Allen S M, Mor V
Center for Gerontology and Health Care Research, Brown University, Providence, RI 02912, USA.
Med Care. 1997 Nov;35(11):1132-48. doi: 10.1097/00005650-199711000-00005.
This article investigates the prevalence, determinants, and consequences of unmet need for assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and transportation in a randomly selected sample of adults with disability residing in Springfield, Massachusetts.
Respondents were contacted through random digit dialing, and eligibility was determined through a disability screen. Eligible individuals were stratified by age; 632 people were interviewed (78% of contacted eligibles). The prevalence of need and unmet need for ADLs, IADLs, and transportation assistance was calculated separately by age strata, as was the prevalence of selected negative consequences attributed to inadequate help with specific activities. The determinants of unmet need were modeled using logistic regression.
The prevalence of unmet need for assistance with individual ADLs ranged from 4.1% (eating) to 22.6% (transferring) of the full sample. Unmet need for IADLs assistance was higher, ranging from 15.9% (cooking) to 34.6% (heavy housekeeping). Respondents younger than age 65 reported higher levels of unmet need for IADLs and transportation help than respondents age 65 or older; members of the younger group also were more likely to report five of the seven negative consequences attributed to inadequate help with IADLs and transportation (eg, missing medical appointments). Regression results revealed inability to meet expenses, having few or no reliable helpers, and impairment severity to be key determinants of unmet need.
Financial problems, and not age per se, placed working age adults at elevated risk of unmet need in this study. The consequences of inadequate help can impede management of chronic health conditions, and may compromise individuals' ability to maintain a safe and reasonable quality of community living.
本文调查了马萨诸塞州斯普林菲尔德市随机抽取的成年残疾人群体中，在日常生活活动（ADL）、工具性日常生活活动（IADL）及交通方面存在未满足的援助需求的患病率、决定因素及后果。
通过随机数字拨号联系受访者，并通过残疾筛查确定其是否符合条件。符合条件的个体按年龄分层；共对632人进行了访谈（占联系到的符合条件者的78%）。分别按年龄层计算ADL、IADL及交通援助的需求患病率和未满足需求的患病率，以及因特定活动帮助不足而导致的选定负面后果的患病率。使用逻辑回归对未满足需求的决定因素进行建模。
在整个样本中，未满足的个体ADL援助需求患病率从4.1%（进食）到22.6%（转移）不等。IADL援助的未满足需求更高，从15.9%（做饭）到34.6%（繁重家务）不等。65岁以下的受访者报告的IADL和交通帮助未满足需求水平高于65岁及以上的受访者；较年轻群体的成员也更有可能报告因IADL和交通帮助不足而导致的七种负面后果中的五种（例如错过医疗预约）。回归结果显示，无法承担费用、几乎没有或没有可靠的帮助者以及损伤严重程度是未满足需求的关键决定因素。
在本研究中，财务问题而非年龄本身使工作年龄的成年人面临未满足需求的风险增加。帮助不足的后果可能会妨碍慢性健康状况的管理，并可能损害个人维持安全合理社区生活质量的能力。
