Freedman Vicki A, Aykan Hakan, Wolf Douglas A, Marcotte John E
Polisher Research Institute, Abramson Center for Jewish Life (formerly Philadelphia Geriatric Center), Horsham, North Wales, Pennsylvania 19454, USA.
J Gerontol B Psychol Sci Soc Sci. 2004 Jan;59(1):S25-33. doi: 10.1093/geronb/59.1.s25.
We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines.
Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models.
Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care.
Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities.
我们描述了美国未婚老年人接受的有偿和无偿家庭护理时长如何因残疾状况的变化而改变。我们检验了对残疾状况下降和改善的反应是否对称；也就是说，我们检验了因残疾状况改善而导致的护理时长减少幅度，是否与因残疾状况下降而导致的护理时长增加幅度相似。
利用一个美国未婚老年人的全国样本，我们研究了个人护理（日常生活活动，即ADL）和常规护理（工具性日常生活活动，即IADL）残疾状况下降和改善时，护理总时长、有偿护理时长和无偿护理时长的变化。我们使用托比特模型对过去一个月接受的护理总时长变化进行建模，并对无偿和有偿护理时长变化进行联合建模。
接受的护理总时长变化对ADL受限数量的增加和减少均有反应，且似乎接近对称。相比之下，对IADL残疾状况变化的反应似乎远非对称：虽然IADL受限数量增加会导致护理总时长大幅增加，但IADL受限数量减少时，护理时长并不会相应大幅下降。无偿护理和有偿护理以及医疗补助资助的家庭护理都呈现出相同的总体模式。
残疾和护理在老年期并非固定不变的情况。未婚老年人会经历功能恶化、稳定和恢复，他们的护理时长也会相应改变。对家庭护理项目的评估必须认识到这些动态现实。
