基于连续性记录与评估工具的我国养老机构老年人照护费用及影响因素研究

背景　随着我国老龄化的日益严峻，老年人的照护费用将给社会和家庭带来沉重的经济负担。探讨养老机构老年人照护费用的影响因素，将有助于根据实际情况进行医疗决策、提供针对性的照护服务、合理分配医疗资源、规划长期护理保险和财政投入等，这对于老年人、家属、医疗照护服务提供者、养老照护机构、国家财政和医疗保险部门等都非常重要。目的　老年人的健康与功能状况能够影响其照护需求和照护费用，本研究基于美国连续性记录与评估工具（CARE）的评估结果，初步探讨老年人的健康与功能状况对养老机构照护费用的影响。方法　2018年1-4月，以北京市顺义区某养老机构中≥60岁的老年人为研究对象，由养老机构的5位照护服务提供者（包括1位医生、1位护士、3位护理员）担任评估员，采用基于中文版CARE设计的手机APP评估软件对养老机构的老年人展开评估。本研究主要提取CARE中4个人口学和20个子量表评估结果。采用主成分分析法将CARE 20个子量表评估结果提取为6个主要因子；采用多元线性逐步回归分析4个人口学变量和6个主要因子对照护费用的影响。结果　本研究共纳入239例养老机构老年人（女119例，男120例），平均年龄（82.3±12.5）岁。多元线性逐步回归分析结果显示，影响养老机构老年人照护费用的因素包括：生活自理能力〔b=-1.244，95%CI=（-1.727，-0.761）〕、肌力〔b=16.140，95%CI=（9.106，23.175）〕、年龄〔b=-4.614，95%CI=（-6.765，-2.463）〕、疾病和用药〔b=21.849，95%CI=（3.261，40.437）〕、性别〔b=56.881，95%CI=（2.814，110.949）〕。结论　我国养老机构在设定老年人的照护等级及收取照护费用时，可以考虑适当加强生活自理能力、肌力、年龄、疾病和用药、性别这5个方面的权重。

The Influencing Factors of Care Cost in Elderly Care Institutions Using the Chinese Version of Continuity Assessment Record and Evaluation

Background The care cost for increasingly aging population will bring heavy economic burden to the society and families in China.So exploring the influencing factors of care cost in elderly care institutions will help make health care decisions,provide targeted services,allocate medical resources reasonably,plan long-term care insurance and financial investment according to the actual situation,which is very important for the elderly,families,health care service providers,elderly care institutions,national finance and medical insurance departments.Objective The health and functional status of the elderly significantly affects their care need and cost.This study was to explore the impact of health and functional status on care cost in Chinese elderly adults from elderly care institutions using the Chinese version of Continuity Assessment Record and Evaluation(CARE-C).Methods Elders aged 60 years and older were recruited from an elderly care institution in Shunyi District of Beijing.5 qualified assessors including 1 doctor,1 nurse and 3 caregivers in the elderly care institution,assessed the elderly from January to April 2018.The data were collected by using a mobile phone-based APP developed in accordance with the CARE-C.This study mainly extracted the evaluation results of 4 demographic and 20 subscales in CARE.Principal component analysis was used to extract the evaluation results of CARE 20 subscale into 6 main factors,and multiple linear stepwise regression was used to analyze the effects of 4 demographic variables and 6 main factors on care costs.Results This study included 239 older adults(119 women and 120 men),with a mean age of(82.3±12.5)years.Multiple linear regression revealed that ability of self-care in daily life〔b=-1.244,95%CI=(-1.727,-0.761)〕,muscle strength〔b=16.140,95%CI=(9.106,23.175)〕,age〔b=-4.614,95%CI=(-6.765,-2.463)〕,diseases and medications〔b=21.849,95%CI=(3.261,40.437)〕,gender〔b=56.881,95%CI=(2.814,110.949)〕were influencing factors of care cost.Conclusion It is suggested that when determining the care level of the elderly and charging the care cost,domestic elderly care institutions should give more considerations for ability of self-care in daily life,muscle strength,age,disease and medication,and gender.