Rabiner D J, Konrad T R, DeFriese G H, Kincade J, Bernard S L, Woomert A, Arcury T, Ory M G
National Center for Health Promotion, VA Medical Center, Durham, NC 27705, USA.
J Rural Health. 1997 Winter;13(1):14-28. doi: 10.1111/j.1748-0361.1997.tb00830.x.
The objective of this study was to use a recent national probability survey of the noninstitutionalized older adult population to compare the functional status and self-care practices of older adults residing in metropolitan and nonmetropolitan communities and to identify differences associated with residential location. The survey used in this study was the National Survey of Self-care and Aging (NSSCA). A cross-sectional design was employed using weighted bivariate and multivariate logistic regression analyses to examine the relationship between metropolitan and nonmetropolitan residential location and self-reported ability to perform basic, mobility, and instrumental activities of daily living (ADLs), as well as to assess the degree to which the levels and types of functional limitations affect metropolitan versus nonmetropolitan older adults' performance of self-care activities. The bivariate logistic analyses pointed to modest, often insignificant metropolitan versus nonmetropolitan differences in the ability to perform functional tasks. However, larger positive effects of nonmetropolitan residence were generally observed once other factors likely to account for some of these differences were taken into account. Older adults from nonmetropolitan areas were more likely to report being able to perform functional activities but also were more likely to report performing self-care activities both in the presence and absence of disability. This study, therefore, concluded that nonmetropolitan older adults may discount the significance of declining functional status, thus normalizing the trajectory of aging in a different way than do their metropolitan counterparts. If this process occurs, it may affect how nonmetropolitan persons use primary health care and/or long-term care services, challenging the economists' concept of demand, the clinicians' concept of need, and the policy analysts' concept of equity. Additional work is required to assess whether such a normalization process actually occurs and, if so, to explore its distribution, causes, correlates, and consequences.
本研究的目的是利用最近一项针对非机构化老年人口的全国概率调查，比较居住在大都市和非大都市社区的老年人的功能状况和自我护理行为，并确定与居住地点相关的差异。本研究使用的调查是全国自我护理与老龄化调查（NSSCA）。采用横断面设计，运用加权双变量和多变量逻辑回归分析，以检验大都市和非大都市居住地点与自我报告的基本、移动和日常生活工具性活动（ADL）能力之间的关系，并评估功能限制的水平和类型对大都市和非大都市老年人自我护理活动表现的影响程度。双变量逻辑分析指出，在执行功能任务的能力方面，大都市与非大都市之间存在适度的、通常不显著的差异。然而，一旦考虑到可能解释其中一些差异的其他因素，通常会观察到非大都市居住的更大积极影响。来自非大都市地区的老年人更有可能报告能够进行功能活动，但也更有可能报告在有残疾和无残疾的情况下都进行自我护理活动。因此，本研究得出结论，非大都市的老年人可能低估了功能状态下降的重要性，从而以与大都市同龄人不同的方式使衰老轨迹正常化。如果这个过程发生，它可能会影响非大都市的人如何使用初级卫生保健和/或长期护理服务，挑战经济学家的需求概念、临床医生的需求概念和政策分析师的公平概念。需要开展更多工作来评估这种正常化过程是否真的发生，如果发生，还要探索其分布、原因、相关性和后果。
