Research On The Construction Of Home Care Services And Training Index System For Older Adults With Severe Dementia In Chengdu

Objectives:To investigate the current situation and influencing factors of the life quality of homebound older adults with severe dementia in Chengdu.To explore their requirements for care service,find their most essential and urgent needs,and construct index systems for home care services and training for home caregivers,respectively.To guide the training for home caregivers and provide a reference for improving the quality of home care services for older adults with severe dementia.Methods:1.Literature research method: analyzed the current research on home-care quality for homebound older adults with severe dementia in China and other countries;studied the relevant content concerning the home-care quality for this group of the existing long-term care insurance system in Chengdu;preliminarily determined the theoretical basis of this study and constructed a questionnaire of care service needs for homebound older adults with severe dementia in Chengdu.2.Questionnaire survey method: 2023 homebound older adults with severe dementia were surveyed by the convenient sampling method to investigate their current life quality and care needs,analyze the existing home care problems and determine their requirements for caregiving and training for care providers.3.Delphi method: based on literature review and quantitative research,combined with the results of the joint discussion among the research group members,the draft index systems of home care services and training for older adults with severe dementia in Chengdu were drawn up.After letter inquiries from relevant experts,the final draft was put forward with a summary and analysis of their opinions and suggestions.Results:1.The life quality,which varies according to marital status,education level,disability level of long-term insurance assessment,and years of dementia,of homebound older adults with severe dementia in Chengdu is relatively low.Among the existing care problems for older adults with severe dementia,the top three are choking,falling,and self-injury.The top three difficulties for daily life care are bathing and grooming,dressing and undressing,and excretion.The top three mental and behavioral problems are forgetting the repetition of words and deeds and irritability/emotional instability.The top three needs for essential daily life care services are to assist in grooming,overall cleaning,and partial body cleaning.The top three demands for instrumental daily life care services are washing,cooking and shopping.The top three safety risk prevention needs are choking,falling and skin care.The top three cognitive behavior management services demands are care for forgetting,night behavior problem and repetitive speech or behavior.The top three demands for professional nursing services are basic vital signs monitoring,assisted medication,and blood glucose monitoring.The top three demands for cognitive training services are language ability training,memory training and attention training.The top three demands for functional rehabilitation services are passive joint activities,rolling training and joint active activities.The top three service demands for pleasure activities are assisting outdoor activities,social activities and family activities.Among the providers of home-based care services for older adults with severe dementia,"family caregivers" are the main force.The ideal primary providers for older patients are "home-based," and the hoped place and way to provide care services are "all at home." The lowest frequency of providing home care service is once a month.The top three demands for caregiver training are related disease health guidance,disease-related knowledge,and safety risk prevention.2.After two rounds of correspondence from experts,their opinions on the contents of the project list are consistent.The numbers of experts in two rounds of correspondence were 23 and 21.The response rates of the correspondence questionnaires were 100.00% and 91.30%,respectively;the authority coefficients of correspondence experts were 0.87 and 0.88,and the Kendall harmony coefficients were0.236 and 0.193,respectively(P<0.001).The final draft of home-based care services for older adults with severe dementia in Chengdu includes 6 first-level items and 51second-level items,including basic daily life care,instrumental daily life care,safety risk prevention,mental and behavioral care,professional nursing,and pleasure activity arrangement services.The final draft of the list of home-based caregiver training items includes 7 first-and 47 second-level items,including theoretical knowledge,daily life care,safety risk prevention,cognitive behavior care,professional operational care,pleasure activities,etc.Conclusions:To understand the demand for home care services for the severely retarded elderly in Chengdu,this study conducted a cross-sectional survey.And on this basis,combined with the Delphi method to build the indexes for home care service and home care training for retarded elderly in Chengdu,the results are scientific and systematic.They can guide the work related to home care for the mentally retarded elderly.The training index system of home caregivers includes six aspects: primary daily life care,instrumental daily life care,safety risk prevention,cognitive behavior care,professional care,and pleasure activity arrangement services.The list of home caregiver training items includes seven aspects: theoretical knowledge,daily life care,safety risk prevention,cognitive behavior care,professional operation care,pleasure activities,and other contents.In this study,the index system of home care service and the training index system of home care for the severely mentally retarded elderly in Chengdu are feasible and targeted.The two indexes can guide home caregivers to improve the quality of home care services and protect the rights of the care of older adults with severe dementia.