老年慢性病患者社区健康管理模式研究进展
Research Progress of Community Health Management Model in Chronic Diseases of Elderly People

随着人口老龄化现象的迅速加剧，在老年人群体中，慢性疾病问题正逐渐凸显。多种疾病并存的现象日益严重，全球慢性病负担急剧增加。中国在全球范围内的人口老龄化进程中处于领先地位，而且，由于中国的老龄化程度日益提高和疾病治疗方法的转型，慢性病已经转变为对大众健康构成巨大威胁的疾病之一，并且这种情况正在持续增长。由于老年人的脏器储存功能降低，顺应力降低，抵抗力减弱，在全球老龄化的大背景下，老年人常伴随多种慢性疾病，例如呼吸系统、心血管系统、内分泌系统等，这些慢性疾病的特征悄然影响着老年人的生活素质。此外，老年人治疗需要高超的医疗技术，然而其参与社会经济发展的能力则较为有限。人们的健康需求正在发生变化，支持老年人管理慢性病以改善其功能、护理质量和整体福祉的需求也在增加。因此，为了有效提升老年人口的生活品质，减轻患者及其家庭的经济负担，并促进社会的协调发展，我们迫切需要实施科学合理的健康管理策略，特别针对那些患有慢性疾病的老年人。本文从老年慢性病的概述，社区健康管理的概念以及应用现状，实施不足以及策略和建议进行综述，旨在优化健康管理服务模式，以不断提高个体和机构对该服务模式的认知度，并促进实践中的积极发展。
With the rapid aging of the population, the problem of chronic diseases is gradually becoming prominent among the elderly. The coexistence of multiple diseases is becoming more and more serious, and the global burden of chronic diseases is increasing dramatically. China is a global leader in the aging of its population, and chronic diseases have become one of the diseases that pose a huge threat to public health due to China’s increasing aging population and the transformation of disease treatments, and this situation is continuing to grow. Due to the reduction of organ storage function, reduced compliance and weakened resistance of the elderly, in the context of global aging, the elderly are often accompanied by a variety of chronic diseases, such as respiratory system, cardiovascular system, endocrine system, etc., the characteristics of these chronic diseases quietly affect the quality of life of the elderly. In addition, the treatment of the elderly requires advanced medical skills, but their ability to participate in socio-economic development is limited. People’s health needs are changing, as is the need to support older adults in managing chronic conditions to improve their functioning, quality of care, and overall well-being. Therefore, in order to effectively improve the quality of life of the elderly population, reduce the economic burden of patients and their families, and promote the coordinated development of society, we urgently need to implement scientific and reasonable health management strategies, especially for those with chronic diseases. This paper reviews the overview of chronic diseases in the elderly, the concept and application status of community health management, the implementation shortcomings, and the strategies and suggestions, aiming to optimize the health management service model, so as to continuously improve the awareness of individuals and institutions about this service model, and promote the positive development of the service model.