宁波市社区养老服务供需现况调查

目的：研究宁波市社区养老服务供需现况,并分析问题和提出对策。方法：采用问卷现场调研宁波市8个社区的400名社区老年人。采用访谈法调研4家社区养老服务中心。结果：60～69岁社区老年人主要需要精神文化方面的养老服务,70～79岁社区老年人主要需要基本的医疗康复和安全保障,80岁及以上社区老年人主要需要生活照料和医疗康复服务。在是否愿意参加社区活动的调查中,有43%的社区老年人选择一般愿意。在社区养老服务满意度调查中,有53%的社区老年人选择基本满意。社区养老服务中心的服务供给情况显示,大部分社区养老服务中心可以提供生活照料和健康护理,但对精神慰藉和身心健康服务提供不足。结论：社区老年人轻度功能障碍者所占比例最大。不同年龄的社区老年人服务需求不同。同时,社区老年人对社区组织活动参与意愿不高,对提供的社区养老服务内容基本满意。因此,需要全面深入评估社区老年人的服务需求,并针对性地提高养老服务供给水平。     

南宁市社区老年人中医药健康养老服务需求及影响因素研究

[目的]通过了解南宁市社区老年人对中医药健康养老服务的需求及影响因素，为促进中医药健康养老服务高质量发展提供参考。[方法]利用文献研究和专家访谈确定调查问卷，采取分层便利抽样方法对广西壮族自治区南宁市60岁及以上的老年人进行问卷调查。[结果]73.87%的调查对象对中医药健康养老服务有需求，不同文化程度、职业、中医药信任度、自行健康状况的调查对象对中医药健康养老服务需求差异有统计学意义(P<0.05),中医药信任度是影响老年人中医药健康养老服务需求的重要因素，74.07%的调查对象需求最高的是中医药养生保健知识。[结论]老年人对中医药健康养老服务的需求度处于较高水平，需求选择受到多种因素的影响，老年人对中医药养生保健知识需求明确。     

健康状况对老年人居家养老服务需求影响

目的分析健康状况对老年人居家养老服务需求的影响,为促进居家养老服务体系建设提供依据。方法 2017年7月在江苏省徐州市采用统计描述分析,调查2 134名≥60岁老年人基本情况;采用Poisson回归模型分析健康状况对老年人居家养老服务需求的影响。结果老年人对医疗护理服务的需求最大,平均为1.954项。工具性日常生活活动能力(IADL)情况对老年人生活照料、医疗护理和文化娱乐等方面的需求影响显著(P 0.001)。健康自评对老年人生活照料(P 0.1)和文化娱乐(P 0.001)需求有影响。但是否患慢病对老年人的4种居家养老服务需求均没有显著影响(P 0.1)。此外,年龄、教育、经济水平和子女个数等也是影响老年人居家养老服务需求的重要因素。结论健康状况对老年人居家养老服务需求有显著影响,居家养老服务内容可以针对老年人的实际需求进行调整,重点关注老年人的身体健康状况,特别是老年人的IADL和健康自评状况。     

社会经济地位、数字素养、代际支持与老年人社区智慧养老支付意愿——一个有中介的调节作用

目的：研究老年人社区智慧养老的支付意愿及其影响因素，促进社区智慧养老的可持续发展。方法：基于湖南省长沙市455位老人的微观调研数据，实证检验了社会经济地位对老年人社区智慧养老支付意愿的影响效应，论证了数字素养的中介作用与代际支持的调节作用。结果：老年人社区智慧养老的总体支付意愿较高但支付水平较低，而且社会经济地位越高的老年人，表现出更高的社区智慧养老支付意愿。此外，越年轻、身体越健康的城镇老人越倾向于支付社区智慧养老的费用。数字素养在社会经济地位与支付意愿之间具有部分中介作用。情感支持和生活照料负向调节社会经济地位与老年人社区智慧养老支付意愿的关系。结论：应通过提高老年人养老金、合理定价社区智慧养老产品及服务、普及老年人数字素养教育等措施促进老年人社区智慧养老支付意愿，提升老年人养老的获得感。     

人口老龄化背景下西部城市社区居家养老现状及养老服务需求的调查分析

目的：了解西部城市老年居民的养老现状及养老服务需求,为政府进行合理的服务供给提供参考依据。方法：对重庆市渝中区6个社区180名老人进行问卷调查。结果：社区目前所提供的养老服务与老人实际需要的服务项目在供需之间存在着一定差距,老年人对社区养老服务的整体满意度不高。结论：政府及相关部门应加大经费投入和统筹规划、加大宣传力度,同时不断完善和丰富养老服务内容,以促进社区居家养老模式的良性发展。     

医疗和养老保障对高龄失能老年人医疗服务利用影响的研究

目的：分析医疗保险和养老保障对高龄失能老年人医疗服务利用的影响。方法：利用2018年中国老年健康影响因素跟踪调查(CLHLS)数据,在社会生态理论基础上构建两部模型进行分析。结果：医疗保险与门诊医疗服务就诊概率呈显著正相关,新农合对高龄失能老年人门诊医疗服务利用水平的影响较住院更为显著,养老保障能够显著促进失能老年人医疗服务利用,日常无人照料的失能老年人平均住院概率低,但是条件期望费用与非条件期望费用均相对较高。结论：建议持续加大对失能老年人的医疗与养老保障支持力度以缓解其医疗负担;重点加强对经济状况较差和无人照料的高龄失能老年人帮扶与健康管理,以有效满足其医疗服务需求。     

老年人居家和社区养老服务利用影响因素研究——基于CHARLS数据的实证分析

本文利用北京大学国家发展研究院(CCER)发布的中国健康与养老追踪调查数据(CHARLS),以安德森医疗服务利用行为模型为分析框架,实证研究了影响我国老年人居家和社区养老服务利用的因素。统计分析结果显示,我国老年人居家和社区养老服务的利用程度整体偏低,其中社区养老服务的利用程度高于居家养老服务;影响我国老年人居家和社区养老服务利用的因素有所交集,但不完全相同。为提高我国老年人居家和社区养老服务利用程度,促进我国养老照护事业发展,应加大政策宣传、提升认知程度,完善基层功能、提升服务质量,重视预防保健、强化精神慰藉,做好需求评估、实现精准供给。     

社区居家养老健康服务模式研究

目的探索桃源社区居家养老健康服务模式,为社区养老的发展提供科学依据。方法建立社区动员体系,成立社区自我健康管理协会,利用社区资源为社区老人提供居家养老健康服务。观察开展居家养老健康服务前后社区老人慢性病的管理及控制情况,自拟调查问卷对接受居家养老健康服务的144名社区老年人进行满意度调查。结果桃源社区居家养老健康服务模式深受社区老人喜爱,满意度达93.1%;居家养老健康服务后,社区老年人对高血压、糖尿病的管理率和控制率得到了明显提高（P〈0.01）。结论社区居家养老健康服务模式充分整合了社区可利用资源,为社区居民提供综合、全面的居家养老健康服务,社区居民乐于接受,进一步促进了社区基本公共卫生服务工作的提升。     

基于ADL模型的老年人异质性养老服务需求研究

目的:基于ADL模型探讨老年人的异质性养老服务需求,以期为养老服务精准供给提供策略建议。方法:采用便利抽样法选取了江苏省苏南、苏中、苏北的12家社区老年人作为研究对象,应用日常生活能力量表、老年人一般资料和异质性养老服务需求调查问卷进行现场调查,共回收有效问卷337份。结果:长期照护型老年人更需要日常生活照料、医疗保健、精神慰藉方面的服务;健康照护型老年人更需要文化娱乐的满足;短期照护型老年人在获得基本的日常照护基础上也需要丰富的文化娱乐。结论:大多数的老年人更倾向于居家养老和社区养老,不同养老服务需求类别老年人对养老服务的需求层次不同。     

基于扎根理论的社区肌少症老年人养老服务 需求框架构建*

摘 要：目的：基于扎根理论构建社区肌少症老年人养老服务需求框架。方法：通过对云南省大理市某社区的 16例肌 少症老年人进行访谈,获取其养老服务需求,使用扎根理论研究方法进行编码与分析。结果：共形成101个概念,13个一级 范畴,8 个二级范畴,建立基于物质性和精神性价值需求的肌少症老年人养老服务需求框架,核心范畴为“给予支持”。 结论：为社区肌少症老年人养老服务需求提供了概念框架,可以将该框架结构与社区实际养老相结合,实现智慧养老。     

老年糖尿病足患者诊疗服务利用及经济负担的定性研究

目的:了解老年糖尿病足患者的就医行为、服务利用和经济负担情况,为改善老年糖尿病足的防治效果提供政策建议。方法:采用目的抽样,获得知情同意后对南京军区联勤部解放军第四五四医院2013年12月—2014年1月住院治疗的15例老年糖尿病足患者进行个人深入访谈。结果:老年糖尿病足患者具有较高的卫生服务需求,重"治"轻"防";服务利用和效果受经济水平、医疗保障制度、社区服务提供能力等诸多因素影响。结论:为提高老年糖尿病足患者的治疗效果和生命质量,应加强患者的健康教育,以社区为基础建立一体化的疾病管理与服务体系,制定减轻患者疾病经济负担的政策。     

Effect of in-home and community-based services on the functional status of elderly in the long-term care insurance system in Japan

ABSTRACT: BACKGROUND: Japan is setting the pace among aging societies of the world. In 2005, Japan became the country with the highest proportion of elderly persons in the world. To deal with the accelerated ageing population and with an increased demand for long-term care services, in April 2000 the Japanese government introduced a mandatory social Long-Term Care Insurance System (LTCI), making long-term care services a universal entitlement for elderly. Overseas literature suggests that the effectiveness of a home visiting program is uncertain in terms of preventing a decline in the functional status of elderly individuals. In Japan, many studies regarding factors associated with LTC service utilization have been conducted, however, limited evidence about the effect of LTC services on the progression of recipient disability is available. METHODS: Data were obtained from databases of the LTC insurer of City A. To examine the effect of in-home and community-based services on disability status of recipients, a survival analysis in a cohort of moderately disabled elderly people, was conducted. RESULTS: The mean age of participants was 81 years old, and females represented 69% of the participants. A decline or an improvement in functional status, was observed in 43% and 27% of the sample, respectively. After controlling for other variables, women had a significantly greater probability of improving their functional status during all phases of the observation period. The use of "one service" and the amount of services utilized (days/month), were marginally (p =< 0.10) associated with a greater probability of improving their functional status at 12 months into the observation period. CONCLUSIONS: The observed effects of in-home and community-based services on disability transition status were considered fairly modest and weak, in terms of their ability to improve or to prevent a decline in functional status. We suggest two mechanisms to explain these findings. First, disability transition as a measure of disability progression may not be specific enough to assess changes in functional status of LTCI recipients. Secondly, in-home and community-based services provided in City A, may be inappropriate in terms of intensity, duration or quality of care.     

城市老年人医养结合服务需求及其影响因素分析

目的:探讨城市老年人医养结合服务需求的现状及其影响因素。方法:采用两阶段随机抽样的方法,运用“城市老年人医养结合服务需求量表”对南京市440名城市老年人进行抽样调查。结果:城市老年人的医养结合服务需求水平比较高(3.7475±0.31499);年龄、性别、收入水平和健康状况是城市老年人医养结合服务需求的影响因素(P<0.05),年龄比较大、收入水平比较高、健康状况比较差的男性城市老年人的医养结合服务需求最高。结论:积极推进医养结合服务供给侧结构性改革,面向全体老年人提供有针对性的、多元化的医养结合服务。     

东部地区社区居家医养结合服务老年人生命质量研究

目的 了解东部地区社区居家医养结合服务老年人生命质量状况,并探讨其影响因素,为我国政府制定促进健康老龄化政策提供理论依据。方法 采用多阶段分层抽样的方法,对苏州、广州两地接受社区居家医养结合服务的老年人进行问卷调查。使用欧洲5维健康量表(EQ-5D量表)计算其健康效用值,单因素分析使用秩和检验,多因素分析使用Tobit回归模型。结果 社区居家医养结合服务老年人健康效用值中位数为0.699。在5个维度中,存在困难比例依次为日常活动能力(56.8%)、行动能力(55.0%)、自我照顾能力(50.8%)、疼痛/不适(42.0%)、焦虑/抑郁(24.7%)。Tobit回归模型结果显示：城镇职工基本医疗保险、月收入1 001～5 000元、未患有慢性病、每日睡眠时间6～8 h是东部地区社区居家医养结合服务老年人健康相关生命质量的保护因素。结论 东部地区社区居家医养结合服务老年人生命质量较差,需采取针对性措施改善社区居家医养结合服务老年人生命质量。     

海南省居家老年人长期照护服务需求调查研究

目的 了解海南省社区居家老年人长期照护服务需求现状及其影响因素,为完善精准供给策略提供参考依据。方法 采用多阶段分层随机抽样方法抽取海南省10个市县2 346例老年人进行问卷调查;采用单因素及多重线性回归分析方法分析影响老年人长期照护服务需求的因素。结果 老年人长期照护服务需求总得分为（39.96±4.71）,其中,医疗保健服务需求子维度得分最高（13.35±2.21）;社会参与需求子维度得分最低（7.70±1.34）。单因素分析结果显示:性别（t = - 2.892）、年龄（F = 54.328）、户籍类型（t = - 2.749）、户籍地（t = 2.604）、婚姻状况（t = - 4.869）和文化程度（F = 10.823）对长期照护服务需求总得分有影响,差异具有统计学意义（P＜0.05）。多重线性回归分析结果显示:性别（β = 0.530,95%CI:0.150～0.910）、年龄（β = 1.175,95%CI:0.908～1.443）、户籍类型（β = 0.463,95%CI:0.074～0.852）、户籍地（β = - 0.691,95%CI: - 1.356～ - 0.026）和婚姻状况（β = 0.620,95%CI:0.098～1.142）是长期照护服务需求总得分的影响因素（P＜0.05）。结论 不同特征老年人长期照护服务需求具有差异性,应以多样化多层次需求为导向,实现社区居家长期照护服务的精准化供给。     

Health care-seeking behaviour and out-of-pocket payments in Tbilisi, Georgia

Based on a household survey conducted in Tbilisi, Georgia, in 2000, this paper examines current patterns of health care-seeking behaviour and the extent of out-of-pocket payments. Results show that health care services are a financial burden and that private (out-of-pocket) payment creates financial barriers to accessing health services. Members of the poorest households are less likely to seek care than people from more affluent households, and devote a higher share of household monthly expenditure to health care. Households have adopted various strategies to overcome these financial barriers, but the strategies are likely to contribute to both declining economic status and worsening health outcomes. The paper provides an evidence base to help direct future policy reform in Georgia. Government needs to: (1) prioritize public financing of services for the poor, in particular through amending the Basic Benefit Package so that it better reflects the needs of the poor; (2) promote the quality and utilization of primary care services; (3) address the issue of rational drug use; and (4) consider mobilizing out-of-pocket payments on a pre-paid basis through formal or community-based risk pooling schemes.     

社区养老服务供需差异对老年人生活质量的影响

目的 了解中国社区养老服务供需现况,分析养老服务供需差异对老年人生活质量的影响,为实现供需匹配和高质高效的居家社区养老服务提供政策依据。方法 采用χ2检验描述我国社区养老服务的供需分布状况,二元logistic回归模型探索不同社区养老服务对老年人的生活质量的影响,并采用Hosmer and Lemeshow检验诊断模型性能。结果 我国社区养老服务供需关系差异明显,经济水平富有（OR = 11.024,P＜0.001）、年龄的增长（OR = 0.568,P＜0.001）、医保类型为城镇居民（OR = 1.216,P＜0.05）、自评健康非常好（OR = 20.455,P＜0.001）、无抑郁症状（OR = 2.124,P＜0.001）、个人护理服务（OR = 1.169,P＜0.05）以及医疗保健教育服务（OR = 1.237,P＜0.05）是影响老年人生活质量的正向促进因素。结论 社区养老服务的建设需各部门与社区协调同步,加强社区个人护理服务水平,同时增加保健教育的财政投入,加大医疗保健教育服务力度。     

Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation

Objectives:

The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide.

Methods:

Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization.

Results:

The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size.

Conclusions:

It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.     

社区居家养老意愿下居住方式和子女支持对老年人基层卫生服务需求的影响

目的:探讨居住方式和子女支持对老年人基层卫生服务需求的影响,使基层卫生服务更具针对性,以满足不同居家类型老年人的卫生服务需求.方法:利用2016年中国老年社会追踪调查数据,采用负二项Hurdle回归模型(NBH模型)分析.结果:与子女同住会显著提高城乡居家老年人对基层卫生服务的需求(P<0.05),子女经济支持则会显著...     

Public financial support receipt and non-medical resource utilization in Alzheimer's disease results from the PLASA study

A major health policy objective is to encourage and sustain informal caregiving networks for people with Alzheimer's disease (AD). This goal can be reached by providing financial assistance to patients facing difficulties in the accomplishment of activities of daily living, in order to encourage utilization of professional service and therefore alleviate informal caregiver burden. The main issue is to understand if and how financial assistance is correlated with the distribution between informal and professional care. We used a cross-sectional sample of 1131 French elderly patients (≥65) with mild to moderate AD. Informal and professional service resource use was measured in hours per month using a validated instrument, the Resource Use in Dementia questionnaire. Our results confirmed the utter dominance of informal care, which represented more than 80% of total care even among patients receiving public financial support. However financial support receipt was associated with differences in care utilization: higher use of total non-medical care (formal and informal) and lower proportion of informal care in total non-medical care. Our results suggested the presence of a threshold effect that would influence non-medical care demand decisions. Even if on average the use of informal care in total was 13.3% lower among patients receiving public financial support, informal care use represented more than 80% of total non-medical care use. Providing robust evidence of these associations is crucial to further identify the right dosage between professional service demand and informal care utilization that could be associated with a lower burden and therefore a lower probability of institutionalization.