山西省老年痴呆疾病影响因素分析及卫生服务研究
|
摘要
研究背景：
老年痴呆是继肿瘤、心脏病、脑血管病之后引起老年人死亡的第四大病因。全世界目前约有3600万人正在遭受老年痴呆疾病的折磨,并且以每7秒钟新增—名患者的速度递增。中国现有老年痴呆患者约600-800万人,约占世界老年痴呆疾病患者总数的1/4。老年痴呆疾病的经济负担在过去的25年中增长了76%。随着中国经济的发展,人口老龄化发展迅速,空巢老人越来越多,老年痴呆疾病患者不断增加,给社会发展、经济发展,患者家庭、本人等都带来了巨大的压力。但目前大多数人仍然把老年痴呆疾病的最初症状认为是衰老的必然表现,缺乏对老年痴呆疾病的认识和重视；社会能够提供专业服务的医护人员和研究人员很少；针对老年痴呆疾病的相关教育、研究、卫生服务的资金投入比例低；针对老年痴呆疾病的卫生服务政策和社会保障体系不健全。本课题调查山西省老年痴呆疾病流行现状,分析其影响因素,为制定老年痴呆疾病卫生服务政策提出可行性建议具有重要意义。
研究目的：
1.初步了解山西省老年痴呆疾病经济负担情况；
2.进行老年痴呆流行病学调查,并探索可能的危险因素,建立基础本地资料；
3.分析空巢期老年人与老年痴呆疾病患病率的关系；
4.分析老年痴呆疾病与老年人死亡原因的关系；
5.为政府规划老年精神卫生服务和制定城乡社区干预和预防措施提供科学依据和可行性建议。
研究对象和方法：
老年痴呆疾病经济负担研究对象为太原市中心医院2009年～2010年精神卫生科住院AD病例共29例,其中女22例,男7例；随机选取精神卫生科非AD老年病例共10例,其中男4例,女6例。老年痴呆流行病学调查分别在2008年8月、2009年5月、2011年7月进行。研究对象为山西省晋中市康乐社区和晋中市庄子乡60岁以上老年人(1948年6月30日前出生)。2008年8月为老年痴呆疾病患者筛查；2009年第一次回访,做老年痴呆疾病影响因素调查,共调查1124例,获有效例数1029例。2011年7月,进行第二次回访,在原调查人群中进行老年人死因分析,获得有效问卷909份。
自制山西省老年痴呆疾病患者经济负担调查问卷；用伤残调整寿命年(Disability Adjusted Life Years, DALYs)来初步测算老年痴呆疾病的经济负担。使用老年精神状况量表(Geriatric Mental State Schedule, GMS)、老年健康状况MDS (Minimum Data Set)和相关因素调查量表、老年健康状况认知测验调查表、老年躯体和神经系统检查表、知情人问卷,利用规范的整群抽样方法,在自然人群中获取研究样本,对调查对象以及其“知情人”的情况进行系统地、全面地调查分析。使用与GMS相配套的计算机诊断系统(Automated Geriatric Examination for Computer Assisted Taxonomy AGECAT)作为老年痴呆诊断工具；运用EpiData3.1录入MDS危险因素调查表数据；使用SPSS13.0统计软件分析,主要用描述性分析、卡方检验,非条件logistic回归等方法,了解性别、年龄、婚姻状况等与疾病的关系；躯体疾病、兴趣爱好等与老年痴呆的关系,进行老年痴呆疾病危险因素探讨。
老年痴呆疾病患者的死亡分析部分由调查者利用VA (Verbal Autopsy)量表入户对死者临终患病情况的知情人进行访谈。
结果与讨论：
1.老年痴呆疾病经济负担：老年痴呆患者的治疗过程中的直接费用比对照组高出近3倍,且损失的伤残调整寿命年要高于对照组,提示山西省的老年痴呆疾病经济负担较高。
2.老年痴呆患病率：山西省老年痴呆疾病的患病率为3.7%(城市老年痴呆疾病患病率为1.6%,农村老年痴呆患病率为5.8%),农村老年人口的痴呆患病率显著高于城市老年人,约是城市老年人白痴呆患病率的3倍。
3.老年痴呆疾病影响因素：单因素分析结果显示：人口基本特征力方面,不同年龄、地区、职业、文化程度的老年痴呆疾病患病率有统计学差异。其中:60-69岁年龄段痴呆患病率为2.0%,70-79岁年龄段为2.5%,而大于等于80岁年龄段的患病率为13.6%,经趋势χ2检验,随着年龄升高,老年痴呆的患病率越来越高(χ2=20.671,P<0.001)；从地域来看,农村患病率(5.8%)要显著高于城市(1.6%)(χ2=12.743,P<0.001)；从职业分布角度分析,农民和家庭主妇的痴呆患病率较高,分别为4.9%和6.8%(Fisher确切概率P=0.003)；从文化程度看,痴呆患者主要分布在文盲、小学及初中文化程度的人群,其患病率分别为8.2%,1.6%和1.7%(Fisher确切概率P=0.000)。女性的患病率虽然高于男性,但是统计学检验并没有发现有意义,分析原因可能与其他因素有关,如女性人群平均寿命较长,文盲比例相对较高等。不吸烟组老年痴呆疾病患病率高于吸烟组老人(不吸烟4.8%,吸烟2.4%,χ2=4.203,P=0.040),说明吸烟是老年痴呆疾病的保护因素,饮酒和不饮酒组老年痴呆疾病患病率的差异无统计学意义。在兴趣爱好方面,经常参加体育锻炼的老人痴呆的患病率(0.5%)低于不常锻炼的老人(4.1%),提示体育锻炼是老年痴呆患病率的保护因素(z2=6.676,P=0.010)。
本研究结果显示,听力有问题的老年痴呆疾病患病率为7.1%,听力正常者的患病率为2.9%,提示听力可能与老年痴呆患病率有关(校症χ2=4.764,P=0.029)；有肾脏病的老年痴呆患病率为12.5%,没有肾脏病的患病率为3.2%,肾脏病与老年痴呆患病率有关(Fisher确切概率法P=0.028)。单因素分析结果显示,是否患有高血压与老年痴呆疾病的患病率差异无统计学意义。分析产生的可能原因有：在目前中国农村社区,老年人连最基本的血压控制都没有,许多人患高血压而未被发现、治疗。另外如现场测量的血压也不是非常准确,调查过程中老人可能会因为面对陌生人而血压升高,或者其他的一些影响因素从而使得所测的血压不准。在这种情况下,需要通过进一步的调查研究来发现高血压和其他的一些心血管疾病患病的情况与老年痴呆疾病的关系。
在本次研究中,运用ADL量表对老年人进行生活自理能力评分,根据综合得分划分为三个等级：无依赖、部分依赖和完全依赖。经单因素分析发现,老年人的生活自理能力与与老年痴呆疾病患病率之间关系显著,并且随着老年人生活依赖性的增强,老年痴呆患病率有逐渐增加的趋势,提示老年人的生活自理能力的高低对老年痴呆疾病有一定影响,但是亦不排除老年痴呆患者山于痴呆疾病而导致生活自理能力退化这一现象对数据信息的影响,即二者之间的影响可能是相互的。
多因素logistic回归分析结果显示：70-79岁老年人患老年痴呆的风险与60-69岁组相比尚不能认为有差别,而80岁以上老年人患痴呆的风险显著增加。在其它变量固定的条件下,80岁以上组患痴呆的概率是60-69岁组的8.17倍；在其它变量固定情况下,农村老年人患痴呆的风险要比城市老年人患痴呆的概率高4.833倍；生活自理能力也影响老年人痴呆症的患病率,研究发现不能独立生活的老人患痴呆症的危险性是能够独立生活的老人的2.058倍,由于样本量的限制,未对生活自理能力设置哑变量,因此,无法通过Logistic回归模型分析不同等级生活自理能力对老年痴呆患病率的影响；听力障碍是老年痴呆疾病的危险因素,研究结果表明,听力障碍老人,痴呆疾病的患病率是无听力障碍老人的2.568倍；邻居朋友的支持是老年痴呆疾病的保护因素,经常与邻居朋友交往的老年人痴呆疾病患病率比不经常交流的老人低0.738倍。
4.空巢期老年人与老年痴呆疾病患病率的关系：
本次调查结果显示：处于空巢期的老人有624人,占调查总人数的60.7%,其中女性317人,占59.6%；男性307人,占61.9%。城市处于空巢期的老年人占73.5%,农村处于空巢期的老年人占48.2%,处于空巢期的城市老年人多于农村老年人。在四种生活状态的研究中得到：处于鳏寡期(独居)的城市老年人占9.6%,农村老年人占11.9%,农村的鳏寡期老人更多；相比城市,单纯与配偶居住的农村老人较少,为36.3%,与配偶和子女共同居住的农村老人更多,占36.2%。丧偶或离异后与子女居住的农村老人较城市多。
处于鳏寡期(独居)的老人痴呆疾病患病率为4.6%,高于非鳏寡期老人的痴呆疾病患病率(3.6%)。通过对四种生活状态的老年痴呆患病率比较发现：与配偶居住的老年人和与配偶和子女共同居住的老年人的痴呆患病率要低于鳏寡期(独居)的老人和与子女居住的老人,说明配偶这一因素是老年痴呆患病率的保护因素。而本研究表明：空巢不仅会引发老年人的生活质量下降,自理能力降低,甚至会带来孤寂、抑郁等问题,同时也是引发老年痴呆疾病的危险因素之一。要进行老年痴呆疾病的预防干预工作,解决老年人空巢问题及空巢带来的一系列精神、生活和社会问题则成为至关重要的一个环节。
5.老年痴呆患者死亡分析
本次调查发现,老年痴呆患者的死亡率(42.1%)远远高于非痴呆老年人(8.6%),提示痴呆是加速老年人死亡进程的危险因素。对痴呆患者进行死因分析,并结合访谈记录,得出如下结论：(1)由于痴呆疾病的疾病经济负担较高,导致照顾者经济、精神、身体的三重疲惫,出现对痴呆老人照顾不周的情况而使老人意外死亡；(2)痴呆老人的生活自理能力减退,活动范围日渐缩小,逐渐导致身体器官功能退化甚至病变；(3)10%的痴呆疾病患者是由抑郁症患者转化而来的,可能在患抑郁症期间,由于其精神状态的影响,健康状况已经受到侵蚀,再受上述两个因素的影响,很容易导致疾病的发生,进而甚至因该疾病而死亡。综上所述,老年痴呆疾病所带来社会、家庭负面效应是不可忽视的,要想有效预防老年痴呆,必须找到关键的影响因素对其干预,方可见成效。
Background
Following the heart disease, cancer, and stroke, Alzheimer is becoming the fourth leading cause of death among the elderly. In the World Alzheimer Report2009, ADI estimated that36million people worldwide are living with Senile Dementia (or Alzheimer Disease, AD), with one new case every seven seconds. The economic burden of dementia has increased76%in the past25years. The aging process of China's society is accelerating, and the problem will get even worse. The incidence rate of dementia will increase by above100%in the coming20years. Dementia brings overwhelming disease burden to the patients, families and the country as well. The name of "Dementia" is not new to most Chinese people, but few of them really know about it. The majority regards it as a part of normal aging, and does not understand the progressive pathological changes from incubation to onset. Many people do not have any knowledge about how to prevent or treat, nor about how to take care of patients. Other problems include that limited medical facilities, limited medical caregivers, lack of capital investment, and so on. Thus, it is important and meaningful for putting forward suggestion to investigate and analyze the status quo, the economic burden of senile dementia.
Objectives
In this study, the economic burden of dementia in Shanxi province was learned and analyzed; The epidemiological survey was earned out to collect the epidemic data about dementia in Shanxi province and to explore the potential risk factors which influence the dementia's development; The relevance of empty nest elderly people and the dementia's morbidity was analyzed; The elderly's cause of death was analyzed, especially the dementia patients. Therefore, scientific basis was provided for the government and policy-maker to make proper plans of mental health service for elderly people and to establish intervention and prevention measures of dementia for the urban communities and rural counties in Shanxi.
Subjects and methods
Subjects:
The subjects include two parts:For analyzing the economic burden of dementia,29dementia inpatients was selected form2009-2010in the Mental Health Department of Taiyuan central Hospital, including22females and7males; And another10non-dementia inpatients in the same department were selected too, including4males and6females.
The epidemiological survey of dementia was carried out in August2008, May2009and July2011respectively. The elderly people (Born before30, June,1948) who live in Kangle District and Zhuangzi County in Jinzhong City were surveyed as the subjects. First, the dementia patients were screened in2008; Second, the impact factors were analyzed in2009,1124cases were surveyed and1029effective cases were obtained; Third, the elderly's death causes were surveyed within the former group in2011, and909effective cases were obtained.
Methods:
By using self-made Economic Burden Questionnaire of AD, the data were collected, and the Disability Adjusted Life Years-DALYs was applied to measure the economic burden of dementia in Shanxi province preliminarily.
The Geriatric Mental State Schedule (GMS) was introduced in Shanxi province, which was created by the Professor Copland in Geriatric Mental State Resource Centre of Liverpool University, and combined with other scales to analyze the mental status of elderly people. By clustering sampling, and using the above scales, the subjects were surveyed systematically and comprehensively. By using the Automated Geriatric Examination for Computer Assisted Taxonomy-AGECAT computer diagnostic system, the elderly's mental status was classified. The data which were input in the computer using EpiData3.1, were then analyzed by SPSS13.0software. The methods, such as descriptive analysis, chi-square test, unconditioned Logistic regression analysis, were used to study the relevance between factors (age, gender, martial status, physical disease, interests and so on) and the dementia.
By using VA (Verbal Autopsy) tool, the door-to-door interviews of the dead's informant were conducted. Usually the spouse, children or other direct relatives of the dead, who take care of him/her at least in the last month, were chosen as the informant. Then the specific death causes were identified by the physician according to the VA tool and were classified and coded in line with the ICD (international classification of diseases)
Findings and discussion
1. The economic burden of dementia in Shanxi:The direct cost of dementia patients during the treatment is3times higher than the control group, and the DALYS is higher than the control group.
2. The prevalence of dementia:According to this study, the prevalence of dementia in Shanxi urban community and rural county is3.7%(with urban community1.6%, and rural county5.8%).The prevalence of dementia in rural counties is almost3times higher than in the urban communities.
3. Risk factors of Dementia:Single factor analysis indicates that statistical significance was found between different ages, regions, professions and education levels. The prevalence rate is2.0%,2.5%,13.6%for age group60-69,70-79, and80or above, respectively. According to the trend X2analysis, the elder the people, the higher the prevalence rate of dementia (X2=20.671,P<0.001); The prevalence rate in rural counties (5.8%) is higher than in the urban communities (1.6%)(X2=12.743,P<0.001), and it is higher in farmers (4.9%) and housewives (6.8%)(Fisher exact probability, P=0.003); Moreover, the dementia patients were more likely to be found in illiterate people (8.2%) or people completed primary education (1.6%) or junior secondary education (1.7%)(Fisher exact probability,P=0.000).The prevalence of dementia in females is higher than in males, but the difference is not significant because of other factors influence. And it needs to be further investigated. The prevalence of dementia in on-smokers is higher than in smokers (non-smoker4.8%, smoker2.4%,X2=4.203, P=0.040), so smoke is a protective factor. There is no significant difference in drink and non-drink people. The study also found that the prevalence of dementia in elderly people who take exercise frequently is lower than those who seldom do(4.1%), so taking exercise is a protective factor for dementia (X2=6.676, P=0.010).
This study shows that the dementia's prevalence rate of the elders with hearing problems (7.1%) is higher than those without hearing problems(2.9%); The dementia's prevalence rate of elders with kidney disease (12.5%) is higher than those without the disease (3.2%)(Fisher exact probability, P=0.028)。 Moreover, the correlation between the dementia and the elder's performance state was analyzed by using the ADL scale. It found out that the more dependent the elder's become, the higher the dementia's prevalence rate.
In the analysis of multi-factor regression, it shows that aging is the risk factor. People aged above80possess higher prevalence rate. And the prevalence rate in people live in rural counties is4.833times higher than those live in urban communities. The dependent elder is (2.058times) more likely to develop the dementia than the independent elders. The elder with hearing problems is (2.568times) more likely to develop the dementia than those without. While the support from neighbours is a protect factor for dementia. The elders who like to communicate with friends or neighbours are less likely to develop dementia.
4. The correlation between empty nest elderly and dementia:In this study, there are624empty nest elderly people, which accounts for60.7%of the total1029effective cases. And within them,317are females, occupying59.6%; while307are males, occupying61.9%. There are more empty nest elderly people in urban communities (73.5%) than in rural counties (48.2%). After the study of four living conditions of elderly people, it is found that there are more widowed or single living elderly people in rural counties (11.9%) than in urban communities (9.6%). Comparing with the urban communities, there are more elderly people live with their spouse and children together (36.2%), while less elderly people live with spouse (36.3%).The study indicates that spouse is a protective factor for dementia. The prevalence of dementia in widowed or single living elderly people (4.6%) is higher than in those non-widowed people (3.6). The prevalence of dementia in people who live with their spouse and children together is lower than in people who live by their own or live with spouse.
The study also states that "empty nest" would not only impact the elderly's quality of life, lower their self-care capacity, lead to loneliness and depression, but also is a risk factor for dementia. It is crucial to solve the empty nest problem and improve the prevention working of dementia.
5. Analysis on death causes of dementia patients
This study demonstrated that the dementia is a risk factor of accelerating the death process, and the death rate of dementia patients (42.1%) is much higher than that of non-dementia ones (8.6%). The following conclusions were made:First, the heavy disease burden of dementia leads to the exhaustion of the caregivers, both physically and psychologically. And the patients died accidentally due to lack of satisfactory care. Second, the dementia patients'self-care skills is poor, and the activity's range is restricted which gradually lead to the degeneration of organ function. Third, there is10%dementia patients were converted from depression patients. The depression patients suffered mentally and physically, and eventually developed to dementia and death. In short, dementia brings severely negative impacts to the society and families. The key impact factors must be found and be effectively prevented and intervened to face the disease.
老年痴呆是继肿瘤、心脏病、脑血管病之后引起老年人死亡的第四大病因。全世界目前约有3600万人正在遭受老年痴呆疾病的折磨,并且以每7秒钟新增—名患者的速度递增。中国现有老年痴呆患者约600-800万人,约占世界老年痴呆疾病患者总数的1/4。老年痴呆疾病的经济负担在过去的25年中增长了76%。随着中国经济的发展,人口老龄化发展迅速,空巢老人越来越多,老年痴呆疾病患者不断增加,给社会发展、经济发展,患者家庭、本人等都带来了巨大的压力。但目前大多数人仍然把老年痴呆疾病的最初症状认为是衰老的必然表现,缺乏对老年痴呆疾病的认识和重视；社会能够提供专业服务的医护人员和研究人员很少；针对老年痴呆疾病的相关教育、研究、卫生服务的资金投入比例低；针对老年痴呆疾病的卫生服务政策和社会保障体系不健全。本课题调查山西省老年痴呆疾病流行现状,分析其影响因素,为制定老年痴呆疾病卫生服务政策提出可行性建议具有重要意义。
研究目的：
1.初步了解山西省老年痴呆疾病经济负担情况；
2.进行老年痴呆流行病学调查,并探索可能的危险因素,建立基础本地资料；
3.分析空巢期老年人与老年痴呆疾病患病率的关系；
4.分析老年痴呆疾病与老年人死亡原因的关系；
5.为政府规划老年精神卫生服务和制定城乡社区干预和预防措施提供科学依据和可行性建议。
研究对象和方法：
老年痴呆疾病经济负担研究对象为太原市中心医院2009年～2010年精神卫生科住院AD病例共29例,其中女22例,男7例；随机选取精神卫生科非AD老年病例共10例,其中男4例,女6例。老年痴呆流行病学调查分别在2008年8月、2009年5月、2011年7月进行。研究对象为山西省晋中市康乐社区和晋中市庄子乡60岁以上老年人(1948年6月30日前出生)。2008年8月为老年痴呆疾病患者筛查；2009年第一次回访,做老年痴呆疾病影响因素调查,共调查1124例,获有效例数1029例。2011年7月,进行第二次回访,在原调查人群中进行老年人死因分析,获得有效问卷909份。
自制山西省老年痴呆疾病患者经济负担调查问卷；用伤残调整寿命年(Disability Adjusted Life Years, DALYs)来初步测算老年痴呆疾病的经济负担。使用老年精神状况量表(Geriatric Mental State Schedule, GMS)、老年健康状况MDS (Minimum Data Set)和相关因素调查量表、老年健康状况认知测验调查表、老年躯体和神经系统检查表、知情人问卷,利用规范的整群抽样方法,在自然人群中获取研究样本,对调查对象以及其“知情人”的情况进行系统地、全面地调查分析。使用与GMS相配套的计算机诊断系统(Automated Geriatric Examination for Computer Assisted Taxonomy AGECAT)作为老年痴呆诊断工具；运用EpiData3.1录入MDS危险因素调查表数据；使用SPSS13.0统计软件分析,主要用描述性分析、卡方检验,非条件logistic回归等方法,了解性别、年龄、婚姻状况等与疾病的关系；躯体疾病、兴趣爱好等与老年痴呆的关系,进行老年痴呆疾病危险因素探讨。
老年痴呆疾病患者的死亡分析部分由调查者利用VA (Verbal Autopsy)量表入户对死者临终患病情况的知情人进行访谈。
结果与讨论：
1.老年痴呆疾病经济负担：老年痴呆患者的治疗过程中的直接费用比对照组高出近3倍,且损失的伤残调整寿命年要高于对照组,提示山西省的老年痴呆疾病经济负担较高。
2.老年痴呆患病率：山西省老年痴呆疾病的患病率为3.7%(城市老年痴呆疾病患病率为1.6%,农村老年痴呆患病率为5.8%),农村老年人口的痴呆患病率显著高于城市老年人,约是城市老年人白痴呆患病率的3倍。
3.老年痴呆疾病影响因素：单因素分析结果显示：人口基本特征力方面,不同年龄、地区、职业、文化程度的老年痴呆疾病患病率有统计学差异。其中:60-69岁年龄段痴呆患病率为2.0%,70-79岁年龄段为2.5%,而大于等于80岁年龄段的患病率为13.6%,经趋势χ2检验,随着年龄升高,老年痴呆的患病率越来越高(χ2=20.671,P<0.001)；从地域来看,农村患病率(5.8%)要显著高于城市(1.6%)(χ2=12.743,P<0.001)；从职业分布角度分析,农民和家庭主妇的痴呆患病率较高,分别为4.9%和6.8%(Fisher确切概率P=0.003)；从文化程度看,痴呆患者主要分布在文盲、小学及初中文化程度的人群,其患病率分别为8.2%,1.6%和1.7%(Fisher确切概率P=0.000)。女性的患病率虽然高于男性,但是统计学检验并没有发现有意义,分析原因可能与其他因素有关,如女性人群平均寿命较长,文盲比例相对较高等。不吸烟组老年痴呆疾病患病率高于吸烟组老人(不吸烟4.8%,吸烟2.4%,χ2=4.203,P=0.040),说明吸烟是老年痴呆疾病的保护因素,饮酒和不饮酒组老年痴呆疾病患病率的差异无统计学意义。在兴趣爱好方面,经常参加体育锻炼的老人痴呆的患病率(0.5%)低于不常锻炼的老人(4.1%),提示体育锻炼是老年痴呆患病率的保护因素(z2=6.676,P=0.010)。
本研究结果显示,听力有问题的老年痴呆疾病患病率为7.1%,听力正常者的患病率为2.9%,提示听力可能与老年痴呆患病率有关(校症χ2=4.764,P=0.029)；有肾脏病的老年痴呆患病率为12.5%,没有肾脏病的患病率为3.2%,肾脏病与老年痴呆患病率有关(Fisher确切概率法P=0.028)。单因素分析结果显示,是否患有高血压与老年痴呆疾病的患病率差异无统计学意义。分析产生的可能原因有：在目前中国农村社区,老年人连最基本的血压控制都没有,许多人患高血压而未被发现、治疗。另外如现场测量的血压也不是非常准确,调查过程中老人可能会因为面对陌生人而血压升高,或者其他的一些影响因素从而使得所测的血压不准。在这种情况下,需要通过进一步的调查研究来发现高血压和其他的一些心血管疾病患病的情况与老年痴呆疾病的关系。
在本次研究中,运用ADL量表对老年人进行生活自理能力评分,根据综合得分划分为三个等级：无依赖、部分依赖和完全依赖。经单因素分析发现,老年人的生活自理能力与与老年痴呆疾病患病率之间关系显著,并且随着老年人生活依赖性的增强,老年痴呆患病率有逐渐增加的趋势,提示老年人的生活自理能力的高低对老年痴呆疾病有一定影响,但是亦不排除老年痴呆患者山于痴呆疾病而导致生活自理能力退化这一现象对数据信息的影响,即二者之间的影响可能是相互的。
多因素logistic回归分析结果显示：70-79岁老年人患老年痴呆的风险与60-69岁组相比尚不能认为有差别,而80岁以上老年人患痴呆的风险显著增加。在其它变量固定的条件下,80岁以上组患痴呆的概率是60-69岁组的8.17倍；在其它变量固定情况下,农村老年人患痴呆的风险要比城市老年人患痴呆的概率高4.833倍；生活自理能力也影响老年人痴呆症的患病率,研究发现不能独立生活的老人患痴呆症的危险性是能够独立生活的老人的2.058倍,由于样本量的限制,未对生活自理能力设置哑变量,因此,无法通过Logistic回归模型分析不同等级生活自理能力对老年痴呆患病率的影响；听力障碍是老年痴呆疾病的危险因素,研究结果表明,听力障碍老人,痴呆疾病的患病率是无听力障碍老人的2.568倍；邻居朋友的支持是老年痴呆疾病的保护因素,经常与邻居朋友交往的老年人痴呆疾病患病率比不经常交流的老人低0.738倍。
4.空巢期老年人与老年痴呆疾病患病率的关系：
本次调查结果显示：处于空巢期的老人有624人,占调查总人数的60.7%,其中女性317人,占59.6%；男性307人,占61.9%。城市处于空巢期的老年人占73.5%,农村处于空巢期的老年人占48.2%,处于空巢期的城市老年人多于农村老年人。在四种生活状态的研究中得到：处于鳏寡期(独居)的城市老年人占9.6%,农村老年人占11.9%,农村的鳏寡期老人更多；相比城市,单纯与配偶居住的农村老人较少,为36.3%,与配偶和子女共同居住的农村老人更多,占36.2%。丧偶或离异后与子女居住的农村老人较城市多。
处于鳏寡期(独居)的老人痴呆疾病患病率为4.6%,高于非鳏寡期老人的痴呆疾病患病率(3.6%)。通过对四种生活状态的老年痴呆患病率比较发现：与配偶居住的老年人和与配偶和子女共同居住的老年人的痴呆患病率要低于鳏寡期(独居)的老人和与子女居住的老人,说明配偶这一因素是老年痴呆患病率的保护因素。而本研究表明：空巢不仅会引发老年人的生活质量下降,自理能力降低,甚至会带来孤寂、抑郁等问题,同时也是引发老年痴呆疾病的危险因素之一。要进行老年痴呆疾病的预防干预工作,解决老年人空巢问题及空巢带来的一系列精神、生活和社会问题则成为至关重要的一个环节。
5.老年痴呆患者死亡分析
本次调查发现,老年痴呆患者的死亡率(42.1%)远远高于非痴呆老年人(8.6%),提示痴呆是加速老年人死亡进程的危险因素。对痴呆患者进行死因分析,并结合访谈记录,得出如下结论：(1)由于痴呆疾病的疾病经济负担较高,导致照顾者经济、精神、身体的三重疲惫,出现对痴呆老人照顾不周的情况而使老人意外死亡；(2)痴呆老人的生活自理能力减退,活动范围日渐缩小,逐渐导致身体器官功能退化甚至病变；(3)10%的痴呆疾病患者是由抑郁症患者转化而来的,可能在患抑郁症期间,由于其精神状态的影响,健康状况已经受到侵蚀,再受上述两个因素的影响,很容易导致疾病的发生,进而甚至因该疾病而死亡。综上所述,老年痴呆疾病所带来社会、家庭负面效应是不可忽视的,要想有效预防老年痴呆,必须找到关键的影响因素对其干预,方可见成效。
Background
Following the heart disease, cancer, and stroke, Alzheimer is becoming the fourth leading cause of death among the elderly. In the World Alzheimer Report2009, ADI estimated that36million people worldwide are living with Senile Dementia (or Alzheimer Disease, AD), with one new case every seven seconds. The economic burden of dementia has increased76%in the past25years. The aging process of China's society is accelerating, and the problem will get even worse. The incidence rate of dementia will increase by above100%in the coming20years. Dementia brings overwhelming disease burden to the patients, families and the country as well. The name of "Dementia" is not new to most Chinese people, but few of them really know about it. The majority regards it as a part of normal aging, and does not understand the progressive pathological changes from incubation to onset. Many people do not have any knowledge about how to prevent or treat, nor about how to take care of patients. Other problems include that limited medical facilities, limited medical caregivers, lack of capital investment, and so on. Thus, it is important and meaningful for putting forward suggestion to investigate and analyze the status quo, the economic burden of senile dementia.
Objectives
In this study, the economic burden of dementia in Shanxi province was learned and analyzed; The epidemiological survey was earned out to collect the epidemic data about dementia in Shanxi province and to explore the potential risk factors which influence the dementia's development; The relevance of empty nest elderly people and the dementia's morbidity was analyzed; The elderly's cause of death was analyzed, especially the dementia patients. Therefore, scientific basis was provided for the government and policy-maker to make proper plans of mental health service for elderly people and to establish intervention and prevention measures of dementia for the urban communities and rural counties in Shanxi.
Subjects and methods
Subjects:
The subjects include two parts:For analyzing the economic burden of dementia,29dementia inpatients was selected form2009-2010in the Mental Health Department of Taiyuan central Hospital, including22females and7males; And another10non-dementia inpatients in the same department were selected too, including4males and6females.
The epidemiological survey of dementia was carried out in August2008, May2009and July2011respectively. The elderly people (Born before30, June,1948) who live in Kangle District and Zhuangzi County in Jinzhong City were surveyed as the subjects. First, the dementia patients were screened in2008; Second, the impact factors were analyzed in2009,1124cases were surveyed and1029effective cases were obtained; Third, the elderly's death causes were surveyed within the former group in2011, and909effective cases were obtained.
Methods:
By using self-made Economic Burden Questionnaire of AD, the data were collected, and the Disability Adjusted Life Years-DALYs was applied to measure the economic burden of dementia in Shanxi province preliminarily.
The Geriatric Mental State Schedule (GMS) was introduced in Shanxi province, which was created by the Professor Copland in Geriatric Mental State Resource Centre of Liverpool University, and combined with other scales to analyze the mental status of elderly people. By clustering sampling, and using the above scales, the subjects were surveyed systematically and comprehensively. By using the Automated Geriatric Examination for Computer Assisted Taxonomy-AGECAT computer diagnostic system, the elderly's mental status was classified. The data which were input in the computer using EpiData3.1, were then analyzed by SPSS13.0software. The methods, such as descriptive analysis, chi-square test, unconditioned Logistic regression analysis, were used to study the relevance between factors (age, gender, martial status, physical disease, interests and so on) and the dementia.
By using VA (Verbal Autopsy) tool, the door-to-door interviews of the dead's informant were conducted. Usually the spouse, children or other direct relatives of the dead, who take care of him/her at least in the last month, were chosen as the informant. Then the specific death causes were identified by the physician according to the VA tool and were classified and coded in line with the ICD (international classification of diseases)
Findings and discussion
1. The economic burden of dementia in Shanxi:The direct cost of dementia patients during the treatment is3times higher than the control group, and the DALYS is higher than the control group.
2. The prevalence of dementia:According to this study, the prevalence of dementia in Shanxi urban community and rural county is3.7%(with urban community1.6%, and rural county5.8%).The prevalence of dementia in rural counties is almost3times higher than in the urban communities.
3. Risk factors of Dementia:Single factor analysis indicates that statistical significance was found between different ages, regions, professions and education levels. The prevalence rate is2.0%,2.5%,13.6%for age group60-69,70-79, and80or above, respectively. According to the trend X2analysis, the elder the people, the higher the prevalence rate of dementia (X2=20.671,P<0.001); The prevalence rate in rural counties (5.8%) is higher than in the urban communities (1.6%)(X2=12.743,P<0.001), and it is higher in farmers (4.9%) and housewives (6.8%)(Fisher exact probability, P=0.003); Moreover, the dementia patients were more likely to be found in illiterate people (8.2%) or people completed primary education (1.6%) or junior secondary education (1.7%)(Fisher exact probability,P=0.000).The prevalence of dementia in females is higher than in males, but the difference is not significant because of other factors influence. And it needs to be further investigated. The prevalence of dementia in on-smokers is higher than in smokers (non-smoker4.8%, smoker2.4%,X2=4.203, P=0.040), so smoke is a protective factor. There is no significant difference in drink and non-drink people. The study also found that the prevalence of dementia in elderly people who take exercise frequently is lower than those who seldom do(4.1%), so taking exercise is a protective factor for dementia (X2=6.676, P=0.010).
This study shows that the dementia's prevalence rate of the elders with hearing problems (7.1%) is higher than those without hearing problems(2.9%); The dementia's prevalence rate of elders with kidney disease (12.5%) is higher than those without the disease (3.2%)(Fisher exact probability, P=0.028)。 Moreover, the correlation between the dementia and the elder's performance state was analyzed by using the ADL scale. It found out that the more dependent the elder's become, the higher the dementia's prevalence rate.
In the analysis of multi-factor regression, it shows that aging is the risk factor. People aged above80possess higher prevalence rate. And the prevalence rate in people live in rural counties is4.833times higher than those live in urban communities. The dependent elder is (2.058times) more likely to develop the dementia than the independent elders. The elder with hearing problems is (2.568times) more likely to develop the dementia than those without. While the support from neighbours is a protect factor for dementia. The elders who like to communicate with friends or neighbours are less likely to develop dementia.
4. The correlation between empty nest elderly and dementia:In this study, there are624empty nest elderly people, which accounts for60.7%of the total1029effective cases. And within them,317are females, occupying59.6%; while307are males, occupying61.9%. There are more empty nest elderly people in urban communities (73.5%) than in rural counties (48.2%). After the study of four living conditions of elderly people, it is found that there are more widowed or single living elderly people in rural counties (11.9%) than in urban communities (9.6%). Comparing with the urban communities, there are more elderly people live with their spouse and children together (36.2%), while less elderly people live with spouse (36.3%).The study indicates that spouse is a protective factor for dementia. The prevalence of dementia in widowed or single living elderly people (4.6%) is higher than in those non-widowed people (3.6). The prevalence of dementia in people who live with their spouse and children together is lower than in people who live by their own or live with spouse.
The study also states that "empty nest" would not only impact the elderly's quality of life, lower their self-care capacity, lead to loneliness and depression, but also is a risk factor for dementia. It is crucial to solve the empty nest problem and improve the prevention working of dementia.
5. Analysis on death causes of dementia patients
This study demonstrated that the dementia is a risk factor of accelerating the death process, and the death rate of dementia patients (42.1%) is much higher than that of non-dementia ones (8.6%). The following conclusions were made:First, the heavy disease burden of dementia leads to the exhaustion of the caregivers, both physically and psychologically. And the patients died accidentally due to lack of satisfactory care. Second, the dementia patients'self-care skills is poor, and the activity's range is restricted which gradually lead to the degeneration of organ function. Third, there is10%dementia patients were converted from depression patients. The depression patients suffered mentally and physically, and eventually developed to dementia and death. In short, dementia brings severely negative impacts to the society and families. The key impact factors must be found and be effectively prevented and intervened to face the disease.
引文
[1]全国老龄委员会.人口老龄化发展趋势预测研究报告[R].北京：2006-02-23
[2]常红.中国老龄化形势超出预测,2055年老人数达峰值4.72亿[EB/0L].http://www.cncaprc.gov.cn/info/16386.html,2011-11-30/2012-01-25
[3]山西统计信息网.山西人口老龄化发展特点和趋势分析[EB/0L].http://www.stats-sx.gov.cn/html/2012-1/201213191119279266054.html,2012-01-31/2012-02-01
[4]张均田.老年痴呆的发病机制及防治药物[J].医药导报,2002,21(8)：469-711
[5]赖世隆,温泽淮,梁伟雄,等.广州市城区75岁以上老年人痴呆患病率调查[J].中华老年医学杂志.2000,19(6)：450-455.
[6]洪震,周玢,黄茂盛.上海城乡老年期痴呆患者死亡率和生存预示因素研究.中华流行病学杂志,2005,26(6)：404-407
[7]陈曦,黄东锋,林爱华,等.广东省成人精神残疾主要致残原因和对策分析[J].中国康复医学杂志,2009(10)：938-941.
[8]Alzheimer's Disease International. World Alzheimer Report 2011 [R]. London, UK:2011-09
[9]王艳平.社区老年人阿尔兹海默病发病及患病相关因素研究[D].山西：山西医科大学,2011
[10]唐闻佳.老年痴呆症“恶名”耽误求医[N].文汇报,2011-09-22(6)
[11]杨柳.锡城老年痴呆症发病率高达5%就诊只有1%[N].无锡日报,2010-10-11(3)
[12]全国老龄工作委员会办公室.中国人口老龄化发展趋势预测研究报告[R].北京：2007-12-27
[13]国际阿尔兹海默病协会亚太地区会员.痴呆在亚太地区流行[R].北京：2006-09-21
[14]Narendran R. The burdens of giving care [EB/OL]. http://expressbuzz.com/magazine/the-burdens-of-giving-care/244775.html,2011-03-03/2011-10-23
[15]行动决定未来—动员全社会力量防治老年痴呆的倡议书[EB/OL].http://www.memory360.org/news/step/2010/0305/action-for-the-future.html,当代中医药发展研究中心记忆健康360工程项目办公室,2011-10-13/2011-12-29
[16]赵涵漠.我国600万老年痴呆患者遭忽视[N].人民文摘2010(7)
[17]Wenger NS, Young RT. Quality indicators for continuity and coordination of care in vulnerable elders [J].Journal of the American Geriatrics Society.2007,10(55):S285-S292
[18]Davey A, Patsios D. Formal and Informal Community Care to Older Adults:Comparative Analysis of the United States and Great Britain [J].Journal of Family and Economic Issues,1999, 11(20):271-299
[19]Desrosiers J. Aging and Social Participation [J]. Aging Clin Exp Res.2007,10 (16):406-412
[20]Johnston B,Weeler L,Deuser J. et al. Outcomes of the Kaiser Permanente Tele-Home Health Research Project [J]. Archives of family medicine,2000.1; 9(1):45-5
[1]中国人口老龄化发展趋势预测研究报告[EB/OL].全国老龄工作委员会办公室,http://www.cncaprc.gov.cn/info/1408.html.2007-12-27/2011-03-05
[2]Murray CJL. Rethinking DALY, Global burden of disease and injury series VoⅡ:The global burden of disease [M]. US:Harvard University Press,1996.
[3]夏毅,龚幼龙,顾杏元,等.疾病负担的测量指标—DALY(一)[J].中国卫生统计,1998,15(3)：51252.
[4]夏毅,龚幼龙,顾杏元,等.疾病负担的测量指标—DALY(二)[J].中国卫生统计,1998,15(3)：54257.
[5]夏毅,龚幼龙,顾杏元,等.疾病负担的测量指标—DALY(三)[J].中国卫生统计,1998,15(3)：58260.
[6]纪文艳,刘美娜.疾病负担的研究进展[J].实用预防医学,2001,8(5)：3952397.
[7]Hyder A, Rotllant G, Morrow RH. Measuring the Burden of Disease:Healthy Life years [J]. American Journal of Public Health,1998,88:196-202.
[8]段蕾蕾.北京市老年性痴呆、帕金森病、脑血管病疾病负担的研究[D].北京：中国协和医科大学.
[9]Murray CJL. The global burden of disease:a comprehensive assessment of mortality and disability from diseases, injuries, and risk reactors in 1990 projected to 2020[M].Cambridge Mass:Harvar School of Public Health,1996.
[10]Luppa M, Heinrich S, et al. Cost-of-illness studies of depression—A systematic review [J]. Journal of Affective Disorders.2007,2(98):29-43
[11]Alzheimer's Association.2009 Alzheimer's disease facts and figures [J]. Alzheimer's & Dementia,2009,5(3):234-270
[12]Sano M.Economic effect of cholinesterase inhibitor therapy:implications for managed care [J]. Managed Care Interface,2004,8(17):44-49
[13]Winblad B, Wimo A. Assessing the societal impact of acetylcholinesterase inhibitor therapies[J]. Alzheimer Disease and Associated Disorders.1999,11 (13):S9-S 19
[14]Wang G,Cheng Q,Zhang S,et al. Economic impact of dementia in developing countries:An evaluation of Alzheimer-type dementia in Shanghai, China [J]. Journal of Alzheimer's Disease. 2008,11(15):109-115
[15]蔡玲玲,张开金,翟成凯,米文婧,唐伯才.社区居民慢性病现状与疾病经济负担研究[J].现代预防医学.2007(03)：434-437
[16]李娟,于保荣.疾病经济负担研究综述[J].中国卫生经济.2007,11(26)：72-74
[17]Paths to Personalization In Mental Health, A Whole System, Whole Life Framework [M]. UK:Lancashire Library,2010
[18]Gardner JW, Sanborn JS. Years of potential life lost (YPLL)-What does it measure? [J]. Epidemiology.1990,7(4):322-329
[1]孟琛,汤哲.社区老年人认知功能变化及其预后的五年前瞻性研究[J].中华神经科学杂志,2000,33(3)：138
[2]刘津,李淑然.社区痴呆筛查量表(CSI-D)中国心理卫生杂志,2001,15(4)：230-231.
[3]胡志,周成超,徐晓超,等.安徽省某农村社区老年抑郁症患病率与影响因素研究概述[J].中国农村卫生事业管理,2007,27(1)：24-26.
[4]Prince M., Acosta D., Chiu H, et al. Dementia diagnosis in developing countries:a cross-cultural validation study [J].Lancet,2003,3(361):909-917.
[5]Juan J Llibre Rodriguez,C.P.F.,Daisy Acosta, et al. Prevalence of dementia in Latin America, India, and China:a population-based cross-sectional survey [J]. Lancet 2008,372(9637):464-474.
[6]闫芳,黄悦勤,巩嘉凯等.社区痴呆筛查知情人问卷在北京部分社区老年人中的试测[J].中国心理卫生,2007,21(6)：375-410.
[7]Prince M., Ferri C.P., Acosta D., et al.The protocols for the 10/66 dementia research group population-based research programme [J].BMC Public Health,2007,7:165.
[8]Prince M.J., Noriega L., et al. The 10/66 Dementia Research Group's fully operationalised DSM-Ⅳ dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis:a population validation study [J].BMC Public Health, 2008,8:219.
[9]The University of Liverpool·Manual for the GMS (A) 3rd Edition:Geriatric Mental State AGECAT package
[10]刘津,李淑然.老年精神状况量表(GMS)及其计算机诊断系统(AGECAT)中国心理卫生杂志,2001,15(1)：19-21.
[11]刘津,李淑然,张维熙,陈昌惠.社区痴呆筛查量表(CSI-D)在中国的初步测试.中国心理卫生杂志,2001,15(4)：223-225.
[12]Hall, K.S., Gao,S.J.,et al. Low education and childhood rural residence:Risk for Alzheimer's disease in African Americans. Neurology,2000,54(1):95
[13]Alzheimer's disease:Unraveling the mystery[R].National Institute on Aging.2006,8.
[14]Alzheimer's Research on Causes and Risk Factors. Fisher Center for Alzheimer's Research Foundation.[EB/OL]http://www.alzinfo.org/research/alzheimers-research-on-causes-and-risk-fac tors,2003-05-01/2011-10-16
[15]Genes, lifestyles, and crossword puzzles:Can Alzheimer's disease be prevented? [EB/OL] http://www.nia.nih.gov/NR/rdonlyres/63B5A29C-F943-4DB7-91B4-0296772973F3/0/CanADbe Prevented.pdf.2005-11-22/2011-11-06
[1]Berr C,W.J.,Ritchie K. Prevalence of dementia in the elderly in Europe [J].European euro psychopharmacology,2005,15(4):463-471.
[2]Rodriguez J.J.L., Ferri C.P., et al. Prevalence of dementia in Latin America,India,and China: a population-based cross-sectional survey [J]. Lancet 2008,372(9637):464-474.
[3]魏会敏,张红杰,胥磊.保定市老年痴呆流行病学调查.[J].现代预防医学,2008,35(5)：547-548.
[4]周玢,洪震,黄茂盛,等.上海市城乡人群痴呆患病率调查[J].中华流行病学杂志,2001,22(5)：368-371.
[5]Dong M.J., Peng B., Lin X.T., et al.The prevalence of dementia in the People's Republic of China:a systematic analysis of 1980-2004 studies [J]. Age and Ageing,2007,36(6):619-624.
[6]Launer LJ, Andersen.K., Dewey ME, et al. Rates and risk factors for dementia and Alzheimer's disease:results from EURODEM pooled analyses.EURODEM Incidence Research Group and Work Groups.European Studies of Dementia [J]. Neurology,1999,52(1):78-84.
[7]吕书臣,余海民,陈勇华,等.舟山市定海城区老年痴呆的流行病学调查[J].中华精神科杂志,1998,31(4)：225-227.
[8]黄文湧,杨星,杨敬,等.贵阳市城区老年痴呆患病率调查[J].中国公共卫生,2007,23(8)：983-985.
[9]Hebert LE,S.P., McCann JJ, et al. Is the risk of developing Alzheimer's diseasegreater for women than for men [J]. American Journal of Epidemiology,2001,153(2):132-136.
[10]屈秋民,乔晋,韩建峰,等Alzheimer病患病率与患者性别的关系[J].中华老年医学杂志,2004,23(7)：511-512.
[11]汤哲,孟琛,董惠卿,等,北京城乡老年期痴呆患病率研究[J].中国老年学杂志,2002,22(4)：244-246.
[12]汤哲,孟琛,陈彪.北京地区老年痴呆流行病学研究[J].中华流行病学杂志,2003,24(8)：734-736.
[13]Leibovici D,R.K.,Ledesert B,et al. The effects of wine and tobacco consumption on cognitive performance in the elderly:a longitudinal study of relative risk [J]. Inernatioanlt Journal Epidemiology,1999,28(1):77-81.
[14]Monique M.B., Breteler, Michiel L.B., et al. Risk factors for vascular disease and dementia. [J]. Pathophysiology ofHaemostasis and Thrombosis,1998,24(3-4):167-173.
[15]Skoog I, Lernfelt B., Landahl S, et al.15-year ongitudinal study of blood pressure and dementia [J]. Lancet,1996,347(9009):1141-1145.
[16]Wu C, Zhou D., Wen C, et al. Relationship between blood pressure and Alzheimer's disease in Linxian County, China [J]. Life Science,2003,72 (10):1125-1133
[1]穆光宗.家庭空巢化过程中的养老问题[J],南方人口,2002,1(17)：33-36
[2]空巢家庭我国老龄化社会现象[EB/OL]. http://house.baidu.com/jiaozuo/news/0/2235637/. 2010-11-08/2012.01.15
[3]王庆华,段晓明,宋荣荣,等.空巢老人生活质量与心理状况的相关性[J].解放军护理杂志,2007,24(10A)：5-8.
[4]李德明,陈天勇,李贵芸.空巢老人心理健康状况研究[J].中国老年学杂志,2003,23(7)：405-407.
[5]张建凤等.合肥市社区空巢老人社区卫生服务需求及影响因素的研究[J].护理研究,2010.24(3)647-648.
[6]徐小林等.社区空巢老人生存状况及社会支持状况[J].中国老年学杂志,2010.10：2973-2975.
[7]杨秀婷等.我国空巢老人焦虑抑郁现状及相关因素研究进展[J].中国老年学杂志,2010,9：2712-2713.
[8]张毓薇.城市空巢老人社会支持研究[D].甘肃：西北师范大学政法学院.2009,5.
[9]赵华硕等.空巢老年人生存质量分级评价调查[J].社区医学杂志,2010,8(15)：35-37.
[10]吴明权.农村空巢老人生存质量及生活满意度调查[J].中国公共卫生管理.2()12.1(28)：93-94.
[11]杨伟民,付慧鹏,刘书红,李瑞莲.社区干预对空巢老人焦虑抑郁状况的影响[J].中国老年学杂志.2012,4：813-814
[12]Liu Meiping. The Old Supporting in Community:the Leading Model of Providing for the Aged from Rural Empty Nest Families [J]. Public Administration & Law.2010,01:54-58
[13]Jofi V. M. The empty nest:Unvoiced Concerns of the Elderly[J]. Asian Journal of Health. 2011,01(1):253-258
[14]David B. Don't let us down on care funding reform, alliance tells Andrew Lansley[EB/OL]. The Guardian. http://www.guardian.co.uk/society/2012/mar/05/care-funding-reform-andrew-lansley, 2012-3-5/2012-3-10
[15]Shufen Cao. The home-based elderly care system analysis:an illustration from Hangzhou, China [D]. Sweden:Umea International School of Public Health.2012,5.
[1]王建华.流行病学(第五版)[M].北京：人民卫生出版社.2011.06.
[2]王黎君.死因监测资料的分析与利用[R].北京：中国疾病控制中心.2006.10.
[3]吴三兵.2003年安徽省疾病监测点居民死亡原因分析与防治策略建议[D].安徽：安徽医科大学.2004.7
[4]郭勇,王法艳,马颖.死因推断及其准确性评价[J].中华疾病控制杂志,2009,13(3)：367-369
[5]郭勇.安徽省某城乡社区老年人口死因统计资料质量评价及相关对策研究[D].安徽医科大学.2009
[6]杨功焕著.中国人群死亡及其危险因素流行水平、趋势和分布[M].北京：中国协和医科大学出版社,2005.
[7]Wang L, Yang G, Jiemin M,et al. Evaluation of the quality of cause of death statistics in rural China using verbal autopsies [J]. J Epidemiol Community Health,2007,61(6):519-526
[8]Kalter HD, Hossain H, Burnham G,et al.Validation of caregiver interviews to diagnose common causes of severe neonatal illness[J]. Paediatr Perinat Epidemiol,1999,13(1):99-113
[9]Reeves B.C., Quigley M.. A review of data-derived Methods for assigning causes of death from verbal autopsy data[J]. International Journal of Epidemiology.1997,26(5):1080-1089.
[10]Walker GJ, Ashley DE, McCaw AM, et al. Maternal mortality in Jamaica [J]. Lancet.1986, 1(8479):486-488.
[11]Fauveau V, Koenig MA, Chakraborty J, et al. Causes of maternal mortality in rural Bangladesh,1976-85[J]. Bulletin of the Word Health Organization,1988,66:643-51.
[12]周脉耕,王玉英,葛辉等.中国2004年县及县以上医疗机构死亡病例报告质量评价[J].中华流行病学杂志,2006,27(4)：328-332.
[13]Rao C.,Yang G..,Hu J., et al. Validation of cause-of-death statistics in urban China [J]. International Journal of Epidemiology.2007; 36:642-651.
[14]杨进,张杰,曾竣等.口头尸检对河池市5-60岁死亡病例进行死因评估结果分析[J].中国初级卫生保健,2004,6：18(6)：19-20.
[15]Gonghuan Yang, Chalapati Rao, Jiemin Ma, et al.validation of verbal autopsy procedures for adult deaths in China [J]. International Journal of Epidemiology.2006,35:741-748.
[16]Quigley MA, Chandramohan D, Rodrigues LC. Accuracy of physician review, expert algorithms and data-derived algorithms in adult verbal autopsies[J], International Journal of Epidemiology.1999,28:1081-1087.
[17]Setel P.W., Sankoh O., Rao C.et al. Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics [J]. Bulletin of the Word Health Organization.2005,83(8):611-617.
[18]Yang G, Hu J., Rao K. et al. Mortality registration and surveillance in China History, current situation and challenges [J].Population health metrics,2005,3:3.
[19]Mohan D.C., Maude G.H., Rodrigues L.C., et al.Verbal autopsies for adult deaths:Issues in their development and validation[J]. International journal of epidemiology.1994,23(2):213-222.
[20]Chandramohan D., Maude G.H., Rodrigues L.C., et al.Verbal autopsies for adult deaths:their development and validation in a multicenter study[J]. Tropical Medicine and International Health.1998,3:436-446.
[21]Kahn K, Tollman SM, Garenne M, et al. Validation and application of verbal autopsies in a rural area of South Africa. Trop Med Int Health 2000; 5:824-31.
[22]余松林主编.医学统计学(第一版)[M].北京：人民卫生出版社,2002：269.
[1]推动老年福利进一步向适度普惠型转变.中国社会报[N].2009-05-01
[2]山西：“全民医保”时代来临.黄河新闻网[EB/OL]. http://www.sxgov.cn/shanxi/ shanxi content/2012-02/28/content 1546944.htm.2012-02-28/2012-02-15
[3]Matsuda S. The health and social system for the aged in Japan [J]. Aging Clin Exp Res.2002 Aug; 14(4):265-70.
[4]Davey B, Levin E, Iliffe S, Kharicha K. Integrating health and social care:implications for joint working and community care outcomes for older people[J]. Journal of Interprofessional Care.2005 Jan;19(1):22-34.
[5]黎筱珊.加快建设临终关怀服务体系[N].老人报.2012-03-21
[6]Tompsett H. Changing systems in health and social care for older people in Japan: observations and implications for interprofessional working[J]. Journal of Interprofessional Care. 2001 Aug; 15(3):215-21.
[7]Gomersall C. A rapid response intermediate care service for older people with mental health problems [J]. Nurs Times.2009 May,105(17):12-3.
[8]陈虹.完善老年医疗保障体系的制度创新和政策仿真[D].浙江：浙江大学.2011
[9]程杰,赵文.人口老龄化进程中的医疗卫生出：WHO成员国的经验分析[J].中国卫生政策研究.2010(04)
[10]马非,曲成毅,王婷,银炯,张晓东.老年居民对社区卫生服务利用及满意度调查[J].中国公共卫生.2008(10)
[11]Robert Pear. Medicare's Costs and Benefits are Elusive[N]. New York Times, Dec9,2003
[12]Cochrane J.H. Health-Status Insurance:How Markets Can Provide Health Security [R].Policy Analysis,2009,2
[13]喻凤娇.对完善我国农村医疗救助制度的思考[J].行政事业资产与财务.2011(06)
[14]民政部财政部卫生部人力资源和社会保障部关于进一步完善城乡医疗救助制度的意见[J].中国劳动.2009(08)
[1]中国人口老龄化发展趋势预测研究报告[R].全国老龄工作委员会办公室,http://www.cncaprc.gov.cn/info/1408.html.2007-12-27
[2]谢瑞满.实用老年痴呆学[M].上海：上海科学技术文献出版社,2010,1
[3]范俭雄,言镜玲,陈震华,等.南京地区老年期痴呆流行病学调查[J].临床精神医学杂志,2000,10(3)：137-138
[4]王德全、姜晓丹.老年痴呆患病率及危险因素调查[J].中国公共卫生,2002,18(12)：1498-1499
[5]周玢,洪震,等.上海市城乡人群痴呆患病率调查[J].中华流行病学杂志,2001,22(5)：368-371
[6]胡志,徐晓超等.合肥市城市社区老年抑郁症患病率调查[J].中国初级卫生保健,200418(4)：30-32
[7]赵芳,马天雯,等.上海市南汇区养老院老年痴呆症流行病学调查[J].现代预防医学,2007(15)：2864-2866
[8]仇成轩,Bengt Winblad, Laura Fratiglioni瑞典斯德哥尔摩市社区人群老年痴呆和阿尔茨海默病的危险因素的队列研究[J].中华流行病学杂志,2005,26(11)；882-887.
[9]李静,周华东,王延江,等.血管性痴呆危险因素的研究[J].中华老年心脑血管病杂志,2006,8(3)：158-161.
[10]Massimo Musicco,Katie Palmer,Giovanna Salamone. Predictors of Progression of cognitive decline in Alzheimer's disease:the role of vascular and socio demographic factors[J].Journal Of Neurology,2009,256(8):1288-1295.
[11]GanguliM, DodgeHH, Shen C, et al. Mild cognitive inpatient amnesic type an epidemiologic study [J]. Neurology.2004,63(1):115-121
[12]杨星,黄文涌,杨靖源,等.贵阳市社区老年人群阿尔茨海默病危险因素病例对照研究[J].现代预防医学,2007,34(18)：3436-3438.
[13]刘光,陈克,汤小琼,等.社区阿尔茨海默病影响因素分析[J].中国老年学杂志,2006.26：750-751.
[14]王德全,姜晓丹.老年痴呆患病率及危险因素调查[J].中国公共卫生,2002,18(12)：1498-1499.
[15]梁维萍,曲成毅,马菲,等.太原市社区老年人轻度认知功能障碍现况调查[J].中国慢性病预防与控制,2008,16(2)：174-175.
[16]刘光,陈克,汤小琼,等.社区阿尔茨海默病影响因素分析[J].中国老年学杂志,2006.26：750-751.
[17]胡文生,唐牟尼,郑洪波等,老年期痴呆患者在社区、老人院与住院中的经济负担研究[J].实用医学杂志,2008,24(10)：1821-1823
[18]李静,周华东,王延江,等.血管性痴呆危险因素的研究[J].中华老年心脑血管病杂志,2006,8(3)：158一161.
[19]马菲,王婷,银炯,等.社区老年人轻度认知功能障碍影响因素病例对照研究[J].中华流行病学杂志,2008,29(9)：873-877.
[20]唐牟尼,刘协和,云扬,等.社区阿尔茨海默病危险因素病例对照研究[J].中国心理卫生杂志,2001,15(1)：22-25.
[21]Verghese J Liptou RR, Katz M J et al. Leisure activities and the risk of Dementia in the elderly [S].N Engl JM ed,2003,348(10):2508-2516.
[22]刘吉林、高虎、宋枫,等.黄河流域11个地区51个干休所离退休于部认知障碍及老年痴呆危险因素分析[J].中国组织工程研究与临床康复,2007,11(30)：869-5871.
[23]陈忠义,李寅超,柳文科.血管性痴呆危险因素研究进展[J].实用医药杂志,2006,23(4)：490-492.
[24]胡善联.疾病负担的研究(上)[J].卫生经济研究,2005(5)：22-27
[25]王刚等.阿尔兹海默病疾病经济负担的国内外研究比较和分析[J].内科理论与实践,2009(4)：275-277
[26]胡善联.卫生经济学[M].上海：复旦大学出版社,2003.
[27]庄润森,王声湧.如何评价疾病的经济负担[J].中国预防医学杂志,2001(12)：245--247
[28]程晓明.卫生经济学[M].北京：人民卫生出版社,2007.102521
[29]张震巍,我国糖尿病疾病负担研究[D].上海：复旦大学,2007
[30]方博,靳文正,宋桂香.疾病负担研究进展[J].现代预防医学,2009(9)：1665-1668
[31]孙丽等.疾病负担测量与评价方法及其研究进展[J].现代医院,2008(6)：4-7
[32]程晓明.卫生经济学[M].北京：人民卫生出版社,2007.102521
[33]行动决定未来-动员全社会力量防治老年痴呆的倡议书.[EB/OL]当代中医药发展研究中心记忆健康360工程项目办公室,http://www.memory360.org/news/step/2010/0305/action-for-the-future.html,2011-1-25
[34]Wimo A,Prince M World Alzheimer Report 2010:Global Impact of Alzheimer's disease[R], Alzheimer's disease international,2010,9
[35]Wimo A, Winblad B, Jonsson L. The worldwide societal costs of dementia:Estimates for 2009. [J], Alzheimers Dement.2010 Mar; 6(2):98-103.
[36]Wang G, Cheng Q, Zhang S, et al. Economic impact of dementia in developing countries:an evaluation of Alzheimer-type dementia in Shanghai, China. [J], J Alzheimers Dis. 2008,15(1):109-115.
[37]安翠霞、于欣.痴呆患者经济负担及相关因素研究[J]. Chinese Mental Health Journal [J],2005,19(9):592-594
[38]陈林利、赵根明等.老年期痴呆患者经济负担研究[J].中国卫生经济,2009,11：19-21
[39]Suh GH, Knapp M, Kang CJ. The economic costs of dementia in Korea,2002[J]. Int J Geriatr Psychiatry.2006 Aug; 21(8):722-8.
[40]Allegri RF, Butman J, et al. Economic impact of dementia in developing countries:an evaluation of costs of Alzheimer-type dementia in Argentina. [J], Int Psychogeriatr.2007 Aug; 19(4):705-18.
[41]Shaji KS, Jotheeswaran AT, et al. THE DEMENTIA INDIA REPORT 2010—Prevalence, impact, costs and services for dementia[R].2010
[42]Leungo-Fenandez, R., Leal, J., Gray, A. Dementia 2010:The prevalence, economic cost and research funding of dementia compared with other major diseases. [R] India, New Delhi: Alzheimer's research trust and University of Oxford.2010
[43]赵涵漠.我国600万老年痴呆患者遭忽视[N].人民文摘,2010,7.
[44]Zhu CW, Scarmeas N, Torgan R, et al. Clinical features associated with costs in early AD: baseline data from the Predictors Study [J]. Neurology,2006,66(7):1021-1028.
[45]Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, et al. Social-economic costs and quality of life of Alzheimer disease in the Canary Island, Spain [J].Neurology,2006, 67(12):2186-2191
[2]常红.中国老龄化形势超出预测,2055年老人数达峰值4.72亿[EB/0L].http://www.cncaprc.gov.cn/info/16386.html,2011-11-30/2012-01-25
[3]山西统计信息网.山西人口老龄化发展特点和趋势分析[EB/0L].http://www.stats-sx.gov.cn/html/2012-1/201213191119279266054.html,2012-01-31/2012-02-01
[4]张均田.老年痴呆的发病机制及防治药物[J].医药导报,2002,21(8)：469-711
[5]赖世隆,温泽淮,梁伟雄,等.广州市城区75岁以上老年人痴呆患病率调查[J].中华老年医学杂志.2000,19(6)：450-455.
[6]洪震,周玢,黄茂盛.上海城乡老年期痴呆患者死亡率和生存预示因素研究.中华流行病学杂志,2005,26(6)：404-407
[7]陈曦,黄东锋,林爱华,等.广东省成人精神残疾主要致残原因和对策分析[J].中国康复医学杂志,2009(10)：938-941.
[8]Alzheimer's Disease International. World Alzheimer Report 2011 [R]. London, UK:2011-09
[9]王艳平.社区老年人阿尔兹海默病发病及患病相关因素研究[D].山西：山西医科大学,2011
[10]唐闻佳.老年痴呆症“恶名”耽误求医[N].文汇报,2011-09-22(6)
[11]杨柳.锡城老年痴呆症发病率高达5%就诊只有1%[N].无锡日报,2010-10-11(3)
[12]全国老龄工作委员会办公室.中国人口老龄化发展趋势预测研究报告[R].北京：2007-12-27
[13]国际阿尔兹海默病协会亚太地区会员.痴呆在亚太地区流行[R].北京：2006-09-21
[14]Narendran R. The burdens of giving care [EB/OL]. http://expressbuzz.com/magazine/the-burdens-of-giving-care/244775.html,2011-03-03/2011-10-23
[15]行动决定未来—动员全社会力量防治老年痴呆的倡议书[EB/OL].http://www.memory360.org/news/step/2010/0305/action-for-the-future.html,当代中医药发展研究中心记忆健康360工程项目办公室,2011-10-13/2011-12-29
[16]赵涵漠.我国600万老年痴呆患者遭忽视[N].人民文摘2010(7)
[17]Wenger NS, Young RT. Quality indicators for continuity and coordination of care in vulnerable elders [J].Journal of the American Geriatrics Society.2007,10(55):S285-S292
[18]Davey A, Patsios D. Formal and Informal Community Care to Older Adults:Comparative Analysis of the United States and Great Britain [J].Journal of Family and Economic Issues,1999, 11(20):271-299
[19]Desrosiers J. Aging and Social Participation [J]. Aging Clin Exp Res.2007,10 (16):406-412
[20]Johnston B,Weeler L,Deuser J. et al. Outcomes of the Kaiser Permanente Tele-Home Health Research Project [J]. Archives of family medicine,2000.1; 9(1):45-5
[1]中国人口老龄化发展趋势预测研究报告[EB/OL].全国老龄工作委员会办公室,http://www.cncaprc.gov.cn/info/1408.html.2007-12-27/2011-03-05
[2]Murray CJL. Rethinking DALY, Global burden of disease and injury series VoⅡ:The global burden of disease [M]. US:Harvard University Press,1996.
[3]夏毅,龚幼龙,顾杏元,等.疾病负担的测量指标—DALY(一)[J].中国卫生统计,1998,15(3)：51252.
[4]夏毅,龚幼龙,顾杏元,等.疾病负担的测量指标—DALY(二)[J].中国卫生统计,1998,15(3)：54257.
[5]夏毅,龚幼龙,顾杏元,等.疾病负担的测量指标—DALY(三)[J].中国卫生统计,1998,15(3)：58260.
[6]纪文艳,刘美娜.疾病负担的研究进展[J].实用预防医学,2001,8(5)：3952397.
[7]Hyder A, Rotllant G, Morrow RH. Measuring the Burden of Disease:Healthy Life years [J]. American Journal of Public Health,1998,88:196-202.
[8]段蕾蕾.北京市老年性痴呆、帕金森病、脑血管病疾病负担的研究[D].北京：中国协和医科大学.
[9]Murray CJL. The global burden of disease:a comprehensive assessment of mortality and disability from diseases, injuries, and risk reactors in 1990 projected to 2020[M].Cambridge Mass:Harvar School of Public Health,1996.
[10]Luppa M, Heinrich S, et al. Cost-of-illness studies of depression—A systematic review [J]. Journal of Affective Disorders.2007,2(98):29-43
[11]Alzheimer's Association.2009 Alzheimer's disease facts and figures [J]. Alzheimer's & Dementia,2009,5(3):234-270
[12]Sano M.Economic effect of cholinesterase inhibitor therapy:implications for managed care [J]. Managed Care Interface,2004,8(17):44-49
[13]Winblad B, Wimo A. Assessing the societal impact of acetylcholinesterase inhibitor therapies[J]. Alzheimer Disease and Associated Disorders.1999,11 (13):S9-S 19
[14]Wang G,Cheng Q,Zhang S,et al. Economic impact of dementia in developing countries:An evaluation of Alzheimer-type dementia in Shanghai, China [J]. Journal of Alzheimer's Disease. 2008,11(15):109-115
[15]蔡玲玲,张开金,翟成凯,米文婧,唐伯才.社区居民慢性病现状与疾病经济负担研究[J].现代预防医学.2007(03)：434-437
[16]李娟,于保荣.疾病经济负担研究综述[J].中国卫生经济.2007,11(26)：72-74
[17]Paths to Personalization In Mental Health, A Whole System, Whole Life Framework [M]. UK:Lancashire Library,2010
[18]Gardner JW, Sanborn JS. Years of potential life lost (YPLL)-What does it measure? [J]. Epidemiology.1990,7(4):322-329
[1]孟琛,汤哲.社区老年人认知功能变化及其预后的五年前瞻性研究[J].中华神经科学杂志,2000,33(3)：138
[2]刘津,李淑然.社区痴呆筛查量表(CSI-D)中国心理卫生杂志,2001,15(4)：230-231.
[3]胡志,周成超,徐晓超,等.安徽省某农村社区老年抑郁症患病率与影响因素研究概述[J].中国农村卫生事业管理,2007,27(1)：24-26.
[4]Prince M., Acosta D., Chiu H, et al. Dementia diagnosis in developing countries:a cross-cultural validation study [J].Lancet,2003,3(361):909-917.
[5]Juan J Llibre Rodriguez,C.P.F.,Daisy Acosta, et al. Prevalence of dementia in Latin America, India, and China:a population-based cross-sectional survey [J]. Lancet 2008,372(9637):464-474.
[6]闫芳,黄悦勤,巩嘉凯等.社区痴呆筛查知情人问卷在北京部分社区老年人中的试测[J].中国心理卫生,2007,21(6)：375-410.
[7]Prince M., Ferri C.P., Acosta D., et al.The protocols for the 10/66 dementia research group population-based research programme [J].BMC Public Health,2007,7:165.
[8]Prince M.J., Noriega L., et al. The 10/66 Dementia Research Group's fully operationalised DSM-Ⅳ dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis:a population validation study [J].BMC Public Health, 2008,8:219.
[9]The University of Liverpool·Manual for the GMS (A) 3rd Edition:Geriatric Mental State AGECAT package
[10]刘津,李淑然.老年精神状况量表(GMS)及其计算机诊断系统(AGECAT)中国心理卫生杂志,2001,15(1)：19-21.
[11]刘津,李淑然,张维熙,陈昌惠.社区痴呆筛查量表(CSI-D)在中国的初步测试.中国心理卫生杂志,2001,15(4)：223-225.
[12]Hall, K.S., Gao,S.J.,et al. Low education and childhood rural residence:Risk for Alzheimer's disease in African Americans. Neurology,2000,54(1):95
[13]Alzheimer's disease:Unraveling the mystery[R].National Institute on Aging.2006,8.
[14]Alzheimer's Research on Causes and Risk Factors. Fisher Center for Alzheimer's Research Foundation.[EB/OL]http://www.alzinfo.org/research/alzheimers-research-on-causes-and-risk-fac tors,2003-05-01/2011-10-16
[15]Genes, lifestyles, and crossword puzzles:Can Alzheimer's disease be prevented? [EB/OL] http://www.nia.nih.gov/NR/rdonlyres/63B5A29C-F943-4DB7-91B4-0296772973F3/0/CanADbe Prevented.pdf.2005-11-22/2011-11-06
[1]Berr C,W.J.,Ritchie K. Prevalence of dementia in the elderly in Europe [J].European euro psychopharmacology,2005,15(4):463-471.
[2]Rodriguez J.J.L., Ferri C.P., et al. Prevalence of dementia in Latin America,India,and China: a population-based cross-sectional survey [J]. Lancet 2008,372(9637):464-474.
[3]魏会敏,张红杰,胥磊.保定市老年痴呆流行病学调查.[J].现代预防医学,2008,35(5)：547-548.
[4]周玢,洪震,黄茂盛,等.上海市城乡人群痴呆患病率调查[J].中华流行病学杂志,2001,22(5)：368-371.
[5]Dong M.J., Peng B., Lin X.T., et al.The prevalence of dementia in the People's Republic of China:a systematic analysis of 1980-2004 studies [J]. Age and Ageing,2007,36(6):619-624.
[6]Launer LJ, Andersen.K., Dewey ME, et al. Rates and risk factors for dementia and Alzheimer's disease:results from EURODEM pooled analyses.EURODEM Incidence Research Group and Work Groups.European Studies of Dementia [J]. Neurology,1999,52(1):78-84.
[7]吕书臣,余海民,陈勇华,等.舟山市定海城区老年痴呆的流行病学调查[J].中华精神科杂志,1998,31(4)：225-227.
[8]黄文湧,杨星,杨敬,等.贵阳市城区老年痴呆患病率调查[J].中国公共卫生,2007,23(8)：983-985.
[9]Hebert LE,S.P., McCann JJ, et al. Is the risk of developing Alzheimer's diseasegreater for women than for men [J]. American Journal of Epidemiology,2001,153(2):132-136.
[10]屈秋民,乔晋,韩建峰,等Alzheimer病患病率与患者性别的关系[J].中华老年医学杂志,2004,23(7)：511-512.
[11]汤哲,孟琛,董惠卿,等,北京城乡老年期痴呆患病率研究[J].中国老年学杂志,2002,22(4)：244-246.
[12]汤哲,孟琛,陈彪.北京地区老年痴呆流行病学研究[J].中华流行病学杂志,2003,24(8)：734-736.
[13]Leibovici D,R.K.,Ledesert B,et al. The effects of wine and tobacco consumption on cognitive performance in the elderly:a longitudinal study of relative risk [J]. Inernatioanlt Journal Epidemiology,1999,28(1):77-81.
[14]Monique M.B., Breteler, Michiel L.B., et al. Risk factors for vascular disease and dementia. [J]. Pathophysiology ofHaemostasis and Thrombosis,1998,24(3-4):167-173.
[15]Skoog I, Lernfelt B., Landahl S, et al.15-year ongitudinal study of blood pressure and dementia [J]. Lancet,1996,347(9009):1141-1145.
[16]Wu C, Zhou D., Wen C, et al. Relationship between blood pressure and Alzheimer's disease in Linxian County, China [J]. Life Science,2003,72 (10):1125-1133
[1]穆光宗.家庭空巢化过程中的养老问题[J],南方人口,2002,1(17)：33-36
[2]空巢家庭我国老龄化社会现象[EB/OL]. http://house.baidu.com/jiaozuo/news/0/2235637/. 2010-11-08/2012.01.15
[3]王庆华,段晓明,宋荣荣,等.空巢老人生活质量与心理状况的相关性[J].解放军护理杂志,2007,24(10A)：5-8.
[4]李德明,陈天勇,李贵芸.空巢老人心理健康状况研究[J].中国老年学杂志,2003,23(7)：405-407.
[5]张建凤等.合肥市社区空巢老人社区卫生服务需求及影响因素的研究[J].护理研究,2010.24(3)647-648.
[6]徐小林等.社区空巢老人生存状况及社会支持状况[J].中国老年学杂志,2010.10：2973-2975.
[7]杨秀婷等.我国空巢老人焦虑抑郁现状及相关因素研究进展[J].中国老年学杂志,2010,9：2712-2713.
[8]张毓薇.城市空巢老人社会支持研究[D].甘肃：西北师范大学政法学院.2009,5.
[9]赵华硕等.空巢老年人生存质量分级评价调查[J].社区医学杂志,2010,8(15)：35-37.
[10]吴明权.农村空巢老人生存质量及生活满意度调查[J].中国公共卫生管理.2()12.1(28)：93-94.
[11]杨伟民,付慧鹏,刘书红,李瑞莲.社区干预对空巢老人焦虑抑郁状况的影响[J].中国老年学杂志.2012,4：813-814
[12]Liu Meiping. The Old Supporting in Community:the Leading Model of Providing for the Aged from Rural Empty Nest Families [J]. Public Administration & Law.2010,01:54-58
[13]Jofi V. M. The empty nest:Unvoiced Concerns of the Elderly[J]. Asian Journal of Health. 2011,01(1):253-258
[14]David B. Don't let us down on care funding reform, alliance tells Andrew Lansley[EB/OL]. The Guardian. http://www.guardian.co.uk/society/2012/mar/05/care-funding-reform-andrew-lansley, 2012-3-5/2012-3-10
[15]Shufen Cao. The home-based elderly care system analysis:an illustration from Hangzhou, China [D]. Sweden:Umea International School of Public Health.2012,5.
[1]王建华.流行病学(第五版)[M].北京：人民卫生出版社.2011.06.
[2]王黎君.死因监测资料的分析与利用[R].北京：中国疾病控制中心.2006.10.
[3]吴三兵.2003年安徽省疾病监测点居民死亡原因分析与防治策略建议[D].安徽：安徽医科大学.2004.7
[4]郭勇,王法艳,马颖.死因推断及其准确性评价[J].中华疾病控制杂志,2009,13(3)：367-369
[5]郭勇.安徽省某城乡社区老年人口死因统计资料质量评价及相关对策研究[D].安徽医科大学.2009
[6]杨功焕著.中国人群死亡及其危险因素流行水平、趋势和分布[M].北京：中国协和医科大学出版社,2005.
[7]Wang L, Yang G, Jiemin M,et al. Evaluation of the quality of cause of death statistics in rural China using verbal autopsies [J]. J Epidemiol Community Health,2007,61(6):519-526
[8]Kalter HD, Hossain H, Burnham G,et al.Validation of caregiver interviews to diagnose common causes of severe neonatal illness[J]. Paediatr Perinat Epidemiol,1999,13(1):99-113
[9]Reeves B.C., Quigley M.. A review of data-derived Methods for assigning causes of death from verbal autopsy data[J]. International Journal of Epidemiology.1997,26(5):1080-1089.
[10]Walker GJ, Ashley DE, McCaw AM, et al. Maternal mortality in Jamaica [J]. Lancet.1986, 1(8479):486-488.
[11]Fauveau V, Koenig MA, Chakraborty J, et al. Causes of maternal mortality in rural Bangladesh,1976-85[J]. Bulletin of the Word Health Organization,1988,66:643-51.
[12]周脉耕,王玉英,葛辉等.中国2004年县及县以上医疗机构死亡病例报告质量评价[J].中华流行病学杂志,2006,27(4)：328-332.
[13]Rao C.,Yang G..,Hu J., et al. Validation of cause-of-death statistics in urban China [J]. International Journal of Epidemiology.2007; 36:642-651.
[14]杨进,张杰,曾竣等.口头尸检对河池市5-60岁死亡病例进行死因评估结果分析[J].中国初级卫生保健,2004,6：18(6)：19-20.
[15]Gonghuan Yang, Chalapati Rao, Jiemin Ma, et al.validation of verbal autopsy procedures for adult deaths in China [J]. International Journal of Epidemiology.2006,35:741-748.
[16]Quigley MA, Chandramohan D, Rodrigues LC. Accuracy of physician review, expert algorithms and data-derived algorithms in adult verbal autopsies[J], International Journal of Epidemiology.1999,28:1081-1087.
[17]Setel P.W., Sankoh O., Rao C.et al. Sample registration of vital events with verbal autopsy: a renewed commitment to measuring and monitoring vital statistics [J]. Bulletin of the Word Health Organization.2005,83(8):611-617.
[18]Yang G, Hu J., Rao K. et al. Mortality registration and surveillance in China History, current situation and challenges [J].Population health metrics,2005,3:3.
[19]Mohan D.C., Maude G.H., Rodrigues L.C., et al.Verbal autopsies for adult deaths:Issues in their development and validation[J]. International journal of epidemiology.1994,23(2):213-222.
[20]Chandramohan D., Maude G.H., Rodrigues L.C., et al.Verbal autopsies for adult deaths:their development and validation in a multicenter study[J]. Tropical Medicine and International Health.1998,3:436-446.
[21]Kahn K, Tollman SM, Garenne M, et al. Validation and application of verbal autopsies in a rural area of South Africa. Trop Med Int Health 2000; 5:824-31.
[22]余松林主编.医学统计学(第一版)[M].北京：人民卫生出版社,2002：269.
[1]推动老年福利进一步向适度普惠型转变.中国社会报[N].2009-05-01
[2]山西：“全民医保”时代来临.黄河新闻网[EB/OL]. http://www.sxgov.cn/shanxi/ shanxi content/2012-02/28/content 1546944.htm.2012-02-28/2012-02-15
[3]Matsuda S. The health and social system for the aged in Japan [J]. Aging Clin Exp Res.2002 Aug; 14(4):265-70.
[4]Davey B, Levin E, Iliffe S, Kharicha K. Integrating health and social care:implications for joint working and community care outcomes for older people[J]. Journal of Interprofessional Care.2005 Jan;19(1):22-34.
[5]黎筱珊.加快建设临终关怀服务体系[N].老人报.2012-03-21
[6]Tompsett H. Changing systems in health and social care for older people in Japan: observations and implications for interprofessional working[J]. Journal of Interprofessional Care. 2001 Aug; 15(3):215-21.
[7]Gomersall C. A rapid response intermediate care service for older people with mental health problems [J]. Nurs Times.2009 May,105(17):12-3.
[8]陈虹.完善老年医疗保障体系的制度创新和政策仿真[D].浙江：浙江大学.2011
[9]程杰,赵文.人口老龄化进程中的医疗卫生出：WHO成员国的经验分析[J].中国卫生政策研究.2010(04)
[10]马非,曲成毅,王婷,银炯,张晓东.老年居民对社区卫生服务利用及满意度调查[J].中国公共卫生.2008(10)
[11]Robert Pear. Medicare's Costs and Benefits are Elusive[N]. New York Times, Dec9,2003
[12]Cochrane J.H. Health-Status Insurance:How Markets Can Provide Health Security [R].Policy Analysis,2009,2
[13]喻凤娇.对完善我国农村医疗救助制度的思考[J].行政事业资产与财务.2011(06)
[14]民政部财政部卫生部人力资源和社会保障部关于进一步完善城乡医疗救助制度的意见[J].中国劳动.2009(08)
[1]中国人口老龄化发展趋势预测研究报告[R].全国老龄工作委员会办公室,http://www.cncaprc.gov.cn/info/1408.html.2007-12-27
[2]谢瑞满.实用老年痴呆学[M].上海：上海科学技术文献出版社,2010,1
[3]范俭雄,言镜玲,陈震华,等.南京地区老年期痴呆流行病学调查[J].临床精神医学杂志,2000,10(3)：137-138
[4]王德全、姜晓丹.老年痴呆患病率及危险因素调查[J].中国公共卫生,2002,18(12)：1498-1499
[5]周玢,洪震,等.上海市城乡人群痴呆患病率调查[J].中华流行病学杂志,2001,22(5)：368-371
[6]胡志,徐晓超等.合肥市城市社区老年抑郁症患病率调查[J].中国初级卫生保健,200418(4)：30-32
[7]赵芳,马天雯,等.上海市南汇区养老院老年痴呆症流行病学调查[J].现代预防医学,2007(15)：2864-2866
[8]仇成轩,Bengt Winblad, Laura Fratiglioni瑞典斯德哥尔摩市社区人群老年痴呆和阿尔茨海默病的危险因素的队列研究[J].中华流行病学杂志,2005,26(11)；882-887.
[9]李静,周华东,王延江,等.血管性痴呆危险因素的研究[J].中华老年心脑血管病杂志,2006,8(3)：158-161.
[10]Massimo Musicco,Katie Palmer,Giovanna Salamone. Predictors of Progression of cognitive decline in Alzheimer's disease:the role of vascular and socio demographic factors[J].Journal Of Neurology,2009,256(8):1288-1295.
[11]GanguliM, DodgeHH, Shen C, et al. Mild cognitive inpatient amnesic type an epidemiologic study [J]. Neurology.2004,63(1):115-121
[12]杨星,黄文涌,杨靖源,等.贵阳市社区老年人群阿尔茨海默病危险因素病例对照研究[J].现代预防医学,2007,34(18)：3436-3438.
[13]刘光,陈克,汤小琼,等.社区阿尔茨海默病影响因素分析[J].中国老年学杂志,2006.26：750-751.
[14]王德全,姜晓丹.老年痴呆患病率及危险因素调查[J].中国公共卫生,2002,18(12)：1498-1499.
[15]梁维萍,曲成毅,马菲,等.太原市社区老年人轻度认知功能障碍现况调查[J].中国慢性病预防与控制,2008,16(2)：174-175.
[16]刘光,陈克,汤小琼,等.社区阿尔茨海默病影响因素分析[J].中国老年学杂志,2006.26：750-751.
[17]胡文生,唐牟尼,郑洪波等,老年期痴呆患者在社区、老人院与住院中的经济负担研究[J].实用医学杂志,2008,24(10)：1821-1823
[18]李静,周华东,王延江,等.血管性痴呆危险因素的研究[J].中华老年心脑血管病杂志,2006,8(3)：158一161.
[19]马菲,王婷,银炯,等.社区老年人轻度认知功能障碍影响因素病例对照研究[J].中华流行病学杂志,2008,29(9)：873-877.
[20]唐牟尼,刘协和,云扬,等.社区阿尔茨海默病危险因素病例对照研究[J].中国心理卫生杂志,2001,15(1)：22-25.
[21]Verghese J Liptou RR, Katz M J et al. Leisure activities and the risk of Dementia in the elderly [S].N Engl JM ed,2003,348(10):2508-2516.
[22]刘吉林、高虎、宋枫,等.黄河流域11个地区51个干休所离退休于部认知障碍及老年痴呆危险因素分析[J].中国组织工程研究与临床康复,2007,11(30)：869-5871.
[23]陈忠义,李寅超,柳文科.血管性痴呆危险因素研究进展[J].实用医药杂志,2006,23(4)：490-492.
[24]胡善联.疾病负担的研究(上)[J].卫生经济研究,2005(5)：22-27
[25]王刚等.阿尔兹海默病疾病经济负担的国内外研究比较和分析[J].内科理论与实践,2009(4)：275-277
[26]胡善联.卫生经济学[M].上海：复旦大学出版社,2003.
[27]庄润森,王声湧.如何评价疾病的经济负担[J].中国预防医学杂志,2001(12)：245--247
[28]程晓明.卫生经济学[M].北京：人民卫生出版社,2007.102521
[29]张震巍,我国糖尿病疾病负担研究[D].上海：复旦大学,2007
[30]方博,靳文正,宋桂香.疾病负担研究进展[J].现代预防医学,2009(9)：1665-1668
[31]孙丽等.疾病负担测量与评价方法及其研究进展[J].现代医院,2008(6)：4-7
[32]程晓明.卫生经济学[M].北京：人民卫生出版社,2007.102521
[33]行动决定未来-动员全社会力量防治老年痴呆的倡议书.[EB/OL]当代中医药发展研究中心记忆健康360工程项目办公室,http://www.memory360.org/news/step/2010/0305/action-for-the-future.html,2011-1-25
[34]Wimo A,Prince M World Alzheimer Report 2010:Global Impact of Alzheimer's disease[R], Alzheimer's disease international,2010,9
[35]Wimo A, Winblad B, Jonsson L. The worldwide societal costs of dementia:Estimates for 2009. [J], Alzheimers Dement.2010 Mar; 6(2):98-103.
[36]Wang G, Cheng Q, Zhang S, et al. Economic impact of dementia in developing countries:an evaluation of Alzheimer-type dementia in Shanghai, China. [J], J Alzheimers Dis. 2008,15(1):109-115.
[37]安翠霞、于欣.痴呆患者经济负担及相关因素研究[J]. Chinese Mental Health Journal [J],2005,19(9):592-594
[38]陈林利、赵根明等.老年期痴呆患者经济负担研究[J].中国卫生经济,2009,11：19-21
[39]Suh GH, Knapp M, Kang CJ. The economic costs of dementia in Korea,2002[J]. Int J Geriatr Psychiatry.2006 Aug; 21(8):722-8.
[40]Allegri RF, Butman J, et al. Economic impact of dementia in developing countries:an evaluation of costs of Alzheimer-type dementia in Argentina. [J], Int Psychogeriatr.2007 Aug; 19(4):705-18.
[41]Shaji KS, Jotheeswaran AT, et al. THE DEMENTIA INDIA REPORT 2010—Prevalence, impact, costs and services for dementia[R].2010
[42]Leungo-Fenandez, R., Leal, J., Gray, A. Dementia 2010:The prevalence, economic cost and research funding of dementia compared with other major diseases. [R] India, New Delhi: Alzheimer's research trust and University of Oxford.2010
[43]赵涵漠.我国600万老年痴呆患者遭忽视[N].人民文摘,2010,7.
[44]Zhu CW, Scarmeas N, Torgan R, et al. Clinical features associated with costs in early AD: baseline data from the Predictors Study [J]. Neurology,2006,66(7):1021-1028.
[45]Lopez-Bastida J, Serrano-Aguilar P, Perestelo-Perez L, et al. Social-economic costs and quality of life of Alzheimer disease in the Canary Island, Spain [J].Neurology,2006, 67(12):2186-2191