作者：NursingResearch护理研究前沿
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The aging population is rapidly growing in the United States, with estimates projecting that by 2030, one in five Americans will be over the age of 65 (U.S. Census Bureau, ). The state of Florida has a high proportion of older adults, with 21.3% of its population being 65 or older, second only to Maine (Population Reference Bureau, ). Nationally, the older population is expected to grow significantly in the future. It is estimated that by 2040, there will be about 80.8 million older persons, more than twice as many as in 2000. That number is projected to reach 94.7 million in 2060 (Administration for Community Living, ). In Florida, which continues to experience a surge in migration of older adults, the 65 and older age group was the fastest growing between and with an increase of 40.3% (USAFacts, ). Persons 65 years and older are also living longer with an average life expectancy of 19.6 years. More than half (61%) of individuals age 65 and older live with a spouse or partner and about 27% live alone, compared to a relatively small number who live in nursing homes (Administration for Community Living, ).
1 AGING IN PLACE
‘Aging in place’ is the ability to remain in ones own home and community as one age, with access to the necessary support and services to maintain quality of life (Administration on Aging, ). As the population continues to age, there is a growing need for programs and initiatives that support aging in place and improve the quality of life for older adults. In a study published by the American Association of Retired Persons (AARP), 86% of adults aged 65 or older reported wanting to stay in their own homes for as long as possible (AARP, ).
Aging in place has been linked to several health benefits, including improved quality of life, reduced healthcare costs and increased social connectedness (Centers for Disease Control [CDC], ). However, aging in place can be challenging for many older adults because of declining health, loss of independence and increased risk of injury. One in three older adults who experience a decline in independence may also require assistance with daily activities, such as bathing, dressing and eating (Freedman et al., ). A positive outcome of the aging-in-place programme would be that older people can get the support needed to maintain their independence while residing in their homes rather than being transferred to live in a nursing care facility. The literature supports that when older persons can age within their own residence, there is improved quality of life (van Leeuwen et al., ).
2 CAPABLE PROGRAM
To support aging in place and improve the quality of life for older adults, there is a need for programs and initiatives that address the challenges of aging, such as health issues, home modifications and access to community resources. One such program is the community aging in place—advancing better living for elders (CAPABLE) program. The CAPABLE program is a 5-month (10-visit) home-based program involving a registered nurse, occupational therapist and handy worker that work with the older adult to develop goals and action plans to change behaviours to improve health, independence and safety (Szanton et al., ). The registered nurse targets pain reduction, medication reconciliation and communication with the primary care provider, and assists with incontinence supplies orders. The occupational therapist teaches clients how to perform ADLs safely at home, which often includes meal preparation, bathing, dressing, strength training, home management and caregiver education to teach the technique of home safety. The handy workers provide home modifications such as the installation of grab bars in the shower or a ramp to make the house wheelchair accessible. Members acquire skills such as learning how to use new equipment and making home adjustments to increase function and safety. Participants receive tools, home modifications and learn skills and exercises to improve function and safety. CAPABLE has been implemented in 34 states in the United States, but not yet in Florida where it is, most greatly needed.
The CAPABLE program has been shown to be effective in improving the quality of life and reducing hospitalizations and nursing home admissions for older adults. Participants in the CAPABLE program experienced improvements in daily activities, home safety and quality of life. Additionally, the program has been found to be cost-effective, with potential savings of $10,000 per participant per year in healthcare costs (Szanton et al., ). While the CAPABLE program has been successful in other states, its implementation in Florida faces several challenges. For example, funding for the program may be a barrier, as Florida has not yet included CAPABLE in its Medicaid waiver or Medicare Advantage supplemental benefits. Additionally, there may be a lack of awareness among older adults and healthcare professionals about the benefits of the program.
To address these challenges, policymakers and healthcare professionals need to work together to increase awareness of the CAPABLE program and secure funding for its implementation in Florida. In addition to the CAPABLE program, other initiatives and programs can support aging in place and improve the quality of life for older adults. One such initiative is the Age-Friendly Sarasota program, which aims to make Sarasota County a livable community for people of all ages. The program focuses on eight domains of livability, including transportation, housing and social connectedness, among others (Age-Friendly Sarasota, n.d.). The Age-Friendly Sarasota program has been successful in improving the quality of life for older adults in the community by implementing various initiatives such as ‘Complete Streets’ policies that promote safe and accessible transportation options, affordable housing initiatives and community engagement programs that foster social connectedness (Age-Friendly Sarasota, n.d.). The programs success has led to Sarasota County being designated as the first ‘Age-Friendly’ county in Florida by the World Health Organization (WHO) (). This model serves as a strategic approach for aging in place and illustrates the eight domains of the livability of the Age-Friendly Sarasota program (Figure 1).
FIGURE 1
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Age-friendly community features eight domains of livability—Age-Friendly Sarasota.
3 IMPLICATIONS FOR NURSES
Implementing aging-in-place initiatives has some positive implications for nursing such as providing opportunities for nurses to work in home-based care settings, promoting a patient-centred approach to care and improving coordination between healthcare providers and community resources. Furthermore, in the U.S., Nurses and Adult-Gerontology Nurse Practitioners (AGPCNP) are at the forefront of promoting successful aging in place due to their unique competencies of being advocates, health educators, change agents and case managers. AGPCNPs with expertise in older adult care are ideal persons to advocate for and actively participate in initiatives that foster aging in place.
4 CONCLUSION
The changing landscape and sociodemographic shift in the United States have implications for the implementation of programs such as the CAPABLE program. In Florida, specifically, the aging-in-place initiatives such as CAPABLE will be of great benefit due to its high older adult population. Remaining in ones own home and community as older adults age, with access to necessary support and services, can foster life satisfaction, a positive quality of life and self-esteem, all of which are essential for maintaining health, and wellness throughout the aging process. CAPABLE focuses on the promotion of independence, safety, prevention and problem-solving, building skills that participants can use in the future.
全文翻译（仅供参考）
美国的老龄化人口正在迅速增长，据估计，到2030年，五分之一的美国人将超过65岁。人口普查局，）。佛罗里达州的老年人比例很高，21.3%的人口为65岁或以上，仅次于缅因州州（人口参考局， ）。在全国范围内，预计未来老年人口将大幅增长。据估计，到2040年，将有约8080万老年人，是2000年的两倍多。预计到2060年，这一数字将达到9470万（社区生活管理局， ）。在佛罗里达州，老年人移民继续激增，65岁及以上年龄组在至间增长最快，增长了40.3%（USAFacts， ）。65岁及65岁以上的人寿命也更长，平均预期寿命为19.6岁。超过一半（61%）的65岁及以上的人与配偶或伴侣住在一起，约27%的人独居，而住在养老院的人相对较少（社区生活管理局， ）。
1现场老化
“就地老龄化”是一个人作为一个年龄留在自己的家中和社区的能力，可以获得必要的支持和服务，以维持生活质量（老龄化管理局，）。随着人口持续老龄化，对支持就地老龄化和改善老年人生活质量的计划和举措的需求日益增长。在美国退休人员协会（AARP）发布的一项研究中，86%的65岁或以上的成年人表示希望尽可能长时间地留在自己的家中（AARP， ）。
就地老龄化与几种健康益处有关，包括提高生活质量，降低医疗保健成本和增加社会联系（疾病控制中心[CDC]， ）。然而，由于健康状况下降，失去独立性和受伤风险增加，对许多老年人来说，原地老化可能具有挑战性。三分之一经历独立性下降的老年人也可能需要日常活动的帮助，例如洗澡，穿衣和吃饭（Freedman等人，& nbsp; ）。就地养老方案的一个积极成果是，老年人可以得到必要的支持，在自己家中生活而不是被转移到护理设施生活的同时保持独立。文献支持当老年人可以在他们自己的住所内变老时，生活质量得到改善（货车Leeuwen等人，& nbsp; ）。
2有能力的计划
为了支持就地老龄化并改善老年人的生活质量，需要制定解决老龄化挑战的方案和举措，例如健康问题，家庭改造和获得社区资源。一个这样的计划是社区老龄化的地方推进更好的生活为老年人（能力）计划。CAPABLE计划是一项为期5个月（10次访问）的家庭计划，涉及注册护士、职业治疗师和勤杂工，他们与老年人一起制定目标和行动计划，以改变行为，改善健康、独立性和安全性（Szanton等人，& nbsp; ）。注册护士的目标是减轻疼痛，药物协调和与初级保健提供者的沟通，并协助失禁用品订单。职业治疗师教导客户如何在家中安全地执行ADL，通常包括膳食准备，洗澡，穿衣，力量训练，家庭管理和护理人员教育，以教授家庭安全技术。手巧的工人提供家庭改造，如在淋浴或坡道，使房子轮椅无障碍安装扶手杆。成员获得的技能，如学习如何使用新设备，使家庭调整，以增加功能和安全。参与者获得工具，家庭改造和学习技能和练习，以提高功能和安全性。CAPABLE已经在美国的34个州实施，但在佛罗里达州还没有实施，而佛罗里达州是最需要的。
能力计划已被证明是有效的，在提高生活质量，减少住院和养老院接纳老年人。参加能力计划的人在日常活动、家庭安全和生活质量方面都有了改善。此外，已经发现该计划是成本有效的，在医疗保健成本方面每个参与者每年潜在节省$10，000（Szanton等人，& nbsp; ）。虽然“能力计划”在其他州取得了成功，但在佛罗里达州的实施面临着一些挑战。例如，该计划的资金可能是一个障碍，因为佛罗里达州尚未将CAPABLE纳入其医疗补助豁免或医疗保险优势补充福利。此外，老年人和医疗保健专业人员可能对该计划的益处缺乏认识。
为了应对这些挑战，政策制定者和医疗保健专业人员需要共同努力，提高对能力计划的认识，并为其在佛罗里达州的实施提供资金。除了能力计划外，其他倡议和计划可以支持就地老龄化并改善老年人的生活质量。其中一项倡议是“对年龄友好的萨拉索塔”计划，该计划旨在使萨拉索塔县成为一个适合所有年龄段的人居住的社区。该计划的重点是八个领域的宜居性，包括交通，住房和社会联系，等等（年龄友好萨拉索塔， 北达科他州。）.萨拉索塔老年友好计划通过实施各种举措，如促进安全和无障碍交通选择的“完整街道”政策，经济适用房举措和促进社会联系的社区参与计划，成功地提高了社区老年人的生活质量（萨拉索塔老年友好计划， N. D。）.该计划的成功导致萨拉索塔县被世界卫生组织（WHO）指定为佛罗里达州第一个“老年友好”县 （）。该模型作为就地养老的战略方法，并说明了老年友好萨拉索塔计划的八个宜居领域（图 1）。
年龄友好社区具有八个宜居领域-年龄友好萨拉索塔。
3对护士的影响
实施老龄化的举措有一些积极的影响，护理，如提供机会，护士在家庭护理环境中工作，促进以病人为中心的方法来照顾和改善医疗服务提供者和社区资源之间的协调。此外，在美国，护士和成人老年学护士执业者（AGPCNP）是在促进成功的老龄化的最前沿，由于他们的倡导者，健康教育工作者，变革推动者和案例管理者的独特能力。具有老年人护理专业知识的AGPCNP是倡导和积极参与促进就地老龄化的倡议的理想人选。
4结论
在美国不断变化的景观和社会人口结构的转变，如能力计划的实施有影响。具体而言，在佛罗里达州，由于老年人口众多，诸如CAPABLE等就地养老计划将带来巨大好处。随着老年人的年龄增长，留在自己的家中和社区，获得必要的支持和服务，可以促进生活满意度，积极的生活质量和自尊，所有这些对于在整个衰老过程中保持健康和健康至关重要。能力的重点是促进独立，安全，预防和解决问题，建设技能，参与者可以在未来使用。
THEEND
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