The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, Hangzhou, China.
Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China.
Front Public Health. 2022 Oct 6;10:921980. doi: 10.3389/fpubh.2022.921980. eCollection 2022.
Limited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions).
A total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors.
Factors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, < 0.01; rich vs poor, OR = 7.23, = 0.01), could afford daily life (yes vs no, OR = 2.33, = 0.03), and lived in the eastern or central region of China (eastern vs western, OR = 2.91, < 0.01; central vs western, OR = 2.40, = 0.02) could access to healthcare services more easily. However, factors in predisposing dimension and need dimension showed no statistical significance. Meanwhile, inconvenience in the movement was the major barrier reported by some participants for not going to the hospital when they got sick.
Access to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.
有限的研究关注的是中国日常生活活动（ADL）受限的老年人获得医疗保健服务的情况和相关因素。本研究基于安德森医疗保健利用模型（即需求、倾向和使能维度）探讨了与他们获得医疗保健服务相关的因素。
共纳入了来自中国长寿纵向研究（CLHLS）最新波次（2018 年）的 3980 名 65 岁及以上 ADL 受限的老年人。采用二元逻辑回归分析探讨影响因素。
使能维度的因素与 ADL 受限的老年人获得医疗保健服务有关。那些经济状况较好（较好 vs 较差，OR=2.98， < 0.01；富裕 vs 较差，OR=7.23， = 0.01）、能够负担得起日常生活（是 vs 否，OR=2.33， = 0.03）、居住在中国东部或中部地区（东部 vs 西部，OR=2.91， < 0.01；中部 vs 西部，OR=2.40， = 0.02）的老年人更容易获得医疗保健服务。然而，倾向维度和需求维度的因素则没有统计学意义。同时，一些参与者表示，行动不便也是他们生病时不去医院的主要障碍。
ADL 受限的老年人获得医疗保健服务主要与经济状况、日常生活负担能力和生活区域等使能维度的因素有关。本研究提出了以健康保险、医疗保健制度、无障碍设施和社会支持为重点的策略，以增加参与者获得医疗保健服务的机会，从而有益于他们的健康。
