失能老人生活照料需求未满足状况及其影响因素:基于2005—2018年CLHLS数据的分析*

目的：研究失能老人生活照料需求未满足状况及其影响因素,为我国建立健全长期护理保障制度提供科学依据。方法：以拓展的安德森健康行为模型作为理论框架,利用2005—2018年中国老年健康影响因素跟踪调查(CLHLS)数据构建Logit模型。结果：失能老人生活照料需求未满足率呈缓慢下降趋势,但仍有一半以上的失能老人生活照料需求未得到满足。家庭相对经济资源越不足、老人身体状况越差、失能程度越高,非子女和配偶照料、照料者不情愿时,失能老人生活照料需求越难得到满足。结论：建议加强对农村、低龄、低收入和重度失能老人生活照料的关注,强化家庭成员照料,并为家庭成员照料创造有利条件。     

失能老人代际照顾需求未满足状况及影响因素分析

目的 了解我国65岁以上失能老人的代际照顾现状及其需求未满足的影响因素,为提高失能老人代际照顾能力提供参考依据。方法 本研究基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据,分析1 908名失能老人代际照顾需求满足状况,再通过多元logistic回归探讨代际照顾需求未满足的影响因素。结果 49.6%的失能老人的代际照顾需求未完全满足。多元logistic回归分析显示,失能老人的年龄、居住地、失能程度、居住方式、子女个数、生活来源是否够用、代际经济支持、照顾者类别、照顾时间、照顾表现是影响失能老人代际照顾需求满足的主要因素（P＜0.05）。结论 失能老人长期照顾问题亟需受到关注,应根据失能老人及其照顾者特点给予针对性的干预措施,提高失能老人的代际照顾水平,满足代际照顾需求。     

基于Anderson模型的我国失能老人机构养老意愿及影响因素分析

目的 剖析我国失能老人养老意愿的现状及机构养老意愿的影响因素,为构建面向失能老人的社会养老服务体系提供循证依据.方法 基于中国老年健康影响因素跟踪调查2014年1700位失能老人数据,以安德森健康行为模型为框架,引入社区因素,运用logistic回归剖析我国失能老人机构养老意愿的影响因素.结果 1700位失能老人中有机...     

城市失能老人长期照料现状及对策

我国长期照料服务严重缺失,失能老人长期照料问题非常紧迫。调查显示,目前长期照料失能老人生存状况尚好,长期照料服务需求多样化,慢性病医疗需求尤其巨大。对此,应加快适合我国国情的长期照料服务体系的构建;长期照料服务体系应建立在社区照顾体系之上;同时,政府应出台政策,推动与社区卫生服务相结合的长期照料服务体系基本框架的建立;最后,应探索建立失能老人长期照料的评估体系。     

不同长期照料服务供给下的失能老人长期照料模式选择

[目的]探究长期照料服务供给(医疗康复服务供给、精神慰藉服务供给、日常生活照料服务供给)对失能老人长期照料模式选择的影响。[方法]抽取中国健康长寿纵向调查(CLHLS)2008年数据的长期失能老人样本进行列联表分析。[结果]对失能老人长期照料模式的选择均有显著影响的因素是:1医疗康复服务包括上门医疗服务(P<0.01)、社区健康教育(P<0.01)、医疗保险情况(P<0.05);2精神慰藉服务包括社区精神慰藉服务(P<0.01)、社会活动与娱乐活动(P<0.01);3日常生活照料服务包括社区起居照料服务(P<0.01)、社区日常购物服务(P<0.01)。[结论]长期照料服务供给对失能老人长期照料模式的选择具有显著影响。     

辽宁省农村独居失能老人长期照护模式选择意愿及其影响因素分析

目的 调查辽宁省农村独居失能老人长期照护模式选择意愿并分析其影响因素,为建立和发展农村独居失能老人长期照护体系提供理论依据。方法 采取便利抽样的方法选取辽宁省农村地区302名独居失能老人作为调查对象,采用一般情况调查表、老年人能力评估问卷、社会支持评定量表和自制长期照护模式调查表进行调查。结果 219例（72.5%）独居失能老人选择居家长期照护,83例（27.5%）选择机构长期照护,勉强能在家生活（76.3%）和没钱去养老机构（60.3%）是独居失能老人选择居家长期照护的2个主要原因,选择机构长期照护最重要的原因是有专人提供生活照料（73.4%）; Logistic回归分析表明月收入（OR = 4.156,P = 0.001）、社会支持（OR = 0.903,P = 0.036）和能力等级（中度失能:OR = 26.593,P = 0.001;重度失能:OR = 557.370,P＜0.001）是长期照护模式选择意愿的影响因素。结论 居家长期照护仍然符合大部分农村独居失能老人的长期照护意愿,应针对独居失能老人的不同特点,加强居家长期照护功能并发展机构长期照护服务。     

城镇失能老人子女照料的影响因素分析 —— 来自CLHLS 2014的经验证据

  目的  了解中国高龄失能老年人长期照料需求满足情况及其影响因素,为我国未来老龄照料服务体系的优化提供参考依据。  方法  收集2018年中国老年健康影响因素跟踪调查(CLHLS)中1561名 ≥ 80岁高龄失能老年人的相关数据,分析高龄失能老年人长期照料需求满足情况及其影响因素。  结果  中国1561名 ≥ 80岁高龄失能老年人中,长期照料需求满足者772人,长期照料需求满足者所占比例为49.46 %。多因素非条件logistic回归分析结果显示,家庭年均收入 > 6万元、名下有房产、生活来源够用、照料者表现为耐心照护、总是向照料者倾诉、有养老保险和有社区生活照料的中国高龄失能老年人长期照料需求更易得到满足,居住在农村、衰弱和照料支出 ≥ 300元/周的中国高龄失能老年人长期照料需求更不易得到满足。  结论  中国高龄失能老年人长期照料需求满足者比例较低,居住地、衰弱情况、家庭年均收入、名下有无房产、生活来源是否够用、照料支出、照料者表现、是否总向照料者倾诉、有无养老保险和社区有无生活照料服务是我国高龄失能老年人长期照料需求满足的主要影响因素。     

农村失能老人居家健康管理需求现状及影响因素分析

目的 了解农村失能老人居家健康管理需求现状,并分析其影响因素,为采取针对性干预措施提供参考依据。方法 整群抽样法,采用自行设计的《农村失能老人居家健康管理需求问卷》,对河南省某乡镇农村社区居家养老的213名失能老人进行问卷调查。结果：农村失能老人居家健康管理需求总得分为(122.65±7.95)分,平均得分为(3.96±0.26)分,处于较高水平,其中各维度平均得分为：健康档案(4.34±0.36),身体评估(3.77±0.45),心理健康(3.81±0.56),医疗环境(4.47±0.54),健康知识(3.99±0.30),智慧养老(4.26±0.63),死亡教育(2.16±0.70),多元回归结果显示,月均医疗费用,失能时长,疾病感知,居住情况,慢性病种类,失能程度是影响农村失能老人居家健康管理需求的影响因素(P<0.05)。结论 农村失能老人居家健康管理需求较大,尤其在医疗环境、健康档案及智慧养老方面,可通过促进医疗资源下沉,完善失能老人签约服务包、定期为老人进行体检并构建远程健康管理平台等方式满足其健康管理需求。     

城市社区长期照料失能老人健康管理初探

目的 了解杭州市拱墅区长期照料失能老人的健康现状,为各级政府制定政策,推进失能老人长期照料健康管理工作提供科学依据.方法 采用现场调查法,对杭州市拱墅区长期照料失能老人的健康现状进行分析研究.结果 杭州市拱墅区836位长期照料失能老人生存状况尚可,生活满意度不高(12.90％),对健康的满意度比对生活的满意度更低(1....     

上海城市社区失能老人长期照料的现况分析和政策建议

城市社区失能老人长期照料是一个严重的社会和卫生问题。以上海市为例,从相关问题的现况分析入手,指出长期照料服务严重缺失,机构服务床位严重不足,城市失能老年人牵涉面广,长期照料问题的紧迫性凸现,长期照料服务体系建设是重大民生工程,失能老人问题是对社会道德底线的现实考验,进而提出了探索建立独立于医疗保险体系的长期照料服务体系、研究和发展老年护理保险等相关配套措施和政策、建立符合国情的以社区长期照料服务为核心的长期照料服务体系、打造满足不同养老模式和层次需求的养老和医疗服务链等政策建议。     

独居老年人生活及精神健康状况调查

目的分析山东省济南市独居老年人生活现状及精神健康状况。方法采用调查问卷收集160名独居老人和911名非独居老人的生活现状及精神健康状况等,应用2χ检验和秩和检验进行统计分析。结果独居老人中女性99人,占61.88%,男性61人,占38.12%,平均年龄为74.45岁,文化程度小学及以下105人,占65.62%;城乡独居老人的平均月收入分别为1 816.40和274.46元,非独居老人分别为1 911.37和372.59元;城乡独居老人中从不与亲戚、朋友交往的比例分别为20.93%和25.68%;从不参加体育活动的比例为60.47%和94.59%;独居老年人的精神健康得分为45.21分,低于非独居老年人的46.81分。结论与非独居老人相比较,独居老年人尤其是农村独居老人的生活状况较差,精神健康水平较低,需进一步改善。     

贵阳市居家失能老年人生活质量调查及影响因素分析

目的 了解贵阳市居家失能老年人生活质量及影响因素。方法 采用多阶段分层随机抽样方法,应用自行设计的一般资料调查表、日常生活活动能力评定量表(Barthel指数评定量表)、健康调查简表（SF - 36）对贵阳市281名居家失能老年人进行调查。结果 贵阳市居家失能老年人除活力维度外其余维度均低于一般老年人（P＜0.05）;性别、年龄、婚姻、失能时间及主要照顾者对居家失能老年人的生活质量有显著影响（P＜0.05）。结论 贵阳市居家失能老年人生活质量总体较低,在制定老年人保健护理措施时应充分考虑到居家失能老年人的特殊性。     

Self-assessment by elderly people-a means of identifying unmet need in primary care

The objective of this research was to assess the value of a self-completed questionnaire in identifying unmet needs amongst elderly patients in primary care. The setting was one general practice in Liverpool. A questionnaire was sent to all patients aged 75 and over on the practice age-sex register (n=498). Responses were compared with existing practice records. Measures were: self-reports of need with 18 questions covering social support, disability, recent life stresses and mood changes; recent contact with members of the practice team; perceived need to see members of the practice team; and evidence in practice records of recent contact and of awareness of elderly patients’ reported needs. There was an 84% response rate. Respondents reported a median score of three problems each (interquartile range 2–5), especially in social support, mobility, bereavement, illnesses and mood states. For people reporting six or more problems, practice records noted less than 50% of problems relating to social support, bereavement and memory. Amongst all respondents, those reporting problems with disability, recent illness and depressed mood were more likely to have been in recent contact with the primary care team than those who did not report such problems. Three further problems-social isolation, bereavement and memory loss-were not associated with increased likelihood of recent contact with the practice team, but were significantly associated with respondents’ expressed need to see a member of the practice. The self-completed questionnaire highlighted gaps in the primary care team's awareness of and response to elderly patients’ social and psychological problems.     

我国失能老人家庭支持与认知功能的相关性研究

目的 探讨我国失能老人认知功能与家庭支持的关系,为制定相应的干预措施提供依据。 方法 使用中国老年健康影响因素跟踪调查2014年的横截面数据,剔除关键指标缺失后得到有效样本1273例。其中失能老人认知功能的衡量采用简易精神状态量表,家庭支持则包括生活照料、精神慰藉和经济支持。在描述我国失能老人认知功能与家庭支持状况的基础上,采用二元 logistic 回归进一步分析失能老人认知功能与家庭支持的关系。 结果 在控制相应变量后,二元 logistic 回归结果显示,家庭提供生活照料并未显著降低失能老人的认知功能受损风险（P>0.05）;而有家庭精神慰藉的失能老人组发生认知功能受损的风险为无精神慰藉组的 0.343(OR=0.343,95%CI: 0.142~0.827,P=0.017);有家庭经济支持的失能老人组发生认知功能受损风险为无经济支持组的0.767(OR=0.767,95%CI: 0.587~1.004,P=0.049)。 结论 家庭精神慰藉和经济支持是失能老人认知功能的保护因素。     

Inequity in long-term care use and unmet need: Two sides of the same coin

We investigate the determinants of several LTC services and unmet need using data from a representative sample of the non-institutionalised disabled population in Spain in 2008. We measure the level of horizontal inequity and compare results using self-reported versus a more objective indicator of unmet needs. Evidence suggests that after controlling for a wide set of need variables, there is not an equitable distribution of use and unmet need of LTC services in Spain; formal services are concentrated among the better-off, while intensive informal care is concentrated among the worst-off. The distribution of unmet needs for LTC services depends on the service considered and on whether we focus on subjective or objective measures. In 2008, only individuals with the highest dependency level had universal coverage. Our results show that inequities in most LTC services and unmet needs among this group either remain or even increase for formal services.     

Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh,India

Background

The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm.

Study Design

Our study uses recently collected longitudinal data from four cities in Uttar Pradesh, India, to examine whether women's fertility desires and family planning (FP) use at baseline predict pregnancy/birth experience in the 2-year follow-up period.

Results

Multivariate models demonstrate that women who were using any method of FP and reported an intention to stop childbearing were the least likely to experience a pregnancy/birth in the 2-year follow-up period. The stated desire to delay childbearing, whether or not the woman was using FP, did not distinguish pregnancy/birth experience. Ninety-two percent of pregnancies/births over the follow-up period were considered “wanted then” suggesting post-hoc rationalization of the pregnancy/birth even among those women who reported a desire to stop childbearing 2 years earlier.

Conclusions

More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.     

我国独居老人自评健康状况及其影响因素研究

目的 了解影响我国独居老人自评健康状况的影响因素,为改善我国独居老人健康及生活质量提供参考依据。方法 通过自评问卷调查方法,采用2018年中国老年健康影响因素跟踪调查（CLHLS）数据,了解独居老人健康状况,采用卡方检验以及多因素logistic 回归方法分析独居老人健康状况的影响因素。结果 1236名独居老年人中,自评健康较好的有551人,占比44.6%,较差的685人,占比55.4%;子女经常看望（OR =1.840,95%CI:1.080~3.135)、体育锻炼（OR =1.813,95%CI:1.385~2.372)、饮酒（OR =1.531,95%CI:1.061~2.209）、体检（OR =1.347,95%CI:1.033~1.756）、慢性病(OR =0.682,95%CI:0.532~0.875)、霉味(OR =0.533,95%CI:0.391~0.726)、睡眠6~9小时（OR =0.528,95%CI:0.393~0.710）、睡眠时间>9小时（OR =0.411,95%CI:0.283~0.597）与独居老人自评健康有关。结论 我国独居老人自评健康状况总体较差。应重视独居老人的子女关怀、生活行为方式、居住环境及慢性病状况等,更好地改善独居老人的健康状况。     

Lower vaccine uptake amongst older individuals living alone: A systematic review and meta-analysis of social determinants of vaccine uptake

IntroductionVaccination is a key intervention to reduce infectious disease mortality and morbidity amongst older individuals. Identifying social factors for vaccine uptake enables targeted interventions to reduce health inequalities.ObjectiveTo systematically appraise and quantify social factors associated with vaccine uptake amongst individuals aged ≥60 years from Europe.MethodsWe searched Medline and Embase from inception to 24/02/2016. The association of vaccine uptake was examined for social factors relevant at an individual level, to provide insight into individuals’ environment and enable development of targeted interventions by healthcare providers to deliver equitable healthcare. Factors included: living alone, marital status, education, income, vaccination costs, area-level deprivation, social class, urban versus rural residence, immigration status and religion. Between-study heterogeneity for each factor was identified using I²-statistics and Q-statistics, and investigated by stratification and meta-regression analysis. Meta-analysis was conducted, when appropriate, using fixed- or random-effects models.ResultsFrom 11,754 titles, 35 eligible studies were identified (uptake of: seasonal influenza vaccine (SIV) only (n = 27) or including pneumococcal vaccine (PV) (n = 5); herpes zoster vaccine (n = 1); pandemic influenza vaccine (n = 1); PV only (n = 1)). Higher SIV uptake was reported for individuals not living alone (summary odds ratios (OR) = 1.39 (95% confidence interval (CI): 1.16–1.68). Lower SIV uptake was observed in immigrants and in more deprived areas: summary OR = 0.57 (95%CI: 0.47–0.68) and risk ratio = 0.93 (95%CI: 0.92–0.94) respectively. Higher SIV uptake was associated with higher income (OR = 1.26 (95%CI: 1.08–1.47)) and higher education (OR = 1.05 (95%CI: 1–1.11)) in adequately adjusted studies. Between-study heterogeneity did not appear to result from variation in categorisation of social factors, but for education was partly explained by varying vaccination costs (meta-regression analysis p = <0.0001); individuals with higher education had higher vaccine uptake in countries without free vaccination.ConclusionsQuantification of associations between social factors and lower vaccine uptake, and notably living alone (an overlooked factor in vaccination programmes), should enable health professionals target specific social groups to tackle vaccine-related inequalities.