基于能力评估的城市养老机构入住老年人服务需求调查

目的了解城市养老机构入住的不同能力等级老年人对不同服务的需求程度。 方法选取全国9个省的18家养老机构中的674名老年人作为调查对象，根据行业标准《老年人能力评估》评定其能力等级，通过自行设计的《养老机构入住老年人服务需求调查表》调查其相关需求情况，并对不同能力等级老年人的不同服务需求（包括日常生活照料服务、医疗健康服务、休闲娱乐服务、心理慰藉服务）进行比较分析。多组间需求评分的比较采用方差分析。 结果674例被调查者中以70～89岁（82.2%）、无配偶（61.3%）、自费入住（86.8%）的老年人为主，入住养老机构的主要原因（占58.9%）是子女亲属无时间照顾。日常生活照料服务、医疗健康服务、心理慰藉指导服务需求得分均随老年人身体受损程度的加重而逐渐上升，休闲娱乐服务需求得分明显下降，差异均有统计学意义（F=177.546、11.269、4.484、10.097，均P<0.01）。不同能力等级老年人所有日常生活照料服务各子项（穿衣服务、修饰服务、口腔清洁、饮食照料、排泄护理、皮肤清洁护理、压疮预防、膳食服务、清洁服务、洗涤服务、帮助购物、房间布置与装扮）的需求得分均随老年人身体受损程度的加重逐渐上升（F=150.468、123.718、129.496、78.739、138.319、160.589，均P<0.01）。在医疗健康服务项目中除健康教育和中医保健服务外，不同能力等级老年人其余各子项（定期健康体检服务、健康指导和督促服务、健康教育服务、基础护理服务、中医保健服务、诊断治疗服务、康复训练服务、安全用药指导）的需求得分均随老年人身体受损程度的加重逐渐上升（F=8.648、7.948、13.009、10.388、7.703、16.342，均P<0.01）。不同能力等级老年人休闲娱乐服务项目各子项（文化类娱乐活动、体育类娱乐活动、娱乐活动的提供或指导）的需求得分均随老年人身体受损程度加重明显下降（F=3.287、16.570、4.127，均P<0.05或0.01），心理慰藉服务项目中增加探视次数的需求得分的差异有统计学意义（F=7.198，P<0.01）。老年人能力等级与日常生活照料服务、医疗健康服务及心理慰藉服务需求均呈正相关（r=0.606、0.214、0.108，均P<0.01），与休闲娱乐服务需求呈负相关（r=-0.197，P<0.01）。 结论城市养老机构入住老年人身体能力等级与日常生活照料服务、医疗健康服务、休闲娱乐服务的需求程度存在相关性且不同等级间需求差异明显，养老机构应重视老年人能力评估工作，并依据相应需求科学开展功能区域划分、照护方案制定、个性服务提供等工作。

Survey on service needs of the elderly in urban nursing homes based on ability assessment

ObjectiveTo understand the services demands of elderly people with different ability levels in urban nursing homes. MethodsThe services demands of 674 elderly people with different ability levels living in 18 nursing homes in 9 provinces were investigated. The ability level was judged by ability assessment for older adults (MZ/T 039-2013). ANOVA was used to compare the demands with different groups. ResultsSix hundred and seventy-four elderly people were mainly constituted by 70~89 years old (82.2%), having no spouse (61.3%), self-funded (86.8%), and the main reason (58.9%) for living in nursing homes is their relatives had no time to take care of them. The demands of daily life care services, medical and health services and psychological comfort services gradually rose with aggravation of physical damage. The demands of leisure and entertainment services declined with aggravation of physical damage. The differences were statistically significant(F=177.546, 11.269, 4.484, 10.097, all P<0.01). The demand degrees of all the daily life care services rose with aggravation of physical damage (F=150.468, 123.718, 129.496, 78.739, 138.319, 160.589, all P<0.01). Except health education and health care of traditional Chinese Medicine, the demand degrees of other medical and health services rose with aggravation of physical damage (F=8.648, 7.948, 13.009, 10.388, 7.703, 16.342, all P<0.01). The demand degrees of all the leisure and entertainment services declined with aggravation of physical damage (F=3.287, 16.570, 4.127, all P<0.05 or P<0.01). In the dimension of psychological comfort services, the differences among groups in adding visitation frequency were statistically significant (F=7.918, P<0.01). The ability level of elderly people was positively correlated with demand of daily life care services, medical and health services and psychological comfort services (r=0.606, 0.214, 0.108, all P<0.01), and was negatively correlated with demand of leisure and entertainment services(r= -0.197,P<0.01). ConclusionThe ability level of elderly people living in the urban nursing homes was relevant with the demand of daily life care services, medical and health services, leisure and entertainment services and psychological comfort services. The differences of ability level groups were statistically significant. Nursing homes should pay attention to the ability assessment, and divide functional area, develop care plan, service delivery personally according to the demands.