中国老年人临终前生活自理能力的衰退轨迹

Disability Trajectories in Activities of Daily Living of Chinese Older People before Death

本文以老年人为研究对象,以基本生活自理能力(ADL)为测量指标,使用"中国老年健康长寿影响因素跟踪调查"(CLHLS)数据,分析在1998-2014年期间去世的老年人群临终前的生活自理能力的变化轨迹。作者利用组基轨迹模型对男性和女性老年人的生活自理能力变化过程分别进行拟合,发现老年人在临终前的生活自理能力存在显著差异并归纳出三种变化轨迹:生活自理能力完好型、快速发展型和缓慢下降型。研究发现生命历程早期阶段的经历、所处的社会经济状况、年龄效应和队列效应都会对生活自理能力的衰退轨迹产生显著影响。增龄带来的生活自理能力下降使老年人临终前的失能风险及其持续时间增加,而较晚的出生队列在临终前出现长时间失能的可能性较低。在三类轨迹中,自理能力缓慢下降型轨迹受到各种因素的影响最为显著,而该类型的出现概率是影响失能老年人照料负担的主要因素,由此也证明了除去年龄效应与性别差异之外,由社会经济状况、健康行为习惯、生活环境等因素合力产生的健康保护作用将会在失能老年人照料负担增长过程中发挥主导作用。研究还发现老年女性在临终前会面临更高的失能风险和更长时间的失能存活期,其生活自理能力变化过程受到更多因素的影响。

This study aims to analyze the dynamic change in activities of daily living(ADL)of the Chineseelderly before death,and to explore the heterogeneity in this process. Employing data from the Chinese Lon-gitudinal Healthy Longevity Survey(CLHLS),we quantify disability trajectories of ADL using a group-basedtrajectory model and find that there are three types of disability trajectories for ADL,good and stable statusof ADL,declining quickly and slowly in ADL. It reveals that the ADL is declining with ageing and it in-creases the possibility of the older people to be disabled and survival long time with disability before death,and the elderly in an early cohort who died at older ages were more likely to have experienced a long dura-tion of disability. The elderly who differ by socioeconomic status,childhood experiences,health behaviors,ages and birth cohorts show significant disparities in disability trajectories. The trajectory of declining slow-ly in ADL is affected by those factors greater than other types,and the prevalence of this trajectory amongthe older people is important predictor of burden of Long-term care. This result verifies that the protectiveeffects of health contributed by good socioeconomic status,healthy behavior and living environment willplay predominant role in the future prediction of Long-term care. The research also reveals that old fe-males are more likely to be disabled and survival long time with ADL disability than old males,and theirprocesses of decline in ADL are affected by more factors.