Whole systems care for post-stroke management in older adults: exploring the options for integration of health and social care systems in China

由于过去几十年的社会和经济变化，一些低收入和中等收入国家的人口迅速老龄化，他们更容易受到长期健康状况的影响。迄今为止，很少有人探讨已形成综合保健和社会护理模式的高收入国家的经验如何为老年人数量不断增加的低收入和中等收入国家的战略提供参考。这项发展资助旨在为中国广东省老年人中风护理系统的发展建立证据。中国人口正在迅速老龄化，60岁以上的成年人中约有一半患有慢性病。高血压是中风的主要危险因素，而中风是该国死亡和残疾的主要原因。由于“独生子女政策”、国内移民和90年代末以来的医疗改革，家庭结构、社会支持水平和老年人获得医疗保险的机会都发生了变化。农村和城市老年人的健康意识和支持程度不同，寻求保健的方式也不同，但总体而言，他们得到的保健不一致且不完整。该项目侧重于卒中护理，以探索卫生和社会系统如何促进或阻碍患有慢性疾病的老年人护理的连续性。首先，我们的目标是从国际文献中提炼出老年人中风护理系统的经验教训，并检查其在中国卫生系统背景下的适用性。其次，我们将在广东省的一个城市和一个农村地区（分别为广州和梅州）对老年人、非专业护理人员以及专业卫生和社会护理提供者进行实地研究，收集数据，以记录他们的经历、求医模式和对慢性疾病管理的感知需求。对中风患者恢复和康复过程的特别关注将使我们能够确定系统目前的工作方式，以及它们在多大程度上阻碍或促进了综合护理。第三，我们将以模型的形式检查和总结收集的数据，该模型说明卫生和社会保健系统目前如何响应和相互作用，以满足正在从中风中恢复的老年患者的需求。最后，我们将通过一个参与性研讨会来传播结果，该研讨会包括来自卫生和社会护理机构的关键人物，以便讨论和提出有关潜在战略的建议，这些战略可以整合当前卫生和社会护理系统的要素，以改善老年中风患者的护理。这项工作将为制定一个更大的提案提供信息，该提案可以实施和评估一个或多个已确定的战略，以支持中国卒中护理系统的发展。

As a result of social and economic change over the past few decades, a number of low- and middle-income countries have rapidly ageing populations who are more vulnerable to long-term health conditions. To date, there has been little exploration of how the experiences of high-income countries that have developed models of integrated health and social care might inform strategies in low- and middle-income countries with growing numbers of older adults. This development grant seeks to build evidence towards development of a stroke care system for older adults in Guangdong Province, China. China's population is rapidly ageing, and approximately half of adults over 60 are living with chronic diseases. High blood pressure is the main risk factor for stroke which is leading cause of death and disability in the country. Family structures, levels of social support, and access to health insurance for older adults have changed due to the 'one-child policy', internal migration, and health reforms since the late 90's. Older adults in rural and urban settings have different levels of health awareness and support and seek health care differently, but overall, the care they receive is inconsistent and patchy. This project focuses on stroke care to explore how health and social systems are working to enable or hinder continuity of care for older adults with chronic disease conditions. First, we aim to distil the lessons learned from the international literature on stroke systems of care for older adults and examine their applicability in the Chinese health systems context. Second, we will conduct field research involving data collection with older adults, lay caregivers, and professional health and social care providers in an urban and a rural prefecture of Guangdong Province (Guangzhou and Meizhou respectively) to document experiences, patterns of care-seeking, and perceived needs for chronic disease management. A specific focus on stroke patients' journeys through recovery and rehabilitation will allow us to identify how the systems currently work, and to what extent they hinder or facilitate integrated care. Third, we will examine and summarise the data collected in the form of a model that illustrates how health and social care systems currently respond and interact to meet the needs of older patients who are recovering from a stroke. Finally, we will disseminate results through a participatory workshop that includes key individuals from health and social care institutions in order to discuss and make recommendations regarding the potential strategies that can integrate elements of current health and social care systems to improve the care of older stroke patients. This work will inform the development of a larger proposal that can implement and evaluate one or more of the strategies identified to support development of a stroke care system in China.