中国老年人居家和社区服务利用情况变化分析：一项全国队列研究

Analysis of Changes in Home- and Community-Based Service Utilisation Among Chinese Older Adults: A National Cohort Study.

作者信息

Yu Yushan, Zheng Xiaoying, Petrovic Mirko, Zhang Wei-Hong

机构信息

Department of Health Services and Management, School of Medical Humanities and Management, Wenzhou Medical University, Wenzhou, China.

International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

出版信息

J Adv Nurs. 2025 Sep;81(9):5845-5857. doi: 10.1111/jan.16704. Epub 2025 Jan 3.

DOI:10.1111/jan.16704

PMID:39749861

Abstract

AIM

To explore changes in home- and community-based service utilisation and its associated factors among Chinese older adults between 2016 and 2018.

DESIGN

A national cohort study.

METHODS

This study included 6924 older adults from the China Longitudinal Aging Social Survey 2016 and 2018 waves, examining the changes in service utilisation among four groups: continuous users, former users, new users and nonusers. Multinomial logistic models were employed to identify the determinants of service utilisation changes, and dominance analysis was performed to compare the relative contribution of the main variables associated with utilisation changes.

RESULTS

Overall, there was an approximate 6% increase in the utilisation of any services among the study population from 2016 to 2018. The changes in service utilisation among four groups were 6.9% as continuing users, 4.2% as former users, 10.1% as new users and 78.8% as nonusers from 2016 to 2018, respectively. Factors associated with utilisation changes, ranked from the most to the least relative contribution, included availability of services, living region, type of pension, activities and instrumental activities of daily living, personal income, age and living alone.

CONCLUSIONS

Despite an increase in service utilisation, low services utilisation remains a concern. Strengthening policy support and boosting financial investments in home- and community-based services to enhance availability across all regions would be an effective measure to improve service utilisation.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The study highlights the need for long-term care professionals and policymakers to increase availability to home- and community-based services, especially in underserved areas.

IMPACT

Identifying key factors associated with changes in service utilisation, such as service availability and living region, can guide targeted strategies to improve access and equity.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

REPORTING METHOD

STROBE statement (Table S5).

摘要

目的

探讨2016年至2018年间中国老年人居家和社区服务利用情况的变化及其相关因素。

设计

全国队列研究。

方法

本研究纳入了来自2016年和2018年中国老年社会追踪调查的6924名老年人，考察了连续使用者、曾经使用者、新使用者和未使用者这四组人群的服务利用变化情况。采用多项逻辑模型来确定服务利用变化的决定因素，并进行优势分析以比较与利用变化相关的主要变量的相对贡献。

结果

总体而言，2016年至2018年研究人群中任何服务的利用率约提高了6%。2016年至2018年，四组人群的服务利用变化分别为：连续使用者6.9%，曾经使用者4.2%，新使用者10.1%，未使用者78.8%。与利用变化相关的因素，按相对贡献从高到低排序，包括服务可及性、居住地区、养老金类型、日常生活活动和工具性日常生活活动、个人收入、年龄以及独居情况。