杭州市居家养老的医养护结合现状调查

  目的  调查杭州市居家养老的医养护结合现状，发现存在的供给和需求不匹配问题，从而提出开展针对性养老服务和养老服务供给侧改革的建议。  方法  于2019年对杭州市西湖区和江干区共5个社区的居家养老人群，共调查942人，按照日常生活能力量表评分结果分为自理组(707人)和失能组(235人)进行问卷调查和实际走访调查，以了解医养护结合需求和供给现状。  结果  居家养老人群中失能组的年龄比自理组的年龄大(P < 0.05)；2组性别比例差异无统计学意义(P=0.273)，均为女性较多；2组的生活照料人员比较差异有统计学意义(P < 0.05)，老年人的主要生活照顾者是伴侣，失能老人独居比例下降，依靠子女和保姆比例增加；除了慢病管理、建立电子档案和健康知识教育外，老年人接受其他项目的公共卫生服务比例均 < 50%；失能老年人接受上门服务、家庭病床、助医服务的比例 < 50%，提示基本医疗的可及性差；接受管道护理、压疮护理服务比例 < 50%，提示老年专科特色医疗护理欠缺；除了急慢性颈肩腰腿疼痛，接受其余康复项目服务的比例均 < 50%，提示专业的康复缺乏。  结论  通过对杭州市居家养老的医养护结合现状调查，发现存在供给与需求不匹配问题，建议有条件的单身人士尽可能结婚，以应对将来老年期的生活照料问题，建议社区养老服务中心增加上门服务和短期照料服务以增强家庭养老能力；建议社区卫生服务机构提高针对老年人公共卫生服务的质量，提高基本医疗的可及性，培训老年专科护士，建设专业康复科室。 

Investigation and research on the current situation of the combination of medical care and maintenance for the aged cared by home in Hangzhou

  Objective  To investigate the current situation of medical care for the aged at home in Hangzhou and find out the mismatch between supply and demand, so as to put forward suggestions for carrying out targeted pension service and pension supply-side reform.  Methods  In order to understand the current situation of demand and supply of medical care combined with maintenance, a questionnaire survey and an actual interview survey were conducted among the elderly in five communities in Xihu District and Jianggan District of Hangzhou in 2019. According to the scoring results of the activity of daily living (ADL), the elderly population was divided into self-care group and disabled group.  Results  The disabled group was older than the self-care group (P < 0.05). There was no significant difference in the sex ratio between the two groups (P=0.273). Major of them were female. There was a significant difference between the two groups of caregivers (P < 0.05). The main caregivers of the elderly were partners. The proportion of disabled elderly living alone decreased while the proportion of depend on children and nannies increased. Except chronic disease management, establishment of electronic archives and health knowledge education, the proportion of elderly people receiving public health services for other projects was less than 50%. The proportion of disabled elderly people receiving on-site services, family sickbeds and medical assistance services was less than 50%, suggesting poor accessibility of basic medical care. The proportion of patients receiving pipeline care and pressure sore care service was less than 50%, which indicated the lack of special medical care for the elderly. Except for acute and chronic neck, shoulder, waist and leg pain, the proportion of receiving other rehabilitation services was less than 50%, suggesting a lack of professional rehabilitation.  Conclusion  Based on the investigation of the current situation of medical care for the aged at home in Hangzhou, it is found that there is a mismatch between supply and demand. It is suggested that the government encourage single persons to marry as much as possible to deal with the problem of life care for the aged in the future. It is also suggested that community service centers for the aged increase home service and short-term care services to enhance the living ability of the aged at home. It is suggested that community health service institutions improve the quality of public health services for the elderly, improve the accessibility of basic medical care, train specialized nurses for the elderly, and build professional rehabilitation departments.