南宁市老年人社区居家养老意愿及影响因素研究

背景　社区居家养老因弥补了机构养老的不足而有望成为老年人养老方式的最佳选择，精准识别老年人社区居家养老服务需求有助于政府相关部门提供有针对性的、有侧重的养老服务。目的　基于养老服务需求方视角，了解南宁市老年人社区居家养老服务需求，并探索其影响因素。方法　2019年3-5月，采用便利抽样法选取南宁市符合纳入标准的≥60岁社区老年人505例。采用自制的调查问卷，以一问一答的方式由调查员协助老年人填写问卷。调查问卷主要内容包括基本资料、社区居家养老服务需求情况、养老方式选择情况（家庭养老、社区居家养老、机构养老）。为了便于进行社区居家养老影响因素的研究，按老年人养老的地点将家庭养老和社区居家养老统一归为社区居家养老进行分析。结果　共发放调查问卷505份，回收有效问卷486份，有效回收率96.2%。91.3%（444/486）的老年人并不清楚所在社区是否有养老服务中心或日间照料中心；53.1%（258/486）的老年人表示知道所在的社区是否有社区卫生服务中心；54.7%（266/486）的老年人对社区提供哪些日常生活照料方面的服务不是很清楚；34.0%（165/486）的老年人知道社区能提供疾病诊治服务。41.3%（201/486）的老年人希望社区能扩大老年活动场所，增加为老服务项目；39.3%（191/486）的老年人认为其不需要社区提供任何日常生活照料服务；66.7%（324/486）的老年人希望社区能提供体检、康复、老年护理服务；60.0%（292/486）的老年人希望社区提供健康咨询、保健指导；48.0%（233/486）的老年人希望社区提供上门看病、送药服务。60.9%（296/486）的老年人选择家庭养老，其次是社区居家养老，占20.0%（97/486），选择机构养老的老年人最少，占19.1%（93/486）。受教育程度〔高中或中专：OR=3.379，95%CI（1.307，9.802）；大专及以上：OR=3.955，95%CI（1.508，10.371）〕、退休前工作〔有：OR=5.097，95%CI（2.382，10.908）〕、子女数〔2个：OR=8.198，95%CI（2.982，22.537）；3个及以上：OR=3.607，95%CI（1.521，8.552）〕、自理情况〔完全不能自理：OR=4.165，95%CI（1.570，11.050）〕、受照顾情况〔保姆照顾：OR=0.046，95%CI（0.010，0.209）〕是老年人选择社区居家养老的影响因素（P<0.05）。结论　家庭养老仍然是南宁市城区老年人首选的养老模式，且愿意选择社区居家养老的老年人逐渐增多，社区居家养老或将成为大趋势。经济条件好（高学历、退休前有工作）、家庭支持条件好（有配偶和多个子女）、健康状况差的老年人更倾向于选择社区居家养老。

Preference and Influencing Factors of Community Home-based Elderly Care in Community-living Elderly People in Nanning

Background　Community home-based elderly care is expected to become the most appropriate choice for the elderly because it makes up for the shortage of institute-based elderly care.Accurate identification of the needs of community home-based elderly care may help the government to provide targeted and focused elderly services for special groups.Objective　To explore the demand of community home-based care and influencing factors in Nanning based on the demand-side perspective.Methods　From March to May 2019，a cross-sectional survey was conducted in Nanning City among a convenience sample of 505 community-dwelling elderly individuals（≥60 years old） who were eligible for the study.A self-made questionnaire consisting of 3 major aspects〔demographic data，demands for community home-based elderly care，choice of elderly care（home-based elderly care，community home-based elderly care，and institution-based elderly care）〕 was used in the survey，and was completed by the participants with the assistance of the investigators using a question-and-answer approach.For ease of exploring the influencing factors of the intention of choosing community home-based elderly care，home-based care was included into community home-based elderly care.Results　A total of 505 sets of questionnaires were distributed，and 486 responsive ones were collected，with a response rate of 96.2%.Among the 486 respondents，91.3%（444/486） did not know whether there was a home-based elderly care center or day-care center in their own community，53.1%（258/486） knew whether there was a community health center in their own community，54.7%（266/486） were not aware of the daily care services provided by the community health center in their own community，34.0%（165/486） knew that the community health center could provide diagnostic and therapeutic services.41.3%（201/486） expected to be provided with expanded activity venues and increased elderly care services，and 39.3%（191/486） did not need any community-based daily care services，66.7%（324/486） expected to be provided with community-based medical examination，rehabilitation，and elderly care services，60.0%（292/486） expected to be provided with community-based health counseling and health guidance，48.0%（233/486） expected to be provided with home-based medical care and medication care.60.9%（296/486） of the elderly chose home-based elderly care，followed by community home-based elderly care，accounting for 20.0%（97/486），and 19.1%（93/486） of the elderly chose institutional pension.Those chose institution-based elderly care accounted for the least〔19.1%（93/486）〕.Education level 〔high school or special（or technical） secondary school：OR=3.379，95% CI（1.307，9.802），second- or three-year college and above level：OR=3.955，95% CI（1.508，10.371）〕，occupation before retirement〔OR=5.097，95% CI（2.382，10.908）〕，number of children 〔 two：OR=8.198，95% CI（2.982，22.537），more than three：OR=3.607，95% CI（1.521，8.552）〕，self-care situation 〔complete dependence：OR=4.165，95% CI（1.570，11.050）〕 and care situation 〔nanny care：OR=0.046，95% CI（0.010，0.209）〕 were the influencing factors associated with the choice of community home-based elderly care（P<0.05）.Conclusion　In Nanning，home-based elderly care is still the first choice for urban elderly people and those choosing community home-based elderly care is increasing，and it seemed that community home-based elderly care may become a major elderly care form.Good economic conditions（high education and having an occupation before retirement），good family support conditions（living with the spouse and having multiple children），and poor health status are associated with the choice of community home-based elderly care.