山东省老年人失能现状及水平变动的拐点年龄分析

目的 了解山东省老年人失能现状,探讨失能水平变动的拐点年龄,为评估老年人养老照护需求提供参考。方法 采用多阶段整群随机抽样方法,选取山东省17个县（市、区）3349名60岁及以上老年人为研究对象。采用Katz日常生活活动量表（Katz-ADL）判断失能情况,绘制年龄预测失能水平的ROC曲线确定失能水平变动的拐点年龄,logistic回归模型验证拐点年龄对失能水平的影响效应。结果 山东省老年人失能率为6.8%,女性（7.1%）高于男性（6.5%）,失能率从70~74岁开始明显增加（P<0.05）。ADL测量指标中洗澡失能率最高（6.4%）,进食最低（2.4%）,女性高于男性。ROC曲线分析结果中,老年人失能水平变动的拐点年龄为73.5岁,女性（71.5岁）低于男性（74.5岁）;洗澡失能水平变动的拐点年龄为73.5岁,其余5项指标均为74.5岁;AUC均在0.7~0.9之间（P<0.05）。Logistic回归结果显示,控制混杂因素影响后,>73岁老年人失能风险是≤73岁的4.919倍,>74岁男性失能风险是≤74岁的4.181倍,>71岁女性失能风险是≤71岁的6.097倍（P<0.05）。基于模型的预测结果与实际失能发生率的吻合程度均较好（Hosmer-Lemeshow检验,P>0.05）。结论 老年人失能水平变动的拐点年龄存在性别差异,年龄对老年人失能水平具有较高预测价值,洗澡是影响老年人ADL最重要的指标。

Prevalence of the disability and inflection point age of the disability level change,Shandong Province

Objective To investigate the prevalence of the disability and explore the inflection point age of the disability level among the elderly in Shandong Province, so as to provide a reference for assessing the elderly care needs. Methods The multi-stage cluster random sampling method was used to extract 3349 elderly people aged 60 years and above from 17 counties (cities, districts) in Shandong Province. Katz Index of Independence in Activities of Daily Living Scale was used to evaluate disability. The ROC curve for predicting the disability level of the elderly was drawn, and determined the inflection point age of the changes in the disability level. The Logistic regression model was used to verify the effect of age on the disability level of the elderly. Results The disability rate of the elderly was 6.8%, and women (7.1%) was higher than men (6.5%) in Shandong Province. The disability rate increased significantly from 70 to 74 years old (P<0.05). Among the measurement index of ADL, bathing was the highest (6.4%) and eating was the lowest (2.4%), and the female was higher than the male. The ROC curve analysis showed that the inflection point age of the change in disability level was 73.5 years old, and the female (71.5 years old) was lower than the male (74.5 years old). The inflection point age of the change of shower disability level was 73.5 years older, and the other 5 indexes were 74.5 years older. AUC was between 0.7 and 0.9(P<0.05). Logistic regression results showed that after adjusting for the influence of confounding factors, the risk of disability in>73 years old was 4.919 times that in ≤73 years old. The risk of disability in>74 years old of the male was 4.181 times that in ≤74 years old. The risk of disability in>71 years old of the female was 6.097 times that in ≤71 years old (P<0.05). The model showed satisfactory calibration (Hosmer Lemeshow test, P>0.05) by Internal verification. Conclusion There is a gender difference in the inflection point of the disability level change. Age has a high predictive value for the disability level, and bathing is the most important indicator affecting the ADL of the elderly.