社区老年人养老方式选择及影响因素分析

Analysis of the choice and influencing factors of the way of providing for the elderly in the community

目的随着失能老人数量增加及家庭结构改变,老年人养老方式选择也在变化。国家在"十三五"规划中提出,要建立以居家为基础、社区为依托和机构为补充的多层次养老服务。本研究了解社区老年人养老能力状况及家庭功能对养老方式选择的影响,以便更科学合理地提供养老服务。方法2020-05-05-08-28采取多阶段随机抽样法抽取济宁市280例≥60岁老年人为调查对象,应用老年人能力评估表和家庭功能量表对老年人进行调查,并采用单因素和多因素分析老年人养老方式选择的影响因素。结果回收有效问卷265份。121名(45.7%)老年人能力完好,200名(75.5%)老年人家庭功能良好,219名(82.6%)老年人选择居家养老。老年人能力完好者94.2%选择居家养老,5.8%选择机构养老;家庭功能良好者87.5%选择居家养老,12.5%选择机构养老。单因素分析结果显示,年龄(χ^(2)=33.00,P<0.01)、婚姻(χ^(2)=41.58,P<0.01)、经济来源(χ^(2)=24.13,P<0.01)、医疗保障(χ^(2)=11.00,P<0.01)、慢性疾病数(χ^(2)=10.37,P=0.02)、老年人能力(χ^(2)=20.93,P<0.01)、日常生活活动能力(χ^(2)=90.86,P<0.01)、感知觉与沟通(χ^(2)=10.04,P=0.01)、精神状态(χ^(2)=28.99,P<0.01)、社会参与(χ^(2)=24.79,P<0.01)和家庭功能(χ^(2)=13.44,P<0.01)方面在不同养老方式选择组间差异有统计学意义。Logistic多因素回归分析结果显示,年龄(OR=0.03,95%CI为0.00~0.15,P<0.01)、经济来源(OR=58.11,95%CI为2.90~1165.56,P=0.01)、婚姻(OR=7.02,95%CI为1.06~46.67,P=0.04)、老年人能力状况(OR=0.04,95%CI为0.01~0.15,P<0.01)、日常生活活动(OR=0.13,95%CI为0.04~0.43,P<0.01)和家庭功能(OR=0.24,95%CI为0.07~0.84,P=0.03)是老年人养老方式选择的影响因素。结论老年人养老方式选择仍以居家养老为主,且受年龄、婚姻、老年人能力、家庭功能和经济来源等多种因素影响。相关部门应加大开展老年人能力评估力度,有效帮助老年人认识自身健康状况,帮助服务提供者甄别老年人的养老需求,为老年人提供多样化和个体化的养老服务。

Objective With the increase of the number of disabled elderly and the change of family structure,the choice of old-age care mode is also changing.In the 13 th Five-Year Plan,the state has proposed to establish a multi-level elderly care service that is based on the home,supported by the community and supplemented by institutions.In order to provide more scientific and reasonable old-age service,this study investigated the influence of the old-age care ability and family function on the choice of old-age care mode of the elderly in the community.Methods From May 5 to August 28 in 2020,280 community-dwelling elderly in Jining City were selected as the survey subjects by multi-stage random sampling method.The elderly ability assessment scale and the family function questionnaire were used in studying,and univariate analysis and multivariate analysis were used to identify factors associated with pension choice.Results A total of 265 valid questionnaires were collected.121(45.7%)of the elderly had good ability,200(75.5%)of the elderly had good family function,and 219(82.6%)of the elderly chose home care.94.2% of the elderly with intact ability chose home care and 5.8%chose institution care;With good family function,87.5%choose home care,and 12.5% choose institution care.Univariate analysis showed that age(χ^(2)=33.00,P<0.01),marriage(χ^(2)=41.58,P<0.01),financial resources(χ^(2)=24.13,P<0.01),medical security(χ^(2)=11.00,P<0.01),the number of chronic diseases(χ^(2)=10.37,P=0.02),the ability of the elderly(χ^(2)=20.93,P<0.01),the ability of daily living activities(χ^(2)=90.86,P<0.01),sensory perception and communication(χ^(2)=10.04,P=0.01),mental state(χ^(2)=28.99,P<0.01),social participation(χ^(2)=24.79,P<0.01)and family function(χ^(2)=13.44,P<0.01)had statistically significant differences among groups with different pension mode choice.Logistic multivariate regression analysis showed that age(OR=0.03,95%CI:0.00-0.15,P<0.01),financial resources(OR=58.11,95%CI:2.90-1165.56,P=0.01),marriage(OR=7.02,95%CI:1.06-46.67,P=0.04),ability status of the elderly(OR=0.04,95%CI:0.01-0.15,P<0.01),activities of daily living(OR=0.13,95%CI:0.04-0.43,P<0.01)and family function(OR=0.24,95%CI:0.07-0.84,P=0.03)were the influencing factors for the choice of oldage care mode.Conclusions The choice of old-age care mode is still mainly based on home-based care,and the choice of old-age care mode is affected by many factors,such as age,marriage,ability of the elderly,family function and economic source.Relevant departments should strengthen the capacity assessment of the elderly,effectively help the elderly to understand their own health conditions,help service providers to identify the elderly’s needs for pension,and provide diversified and individualized pension services for the elderly.