The future burden of disability in the UK: the time for urgent action is now.
The future burden of disability in the UK: the time for urgent action is now.
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英国未来的残疾负担：现在是采取紧急行动的时候了。
DOI：
10.1016/s2468-2667(17)30098-1
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
S. Gilmour
中科院分区：
文献类型：
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作者：
S. Gilmour
在《柳叶刀公共卫生》杂志上，玛丽亚·古兹曼-卡斯蒂略和同事们及时警告说，英国在不久的将来将面临巨大的卫生系统挑战。研究人员使用了一个详细的概率马尔可夫模型来估计到2025年英格兰和威尔士65岁或65岁以上人群因心血管疾病、痴呆和其他原因导致的残疾的患病率。他们发现，与2015年相比，将生活在残疾状态下的老年人数量增加了25%，这意味着英格兰和威尔士将有56万老年人需要照顾他们的残疾状况，并表明痴呆症病例的相对增加幅度最大。他们还预测，尽管65岁以上人群的预期寿命将增加1.7年，但其中0.7年将生活在残疾状态下。该模型使用了从一个完善的纵向队列模型中获得的疾病发病率的详细估计以及心血管疾病和痴呆症之间的共病率。该研究提供了以前的研究的进步，2因为使用了具有相互作用状态的马尔可夫模型，而不是统计模型，并以病例数而不是残疾年数的形式，对政策制定者可以立即获得的护理负担的快速增长进行了估计。以这种形式呈现的结果赤裸裸地显示了英国国民健康服务（NHS）和社会护理系统在未来十年将面临的日益增长的残疾负担。痴呆症相关残疾患病率的快速增加发生在痴呆症患者的护理质量以及英国卫生和社会护理系统管理这种复杂状况的准备程度受到质疑的时候。3 NHS在非传染性疾病（NCDs）4护理方面仍然面临不平等，老年人关键残疾状况的护理质量较差，对其服务的需求前所未有，以及巨大的财务和劳动力规划挑战。6其他研究的结果表明，能够接受护理的老年人人数迅速下降，工作人员短缺，越来越多的负担转移到私人或非正式安排，7但正是在这种情况下，古兹曼-卡斯蒂略和
In the Lancet Public Health, Maria Guzman-Castillo and colleagues1 present a timely warning of the huge health system challenges looming in the UK’s near future. The investigators used a detailed probabilistic Markov model to produce estimates of the prevalence of disability due to cardiovascular disease, dementia, and other causes in people aged 65 years or older in England and Wales to the year 2025. They found a 25% increase from 2015 in the number of older people who will be living with disability, representing 560 000 additional elderly people in England and Wales who will need care for their disabling condition, and showed that the largest relative increases will be in dementia cases. They also predicted that although life expectancy among people older than 65 years will increase by 1· 7 years, 0· 7 of these years will be lived with disability.The model used detailed estimates of incidence of illness obtained from a well established longitudinal cohort model and comorbidity between cardiovascular disease and dementia. The study offers an advance on previous studies, 2 because of the use of a Markov model with interacting states rather than a statistical model, and gives estimates of the rapid growth in care burden that are immediately accessible to policy makers, in the form of case numbers rather than years lived with disability. Presented in this form, the results show starkly the growing burden of disability that the UK National Health Service (NHS) and social care system will face over the next decade. This rapid increase in prevalence of dementia-related disability occurs at a time when the quality of care for people living with dementia, and the readiness of the UK health and social care system to manage this complex condition, has been questioned. 3 The NHS also still faces inequality in care of non-communicable diseases (NCDs) 4 and poorer quality care of key disabling conditions in older people, 5 unprecedented demand for its services, and substantial financial and workforce planning challenges. 6 Findings from other studies have shown rapid declines in the number of older people able to receive care, shortages of staff, and increasing burden-shifting to private or informal arrangements, 7 but it is in this context that Guzman-Castillo and