屏東縣社區護理師高齡友善照護之經驗－以長者健康整合式評估與照護為例

Hsiu-Chun CHANG; Chia-Hui CHIU; Yi-Hua LEE; Pei-Fang CHIA

doi:10.6224/JN.202502_72(1).05

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P29 - 35

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6224/JN

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屏东县社区护理师高龄友善照护之经验－以长者健康整合式评估与照护为例

Age-Friendly Health Care: An Example of Providing Integrated Care for Older People (ICOPE) in Pingtung County, Taiwan

张秀君(Hsiu-Chun CHANG) ；邱家惠(Chia-Hui CHIU) ；李依桦(Yi-Hua LEE) ；贾佩芳(Pei-Fang CHIA)

护理杂志； 72 卷 1 期 (2025 / 02 / 01) ， P29 - 35

繁体中文;英文 DOI： 10.6224/JN.202502_72(1).05

高龄化；长者整合性照护指引；社区护理； aging ； integrated care for older people (ICOPE) ； community nursing

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摘要 │ 参考文献 (21)

摘要〈TOP〉

并列摘要〈TOP〉

Population aging has become a prevalent societal trend in the 21st century, giving rise to intricate challenges for healthcare systems. Taiwan is expected to become a "super-aging society" in 2025. In 2020, the Health Promotion Administration, referencing World Health Organization (WHO) guidelines on integrated care for older people (ICOPE), began promoting person-centered functional assessments for older adults to prevent and delay disability, reduce reliance on formal healthcare, and promote healthy aging, aging in place, and active aging. Pingtung County faces a healthcare gap between urban and rural areas. To address this, the county's executive team integrated community and healthcare systems into a single Age-Friendly Health Network to help older adults self-detect intrinsic functional decline problems at an early stage and receive early treatment. The implementation of this network is being done in the following four phases: preparation, action, implementation and revision, and promotion. As of August 2024, ICOPE intake in the county reached 11,873, representing a coverage rate of 7.42%. In addition to inadequate training opportunities for community healthcare professionals, rural communities are currently confronted with a dearth of referral mechanisms for post-ICOPE screening aftercare services for anomalous cases, representing a significant challenge that demands collaboration between industry, government, academia, and research. In light of the expanding older adult population, community nursing can be a formidable undertaking, necessitating the provision of ongoing nursing professional training and psychosocial support.

参考文献 ( 21 ) 〈TOP〉

Briggs, A. M.,Araujo de Carvalho, I.(2018).Actions required to implement integrated care for older people in the community using the World Health Organization’s ICOPE approach: A global Delphi consensus study.PLOS ONE,13(10),e0205533.
Cruz, T. H.,FitzGerald, C. A.,Quintana, V.,Barnes, J.,Sanchez, K. E.,Hirschl, M.,Lavender, A.,Caswell, L.(2022).Healthy here: A promising referral system model for community–clinical linkages to prevent chronic disease.Health Promotion Practice,23(1, Suppl.),153S-163S.
Deschodt, M.,Laurent, G.,Cornelissen, L.,Yip, O.,Zúñiga, F.,Denhaerynck, K.,Briel, M.,Karabegovic, A.,De Geest, S.(2020).Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis.International Journal of Nursing Studies,105,103552.
Donnell, D,O’Donoghue, G,Ní Shé, É.,O’Shea, M,Donnelly, S.(2023).Developing competence in interprofessional collaboration within integrated care teams for older people in the Republic of Ireland: A starter kit.Journal of Interprofessional Care,37(3),480-490.
GBD 2015 Risk Factors Collaborators(2016).Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the global burden of disease study 2015.The Lancet,388(10053),1659-1724.

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