care continuity, to empower elderly people and recognise these common threats to their ability to manage at home. |
摘要
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超過七十歲的長者使用意外及急症部門後的機能活動及抑鬱症 目的：調查長者（超過七十歲）使用意外及急症部門之後的機能家居活動及的抑鬱事件。雖然長者經常使用急症服務，但是年老病人於急性照顧環境下的研究較其他年齡組別為少。 |
Keywords
Activities of daily living, Depression, Elderly people, Interview, Social activity
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Characteristics of Mental Patients with High Fall Risk and the use of Fall Assessment Tool in a Mental Hospital
Mimi M C Wong K W Wu Castle Peak Hospital |
Abstract
| Background: The Morse Fall Scale was used to assess the risk of fall of patients in Castle Peak Hospital since 2011. Participants and Methods: A comparison between the previous and new assessment scales was conducted to assess their agreeability if they were performed on the same patient at the same time. Results: Seven hundred thirty two in-patients were involved. Forty-six patients were identified to have high fall risk (26 by both tools, 19 by the Fall Risk Predictive Factors Assessment only and one by the Morse Fall Scale only). The commonest risk factor for fall was their overestimation of their ability, followed by the presence of more than one active diagnosis as well as the need for medications which would increase their fall risk. Conclusion: There is a need to follow up the number of fall incidents in the hospital after the change in the fall assessment tool. |
摘要
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精神病人跌倒高危險因子的特徵及評估量表的運用 青山醫院自2011年起轉用了一個新的病人跌倒高危險因子評估量表。這個研究為舊及新的量表作出比較。共有732名住院病人參加了這研究。當中有46名病人被視為有高跌倒風險（26名病人被兩個量表視為有高風險、另外19名病人只被舊的量表視為有高風險、1名病人則只被新的量表視為有高風險）。精神病人最常見的跌倒高危險因子包括高估了自己的能力、患有多過一個疾病、以及需要服用藥物。由於新舊量表有明顯分別，醫院有需要繼續跟進自轉換量表後病人跌倒的數目。 |
Keywords
| Fall assessment, mental hospital |
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Family-Centred Care for Children and Youth with Mental Health Needs: The Case of Anorexia Nervosa
Prof. Joyce L C Ma
Professor and Chairperson
Department of Social Work
The Chinese University of Hong Kong
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| Transcript of the presentation at the 13th T.P. Khoo Memorial Lecture of the Mental Health Association of Hong Kong delivered on 8th December 2011. |
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