高龄老年人衰弱进程中日常照护及精神慰藉需求状况分析

Frailty-related needs of daily care and spiritual comfort among oldest old persons in Tangshan city

目的了解高龄老人的衰弱进程、日常照护及精神慰藉需求状况,分析衰弱程度与日常照护及精神慰藉需求的相关性。方法于2016年7月—2017年1月采用分层随机整群抽样方法抽取河北省唐山市2家医院的10个社区卫生服务中心辖区≥75岁老年人,使用衰弱综合评估工具(CFAI)、日常生活能力量表(ADL)、孤独量表进行(UCLA)评测。结果 3 448名高龄老人衰弱率为100%,随年龄的增加其衰弱程度呈加重趋势,差异有统计学意义(χ2=133.355,P<0.001);日常照护低需求者860人(24.9%),高需求者804人(23.3%),而高龄老人自评需要生活照护者占61.0%,高于ADL评估结果,选择需要子女照顾者2 021人次,占58.6%;精神慰藉低需求1 071人(31.06%),中等需求1 598人(46.35%),中上等需求679人(19.69%),高需求100人(2.90%),精神照护中等及以上需求者占68.94%,远高于日常生活照顾需求者。而高龄老人自评需要精神照护者2 441人,占70.17%,2组数据基本持平。选择需要子女提供精神照护者1 906人次,占78.08%。多因素分析显示,年龄、衰弱程度是高龄老人日常照护和精神慰藉需求的影响因素。结论应加强对高龄老人日常生活和精神生活的照护,依据衰弱程度提供相应的照护。

Objective To examine frailty-related needs of daily care and spiritual comfort and to analyze the relationship between the degree of weakness and needs of daily care and spiritual comfort among oldest old residents. Methods We recruited 3 448 residents aged ≥ 75 years from communities covered by 10 community health care centers in Tangshan city of Hebei province with stratified cluster random sampling; then we conducted a face-to-face interview among the residents with the Comprehensive Frailty Assessment Instrument （CFAI）, Activity of Daily Living Scale （ADL）, and University of California, Los Angeles （UCLA） Loneliness Scale from July 2016 to January 2017. Results Among the 3 448 participants with valid information, the prevalence of frailty was 100% and the frail condition tended to be severe with the increment of age （P 〈 0.05）. Of the participants, 860 （24.9%） and 804 （23.3%） were evaluated with low and high demand for daily care according to their ADL scores; whereas, 61.0% of the participants reported daily care demand by themselves and the ratio was higher than that of ADL assessment. More than a half （2 021, 58.6%） of the participants selected their children to provide the daily care they required. There were 1 071 （31.06%）, 1 664 （48.26%）, and 713 （20.69%） of the participants reporting low, moderate, and high demand for spiritual comfort. The proportion of the participants assessed with moderate and high demand for spiritual comfort was 68.94%, much higher than that of those for demand of daily care; while, the number of the participants with the self-reported demand for spiritual comfort was 2 441 （70.17%）, similar to that for daily care. Of the participants requiring spiritual comfort, 1 906 （78.08%） selected their children to provide the spiritual comfort. Multivariate analysis showed that age and the degree of frailty were the influencing factors of demand for daily care and spiritual comfort. Conclusion More daily care and spiritual comfort should be provided to community oldest old persons according to their frailty conditions.