流动老人与户籍老人生活自理能力影响因素差异研究

Factors influencing the self-care abilities of older migrants and older locals

目的探讨流动老人和户籍老人生活自理能力的影响因素。方法基于2018年中国健康与养老追踪调查数据(CHARLS)中4893名老年人作为研究对象,综合日常生活自理能力(ADL)与工具性日常生活自理能力(IADL)量表对户籍老人和流动老人生活自理能力进行评估,分别建立logistic回归和CART决策树模型分析其生活自理能力影响因素,并采用接受者操作特性曲线(ROC)评价2种模型分析效果。结果流动老人与户籍老人在生活自理能力水平上存在差异,户籍老人生活自理能力受损率高于流动老人;综合logistic回归和决策模型分析结果,依据ROC曲线分类效果(AUC=0.777、0.723、0.772、0.680,95%CI=0.763~0.791、0.708~0.739、0.723~0.821、0.620~0.741),判断影响户籍老人生活自理能力的因素有年龄、性别、慢性病、抑郁和锻炼,影响流动老人生活自理能力的因素是抑郁、参与社会经济、参与社会交往和喝酒;从户籍老人和流动老人生活自理能力影响因素差异来看,其中抑郁是共性因素,年龄、性别、慢性病和锻炼是户籍老人生活自理能力的特有影响因素,参与社会经济、参与社会交往和喝酒是流动老人生活自理能力的特有影响因素。结论对高龄、有心理疾病的户籍老人作为健康干预的重点人群;同时拓宽养老服务方式和内容,推动流动老人积极进行社会参与。

Objective To explore factors influencing the self-care abilities of older migrants and older locals.Methods A total of 4,893 elderly people in the 2018 China Health and Retirement Longitudinal Study(CHARLS)served as the research subjects,and the Activities of Daily Living(ADL)and the Lawton-Brody Instrumental Activities of Daily Living(IADL)were used to assess the self-care abilities of older migrants and older locals.Logistic regression model and Classification and Regression Tree(CART)model were used to analyze the factors influencing the self-care abilities,and the receiver operating characteristic(ROC)curves were used to evaluate the performance of these two models.Results The self-care ability significantly differed between older migrants and older locals,and the rate of impaired self-care ability of the older locals was higher than that of the older migrants.Based on the Logistic regression and CART models and the classification effects of the ROC curves(AUC=0.777,0.723,0.772,and 0.680;95%CI=0.763-0.791,0.708-0.739,0.723-0.821,and 0.620-0.741),it was determined that the factors affecting the self-care ability of older locals included age,gender,chronic diseases,depression,and exercise,and the factors affecting the self-care ability of older migrants were depression,participation in social economy,participation in social activities,and alcohol consumption.Therefore,depression was a common factor affecting the self-care abilities of older locals and older migrants,whereas age,gender,chronic diseases,and exercise were the unique factors influencing the self-care ability of the older locals and participation in social economy,participation in social activities,and alcohol consumption were the unique factors among the older migrants.Conclusions The older locals with advanced age and mental illnesses are the priority population for health intervention.Meanwhile,the programs for elderly adults should be expanded to encourage the active social participation of older migrants.