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目的 了解北京市失能老年人长期护理需求及影响其选择偏好的关键因素.方法 基于横断面研究,采用分层整群抽样方法,以1549名失能老人为研究对象,其中男性671名,女性878名,平均年龄70.64岁.了解其人口学、失能状况、长期护理选择模式等信息,采用χ2检验和多分类Logistic回归进行分析.结果 选择居家长期护理的比例较高,有1169名(75.5%);选择社区日间护理的较少,仅有12名(0.8%).单因素分析发现,影响老年人选择长期护理模式的因素有性别、年龄、文化程度、居住情况、婚姻状况、月收入、医疗保险与养老保险参与情况、慢性病患病情况、视力、听力、味觉、触觉及健康情况自我评价(χ2=35.19、195.58、295.21、245.88、10.89、30.33、230.62、277.87、77.09、51.07、131.03、124.50、23.18、37.51,P均<0.05).多因素分析发现影响多数老年人选择居家护理的主要因素是文化程度、已婚有配偶、医疗保险与养老保险的参与情况、健康状况的自我评价,其OR值(95%CI)分别为:0.69(0.54~0.89)、51.61(21.55~123.59)、0.29(0.09~0.94)、0.40(0.22~0.73)、0.63 (0.45~0.88).结论 尊重老年人人性化、多元化的服务需求是长期护理事业健康发展的必然,建议建立长期护理保险机制并加强社区基础护理设施建设,进一步完善以家庭为基础、社区为依托、机构为补充的长期护理服务体系.

Objective To analyze the choice preferences and factors influencing the long-term care (LTC)of disabled elderly in Beijing and to provide a reference for the development of aging service industry based on the present supply situations. Methods This cross-sectional study included the sociodemographic and disability information and the need for LTC.Statistical analysis was performed using the chi-square test and multivariate logistic regression analysis. Results About 75.5% (1 169) of respondents preferred household-based LTC,whereas only 0.8%(12)preferred community-based LTC.In a single factor analysis,gender,age,educational level,living conditions,marital status,income,medical and pension insurances,chronic diseases,vision,hearing,sense of taste and touch,and self-evaluation of health had statistically significant difference (χ2= 35.19, 195.58, 295.21, 245.88, 10.89, 30.33, 230.62, 277.87, 77.09, 51.07, 131.03, 124.50, 23.18, and 37.51,respectively, P<0.05). Multivariate analysis showed that educational level, marital status, medical and pension insurances, self-evaluation of health were correlated with household-based LTC,(odds ratio and 95%confidence interval,0.69(0.54-0.89),51.61(21.55-123.59), 0.29(0.09-0.94),0.40(0.22-0.73),and 0.63(0.45-0.88),respectively).Conclusions The services in the old-age caring industry have become inevitably diverse, and many factors affect the choice of LTC. Therefore,LTC insurance and community-based care should be established to meet the needs of the elderly.