老年女性日常生活照料需求及影响因素分析

目的 分析山东省老年女性日常生活照料资源需求现状及其影响因素,探讨适合老年女性的日常生活照料资源.方法 采用问卷调查收集378名老年女性的人口学资料、经济状况、躯体健康、心理健康、社会健康及日常生活照料资源需求状况,采用t检验、x2检验、方差分析和逐步回归方法进行统计分析.结果 老年女性日常生活依靠自身照料者256人,占67.72％,依靠家庭照料者119人,占31.48％,其中依靠配偶照料者87人,占23.02％,靠子女及其他亲属照料者32人,占8.47％,依靠社会照料者仅为3人,占0.79％;无论单因素分析还是多因素分析,年龄、居住状况、健康自评、日常生活能力(ADL)、功能性日常生活能力(IADL)及认知功能均为老年女性日常生活照料资源需求的主要影响因素.结论 自身照料是老年女性日常生活照料的主要资源,配偶是来自家庭照料资源的主要力量;关注并提高老年女性ADL、IADL及认知功能,有助于老年女性的健康老龄化.     

老年慢性病出院患者抑郁状况的影响因素分析

目的了解老年慢性非传染性疾病(慢性病)出院患者的抑郁状况及其影响因素,为制订针对性的出院指导提供依据。方法 2015年1月—2015年6月采用老年抑郁量表对232例出院老年慢性病患者进行调查,了解老年慢性病出院患者抑郁状况。单因素分析采用F检验,计数资料采用秩和检验,多因素分析采用多重线性回归分析,P0.05为差异有统计学意义。结果了解老年慢性病出院患者抑郁发生率为50.40%,经单因素分析,高龄、女性、无配偶、小学及以下程度老人和大专及以上老人、从不参加体育活动者其抑郁状况最差,对比差异均有统计学意义(均P0.05)。经多重线性回归分析,影响老年慢性病出院患者的抑郁总分的主要因素有年龄、性别、参加体育活动、生活能否自理、疾病对日常生活影响程度,对比差异均有统计学意义(均P0.05)。结论影响老年慢性病出院患者的抑郁状况的因素众多,护士在实施出院护理时,重点应关注高龄、女性、无配偶、文化程度低、生活不能自理、疾病对日常生活影响严重的患者,并有针对性地做好出院指导,改善老年慢性病患者的抑郁状况。     

20年北京老年人照料者变化情况调查

调查1992、2000、2007和2012年北京老年人照料者的变化情况，以期为养老产业发展提供参考依据和合理化建议。方法 本研究根据中国第三—五次人口普查北京市的抽样资料为依据，采用三阶段、分层、整群抽样方法，选择西城区小红庙社区的2个居委会（城区）、大兴区魏善庄镇的9个自然村（近郊农村）以及怀柔区渤海的3个自然村（山区农村）作为调查点，分别于1992、2000、2007及2012年对调查点所有60岁以上的老年人进行调查及随访。结果 1992、2000、2007及2012年北京老年人的照料主要依靠配偶和儿女。2007—2012年北京老年人由配偶照料的比例逐渐上升，同时保姆和其他照料者的比例略有上升。1992、2000、2007及2012年北京男性老年人由配偶照料的比例均高于女性老年人，而由儿女照料的比例明显低于女性老年人，差异均有统计学意义（P<0.05）。1992、2007及2012年北京城市老年人由配偶照料的比例均高于农村老年人，差异均有统计学意义（P<0.05）。1992、2000、2007及2012年北京城市老年人由儿女照料的比例均低于农村老年人，差异均有统计学意义（P<0.05）。结论 1992、2000、2007及2012年北京老年人均以居家养老为主，儿女照料逐渐减少，配偶照料逐渐增多。因此，相关部门应积极完善长期护理保险制度，关注照料者的身心健康，为家庭照料者提供喘息服务、经济补贴和教育培训。     

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。     

我国中年与老年女性抑郁倾向及影响因素的比较分析

目的 比较分析我国中年和老年女性抑郁倾向及影响因素的差异性,为有针对性的改善中年与老年女性群体的心理健康水平提供参考。方法 选取中国健康与养老追踪调查(CHARLS)2018年数据,以45～59岁中年女性和≥60岁老年女性为研究对象,采用流行病调查中心抑郁量表(CES-D)评估其抑郁倾向。中年和老年女性抑郁倾向的比较采用均值检验,使用倾向性评分匹配法(PSM)对中年和老年女性进行匹配后,进一步探索其组间的差异,采用稳健Tobit回归模型探究抑郁倾向的影响因素。结果 7 964例中老年女性的CES-D评分为(9.53±6.86)分。其中,中年女性、老年女性CES-D评分分别为(9.13±6.62)分、(9.96±7.09)分,老年女性的抑郁倾向评分高于中年女性(t=-5.361,P<0.001)。稳健Tobit回归结果显示,文化程度、居住地、健康自评、身体残疾、慢性病、因身体疼痛而苦恼、BADL受损、IADL受损、是否与配偶或同居者一起生活、家庭成员数量、现有负债、地带分布是中年和老年女性抑郁倾向共同的影响因素。年龄及其二次项、子女数量、有无农业自雇以外的工作是中年女性抑郁倾向的影响因素; 每月来看望1次及以上的子女数量、是否照顾孙子女、是否有社交活动、是否上网、是否退休是老年女性抑郁倾向的影响因素。结论 我国老年女性的抑郁倾向较中年女性明显,且影响因素存在差异性。应针对不同人群特征,提供更有针对性的预防策略,促进中年和老年女性心理健康良性发展。     

老年人居家不出现状及与健康自评、抑郁关系

目的 探讨老年居家不出状态与健康自评、抑郁的关系.方法 以河北省唐山市5个社区内≥60岁的老年人为研究对象,采用面对面访谈式方法进行问卷调查;应用SPSS 13.0软件进行单因素和多因素非条件Logistic回归分析.结果 在调查的1 475名老年人中,老年居家不出状态发生率为18.8%,女性居家不出状态发生率(20.9%)高于男性(15.9%),无配偶者居家不出状态发生率(23.5%)高于有配偶者(16.9%),随年龄增高居家不出状态发生率也随之增加,差异均有统计学意义(P<0.01);非条件Logistic回归分析结果显示:不锻炼、抑郁、高龄、女性、健康自评差是居家不出状态发生的危险因素.结论 健康自评、抑郁与老年人居家不出状态的发生相关.     

我国老年长期护理服务质量及其影响因素分析——基于上海市的实证研究

利用上海市调研数据,以60岁及以上老人为研究对象,基于SERVQUAL模型和有序多分类逻辑回归方法分析我国老年长期护理服务质量及其影响因素。研究发现:老人对长期护理服务质量评价不高,且常用临床护理服务质量略低于基本生活照料服务质量。供给方因素中护理机构基础设施、管理水平、护理人员专业水平对长期护理服务质量的提升具有正向激励作用。需求方因素中老人养老金水平对长期护理服务质量的提高具有显著正向激励,而老人的失能程度对服务质量具有显著负向影响,且与男性老人相比,女性老人对长期护理服务质量评价显著更高。研究结果为精确地评估我国老年长期护理服务质量提供了科学依据,对提升失能老人的生活质量,促进我国长期护理服务产业的发展具有重要的政策启示。     

基于双向固定效应模型的我国老年人养老意愿影响因素研究

目的 了解我国老年人在消除无法观测变量的影响后，其养老意愿的相关因素。方法 本文基于2008、2011、2014和2018年中国老年健康影响因素跟踪调查数据构成的面板数据，分别以个人养老、家庭养老和机构养老为因变量，通过构建固定效应模型来探讨老年人养老意愿选择的影响因素，为了消除内生性，采用倾向性得分匹配(PSM)进行验证。结果 自理能力(OR=1.597,95%CI:1.293～1.972)、配偶照料支持(OR=1.556,95%CI:1.187～2.039)和情感支持(OR=1.422,95%CI:1.182～1.711)、照料者态度(OR=1.91,95%CI:1.359～2.683)对老年人个人养老意愿有着显著影响；照料者态度(OR=1.933,95%CI:1.356～2.756)、配偶照料支持(OR=0.718,95%CI:0.539～0.957)和情感支持(OR=0.727,95%CI:0.601～0.879)是影响老人家庭养老意愿的重要因素；照料者态度(OR=0.001,95%CI:0～0.019)、子女照料支持(OR=0.071,95%CI:0.008～0.68)和情感...     

家庭资源禀赋视角下我国农村居家高龄失能老年人日常生活照料需求满足程度及其影响因素研究

目的 了解我国农村居家高龄失能老年人的日常生活照料需求满足程度,探讨其影响因素,为完善失能老年人长期照护服务体系提供参考依据。方法 基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据,对2369名农村居家高龄失能老年人进行描述性统计分析,采用卡方检验、多元有序逻辑回归分析日常生活照料需求满足程度的影响因素。结果 农村居家高龄失能老年人日常生活照料需求完全满足、基本满足、不满足的比例分别为44.4%、52.7%、2.9%,失能程度（OR=1.76,95%CI:0.241~0.889）、自评健康状况（OR=1.61,95%CI:0.133~0.822）、生活富裕程度（OR=2.98,95%CI:0.531~1.653）、生活来源是否够用（OR=2.27,95%CI:0.404~1.237）、生病能否及时就医(OR=2.04,95%CI:0.074~1.352)、主要照料者（OR=9.14,95%CI:0.280~4.147）、主要照料者态度(OR=10.88,95%CI:1.334~3.440)、平时主要聊天者 (OR=2.46,95%CI:0.227~1.576)是农村居家高龄失能老年人日常生活照料需求满足程度的影响因素。结论 亟需构建完善的失能老年人长期照护服务体系,满足农村居家高龄失能老年人的日常生活照料需求。     

女性哮喘患者配偶的心理状况调查

目的了解女性哮喘患者配偶的心理健康状况。方法用症状自评量表(SCL-90)对150例女性患者配偶进行调查。结果女性患者配偶的SCL-90各因子分明显高于常人,尤在强迫、敌对、抑郁、人际关系、偏执项目评分为著。低文化组SCL-90因子分高于高文化组,农村组高于城市组。结论女性哮喘患者配偶心理健康水平下降,应注意加强心理疏导和咨询工作。     

A Caregiving Model of Coping with a Partner's Depression*

Abstract: To test a caregiving model of depression in spouses, 31 married couples completed interview and questionnaire assessments of depressive symptoms and caregiving activities. Spouses living with a partner with depressive symptoms had more symptoms of depression themselves. However, this association was found to be fully mediated by spouses’ perceived level of caregiving stress and burden. Results suggest that feelings of stress associated with caring for a depressed spouse may lead to depressive symptoms in the caregiving spouse and should be addressed in treatment.     

Reverberations of family illness: a longitudinal assessment of informal caregiving and mental health status in the Nurses' Health Study

OBJECTIVES:. This study examined the association between caregiving for disabled or ill family members, estimated to occur in more than 22 million US households, and change in mental health. METHODS: We assessed 4-year change in mental health among 37 742 Nurses' Health Study participants with the Medical Outcomes Study Short-Form 36. RESULTS: Women who provided 36 or more weekly hours of care to a disabled spouse were almost 6 times more likely than noncaregivers to experience depressive or anxious symptoms (multivariate odds ratio [OR] = 5.6; 95% confidence interval [CI] = 3.8, 8.3). Caring for a disabled or ill parent (>or= 36 weekly hours) was associated with a less dramatic elevation in depressive or anxious symptoms (multivariate OR = 2.0; 95% CI = 0.9, 4.3). CONCLUSIONS: In this population, caregiving was associated with increased risk of depressive or anxious symptoms.     

Caregiving and risk of coronary heart disease in U.S. women: a prospective study

BACKGROUND: A growing number of women provide care to disabled or ill relatives. Many studies have linked caregiving to psychiatric morbidity, lower perceived health status, elevated blood pressure, and poorer immune function. However, no studies have examined the association between caregiving and cardiovascular disease incidence. METHODS: We conducted the study in 54,412 women from the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 U.S. states. These women were aged 46 to 71 years and did not have diagnosed coronary heart disease (CHD), stroke, or cancer at baseline (1992). We collected information on caregiving responsibilities in 1992 and coronary heart disease between baseline (June 1, 1992) and return of the 1996 questionnaire. RESULTS: During 4 years of follow-up, we documented 321 incident cases of CHD (231 nonfatal cases of myocardial infarction and 90 CHD deaths). In multivariate analyses controlling for age, smoking, exercise, alcohol intake, body mass index, history of hypertension, diabetes mellitus, and other covariates, caregiving for disabled or ill spouse for > or =9 hours per week was associated with increased risk of CHD (RR, 1.82; 95% confidence interval, 1.08-3.05). However, caregiving for disabled or ill parents or disabled or ill others was not significantly associated with increased risks of CHD. CONCLUSION: These data indicate that high levels of caregiving burden for ill spouses may increase the risk of CHD among women.     

Home care for older couples: "it feels like a security blanket . . ."

In this article, the authors explore the home care experience as described by older physically impaired individuals and their caregiving spouses. Separate face-to-face semistructured interviews were carried out with each spouse from nine couples. Analysis of the interview data revealed four themes. For care receivers the themes were Independence and Developing a Trusting Relationship With Home Care Workers. Relief and Continuity were voiced by the caregiving spouses. The authors show how these themes relate to the participants' sense of security, which emerged as a key underlying concept in the home care experience. This study adds to the home care and caregiving literature as it expands our understanding of the relationship between formal and informal caregiving, highlights issues and concerns older couples face as they receive home-based care, and includes both older spouse caregivers and their direct-care recipients.     

新疆牧业地区失能老年人居家非正式照护质量的影响因素分析

目的 分析新疆牧业地区失能老年人居家非正式照护质量的影响因素。方法 运用家庭照护质量量表（FCCI）对335例新疆牧业地区哈萨克族失能老年人居家非正式照护者进行现场调研,采用多重线性回归法对照护质量的影响因素进行分析。 结果 居家非正式照护质量平均得分为44分;被照护老年人的失能程度、与照护者关系、被照护时间、照护者就业情况、年龄及社会支持是影响居家照护质量的主要因素,上述6个变量解释失能老年人居家照护质量总变异量的32.3%。其中,被照护老人的失能程度重（Beta = - 0.475）、配偶照护者(Beta = - 0.171)、被照护时间长(Beta = - 0.180)、照护者就业状况差(Beta = - 0.134)、照护者年龄大(Beta = - 0.116)为其危险因素,高社会支持(Beta = 0.110)为保护因素。结论 新疆政府相关部门在解决失能老年人的长期照护问题中,应优先考虑牧业地区失能程度重、照护时间长及年龄较大的照护者,减轻其照护负担,提高居家非正式照护质量。     

Employment status, social ties, and caregivers' mental health

The purpose of this study of mid-life and older women was to assess the relation between informal care provision and depressive symptoms, taking into account concurrent demands on women's time (including multiple caregiving roles and employment outside the home) as well as participants' access to potentially supportive social ties. This cross-sectional study included women ages 46-71, free from major disease, who provided complete health and social information in the 1992 Nurses' Health Study follow-up survey (n = 61,383). In logistic regression models predicting depressive symptoms, we examined the interaction between employment outside the home and informal care provision for a disabled or ill spouse or parent. We also investigated level of social ties, measured with the Berkman-Syme Social Network Index, as a potential modifier of the association between informal care provision and depressive symptoms. In all analyses, higher weekly time commitment to informal care for a spouse or parent was associated with increased risk of depressive symptoms. This relationship persisted whether women were not employed outside the home, were employed full-time, or were employed part-time. Higher weekly time commitment to informal care provision was associated with increased risk of depressive symptoms whether women were socially integrated or socially isolated. However, both informal care provision and social ties were potent independent correlates of depressive symptoms. Therefore, women who reported high spousal care time commitment and few social ties experienced a dramatic elevation in depressive symptoms, compared to women with no spousal care responsibilities and many social ties (OR for depressive symptoms=11.8; 95% CI 4.8, 28.9). We observed the same pattern among socially isolated women who cared for their parent(s) many hours per week, but the association was not as strong (OR for depressive symptoms=6.5; 95% CI 3.4, 12.7). In this cross-sectional study, employment status did not seem to confer additional mental health risk or benefit to informal caregivers, while access to extensive social ties was associated with more favorable caregiver health outcomes.     

Caring-related inequalities in psychological distress in Britain during the 1990s

BACKGROUND: This paper examines recent trends in inequalities in psychological distress associated with the provision of unpaid care by those who look after frail older people and younger disabled adults and children. Caring activities intensified during the 1990s, associated with increasing amounts of time devoted to the more demanding types of care and to those relationships that typically make heavy demands on the carer. Heavy involvement in caregiving is often associated with symptoms of anxiety and distress, and the intensification of care may increase rates of distress in carers relative to that in non-carers. METHODS: A secondary analysis was carried out of data drawn from the first 10 waves of the British Household Panel Survey covering 1991-2000, based on around 9000 adults interviewed personally in successive waves. Symptoms of psychological distress, including anxiety and depression, were assessed using the 12-item General Health Questionnaire. RESULTS: Carers present higher rates of distress than noncarers and the health gap widens as the definition of caregiving focuses on those living with the person they care for, and those devoting 20 h or more per week to their caring activities. Differences in distress rates between carers and non-carers are greater for women than for men. There is no support for the hypothesis that inequalities in distress associated with caregiving have increased over time. CONCLUSION: There was no change during the 1990s in the extent of inequalities in psychological distress associated with caregiving in Britain. The need to maintain carers' emotional and mental health is as compelling as ever it was.     

Financial Conflicts Facing Late‐Life Remarried Alzheimer’s Disease Caregivers*

Abstract: This qualitative study explores financial conflicts faced by late‐life remarried wives providing care for their husbands with Alzheimer’s disease. Interviews with 9 women identified intergenerational secrets and tensions regarding financial and inheritance decisions. Participants’ remarried spouse status, underlying family boundary ambiguities, and changing realities brought on by the onset of Alzheimer’s disease all appear to contribute to intergenerational tension over financial decisions. Findings suggest that remarried older couples with chronic health issues may be at additional financial and psychological risk, especially in the caregiving role. Future research, intervention, and policy should anticipate and address the special needs of remarried and stepfamily members to support their efforts to successfully manage the health and caregiving concerns associated with Alzheimer’s disease.     

The unmet needs of family caregivers for frail and disabled adults

This study examines the efforts and needs associated with family care for disabled and frail adults. A survey of 117 primary caregivers focused on: the health problems associated with caregiving; the existence of informal, family support systems; the use of formal social services, and the need for additional social service programs. Most caregivers report physical and emotional problems due to caregiving ranging from hypertension and back problems to depression and mental exhaustion. The characteristics of caregivers at high risk for health problems are identified. Less than half of the caregivers have family or friends to assist them with caregiving. At least one type of social service was being used by over 80% of caregivers, with utilization patterns in male and female caregivers. Based on the study findings, several policy implications are reviewed.     

Evaluation of gender differences of family caregivers with reference to the mode of caregiving at home and caregiver distress in Japan

PURPOSE: Male caregivers are growing in number, as the frequency of spouse caregiving rapidly increases. This study aimed to examine gender differences in family caregivers with reference to the mode of caregiving and caregiver distress in Japan. It was designed to clarify the characteristics of both female and male caregivers. METHODS: The subjects were 2,020 users of public Long-term Care Insurance, randomly stratified and sampled in Higashi-osaka city, Osaka prefecture. Data were collected through mailed, anonymous self-report questionnaires. 1,287 (63.7%) surveys were collected and data from 868 caregivers and care recipients were analyzed, after excluding incomplete cases from 947 participants who were family caregivers. We compared males and females for the level of nursing needs, cognitive disorders of their care recipients, the types and amounts of care provided, the levels of their burdens and the depression associated with providing care, the availability of informal support, the frequency of usage of Long-term care insurance services, and the types of stress coping strategies. RESULTS: Of the total, 27.1% of the caregivers were male. Their age was higher than that of females, but the age of care recipients of female caregivers was significantly higher than that of care recipients of males. There were no significant gender differences in the level of nursing needs of recipients. However, cognitive disorders of care recipients of female caregivers were more severe. Female caregivers spent more time providing care, and performed a greater number of care activities. In particular, female caregivers assisted their care recipients in taking medications, dressing, bathing, eating, meal preparation, shopping, laundry, and money management more often to a significant degree. Furthermore, the average scores for burden and depression were higher in female than in male caregivers. Concerning the usage of Long-term care insurance services, males used a Home-helper service more often. Female caregivers used types of Informal support seeking and Positive acceptance of caregiving role as coping strategies more often than the men. Multiple logistic regression analysis indicated that caregiver's subjective burden and types of informal support seeking, as well as acceptance of the caregiving role were significantly higher in female caregivers. CONCLUSIONS: These results suggest that there are significant gender differences regarding the mode of caregiving and experience of caregiver distress in Japan. It is important that future research be focused on supplying appropriate social support for family caregivers, taking gender differences into account.