Johansson-Pajala Rose-Marie, Alam Moudud, K Gusdal Annelie, Marmstål Hammar Lena, Boström Anne-Marie
School of Health, Care and Social Welfare, Mälardalen University, Sweden.
School of Information and Engineering/Statistics, Dalarna University, Falun, Sweden.
Scand J Public Health. 2025 May;53(3):250-257. doi: 10.1177/14034948241236830. Epub 2024 Mar 22.
Older adults are increasingly encouraged to continue living in their own homes with support from home care services. However, few studies have focused on older adults' safety in home care. This study explored associations between the sense of security and factors related to demographic characteristics and home care services.
The mixed longitudinal design was based on a retrospective national survey. The study population consisted of individuals in Sweden (aged 65+ years) granted home care services at any time between 2016 and 2020 (=82,834-94,714). Multiple ordinal logistic regression models were fitted using the generalised estimation equation method to assess the strength of relationship between the dependent (sense of security) and independent (demographics, health and care-related factors) variables.
The sense of security tended to increase between 2016 and 2020, and was significantly associated with being a woman, living outside big cities, being granted more home care services hours or being diagnosed/treated for depression (cumulative odds ratio 2-9% higher). Anxiety, poor health and living alone were most strongly associated with insecurity (cumulative odds ratio 17-64% lower). Aside from overall satisfaction with home care services, accessibility and confidence in staff influenced the sense of security most.
We stress the need to promote older adults' sense of security for safe ageing in place, as mandated by Swedish law. Home care services profoundly influence older adults' sense of security. Therefore, it is vital to prioritise continuity in care, establish trust and build relationships with older adults. Given the increasing shortage of staff, integrating complementary measures, such as welfare technologies, is crucial to promoting this sense of security.
越来越多的人鼓励老年人在家庭护理服务的支持下继续住在自己家中。然而，很少有研究关注老年人在家庭护理中的安全问题。本研究探讨了安全感与人口统计学特征及家庭护理服务相关因素之间的关联。
混合纵向设计基于一项全国性回顾性调查。研究人群包括2016年至2020年期间（=82,834 - 94,714）随时获得家庭护理服务的瑞典65岁及以上老年人。使用广义估计方程法拟合多个有序逻辑回归模型，以评估因变量（安全感）和自变量（人口统计学、健康及护理相关因素）之间关系的强度。
2016年至2020年期间，安全感呈上升趋势，且与女性、居住在大城市以外、获得更多家庭护理服务时长或被诊断/治疗为抑郁症显著相关（累积优势比高2 - 9%）。焦虑、健康状况差和独居与不安全感的关联最为强烈（累积优势比低17 - 64%）。除了对家庭护理服务的总体满意度外，服务的可及性和对工作人员的信心对安全感影响最大。
我们强调，按照瑞典法律的要求，为实现安全的就地养老，有必要提升老年人的安全感。家庭护理服务对老年人的安全感有深远影响。因此，优先考虑护理的连续性、建立信任并与老年人建立关系至关重要。鉴于工作人员日益短缺，整合福利技术等补充措施对于提升这种安全感至关重要。
