State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen 361102, China.
Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen 361102, China.
Int J Environ Res Public Health. 2020 Mar 5;17(5):1701. doi: 10.3390/ijerph17051701.
Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban-rural differences. This study aims to evaluate the differences of LTC current status and needs between urban-rural areas and age groups, and to identify influencing factors causing the different LTC needs.
The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs.
A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees ( 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 OR 1.69, 0.05).
The aged cohort in urban-rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.
在亚洲老龄化进程迅速加快的背景下，老年人的长期护理需求成为一个日益重要的政策关注点，中国作为人口最多的国家，情况更是如此。然而，目前很少有研究从城乡差异的角度来考察老年人对长期护理服务的现有和预期利用情况。本研究旨在评估城乡地区和年龄组之间长期护理现状和需求的差异，并确定导致不同长期护理需求的影响因素。
数据来自 2014 年中国健康与养老追踪调查。采用多阶段抽样方法，共纳入 7192 名居住在家、年龄≥65 岁的老年人。采用 Andersen 模型将影响因素分为三个部分：倾向因素、促成因素和需求因素。采用多变量逻辑回归分析方法，对三个层次的长期护理需求的影响因素进行分析。
本研究共纳入 6909 例有效样本。老年人的总体长期护理需求呈快速上升趋势，其中洗澡和如厕的需求最高（分别为 27.29%和 15.8%）。城乡老年人的年龄队列对长期护理现状和需求的各个方面都有不同程度的影响（0.05）。与城市地区相比，农村地区老年人对长期护理服务的需求更为迫切，但供应严重不足。年龄较大、居住在农村、未婚、非农业、收入较低、健康状况较差、自理能力较差的老年人对长期护理服务的预期需求较高（OR>1，0.01）。与农村的年轻老年人相比，城市地区的年轻老年人更倾向于独居（OR=1.61，0.01）。年龄较大、居住在农村、从事农业、收入较低、孤独抑郁的老年人对社区服务的预期需求较高（OR=1.69，0.05）。
由于支持不足，城乡老年人都面临着对即时护理需求的增加，特别是农村老年人。农村最年长的老年人对长期护理的需求较高，不同层次的需求受到年龄、经济水平、家庭支持、健康状况等相关因素的影响。本研究为进一步完善中国长期护理体系的建设和发展提供了循证建议。
