With the increasing of older adults with disability, it is urgent to understand the disability status of older adults in different settings and to improve the long-term care service model from professional institutions to communities and families.

To investigate the disability status of older adults in different settings (hospitals, nursing facilities, and communities) , compare and analyze the differences in the disability status of the elderly in different settings.

The multi-stage sampling method was used in this study from January 2022 to January 2023. At the first stage, one or two provinces were conveniently selected in East China, South China, Central China, North China, and Southwest China; at the second stage, 3 tertiary hospitals, 2 secondary hospitals, 2 community health centers, and 1 nursing facility were conveniently selected as the study sites in each province. Older adults in 27 tertiary hospitals, 18 secondary hospitals, 18 community health service centers, and 9 nursing facilities in 9 provinces and cities (Beijing, Hunan, Jiangsu, Guangdong, Fujian, Xinjiang Uygur Autonomous Region, Guizhou, Hainan, and Sichuan) were finally included as study subjects. Barthel Index (BI) was used to evaluate basic activity of daily living (BADL) . Lawton-Brody Instrumental Activity of Daily Living scale was used to evaluate instrumental activity of daily living (IADL) . The Logistic regression analysis was used to explore the association of settings with BADL disability degree, IADL disability degree and functional disability in different aspects for older adults.

A total of 27 344 questionnaires were collected and 23 922 were valid, with a valid recovery rate of 87.5%. There were 10 318 cases (43.1%) disabled in BADL, and the top three disabled BADL functions were bed-chair transfers, ascend and descend stairs, mobility on level surfaces. The incidence of BADL disability in various places was 29.0% in communities, 74.9% in elderly care institutions, 54.0% in secondary hospitals, and 44.6% in tertiary hospitals. Besides, 19 200 (80.3%) cases were disabled in IADL and the top three disabled IADL functions were mode of transportation, housekeeping and shopping. The incidence of IADL disability in various places was 74.6% in communities, 96.4% in elderly care institutions, 83.6% in secondary hospitals, and 81.1% in tertiary hospitals. Different settings were the influencing factor for the disability degree and functional disability types (P<0.05) .

The status of disability of older adults in nursing institutions is most dismal, which were recommended to develop professional disability care services and improve the service capacity of practitioners.

随着失能老年人数逐年增多，亟须了解不同场所老年人失能状况，完善从专业机构到社区、家庭的失能长期照护服务模式。

调查我国不同场所（医院、养老机构、社区）老年人的失能现状，并对比分析不同场所老年人失能状况的差异。

本研究采用多阶段抽样的方法，于2022年1月—2023年1月在我国华东、华南、华中、华北、西南地区分别便利选取1~2个省市，每个省市分别便利选取3所三级医院、2所二级医院、2个社区卫生服务中心和1个养老机构作为研究场所。最终纳入9个省市（北京市、湖南省、江苏省、广东省、福建省、新疆维吾尔自治区、贵州省、海南省、四川省）的27所三级医院、18所二级医院、18个社区卫生服务中心和9个养老机构的老年人作为研究对象。采用巴氏指数（BI）量表评价基础性日常生活活动能力（BADL）、Lawton-Brody工具性日常生活活动能力量表评定工具性日常生活活动能力（IADL）。采用Logistic回归分析探讨来源场所与BADL失能程度、IADL失能程度以及不同方面功能失能发生状况的关系。

本研究共回收问卷27 344份，有效问卷23 922份，有效回收率为87.5%。10 318例（43.1%）老年人存在BADL失能，排在前三位的失能功能分别为床椅转移、上下楼梯与平地行走。各个场所BADL失能发生率为社区29.0%、养老机构74.9%、二级医院54.0%、三级医院44.6%。19 200例（80.3%）存在IADL失能，排在前三位的失能功能分别为交通工具、家务维持、上街购物。各个场所IADL失能发生率分别为：社区74.6%、养老机构96.4%、二级医院83.6%、三级医院81.1%。不同场所是老年人失能程度和各类功能失能的影响因素（P<0.05）。

养老机构老年人失能状况最不容乐观，建议鼓励更多养老机构开展专业失能护理服务，提升从业人员服务能力。