分析英、美、日、加4个国家的医养结合养老模式,英国为社区照顾模式(分为社区内照顾和由社区照顾2类);美国以机构养老为主的长期照护模式;日本为介护养老模式;加拿大为PRISMA模式.提出我国可借鉴上述国家的思路和经验,整合医疗资源,健全政府主导的多元化服务体系;构建规范化医养服务分级模式;加强监督管理,强化医养服务业法律保障,建立和完善医养智能服务平台,推进特色化老龄事业的发展.

截止到2018年底,我国老龄人口达2.49亿,有失能、半失能老年人4400万[1].随着老龄化日益加重,老年人口比例越来越高,考虑到全国人口年龄分布的变化,老年人被看作是影响今后50年保健服务方式最重要的群体[2].因为养老需求持续增加,所以为老年人提供照护的护理人数稳步上升,逐渐形成了老年保健护士的概念,即不单指老年科护士,还包括从事急救护理、社区护理、门诊服务、长期照护、短期照护、康复护理、家庭保健、姑息护理等工作中,能够满足老年医疗保健需求的护理人员.目前我国尚无老年保健护士的培训和认证体系,老年护理专科护士的培训实践也才刚刚起步,但在庞大的养老服务大军中,老年保健护士无疑是与老年人接触频率最高的医务工作者,她们的发展对患者、家庭、社区及医疗卫生事业均具有深远的影响[3].所以本研究通过美国对老年保健护士态度影响的特征研究,结合我国老年照护工作者培训发展现况,提出影响老年保健护士发展因素的思考,以期为我国老年专科护理教育的发展提供借鉴.

Objective To investigate the test-retest reliability of the scale of postoperative cognitive dysfunction. Methods Fifty healthy elderly people were randomly selected and tested by the scale of postoperative cognitive dysfunction, involving visual verbal learning (VVL), concept shifting task (CST), stroop colour word test (SCWT) and symbol digit substitution coding (SDSC). After the first test (T1), they were tested three days (T2) and seven days (T3) later. The test results were recorded each time and the test-retest reliability was calculated. Results Compared with T1, the scores of VVL and SDSC on T2 and T3 were increased, but the scores of SCWT were decreased, and there were no significant changes in CST. The split half reliability of two parts of the total scale was greater than 0.5. The test-retest reliability of VVL, SDSC and SCWT was high (r=0.564-0.951,P<0.01). The test-retest reliability of the time part in CST was high (r=0.725-0.779,P<0.01), but was low in the number of errors in CST (r=0.000-0.316,P>0.05). Conclusion The measurement scale of postoperative cognitive dysfunction has some learning effects, and the test-retest reliability is high, so it can be used to evaluate postoperative cognitive dysfunction.