中国失能老人问题探究——兼论失能评估工具在中国长期照护服务中的发展方向

A Study on issues linked to China's Disabled Elderly——with focus on the Disability Assessment Tools in China's Long-term Care Service

文本从宏观数据层面较为系统地归纳、总结了中国学者对当前全国失能老人规模的研究结论,试图找寻中国失能率评价差异之巨的工具性因素;从中微观操作层面上,评述了中国长期照护服务代表性试点城市评估工具,将失能率与失能指标体系的政策蕴意与实践运用进行了充分的比较和整合。通过将国际主流评估工具和中国残疾人分类分级标准相结合的操作方法,提出了一个可供学界讨论的失能率概念框架,并由此测算得出了2014年中国失能老人的规模在1320万左右的结论。文本最后就"失能"与"生活不能自理"的概念差异、"衰弱"视角看待失能在老年生命周期中的发展、针对不同政策目标发展一组失能操作性定义和培育老年人"复原力"以应对健康风险等政策建议进行了论述,以期为推进中国老年政策的基础工程建设拓展思路,并提供可能的"中国方案"。

This paper reviews and analyzes the research findings on the scale of cunent disabled elderly in China, and discusses the fundamental and instrumental factors that caused statistic disparity among scholars. The paper also compares the evaluation tools for long-term care service used by pilot cities in China. Through the combination of international mainstream assessment tools and Chinese standard of ＂classification and grading criteria of disability＂, a conceptual framework of disability rates is proposed that can be explored further for Chinese gerontology-related researchers. Based on this framework, it is estimated that t^e total number of disabled elderly in 2014 was 13.2 million for China as a whole. This paper tries to clarify the conceptual differences between ＂disability＂ and ＂care dependency＂, argues the importance of ＂frailty＂ in life course study of disability, and discuss the use of ＂resilience＂ in terms of strengthening the abilities in the face of adversity, etc., for the development and promotion of efficient policies for the elderly, and providing the possible ＂Chinese version＂ solutions in this field for the rest of the world.