医养结合养老机构老年人日常生活活动需求未满足状况及影响因素研究

doi:10.12114/j.issn.1007-9572.2021.00.131

摘要/Abstract

摘要： 背景　随着我国人口老龄化形势日益严峻，老年人数量逐年上升，医养结合型养老机构规模不断扩大，老年人对养老的需求逐渐扩大，需求未得到满足会造成老年人住院率、再入院率、抢救率甚至死亡率的上升。目的　了解医养结合型养老机构老年人日常生活活动需求未满足状况并分析其影响因素。方法　2019年6—12月，采取便利抽样方法，对四川省53所医养结合型养老机构中的1 325例老年人及其主要照顾者进行问卷调查。对机构老年人采用一般资料调查表、功能活动问卷（FAQ）、Barthel指数评定表（BI）、未满足需求评估表（改编自FAQ和BI）进行统计调查；对主要照顾者采取一般资料调查表进行统计调查。通过单变量分析筛选出影响因素，再运用Logistic回归分析确定风险因素。结果　共调查机构失能老人1 325例，照顾者442例，1 290例（97.36%）失能老年人至少有一项日常生活活动需求未得到满足，其中有5项未满足率超过50%，从低到高依次是平地行走、出行、修饰、娱乐、社交。多因素Logistic 回归分析结果显示：机构失能老年人失能时长越长、FAQ得分越高及其主要照顾者的年龄越大，失能老年人的需求未满足率越高；失能老年人的文化程度和月收入水平越高及其主要照顾者的月收入水平越高，失能老年人的需求未满足率越低（P<0.05）。结论　四川省医养结合型养老机构失能老人的需求未满足情况较严重且受多种因素影响。应提升机构的科学管理水平并重视人文关怀，不断改善失能老年人的需求未满足情况，照顾者也应不断提升自我素养以确保更优的照护，同时政府也应给予更多的财政帮助、鼓励社会捐赠及更加深刻地探讨有关护理的保险制度。

关键词: 医养结合, 日常生活活动, 失能老人, 未满足需求, 养老机构

Abstract: Background　 In China，rapid aging has brought severe challenges. The increasing elderly care needs of growing older people may not be met although the number of medical and nursing care institutions is increasing. And their unmet health needs may lead to increased rates of hospitalization，readmission，rescue and even mortality. Objective　To explore the unmet needs of activities of daily living and influencing factors in older adults from medical and nursing care institutions. Methods　 From June to December in 2019，Participants for a survey were selected from 53 medical and nursing care institutions，Sichuan Province，by use of convenience sampling，including older adults surveyed using a self-developed demographic information questionnaire（for older adults），the Functional Activities Questionnaire（FAQ），the Barthel Index（BI），and the Unmet Needs Assessment Scale（developed by us in accordance with the contents of FAQ and BI），and their major caregivers surveyed using a self-developed demographic information questionnaire（for older adults' caregivers）. Factors associated with older adults' unmet needs were screened using univariate analysis，and were determined using logistic regression analysis. Results　A total of 1 325 older adults with disabilities and 442 caregivers were finally included. In the older adults，the prevalence of having at least one unmet need was 97.36%；the prevalence of having 5 unmet needs was 50%，and the most needed was walking on flat ground，followed by traveling，dressing up，engaging in daily recreational activities，and socializing. Logistic regression analysis revealed that the possibility of having unmet needs of these older adults increased with the prolongation of disability and increase of FAQ score，and age of the caregiver，but decreased with their increased level of education and monthly income，as well as increased monthly income of the caregiver（P<0.05）. Conclusion　 In medical and nursing care institutions in Sichuan Province，the rate of having unmet needs of activities of daily living in older adults with disabilities was high and affected by many factors. To satisfy the needs of these people，it is suggested to improve the scientific management of the institutions，with special attention given to humanistic care，enhance the care level of caregivers via improving their comprehensive qualities，increase the financial aid from the government，encourage social donation and in-depth research on elderly care insurance system.

Key words: Combination of medical and nursing care, Activities of daily life, Disabled elderly, Unmet demand, Pension institutions

王彬丁,刘刚,郑新烈,等. 医养结合养老机构老年人日常生活活动需求未满足状况及影响因素研究[J]. 中国全科医学, 2021, 24(19): 2465-2471. DOI: 10.12114/j.issn.1007-9572.2021.00.131.
WANG Binding,LIU Gang,ZHENG Xinlie, et al. Unmet Needs of Activities of Daily Living and Influencing Factors in the Elderly：a Survey from Medical and Nursing Care Institutions　[J]. Chinese General Practice, 2021, 24(19): 2465-2471. DOI: 10.12114/j.issn.1007-9572.2021.00.131.

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