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Article(id=1240738485619970615, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410482, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729872000000, receivedDateStr=2024-10-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773744706778, onlineDateStr=2026-03-17, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773744706778, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773744706778, creator=13701087609, updateTime=1773744706778, updator=13701087609, issue=Issue{id=1240738480549065614, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773744705569, creator=13701087609, updateTime=1773744787657, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240738824918192654, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240738824922386959, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1617, endPage=1622, ext={EN=ArticleExt(id=1240738487008285351, articleId=1240738485619970615, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of care service needs and influencing factors for disabled elderly in Weifang city based on the Anderson model, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the care service needs of disabled elderly individuals in Weifang city and analyze the influencing factors on the willingness to utilize care services among elderly individuals with varying degrees of disability, aiming to provide better care services for this population.

Methods

A care service needs questionnaire was developed based on the Anderson model as a theoretical framework. A convenience sampling method was employed to select 1 322 disabled elderly individuals in Weifang city, and a questionnaire survey was conducted to assess their care service needs. Logistic regression models were utilized to analyze the influencing factors affecting the care service needs of elderly individuals with mild, moderate, and severe disabilities.

Results

Among the disabled elderly in Weifang city, those with mild and moderate disabilities had the highest demand for general care services (59.2%), while those with severe disabilities had the highest demand for medical care services (45.0%). Comprehensive analysis using three models revealed that factors such as “gender” (OR=0.778, 95%CI: 0.604-0.961), “educational level” (OR=0.598, 95%CI:0.511-0.701), “economic status” (OR=0.789, 95%CI: 0.640-0.961), “source of income” (OR=1.251, 95%CI: 1.084-1.444), “type of health insurance” (OR=1.870, 95%CI: 1.291-2.710), “number of chronic disease medications” (OR=0.767, 95%CI: 0.692-0.852),and “hearing status” (OR=0.833, 95%CI: 0.699-0.994) were significant factors influencing the care service needs of disabled elderly individuals.

Conclusion

Elderly individuals with varying degrees of disability have different demands for care service items, and these needs are influenced by factors such as gender, educational level, economic status, source of income, type of health insurance, number of chronic disease medications, and hearing status. Government, market, and societal sectors should play an active role in meeting the care service needs of disabled elderly individuals, aiming to ensure that high-quality care services genuinely benefit this population.

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目的

调查潍坊市失能老年人的照护需求情况并分析不同程度失能老年人照护服务需求意愿的影响因素，以期为失能老年人群提供更好的照护服务。

方法

以安德森模型为理论框架编制照护服务需求问卷。采用便利抽样方法抽取潍坊市1 322名失能老年人，通过问卷调查了解照护服务的需求。利用logistic回归模型，分析轻度、中度、重度失能老年人对照护服务需求情况的影响因素。

结果

潍坊市失能老年人中，轻度及中度失能老年人对于一般照护服务的需求最高（59.2%），而重度失能老年人对于医疗照护服务的需求最高（45.0%）。综合三个模型分析发现，性别(OR=0.778，95%CI：0.604～0.961)、文化程度(OR=0.598，95%CI：0.511～0.701)、经济状况（OR=0.789，95%CI：0.64～0.961)、经济来源（OR=1.251，95%CI：1.084～1.444)、医保类别（OR=1.870，95%CI：1.291～2.710)、慢性病用药数量(OR=0.767，95%CI：0.692～0.852)和听力情况(OR=0.833，95%CI：0.699～0.994)是影响失能老年人照护服务需求的因素。

结论

不同程度的失能老人对于照护服务项目需求不同，照护服务需求受性别、文化程度、经济状况、经济来源、医保类别、慢性病用药数量和听力情况等因素的影响。政府、市场及社会各方面在满足失能老年人群照护服务需求方面应发挥积极作用，旨在让优质照护服务真正惠及失能老年人群。

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郝晓宁，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=rvjoWLGcZOdpqSIt7XkVKw==, magXml=kSI9Yo4LNiVbZwXq37F/Ag==, pdfUrl=null, pdf=FNdFdiHx6cNka0tAeg3Nng==, pdfFileSize=663843, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=vuAD+bf5ZC2tjDRWZAJFPw==, mapNumber=null, authorCompany=null, fund=null, authors=

盛晨（2000—），女，硕士在读，研究方向：卫生管理与政策研究

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盛晨（2000—），女，硕士在读，研究方向：卫生管理与政策研究

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盛晨（2000—），女，硕士在读，研究方向：卫生管理与政策研究

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Variable characteristics of influencing factors for care service demand among the elderly with different disability levels［n=1 322，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别失能程度总计
轻度失能中度失能重度失能
是否需要照护服务是108(26.21)76(50.00)415(54.75)599(45.31)
否304(73.79)76(50.00)343(45.25)723(54.69)
性别男198(48.06)71(46.71)368(48.55)637(48.18)
女214(51.94)81(53.29)390(51.45)685(51.82)
年龄（岁）60～6975(18.20)33(21.71)176(23.22)284(21.48)
70～79188(45.63)75(49.34)279(36.81)542(41.00)
≥80149(36.17)44(28.95)303(39.97)496(37.52)
文化程度小学及以下269(65.29)103(67.76)412(54.35)784(59.30)
初中及以上143(34.71)49(32.24)346(45.65)538(40.70)
婚姻状况有配偶306(74.27)108(71.05)574(75.73)988(74.74)
无配偶106(25.73)44(28.95)184(24.27)334(25.26)
经济状况有结余113(27.43)44(28.95)233(30.74)390(29.50)
收支平衡99(24.03)37(24.34)218(28.76)354(26.78)
较欠缺200(48.54)71(46.71)307(40.50)578(43.72)
经济来源自己劳动所得174(42.23)55(36.18)403(53.17)632(47.81)
其他238(57.77)97(63.82)355(46.83)690(52.19)
医保类别无医保19(4.61)12(7.89)66(8.71)97(7.34)
居民基本医疗保险308(74.76)109(71.71)429(56.60)846(63.99)
城镇职工医保92(22.33)34(22.37)279(36.81)405(30.64)
其他保险9(0.24)3(0.66)50(0.13)62(0.23)
与谁居住独自居住81(19.66)21(13.82)84(11.08)186(14.07)
非独自居住331(80.34)131(86.18)674(88.92)1 136(85.93)
子女数量（个）011(2.67)5(3.29)12(1.58)28(2.12)
135(8.50)17(11.18)118(15.57)170(12.86)
≥2366(88.83)130(85.53)628(82.85)1 124(85.02)
是否患有慢病是326(79.13)127(83.55)598(78.89)1 051(79.50)
否86(20.87)25(16.45)160(21.11)271(20.50)
慢性病用药数量（种）无73(17.72)7(4.61)136(17.94)216(16.34)
1～2134(32.52)54(35.53)230(30.34)418(31.62)
≥3205(49.76)91(59.87)392(51.72)688(52.04)
近两周是否出现不适否167(40.53)87(57.24)327(43.14)581(43.95)
是245(59.47)65(42.76)431(56.86)741(56.05)
视力情况正常105(25.49)44(28.95)203(26.78)352(26.63)
视力有障碍306(74.27)108(71.05)546(72.03)960(72.62)
失明1(0.24)0(0.00)9(1.19)10(0.76)
听力情况正常126(30.58)50(32.89)225(29.68)401(30.33)
听力有障碍286(69.42)99(65.13)524(69.13)909(68.76)
失聪0(0.00)3(1.97)9(1.19)12(0.91)
意识情况意识清楚396(96.12)138(90.79)557(73.48)1 091(82.53)
意识较为模糊16(3.88)14(9.21)185(24.41)215(16.26)
昏迷0(0.00)0(0.00)16(2.11)16(1.21)
), ArticleFig(id=1241081873649168506, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=CN, label=表1, caption=

各失能程度老年人照护服务需求影响因素的变量特征［n=1 322，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别失能程度总计
轻度失能中度失能重度失能
是否需要照护服务是108(26.21)76(50.00)415(54.75)599(45.31)
否304(73.79)76(50.00)343(45.25)723(54.69)
性别男198(48.06)71(46.71)368(48.55)637(48.18)
女214(51.94)81(53.29)390(51.45)685(51.82)
年龄（岁）60～6975(18.20)33(21.71)176(23.22)284(21.48)
70～79188(45.63)75(49.34)279(36.81)542(41.00)
≥80149(36.17)44(28.95)303(39.97)496(37.52)
文化程度小学及以下269(65.29)103(67.76)412(54.35)784(59.30)
初中及以上143(34.71)49(32.24)346(45.65)538(40.70)
婚姻状况有配偶306(74.27)108(71.05)574(75.73)988(74.74)
无配偶106(25.73)44(28.95)184(24.27)334(25.26)
经济状况有结余113(27.43)44(28.95)233(30.74)390(29.50)
收支平衡99(24.03)37(24.34)218(28.76)354(26.78)
较欠缺200(48.54)71(46.71)307(40.50)578(43.72)
经济来源自己劳动所得174(42.23)55(36.18)403(53.17)632(47.81)
其他238(57.77)97(63.82)355(46.83)690(52.19)
医保类别无医保19(4.61)12(7.89)66(8.71)97(7.34)
居民基本医疗保险308(74.76)109(71.71)429(56.60)846(63.99)
城镇职工医保92(22.33)34(22.37)279(36.81)405(30.64)
其他保险9(0.24)3(0.66)50(0.13)62(0.23)
与谁居住独自居住81(19.66)21(13.82)84(11.08)186(14.07)
非独自居住331(80.34)131(86.18)674(88.92)1 136(85.93)
子女数量（个）011(2.67)5(3.29)12(1.58)28(2.12)
135(8.50)17(11.18)118(15.57)170(12.86)
≥2366(88.83)130(85.53)628(82.85)1 124(85.02)
是否患有慢病是326(79.13)127(83.55)598(78.89)1 051(79.50)
否86(20.87)25(16.45)160(21.11)271(20.50)
慢性病用药数量（种）无73(17.72)7(4.61)136(17.94)216(16.34)
1～2134(32.52)54(35.53)230(30.34)418(31.62)
≥3205(49.76)91(59.87)392(51.72)688(52.04)
近两周是否出现不适否167(40.53)87(57.24)327(43.14)581(43.95)
是245(59.47)65(42.76)431(56.86)741(56.05)
视力情况正常105(25.49)44(28.95)203(26.78)352(26.63)
视力有障碍306(74.27)108(71.05)546(72.03)960(72.62)
失明1(0.24)0(0.00)9(1.19)10(0.76)
听力情况正常126(30.58)50(32.89)225(29.68)401(30.33)
听力有障碍286(69.42)99(65.13)524(69.13)909(68.76)
失聪0(0.00)3(1.97)9(1.19)12(0.91)
意识情况意识清楚396(96.12)138(90.79)557(73.48)1 091(82.53)
意识较为模糊16(3.88)14(9.21)185(24.41)215(16.26)
昏迷0(0.00)0(0.00)16(2.11)16(1.21)
), ArticleFig(id=1241081873816940682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=EN, label=Table 2, caption=

The demand for nursing services among disabled elderly in Weifang city ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目各条目需求人数轻度及中度失能老年人需求人数重度失能老年人需求人数
生活起居服务卫生清洁580（19.45）159（27.41）421（72.59）
饮食照料617（20.69）162（26.26）455（73.74）
如厕需要495（16.60）100（20.20）395（79.80）
生活陪伴519（17.40）148（28.52）371（71.48）
代购物品338（11.33）99（29.29）239（70.71）
夜间照护433（14.52）102（23.56）331（76.44）
医疗照护服务上门诊疗239（12.88）51（21.34）188（78.66）
照护服务355（19.14)68（19.15）287（80.85）
送药、用药指导338（18.22）93（27.51）245（72.49）
健康宣教305（16.44）93（30.49）212（69.51）
上门输液112（6.04）26（23.21）86（76.79）
康复理疗203（10.94）51（25.12）152（74.88）
就诊转运105（5.66）20（19.05）85（80.95）
健康评估198（10.67）53（26.77）145（73.23）
精神慰藉服务休闲娱乐68（11.09）21（30.88）47（69.12）
情感交流168（27.41）52（30.95）116（69.05）
情感疏导135（22.02）22（16.30）113（83.70）
关怀访视144（23.49）41（28.47）103（71.53）
心理咨询98（15.99）22（22.45）76（77.55）
), ArticleFig(id=1241081873955352721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=CN, label=表2, caption=

潍坊市失能老年人对照护服务的需求情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
维度条目各条目需求人数轻度及中度失能老年人需求人数重度失能老年人需求人数
生活起居服务卫生清洁580（19.45）159（27.41）421（72.59）
饮食照料617（20.69）162（26.26）455（73.74）
如厕需要495（16.60）100（20.20）395（79.80）
生活陪伴519（17.40）148（28.52）371（71.48）
代购物品338（11.33）99（29.29）239（70.71）
夜间照护433（14.52）102（23.56）331（76.44）
医疗照护服务上门诊疗239（12.88）51（21.34）188（78.66）
照护服务355（19.14)68（19.15）287（80.85）
送药、用药指导338（18.22）93（27.51）245（72.49）
健康宣教305（16.44）93（30.49）212（69.51）
上门输液112（6.04）26（23.21）86（76.79）
康复理疗203（10.94）51（25.12）152（74.88）
就诊转运105（5.66）20（19.05）85（80.95）
健康评估198（10.67）53（26.77）145（73.23）
精神慰藉服务休闲娱乐68（11.09）21（30.88）47（69.12）
情感交流168（27.41）52（30.95）116（69.05）
情感疏导135（22.02）22（16.30）113（83.70）
关怀访视144（23.49）41（28.47）103（71.53）
心理咨询98（15.99）22（22.45）76（77.55）
), ArticleFig(id=1241081874097959068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=EN, label=Table 3, caption=

Logistic regression model fitting results

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
特征因素
性别0.761（0.604～0.961）0.0220.778（0.574～1.054）0.1050.754（0.551～1.030）0.076
年龄0.932（0.800～1.086）0.3651.001（0.817～1.227）0.9900.969（0.782～1.200）0.770
文化程度0.598（0.511～0.701）0.0001.065（0.853～1.329）0.5791.106（0.882～1.386）0.384
婚姻状况1.034（0.791～1.350）0.8081.342（0.931～1.936）0.1151.323（0.911～1.922）0.141
使能因素
经济状况0.789（0.648～0.961）0.0180.835（0.682～1.021）0.079
经济来源1.251（1.084～1.444）0.0021.211（1.048～1.401）0.010
医保类别1.870（1.291～2.710）0.0011.717（1.179～2.501）0.005
与谁居住1.009（0.711～1.432）0.9581.092（0.761～1.566）0.633
子女数量15.006（10.578～21.287）0.0001.030（0.722～1.471）0.869
需要因素
是否患有慢病0.964（0.632～1.470）0.864
慢性病用药数量0.767（0.692～0.852）0.000
近两周是否不适1.074（0.885～1.304）0.468
视力情况0.931（0.782～1.109）0.424
听力情况0.833（0.699～0.994）0.042
意识情况0.798（0.617～1.032）0.086
χ2值12.45315.4585.658
P值0.1320.0510.685
), ArticleFig(id=1241081874223788197, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=CN, label=表3, caption=

Logistic回归模型拟合结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
特征因素
性别0.761（0.604～0.961）0.0220.778（0.574～1.054）0.1050.754（0.551～1.030）0.076
年龄0.932（0.800～1.086）0.3651.001（0.817～1.227）0.9900.969（0.782～1.200）0.770
文化程度0.598（0.511～0.701）0.0001.065（0.853～1.329）0.5791.106（0.882～1.386）0.384
婚姻状况1.034（0.791～1.350）0.8081.342（0.931～1.936）0.1151.323（0.911～1.922）0.141
使能因素
经济状况0.789（0.648～0.961）0.0180.835（0.682～1.021）0.079
经济来源1.251（1.084～1.444）0.0021.211（1.048～1.401）0.010
医保类别1.870（1.291～2.710）0.0011.717（1.179～2.501）0.005
与谁居住1.009（0.711～1.432）0.9581.092（0.761～1.566）0.633
子女数量15.006（10.578～21.287）0.0001.030（0.722～1.471）0.869
需要因素
是否患有慢病0.964（0.632～1.470）0.864
慢性病用药数量0.767（0.692～0.852）0.000
近两周是否不适1.074（0.885～1.304）0.468
视力情况0.931（0.782～1.109）0.424
听力情况0.833（0.699～0.994）0.042
意识情况0.798（0.617～1.032）0.086
χ2值12.45315.4585.658
P值0.1320.0510.685
), ArticleFig(id=1241081874345423023, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=EN, label=Table 4, caption=

Logistic regression model fitting results

, figureFileSmall=null, figureFileBig=null, tableContent=
变量重度失能群体模型3结果轻度及中度失能群体模型3结果
OR值（95%CI）P值OR值（95%CI）P值
特征因素
性别0.740（0.512～1.070）0.1100.898（0.581～1.386）0.627
年龄0.802（0.625～1.027）0.0811.104（0.808～1.507）0.535
文化程度0.731（0.494～1.081）0.1171.168（0.714～1.911）0.535
婚姻状况1.013（0.628～1.636）0.9571.854（1.053～3.266）0.033
使能因素
经济状况0.874（0.694～1.101）0.2540.932（0.704～1.234）0.623
经济来源1.320（1.152～1.513）0.0000.961（0.817～1.131）0.634
医保类别0.644（0.594～0.698）0.00026.955（11.624～62.510）0.000
与谁居住1.593（0.861～2.948）0.1381.278（0.693～2.354）0.432
子女数量1.165（0.767～1.771）0.4730.960（0.579～1.591）0.874
需要因素
是否患有慢病1.370（0.840～2.237）0.2070.759（0.403～1.432）0.395
慢性病用药数量0.690（0.586～0.814）0.0000.631（0.510～0.782）0.000
近两周是否出现不适0.922（0.649～1.309）0.6491.108（0.735～1.671）0.624
视力情况0.947（0.635～1.415）0.7920.901（0.504～1.609）0.724
听力情况1.171（0.805～1.702）0.4101.294（0.763～2.195）0.339
意识情况0.837（0.585～1.196）0.3270.765（0.326～1.800）0.540
χ2值6.0777.043
P值0.6390.532
), ArticleFig(id=1241081874467057846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738485619970615, language=CN, label=表4, caption=

Logistic回归模型拟合结果

, figureFileSmall=null, figureFileBig=null, tableContent=
变量重度失能群体模型3结果轻度及中度失能群体模型3结果
OR值（95%CI）P值OR值（95%CI）P值
特征因素
性别0.740（0.512～1.070）0.1100.898（0.581～1.386）0.627
年龄0.802（0.625～1.027）0.0811.104（0.808～1.507）0.535
文化程度0.731（0.494～1.081）0.1171.168（0.714～1.911）0.535
婚姻状况1.013（0.628～1.636）0.9571.854（1.053～3.266）0.033
使能因素
经济状况0.874（0.694～1.101）0.2540.932（0.704～1.234）0.623
经济来源1.320（1.152～1.513）0.0000.961（0.817～1.131）0.634
医保类别0.644（0.594～0.698）0.00026.955（11.624～62.510）0.000
与谁居住1.593（0.861～2.948）0.1381.278（0.693～2.354）0.432
子女数量1.165（0.767～1.771）0.4730.960（0.579～1.591）0.874
需要因素
是否患有慢病1.370（0.840～2.237）0.2070.759（0.403～1.432）0.395
慢性病用药数量0.690（0.586～0.814）0.0000.631（0.510～0.782）0.000
近两周是否出现不适0.922（0.649～1.309）0.6491.108（0.735～1.671）0.624
视力情况0.947（0.635～1.415）0.7920.901（0.504～1.609）0.724
听力情况1.171（0.805～1.702）0.4101.294（0.763～2.195）0.339
意识情况0.837（0.585～1.196）0.3270.765（0.326～1.800）0.540
χ2值6.0777.043
P值0.6390.532
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基于安德森模型的潍坊市失能老年人照护服务需求及影响因素分析
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盛晨 1 , 郝晓宁 1, 2 , 丰志强 2 , 宋春燕 3
现代预防医学 | 基层卫生服务 2025,52(9): 1617-1622
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现代预防医学 | 基层卫生服务 2025, 52(9): 1617-1622
基于安德森模型的潍坊市失能老年人照护服务需求及影响因素分析
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盛晨1, 郝晓宁1, 2 , 丰志强2, 宋春燕3
作者信息
  • 1.山东第二医科大学管理学院，山东 潍坊 261053
  • 2.国家卫生健康委卫生发展研究中心，北京 100044
  • 3.山东第二医科大学公共卫生学院

    • 盛晨（2000—），女，硕士在读，研究方向：卫生管理与政策研究

通讯作者:

郝晓宁，E-mail:
Analysis of care service needs and influencing factors for disabled elderly in Weifang city based on the Anderson model
Chen SHENG1, Xiao-ning HAO1, 2 , Zhi-qiang FENG2, Chun-yan SONG3
Affiliations
  • School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-05-10 doi: 10.20043/j.cnki.MPM.202410482
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摘要
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目的

调查潍坊市失能老年人的照护需求情况并分析不同程度失能老年人照护服务需求意愿的影响因素，以期为失能老年人群提供更好的照护服务。

方法

以安德森模型为理论框架编制照护服务需求问卷。采用便利抽样方法抽取潍坊市1 322名失能老年人，通过问卷调查了解照护服务的需求。利用logistic回归模型，分析轻度、中度、重度失能老年人对照护服务需求情况的影响因素。

结果

潍坊市失能老年人中，轻度及中度失能老年人对于一般照护服务的需求最高（59.2%），而重度失能老年人对于医疗照护服务的需求最高（45.0%）。综合三个模型分析发现，性别(OR=0.778，95%CI：0.604～0.961)、文化程度(OR=0.598，95%CI：0.511～0.701)、经济状况（OR=0.789，95%CI：0.64～0.961)、经济来源（OR=1.251，95%CI：1.084～1.444)、医保类别（OR=1.870，95%CI：1.291～2.710)、慢性病用药数量(OR=0.767，95%CI：0.692～0.852)和听力情况(OR=0.833，95%CI：0.699～0.994)是影响失能老年人照护服务需求的因素。

结论

不同程度的失能老人对于照护服务项目需求不同，照护服务需求受性别、文化程度、经济状况、经济来源、医保类别、慢性病用药数量和听力情况等因素的影响。政府、市场及社会各方面在满足失能老年人群照护服务需求方面应发挥积极作用，旨在让优质照护服务真正惠及失能老年人群。

失能老年人  /  照护服务需求  /  安德森模型  /  影响因素
Objective

To investigate the care service needs of disabled elderly individuals in Weifang city and analyze the influencing factors on the willingness to utilize care services among elderly individuals with varying degrees of disability, aiming to provide better care services for this population.

Methods

A care service needs questionnaire was developed based on the Anderson model as a theoretical framework. A convenience sampling method was employed to select 1 322 disabled elderly individuals in Weifang city, and a questionnaire survey was conducted to assess their care service needs. Logistic regression models were utilized to analyze the influencing factors affecting the care service needs of elderly individuals with mild, moderate, and severe disabilities.

Results

Among the disabled elderly in Weifang city, those with mild and moderate disabilities had the highest demand for general care services (59.2%), while those with severe disabilities had the highest demand for medical care services (45.0%). Comprehensive analysis using three models revealed that factors such as “gender” (OR=0.778, 95%CI: 0.604-0.961), “educational level” (OR=0.598, 95%CI:0.511-0.701), “economic status” (OR=0.789, 95%CI: 0.640-0.961), “source of income” (OR=1.251, 95%CI: 1.084-1.444), “type of health insurance” (OR=1.870, 95%CI: 1.291-2.710), “number of chronic disease medications” (OR=0.767, 95%CI: 0.692-0.852),and “hearing status” (OR=0.833, 95%CI: 0.699-0.994) were significant factors influencing the care service needs of disabled elderly individuals.

Conclusion

Elderly individuals with varying degrees of disability have different demands for care service items, and these needs are influenced by factors such as gender, educational level, economic status, source of income, type of health insurance, number of chronic disease medications, and hearing status. Government, market, and societal sectors should play an active role in meeting the care service needs of disabled elderly individuals, aiming to ensure that high-quality care services genuinely benefit this population.

Disabled elderly  /  Care service needs  /  Anderson model  /  Influencing factors
盛晨, 郝晓宁, 丰志强, 宋春燕. 基于安德森模型的潍坊市失能老年人照护服务需求及影响因素分析. 现代预防医学, 2025 , 52 (9) : 1617 -1622 . DOI: 10.20043/j.cnki.MPM.202410482
Chen SHENG, Xiao-ning HAO, Zhi-qiang FENG, Chun-yan SONG. Analysis of care service needs and influencing factors for disabled elderly in Weifang city based on the Anderson model[J]. Modern Preventive Medicine, 2025 , 52 (9) : 1617 -1622 . DOI: 10.20043/j.cnki.MPM.202410482
正文
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随着我国老龄人口的不断增加，我国已经逐渐进入“老龄化”社会，我国的人口老龄化进程进入新的加速阶段[1]。随之而来的老年人失能问题也逐渐突显，失能、半失能老年人数量逐渐攀升[2]，预测显示，到2030年，我国将有7 611万名失能和半失能的老年人，2050年将增长至1.2亿[3]。庞大的失能老年群体给我国长期照护服务体系建设带来了严峻的挑战[4]，面对这一挑战，我国失能老年人照护服务体系的建设与完善显得尤为重要。明确照护需求的影响因素是相关涉老部门制定合理长期照护政策的关键依据之一，有助于政府端进行合理的规划，提供更有针对性的照护服务。目前对于失能老年人照护服务需求的研究多集中于需求预测[5]、需求现状[6]及评估指标[7]等方面，缺乏理论模型指导和对不同程度失能老年人照护服务的具体需求分析。基于此，本研究以安德森模型作为理论框架[8-9]，将其应用于潍坊市失能老年人的照护服务需求分析，实现了模型的本土化应用，继而区分了轻度、中度和重度失能老年人，分别分析了不同失能程度老年人对一般照护服务、医疗照护服务和预防保健服务的需求，为提供差异化的照护服务提供了依据。本研究结果不仅停留在理论分析层面，还提出了针对性的政策建议和实践指导，以期为失能老年人提供更加精准和高效的照护服务方案，从而提升他们的生活质量。
1　资料与方法
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1.1　数据来源
本研究聚焦潍坊市失能老年人群体，即根据调查问卷所测量的日常生活自理能力(ADL)6项指标(洗澡、穿衣、吃饭、控制大小便、上厕所和室内活动)进行筛选[10]。根据国际通行法则，所有活动均可独立完成的视为未失能老人，有一项及以上需要他人帮助的则为失能老人，失能程度可划分为：（1）轻度失能：有1～2项需要帮助；（2）中度失能：有3～4项需要帮助；（3）重度失能：有5～6项需要帮助[11]。
本研究使用课题组自制的老年人照护服务需求调查问卷，采用便利抽样法，于2023年11月抽取潍坊市养老机构及医养结合机构中的1 322例研究对象作为本次调查对象。纳入标准：（1）年龄在60岁及以上，且满足失能评估标准；（2）目前居住于潍坊市；（3）愿意参加本次调查；（4）意识清晰，可以明确回答问题，或有可代为回答的照顾者在旁。排除标准：（1）中途退出调查者；（2）拒绝参与本项调查者；（3）患有精神疾病或存在认知功能障碍者。本研究符合赫尔辛基宣言的伦理准则，调查对象均知情同意，自愿参加本研究，并签署知情同意书。
1.2　变量选择
被解释变量：失能老年人照护服务需求，根据项目分属的主题确定三个问卷维度，包括一般照护服务、基本医疗服务和预防保健服务；其中一般照护服务包括测量血压及血糖，送药、用药指导，上门输液以及康复理疗；基本医疗服务包括疾病诊治，就诊转运以及预约就诊；预防保健服务包括健康宣教，健康监测指导以及健康体检项目。
解释变量:以安德森模型为基础理论框架，将研究变量分为三个集合，分别为使能因素、特征因素、需求因素，问卷调查了老年人是否患有12种特定疾病以及6种不适症状。患病率最高的三种疾病依次是高血压、心脏病/冠心病和脑血管疾病。这些疾病被选为模型中的关键变量，并对其进行了相应的赋值[12]。近两周内身体出现不适的症状前三位的分别为疼痛、心慌、睡眠障碍，因此分别将其纳入模型各变量及赋值。
1.3　统计学方法
本研究使用SPSS 27.0统计学软件进行统计分析，采用描述性统计分析变量的基本特征；采用logistic回归模型分析失能老年人照护服务需求的影响因素，检验水准α=0.05。
本文采用logistic回归模型，因变量“有无照护服务需求”是二分变量，取值0或1。为了分析促进因特征因素和需要因素对失能老年人服务需求的影响程度，依据安德森模型理论框架，分别在轻度及中度失能老年人、重度失能老年人维度拟合并分析了三个不同的回归模型，回归模型结构如下:
模型1：
模型2：
模型3：
其中，p表示事件发生概率，X表示因变量中无法被自变量解释的误差项。回归模型采用Hosmer-Lemeshow Test进行模型拟合优度检验，P>0.05表明模型拟合优度好。
2　结果
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2.1　失能老年人基本特征
通过对数据的整理分析，本研究纳入的1 322位老人平均年龄为(72.16±7.5)岁，其中男性637人(48.18%)，女性685人(51.82%)。整体文化层次相对较低，784名(59.30%)为小学文化及以下；有配偶的失能老年人988人（74.74%）；参与居民基本养老保险的人数居多，为846人（占63.99%），大部分失能老年人与配偶或者子女居住，1 136人（占85.93%）；多数老年人患有慢病，1 051人（占79.50%）。研究以有无照护服务需求作为结局变量:有照护服务需求599人(45.31%)，无照护服务需求723人(54.69%)；按照ADL分类定义的失能程度，可以发现重度失能老人对于照护服务的需求较高。其中轻度失能老年人有412人（31.16%），中度失能152人（11.50%），重度失能758人（57.34%）。见表1。
2.2　失能老年人的照护服务需求情况
总体来看，失能老年人中生活起居服务方面有需求的人数最多，占54.72%，需求排名依次为医疗照护服务（34.04%）、精神慰藉服务（11.25%）。其中，在生活起居服务维度中，失能老年人对饮食照料、卫生清洁和生活陪伴的服务需求相对较高；在医疗照护服务维度中，失能老年人对照护服务、送药及用药指导、健康宣教方面的服务需求相对较高；在精神慰藉服务维度中，失能老年人对情感交流、情感疏导的服务需求相对较高。见表2。
2.3　照护服务需求影响因素分析
根据研究设计，对总体失能老年人群、轻中度及重度失能老年人群分两次进行回归分析。通过两阶段分析，更精确地识别和评估不同程度失能老人的照护需求在影响因素上的差异性。最终得出分析结果如下。
2.3.1　总体模型分析结果
依据安德森模型对照护服务需求影响因素的分类，本研究将使能因素、特征因素及需要因素纳入回归模型中，以评估加入变量对先前类别变量的影响。最终形成3组回归模型，见表3。
模型1整体拟合优度较好(Wald χ2=12.453，P=0.132)，模型提取的影响因素为性别(OR=0.778，95%CI：0.604～0.961)与文化程度(OR=0.598，95%CI：0.511～0.701)，即有照护服务需求的女性概率是男性的0.778倍，文化程度较高的老年人照护需求较高。模型2拟合优度相对较差(Wald χ2=15.458，P=0.051)，经济来源（OR=1.251，95%CI：1.084～1.444)、医保类别（OR=1.870，95%CI：1.291～2.710)会对是否需要照护服务产生正向影响关系，以及经济状况（OR=0.789，95%CI：0.648～0.961)会对是否需要照护服务产生负向影响关系，见表3。模型3纳入需要因素后，模型保留经济来源、医保类型，新纳入的需要因素中，慢性病用药数量(OR=0.767，95%CI：0.692～0.852)和听力情况(OR=0.833，95%CI：0.699～0.994)对照护服务需求具有一定影响。
2.3.2　轻度、中度及重度失能老年人维度模型分析结果
对轻度、中度及重度失能老年人维度进行分析，最终形成3个回归模型。见表4。
轻度及中度失能老年群体中，模型3纳入需要因素后，模型总体拟合优度提升(Wald χ2=7.043，P=0.532)，模型保留婚姻状况、医保类别，新纳入的因素中，慢性病用药数量(OR=0.631，95%CI：0.510～0.782)对照护服务需求具有一定影响；重度失能老年群体中，模型3纳入需要因素后，模型总体拟合优度整体提升(Waldχ2=6.077，P=0.639)，模型保留经济来源、医保类别，新纳入的需要因素中，慢性病用药数量(OR=0.690，95%CI：0.586～0.814)对照护服务需求具有一定影响。见表4。
3　讨论
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本研究中，潍坊市失能老年人对照护服务需求呈现多样化趋势。总体失能老年人群体中，模型3在总体的拟合优度上最佳，解释度接近70%，从模型分析的结果中，可得出以下结论。
从特征因素来看，轻度及中度失能老年人中，婚姻状况对失能老年人的照护服务需求产生显著影响。分析其原因可能是，独居、空巢老年人因子女常年在外，其突发急病时可能因无人照顾而不能得到有效的照护与救治[13]，且有研究表明空巢老人的抑郁症患病率高于一般老人[14]，因此缺少陪伴的失能老年人会出现不良情绪，影响身心健康并加剧患病风险，因此对于照护服务的需求随之增加。而重度失能老年人中年龄较大的失能老年人对照护服务的需求较高，分析其原因可能是年龄较大的失能老年群体的身体状况相对较差，因此对于照护服务的需求较高。从使能因素来看，经济状况的回归系数为负值且对总体失能老年人的照护服务需求产生显著影响，说明经济状况越好的家庭对于长期照护服务的需求越低。分析其原因可能是，随着家庭经济水平的提高，失能老年人的生活质量也会越好，失能老年人会更加注重自身的保健与照护，因此其对照护服务的需求会相应降低。从需要因素来看，慢性病用药数量在轻度中度及重度失能老年人群体中均有影响。一般来说，患有慢性病的种类越多，其用药数量就越多（本文只统计了问卷中潍坊市失能老人发病率前三位的慢性疾病，即高血压、心脏病和脑血管疾病)。随着慢病用药数量的增多，老年人失能发生率增加，这与既往研究一致[15]。分析其原因可能是多种用药意味着存在多种共病，随着患病数量的上升及影响，对老年人的日常活动能力不可避免的产生了影响，继而对于照护服务的需求便会增多。
针对上述分析结果，建议重视失能老年人照护服务需求的多样性，采取相应措施满足不同层次的需求。通过社区服务、家庭医生签约服务等手段，提供及时的医疗照护和心理支持，减少因无人照顾导致的健康风险。其次，针对年龄较大、身体状况较差的重度失能老年人，应增加专业照护人员的配备，提供更为细致的照护服务。此外，建议通过政策引导和经济激励，鼓励家庭成员参与失能老年人的日常照护，减轻社会照护服务的压力。经济因素方面，由于经济状况较好的家庭对长期照护服务需求较低，建议政府和相关机构考虑为经济条件较差的失能老年人提供一定的经济补贴或照护服务优惠，以减轻他们的经济负担。同时，应加强对慢性病用药管理的宣传和教育，减少因用药不当导致的失能风险。
综合来看，潍坊市失能老年人对于照护服务的需求存在差异性，基于安德森模型研究发现其照护需求受性别、文化程度、慢性病用药数量和听力情况等多种因素的影响。因此通过出台相关政策、加大投入力度等，为潍坊市失能老年人群创造更加舒适的生活环境，让他们能够享受到更加优质的照护服务。
基金
收起
  • 国家自然科学基金项目(71774034)
  • 国家卫生健康委人才交流服务中心项目(RCLX2220022)
  • 中国博士后科学基金面上资助项目(2023M740873)
文献
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doi: 10.20043/j.cnki.MPM.202410482
  • 接收时间：2024-10-26
  • 首发时间：2026-03-17
  • 出版时间：2025-05-10
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  • 收稿日期：2024-10-26
基金
国家自然科学基金项目(71774034)
国家卫生健康委人才交流服务中心项目(RCLX2220022)
中国博士后科学基金面上资助项目(2023M740873)
作者信息
    1.山东第二医科大学管理学院，山东 潍坊 261053
    2.国家卫生健康委卫生发展研究中心，北京 100044
    3.山东第二医科大学公共卫生学院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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