社区老年人照护需求现状及影响因素研究:基于三省的基线调查

The Prevalence and Influencing Factors of Care Need among Community-dwelling OldeRPeople in Three Provinces of China

背景人口老龄化背景下对老年人照护的研究逐渐成为热点。以往对老年人照护需求率的调查存在较大差异(8.54%~53.15%),缺乏大样本的研究证据。目的了解我国社区老年人照护需求现状及其影响因素。方法调查对象来自国家重大公共卫生专项“老年期重点疾病预防和干预”项目2019年的基线调查,该调查采用多阶段分层整群随机抽样方法,在辽宁省、河南省和广东省的16个区(县)共抽取16199名60岁及以上老年人开展问卷调查,问卷内容主要包括基本人口学特征(性别、年龄、城乡、婚姻状况、文化程度、职业、体质量、居住情况)、照护需求现状、患慢性病情况、病人健康问卷抑郁自评量表(PHQ-9)、简易智能精神状态检查(MMSE)量表、老年人日常生活活动能力调查(ADL)量表、自评健康状况、每天锻炼身体和跌倒情况(过去1年)等。采用PHQ-9评定老年人的心理状况、MMSE量表评估老年人的认知功能,老年人照护需求评估采用ADL量表(存在BADL或IADL失能)或自报需要照护。采用Logistic回归分析探讨老年人照护需求的影响因素。结果收集有效样本数据16193份,社区老年人照护需求率为14.57%(95%CI=14.02%~15.11%),随着年龄增加照护需求率逐步上升,女性的照护需求率高于男性(P<0.05)。多因素Logistic分析结果显示,年龄每增加一岁照护需求风险增加7%(OR=1.07,95%CI=1.06~1.08);与文盲相比,文化程度在小学、初中、高中及以上老年人照护需求OR(95%CI)分别为0.33(0.29~0.37)、0.24(0.20~0.28)、0.17(0.12~0.22);与每日锻炼身体相比,每日不锻炼老年人照护需求OR(95%CI)为1.17(1.05~1.30);与不患慢性病人群相比,患1~2种和患3种及以上慢性病老年人照护需求OR(95%CI)分别为1.29(1.10~1.51)、1.57(1.35~1.82);与认知功能正常相比,认知功能异常老年人照护需求OR(95%CI)为2.02(1.79~2.27);与自评健康状态好相比,自评健康状况一般和自评健康状况差老年人照护需求OR(95%CI)分别为1.29(1.14~1.46)、2.68(2.27~3.16);与没有摔倒过相比,摔倒1~2次和3次及以上老年人照护需求OR(95%CI)分别为1.23(1.06~1.43)、2.00(1.59~2.52);与心理状况良好相比,轻度和中重度抑郁老年人照护需求OR(95%CI)分别为1.14(1.21~1.65)、2.05(1.69~2.48)。结论我国三省社区老年人照护需求率较高,且高龄、身体及心理健康状况差、跌倒次数多的老年人照护需求率更高。

Background With the aging population,research on elderly care has increasingly become a focal point.Previous surveys on the demand rate foRelderly care have shown significant variation(8.54%to 53.15%)and lack largescale study evidence.Objective To understand the prevalence and influencing factors among community-dwelling older people in three provinces of China.Methods The study subjects were from the baseline survey of Prevention and Intervention on Neurodegenerative Disease foRElderly in China conducted in 2019.This survey employed a multi-stage stratified cluster random sampling method,selecting a total of 16199 elderly individuals aged 60 and above from 16 districts and counties across Liaoning,Henan,and Guangdong provinces.The questionnaire covered basic demographic characteristics(gender,age,urban/rural residence,marital status,education level,occupation,weight,living situation),current care needs,chronic disease status,the Patient Health Questionnaire(PHQ-9),the Mini-Mental State Examination(MMSE),the Activities of Daily Living(ADL)scale,self-rated health status,daily exercise habits,and the numbeRof falls.The PHQ-9 was used to assess the psychological health of the elderly,the MMSE was used to evaluate cognitive function,and the ADL scale oRselfreported need foRcare was used to assess elderly care needs,defined as the presence of BADL oRIADL disabilities,oRa selfreported need foRcare.Logistic regression analysis was used to explore the influencing factors of elderly care needs.Results The prevalence of care needs among community-dwelling oldeRpeople in three provinces was 14.57%(95%CI=14.02%-15.11%),and the prevalence of care needs increased gradually with age,consistently higheRamong females than males in all age groups.The results of multifactorial analysis showed that the risk of care need increased 7%(OR=1.07,95%CI=1.06-1.08)foReach additional yeaRof age.Compared with illiteracy,the ORs of care need foRthose with primary school,secondary school,high school and above were 0.33(95%CI=0.29-0.37),0.24(95%CI=0.20-0.28),0.17(95%CI=0.12-0.22),respectively.Compared with daily exercise,the ORof care needs foRthose who did not exercise daily was 1.17(95%CI=1.05-1.30).Compared with those who did not suffeRfrom chronic diseases,the ORs of care needs foRthose who suffered from 1-2 kinds and those 3 oRmore kinds of chronic diseases were 1.29(95%CI=1.10-1.51)and 1.57(95%CI=1.35-1.82).Compared with normal cognitive function,the ORof care need foRthose with abnormal cognitive function was 2.02(95%CI=1.79-2.27).Compared with good self-assessed health status,the ORof care need foRthose with faiRhealth status and those with pooRhealth status were 1.29(95%CI=1.14-1.46)and 2.68(95%CI=2.27-3.16).Compared with those did not having fallen,ORs of care needs for those with 1-2 and 3 oRmore falls were 1.23(95%CI=1.06-1.43)and 2.00(95%CI=1.59-2.52).ORs of care needs foRthose with mild and moderately severe depression compared to those with a good mental status were 1.14(95%CI=1.21-1.65)and 2.05(95%CI=1.69-2.48).Conclusion The demand foRelderly care among community-dwelling oldeRadults of China is notably high.This demand is particularly elevated among individuals who are older,have pooreRphysical and psychological health,and have experienced a higheRfrequency of falls.