Analysis of the current situation of demand for community home medical care with pension services and its influencing factors for the urban elderly
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摘要:
目的 调查成都市城市老年人社区居家医养结合养老服务需求现状,并探究老年人选择养老服务的影响因素, 为构建以需求为导向的居家养老模式提供借鉴。 方法 2022年11月—2023年2月采用便利抽样法选取成都市4个城区共606名老年人作为研究对象,使用一般资料调查表、社会支持量表、城市老年人社区居家医养结合养老服务需求问卷进行问卷调查,对城市老年人社区居家医养结合养老服务的需求现状及影响因素进行分析。 结果 城市老年人社区居家医养结合养老服务需求总分为(158.31±35.03)分,平均分为(3.68±0.81)分,处于较高水平,各维度中心理与精神需求服务得分最高[(3.81±0.85)分]。多元线性回归分析显示,每月可承受的养老服务费用(P=0.001)、社会支持水平(P=0.006)、是否患慢性病(P=0.001)、健康状况(P=0.023)、社区居家医养结合养老服务的认知程度(P=0.035)及参与意愿(P<0.001)是城市老年人服务需求的影响因素。 结论 城市老年人对社区居家医养结合养老服务需求较高,尤其在心理与精神需求服务方面。城市老年人的服务需求受多种因素的影响,建议根据老年人的服务需求特征,构建有区域特色的养老服务体系,精准服务于老年人。 Abstract:Objective To investigate the current situation of the demand for community home medical care with pension services for the elderly in Chengdu, and to explore the influencing factors of the elderly' s choice of elderly care services, in order to provide reference for the construction of a demand-oriented model of home care services. Methods From November 2022 to February 2023, 606 elderly people in four urban areas of Chengdu were selected as the research subject using the convenience sampling method, survey was conducted by general information questionnaire, social support revalued scale, and the questionnaire on the demand for community home medical care with pension services for the urban elderly. The current situation of the demand for and influencing factors of the demand for community home medical care with pension services for the urban elderly were analyzed. Results The total demand for community home medical care with pension services for the urban elderly was scored (158.31±35.03) points, with a mean score of (3.68±0.81) points, which was at a relatively high level, with the highest score for psychological and spiritual needs services among the dimensions [(3.81±0.85) points]. The results of the multiple linear regression analysis showed that the monthly affordable cost of elderly care services (P=0.001), level of social support (P=0.006), presence of chronic diseases (P=0.001), health status (P=0.023), level of awareness of community-home medical care with pension services (P=0.035) and the willingness to participate (P<0.001) were the factors influencing the demand for services. Conclusion The demand for community home medical care with pension services is high among the urban elderly, especially in terms of services for psychological and spiritual needs. The service needs of the urban elderly are affected by a variety of factors. It is proposed to build an elderly service system with regional characteristics based on the characteristics of the service needs of the elderly and to serve them precisely. -
表 1 606例城市老年人社区居家医养结合养老服务需求得分(x±s, 分)
Table 1. Scores of demand for community home medical care combined with pension service needs for 606 urban elderly(x±s, points)
维度 条目数 总分 平均分 医疗/护理服务 9 32.88±7.70 3.71±0.87 生活照料服务 6 21.93±5.45 3.66±0.91 健康教育服务 8 28.98±7.86 3.62±0.98 心理与精神需求服务 6 22.84±5.10 3.81±0.85 社会支持服务 8 29.67±6.95 3.65±0.86 康复服务 6 22.01±6.38 3.67±1.06 社区居家医养结合养老服务 43 158.31±35.03 3.68±0.81 表 2 606例城市老年人社区居家医养结合养老服务需求前5及后5条目
Table 2. Top five and bottom five entries in the demand for community home medical care combined with pension service needs for 606 urban elderly
项目 序号 维度 条目 平均分(x±s, 分) 得分前5 1 心理与精神需求服务 心理健康评估 4.29±1.15 2 医疗/护理服务 健康体检 4.17±1.08 3 生活照料服务 老年供餐 4.16±1.14 4 医疗/护理服务 慢性病随访 4.09±1.14 5 心理与精神需求服务 隐私与尊严维护 4.08±1.09 得分后5 39 健康教育服务 中医养生知识指导 3.51±1.16 40 生活照料服务 24小时服务热线 3.49±1.10 41 健康教育服务 健康教育影像资料 3.49±1.13 42 健康教育服务 防走失指导 3.35±1.06 43 医疗/护理服务 临终关怀 2.75±0.70 表 3 城市老年人社区居家医养结合养老服务需求的单因素分析
Table 3. Univariate analysis of factors influencing the demand for community home medical care combined with pension service needs for the urban elderly
项目 例(%) 社区居家医养结合养老服务需求得分(x±s, 分) 统计量 P值 项目 例(%) 社区居家医养结合养老服务需求得分(x±s, 分) 统计量 P值 性别 0.083a 0.934 主要照顾者 3.069b 0.016 男性 175(28.9) 158.50±34.76 自己 458(75.6) 157.50±36.01 女性 431(71.1) 158.24±35.18 配偶 88(14.4) 166.20±31.13 年龄(岁) 2.490b 0.084 子女 58(9.6) 153.07±30.64 60~<70 248(40.9) 157.20±33.54 其他 2(0.4) 150.00±67.88 70~<80 255(42.1) 156.56±35.99 每月可承受的养老服务费用(元) 2.436b 0.046 ≥80 103(17.0) 165.28±35.03 <1 000 56(9.2) 150.18±34.16 婚姻状况 0.186a 0.852 1 000~<2 000 200(33.0) 160.12±36.81 已婚,有老伴 439(72.4) 158.15±35.10 2 000~<3 000 229(37.8) 156.09±32.59 离异、丧偶、无婚姻经历 167(27.6) 158.74±34.94 3 000~<4 000 106(17.5) 164.36±37.27 文化程度 1.374b 0.242 ≥4 000 15(2.5) 155.87±28.39 文盲、半文盲 160(26.4) 159.41±32.75 健康状况 3.388b 0.018 小学 226(37.3) 154.42±37.24 不好 345(56.9) 162.04±33.95 初中 155(25.6) 160.59±35.23 一般 172(28.4) 151.85±37.23 高中、技校、中专 49(8.1) 162.29±33.63 好 83(13.7) 156.24±33.52 大专及以上 16(2.6) 168.06±22.70 很好 6(1.0) 157.67±30.06 经济来源 2.141b 0.074 是否患慢性病 2.419a 0.016 退休金 113(18.6) 155.83±30.89 否 162(26.7) 152.64±33.25 子女赡养 46(7.6) 147.91±29.45 是 444(73.3) 160.38±35.47 社会福利或救助 21(3.5) 170.24±26.30 社区居家医养结合养老服务的认知程度 3.937b 0.004 社保 366(60.4) 158.49±37.26 完全不了解 253(41.7) 159.61±37.52 其他 60(9.9) 165.68±32.94 基本不了解 174(28.7) 150.75±33.03 月收入(元) 5.716b 0.001 一般 100(16.5) 166.25±34.20 <1 000 80(13.2) 159.98±29.82 比较了解 77(12.8) 159.97±28.90 1 000~<2 000 172(28.4) 149.17±33.17 非常了解 2(0.3) 190.50±27.58 2 000~<3 000 232(38.3) 161.93±38.17 社区居家医养结合养老服务的参与意愿 4.690b 0.010 ≥3 000 122(20.1) 163.22±32.38 愿意 304(50.2) 155.61±32.11 居住情况 3.176b 0.013 不愿意 122(20.1) 155.21±29.88 独自居住 79(13.1) 154.28±37.17 无所谓 180(29.7) 164.97±41.66 与配偶同住 273(45.0) 158.28±35.86 社会支持水平 17.341b <0.001 与子女同住 128(21.1) 154.11±30.79 低水平 346(57.1) 164.91±32.85 与配偶子女同住 126(20.8) 165.17±35.21 中等水平 187(30.9) 152.29±33.56 子女个数(个) 1.360b 0.254 高水平 73(12.0) 142.40±40.87 0 10(1.7) 175.40±39.16 1 220(36.3) 158.00±35.35 2 207(34.1) 155.95±33.10 ≥3 169(27.9) 160.62±36.54 注:a为t值,b为F值。 表 4 自变量赋值情况
Table 4. Names and assignments of independent variables
变量 赋值方法 月收入(元) <1 000=1;1 000~<2 000=2;2 000~<3 000=3;≥3 000=4 居住情况 独自居住=(0,0,0);与配偶同住=(1,0,0);与子女同住=(0,1,0);与配偶子女同住=(0,0,1) 主要照顾者 自己=(1,0,0);配偶=(0,1,0);子女=(0,0,1);其他=(0,0,0) 每月可承受的养老服务费用(元) <1 000=1;1 000~<2 000=2;2 000~<3 000=3;3 000~<4 000=4;≥4 000=5 社会支持水平 低水平=1;中等水平=2;高水平=3 是否患慢性病 是=0;否=1 健康状况 不好=1;一般=2;好=3;很好=4 社区居家医养结合养老服务的认知程度 完全不了解=1;基本不了解=2;一般=3;比较了解=4;非常了解=5 社区居家医养结合养老服务的参与意愿 愿意=(1,0);不愿意=(0,1);无所谓=(0,0) 表 5 城市老年人社区居家医养结合养老服务需求的多元线性回归分析
Table 5. Multivariate linear regression analysis of factors influencing the demand for community home medical care combined with pension service needs for the urban elderly
变量 B SE β t值 P值 每月可承受的养老服务费用 8.002 2.446 0.130 3.271 0.001 社会支持水平 -7.481 2.711 -0.127 -2.759 0.006 是否患慢性病 -12.528 3.828 -0.135 -3.273 0.001 健康状况 -5.633 2.479 -0.104 -2.272 0.023 社区居家医养结合养老服务的认知程度 3.423 1.619 0.088 2.114 0.035 社区居家医养结合养老服务的参与意愿 13.558 2.327 0.230 5.827 <0.001 -
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