“医养一体化远程照护模式”对农村失能老人积极老龄化的作用机制研究

In order to meet the rural disabled elderly’s increasing need for long-term care, adapt to development trend of telenursing discipline in the age of big data, it is based on the former research results of the “stroke continuous rehabilitation nursing model”, in view of the current status that domestic rural disabled elderly care has sever contradiction between supply and requirement, participation and security are insufficient, this study intends to build a medical-nursing integration telenursing model of the rural disabled elderly, under the guidelines of telemedicine theory and technology, based on extensive investigations and large amount of practical data , besides that, analyze and demonstrate contribution factor and indicators which influences the model’s operation. According to the informationalized, specialized and holistic principle, we plan to establish telenursing model practice path by combining subjective method with objective method. This research will also integrate the advantages of the resources provided by different caregivers, build telenursing model to do empirical study, verify the model’s practical significance of further popularization, the reliability and validity of the variables, reveal different telenursing caregivers’mechanism of action on active aging based on complex science theory and niche theory, build and compact this model’s development strategy combaining path analysis. We aims to solve the bottleneck problem on long-term care for rural disabled elderly from the perspective of mechanism and practical evaluation, laying a practical foundation for standardized , systematic management of telecare, providing supportive advice and theoretical foundation for relevant health policy in the level of technology and practice.

为满足国内农村失能老人不断增长的长期照护需求，适应大数据时代远程照护发展趋势，基于前期课题组实施“脑卒中失能患者连续康复护理模式”的初步效果，针对目前国内农村失能老人的照护供需矛盾突出、参与和保障不足现状，本研究拟以远程医学理论及技术为指导,基于广泛的调查研究和大量的实践数据,提出“农村失能老人医养一体化远程照护模式”,分析论证该模式运行的贡献因子及表达指标；按照信息化、专业化、整体化原则,结合主、客观法确立远程照护模式实践路径；整合不同照护主体的资源优势,对模式进行实证研究，验证其现实推广性及指标信效度；基于复杂科学理论、生态位理论揭示远程照护各主体对积极老龄化的作用机制，并结合路径分析凝练该模式的发展策略。从机制和实践评价角度解决农村失能老人长期照护的瓶颈问题，为远程照护的规范化、系统化管理提供实践基础，为相关卫生政策提供技术、实践层面的支撑性建议和理论依据。

研究背景：中国十四五规划和2035年远景目标纲要明确提出要构建居家社区机构相协调、医养康养相结合的养老服务体系，以积极应对人口老龄化，缓解农村失能老人长期照护需求激增、照护供需矛盾突出、社会参与和保障不足现状。研究内容：本研究从服务供需双方视角出发，采用量性和质性研究相结合的方法，在深入了解农村失能老人的积极老龄化水平、远程照护需求和使用意愿、智慧医养结合期待及医联体内医护人员远程健康照护准备度、智慧医养结合服务意愿和期待的基础上，构建“医养一体化远程照护模式”，基于开发的远程照护平台、农村乐龄学堂公众号和抖音号，整合医疗、养老和社会资源，对农村失能老人实施多模态远程照护干预，采用类实验性研究设计进行效果评价，并结合临床实践构建农村失能老人远程照护评价指标体系，基于生态位理论分析医养一体化远程照护模式对积极老龄化的作用机制。重要结果和关键数据：本研究结果提示我们，农村失能老人医养结合服务供需失衡明显、未满足需求突出、积极老龄化水平亟待提升，而基于远程照护平台整合实施的医养一体化模式可显著改善农村失能老人的生活质量、虚弱状态、焦虑情绪，增强其主动参与学习健康知识的积极性和照顾者的照护能力，提升各类服务的可及性、便捷性，推动失能老人与服务资源的动态交互，逐步改善其健康状况、社会参与及保障，以达成养老服务需求和现实资源供给相匹配，实现最佳养老生态位。科学意义：本项目为积极应对农村老龄化、失能化，推动信息化发展背景下农村失能老人积极老龄化的实现、提升其生活质量、促进晚年生活幸福感提供现实可行的实践经验。同时，也为丰富“全民健康”战略内涵，推动国家实现健康中国2030目标规划提供了参考依据，具有重要的理论和实践意义。