老年人对社区服务的需求与实际供给及老年人照料方式的影响因素探讨

Demand and supply of community-based care services for the elderly in China and its influencing factors

目的探究老年人对社区服务的需求与实际供给及影响老年人照料方式的因素。方法采用2018年第7次中国健康长寿纵向调查(CLHLS)截面数据,选取其中15854例60岁及以上的老年人为研究对象。采用Logistic回归方法对城市、城镇和农村老年人的社区照料需求模式及其影响因素进行分析。结果15854例老年人中,男6912例(43.60%)、女8942例(56.40%);日常生活活动能力(ADL)评价结果显示,11109例老年人可完全自理,失能老年人3889例,失能率为25.93%。城镇老年人在起居照料、精神慰藉和聊天解闷,提供保健知识,处理家庭邻里纠纷等方面期望社区为其提供的社会服务比例高于城市和农村老年人。从社区为老年人实际提供的服务来看,除了上门看病送药服务,城镇与农村老年人其他社区服务可获得的比例相近,但明显低于城市社区为老年人提供的社会服务比例。年龄、有无配偶、居住地、文化差异、健康状况、生活来源及居住意愿对照料需求模式选择具有显著影响,高龄[70~79岁老年人(OR=2.29、95%CI:1.04~5.03)、≥80岁老年人(OR=2.94、95%CI:1.38~6.25)]、无配偶(OR=3.50、95%CI:2.49~4.92)、失能等级高[轻度失能老年人(OR=4.24、95%CI:3.12~5.77)、中度失能老年人(OR=7.54、95%CI:5.19~10.95)、重度失能老年人(OR=10.50、95%CI:7.59~14.53)]的老年人更倾向于选择社会化照料。结论在我国快速城镇化的过程中城镇老年人对照料服务需求增加,但城镇老年人所在社区实际提供的照料服务尚待提高,其照料方式与农村老年人相同仍倾向于家庭照料。

Objective To explore the demand and actual supply of community-based care services for the elderly residents and the factors that affecting care mode for them in the context of rapid urbanization and population aging in China.Methods Based on the cross-sectional data of the seventh China Longitudinal Survey on Health and Longevity(CLHLS)(2018),15854 elderly residents aged 60 and above were selected as the research population.Logistic regression method was used to analyze the patterns of community-based care services and their influencing factors.Results Among 15854 elderly residents,6912(43.60%)were male and 8942(56.40%)were female.The results of activities of daily living(ADL)evaluation showed that 11109 elderly residents could take care of themselves completely,and 3889 elderly residents were disabled.The disability rate was 25.93%.The proportion of social services that elderly town dwellers expect the community to provide is higher than those living in cities and rural areas in terms of daily care,spiritual care,providing health care knowledge,and dealing with neighborhood disputes.From the perspective of social services actually provided by the community,in addition to providing home-based care,the proportion of community services available to the elderly living in towns and rural areas are similar,but significantly lower than the proportion of social services provided for elderly city dwellers.Age,marital status,residence,cultural differences,health status,source of life and living preference had significant impacts on the choice of care demand patterns.Those of older age(OR=2.29,95%CI:1.04-5.03 for 70-79 years old;OR=2.94,95%CI:1.38-6.25 for elderly 80 years old or above),having no spouse(OR=3.50,95%CI:2.49-4.92),and with higher levels of disability(OR=4.24,95%CI:3.12-5.77 for mild disability;OR=7.54,95%CI:5.19-10.95 for moderate disability;OR=10.50,95%CI:7.59-14.53 for severe disability)are more inclined to choose socialized care.Conclusions In the process of rapid urbanization in China,the demands for care services of elderly living in towns has increased,but the actual care services provided for them by the communities are yet to be improved.Moreover,elderly town dwellers are still inclined to family care,the same as those of elderly rural dwellers.