A Multi-factor analysis of the current state of disability among economically disadvantaged older people in rural ethnic minority areas
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摘要:
目的 分析甘肃省临夏回族自治州60岁以上经济困难老年人自理能力现状。 方法 使用多阶段分层抽样，2021年12月—2022年5月于该地区康乐县调查3 724名老年人，根据《老年人能力评估规范(征求意见稿)》，使用多分类无序logistic回归分析探究自理能力的影响因素。 结果 能力完好44人(1.2%)，轻度失能2 316人(64.0%)，中度失能828人(22.8%)，中重度失能320人(8.8%)，重度失能116人(3.2%)；性别、民族、宗教信仰、婚姻状况、疾病诊断、肥胖程度、年龄段、跌倒、噎食、压疮、关节活动度、伤口情况、牙齿缺损松动、吞咽困难、清理呼吸道无效、能力等级变更依据对老年人能力最终等级有影响(均P＜0.05)；多分类无序logistic回归分析显示, 婚姻状况(重度失能: OR=0.269, 95% CI：0.091~0.793)、疾病诊断(重度失能: OR=0.283, 95% CI：0.125~0.643)、肥胖程度(重度失能: OR=5.867, 95% CI：1.443~23.862)、年龄段(重度失能: OR=6.036, 95% CI：2.488~14.643)、关节活动度(重度失能: OR=17.337, 95% CI：5.067~59.320)、牙齿缺损松动(重度失能: OR=3.678, 95% CI：1.487~9.096)、压疮(重度失能: OR=43.535, 95% CI：1.273~1 488.906)是老年人能力最终等级的影响因素。 结论 甘肃省临夏回族自治州60岁以上经济困难老年人失能率达98.8%，对其养老服务与健康需求应高度重视。 Abstract:Objective To analyze the current status of self-care ability of economically disadvantaged older adults over 60 years old in Linxia Hui Autonomous Prefecture, Gansu Province. Methods Using multistage stratified sampling, 3 724 older adults were surveyed in Kangle County of the region from December 2021 to May 2022, and the influencing factors of self-care ability were explored using multi-classified unordered logistic regression analysis according to the Specification for the Assessment of Elderly People ' s Ability (Draft for Public Comments). Results Ability was intact in 44 (1.2%), mildly disabled in 2 316 (64.0%), moderately disabled in 828 (22.8%), moderately severely disabled in 320 (8.8%), and severely disabled in 116 (3.2%). Gender, ethnicity, religious beliefs, marital status, diagnosis of disease, obesity level, age group, falls, choking, pressure sores, joint mobility, wound condition, missing loose teeth, dysphagia, ineffective airway clearance, and basis for change in competency class had an effect on the final class of competency of the elderly (all P < 0.05). Multi-classified unordered logistic regression analysis showed that marital status (severe disability, OR=0.269, 95% CI: 0.091-0.793), disease diagnosis (severe disability, OR=0.283, 95% CI: 0.125-0.643), degree of obesity (severe disability, OR=5.867, 95% CI: 1.443-23.862), age group (severe disability, OR=6.036, 95% CI: 2.488-14.643), joint mobility (severe disability, OR=17.337, 95% CI: 5.067-59.320), loose tooth defect (severe disability, OR=3.678, 95% CI: 1.487-9.096), pressure ulcer (severe disability, OR=43.535, 95% CI: 1.273-1 488.906) were the influencing factor of the final level of the ability of the elderly. Conclusion The incapacity rate of economically disadvantaged older people over 60 years old in Linxia Hui Autonomous Prefecture, Gansu Province, reaches 98.8%, and great attention should be paid to their elderly care services and health needs. -
Key words:
- Older adults /
- Self-care ability assessment /
- Incapacity /
- Ethnic minority areas /
- Rural areas /
- Economic disadvantaged
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表 1 不同能力等级老年人基本特征比较(n=3 624)
Table 1. Comparison of basic characteristics of elderly people with different ability levels(n=3 624)
项目 类别 能力完好
(人)轻度失能
(人)中度失能
(人)中重度失能
(人)重度失能
(人)总计
[人(%)]统计量 P值 性别 男性 25 1 176 397 117 45 1 760(48.6) 7.220a ＜0.001 女性 19 1 140 431 203 71 1 864(51.4) 民族 汉族 25 1 011 278 124 45 1 483(40.9) 30.673b ＜0.001 回族 19 1 254 529 188 67 2 057(56.8) 东乡族 0 51 21 8 4 84(2.3) 宗教信仰 无 25 1 005 277 123 46 1 476(40.7) 2.973a ＜0.001 伊斯兰教 19 1 311 551 197 70 2 148(59.3) 婚姻状况 未婚/离婚 4 67 25 6 2 104(2.9) 46.689b ＜0.001 已婚 35 1 529 475 179 62 2 280(62.9) 丧偶 5 720 328 135 52 1 240(34.2) 用药情况 无 44 2 250 804 315 108 3 521(97.2) 0.015a 0.998 有 0 66 24 5 8 103(2.8) 疾病诊断 无 21 1 285 370 137 48 1 861(51.4) 4.156a ＜0.001 有 23 1 031 458 183 68 1 763(48.6) 肥胖程度 低于正常值 3 395 183 81 41 703(19.4) 37.165b ＜0.001 正常体重 31 1 600 553 198 64 2 446(67.5) 超重 8 290 75 29 10 412(11.4) 轻度肥胖 2 24 14 8 1 49(1.4) 重度肥胖 0 7 3 4 0 14(0.3) 年龄段 60~70岁 39 1 201 356 104 43 1 743(48.1) 115.227b ＜0.001 71~80岁 4 868 323 137 41 1 373(37.9) 81~90岁 1 242 139 67 25 474(13.1) 90岁以上 0 5 10 12 7 34(0.9) 注：a为Z值，b为H值。 
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表 2 不同能力等级老年人照护危险事件、健康相关问题分布情况(n=3 624)
Table 2. Distribution of care risk events and health-related problems of elderly people with different ability levels(n=3 624)
项目 类别 能力完好
(人)轻度失能
(人)中度失能
(人)中重度失能
(人)重度失能
(人)总计
[人(%)]统计量 P值 照护危险事件 跌倒 无 44 2 131 475 169 67 2 886(79.6) 759.443a ＜0.001 发生过1次 0 185 64 15 3 267(7.4) 发生过2次 0 0 120 52 11 183(5.1) 发生过3次及以上 0 0 169 84 35 288(7.9) 噎食 无 44 2 259 604 215 82 3 204(88.4) 587.440a ＜0.001 发生过1次 0 57 37 10 0 104(2.9) 发生过2次 0 0 70 39 7 116(3.2) 发生过3次及以上 0 0 117 56 27 200(5.5) 自杀 无 44 2 312 826 318 116 3 616(99.8) 2.986b 0.560 发生过1次 0 4 2 2 0 8(0.2) 压疮 无 44 2 312 821 302 88 3 567(98.4) 127.675b ＜0.001 有 0 4 7 18 28 57(1.6) 健康相关问题 关节活动度 灵活 39 952 163 40 20 1 214(33.5) 20.959a ＜0.001 不灵活 5 1 362 663 275 88 2 393(66.0) 无法判断 0 2 2 5 8 17(0.5) 伤口情况 无 44 2 046 676 265 99 3 130(86.4) 49.135b ＜0.001 有 0 270 152 55 17 494(13.6) 疼痛 无 2 19 4 2 1 28(0.8) 72.634a ＜0.001 有 35 1 824 700 284 101 2 944(81.2) 无法判断 7 473 124 34 14 652(17.9) 牙齿缺损松动 无 31 650 118 39 19 857(23.6) 235.266b ＜0.001 有 13 1 666 710 281 97 2 767(76.4) 吞咽困难 无 42 1 955 504 161 58 2 720(75.1) 232.609b ＜0.001 有 2 361 324 159 58 904(24.9) 清理呼吸道无效 无 41 2 291 821 314 111 3 578(98.7) 22.097b ＜0.001 有 3 25 7 6 5 46(1.3) 能力等级变更依据 保持不变 44 2 315 412 117 55 2 943(81.2) 1 582.031a ＜0.001 痴呆、精神疾病 0 1 8 10 9 28(0.8) 2次以上跌倒、噎食、自杀、走失 0 0 408 193 48 649(17.9) 昏迷状态 0 0 0 0 4 4(0.1) 老年人能力最终等级 44 2 316 828 320 116 3 624(100.0) 注：a为H值，b为Z值。
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表 3 变量赋值情况
Table 3. Variable assignment description
变量 条目 赋值方法 自变量 基本信息 性别 男性=1；女性=1 民族 汉族=0，0；回族=1，0；东乡族=0，1 宗教信仰 无=1；伊斯兰教=2 婚姻情况 未婚/离婚=0，0；已婚=1，0；丧偶：0，1 用药情况 无=0；有=1 疾病诊断 无=0；有=1 肥胖程度 低于正常值=0；正常体重=1；超重=2；轻度肥胖=3；重度肥胖=4 年龄段 60~70岁=1；71~80岁=2；81~90岁=3；90岁以上=4 照护危险事件 跌倒 无=0；发生过1次=1；发生过2次=2；发生过3次及以上=3 噎食 无=0；发生过1次=1；发生过2次=2；发生过3次及以上=3 压疮 无=0；有=1 健康相关问题 关节活动度 无法判断=0，0；灵活=1，0；不灵活，影响日常功能=0，1 伤口情况 无=0；有=1 疼痛 不知道或无法判断=0，0；无疼痛=1，0；疼痛=0，1 牙齿缺损松动 无=0；有=1 吞咽困难 无=0；有=1 清理呼吸道无效 无=0；有=1 能力等级变更依据 等级保持不变=0；医疗确诊痴呆、精神疾病者，提高一个等级=1；近30 d内发生过2次及以上照护危险事件者，提高一个等级=2；处于昏迷状态者，直接评定为重度失能=3 因变量 老年人能力最终等级 功能完好=0；轻度失能=1；中度失能=2；中重度失能=3；重度失能=4
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表 4 老年人基本特征的多分类无序logistic回归分析
Table 4. Multiple disordered logistic regression analysis of basic characteristics of elderly people
能力等级 相关因素 B SE Wald χ2 P值 OR值 95% CI 能力完好 婚姻状况=已婚 1.313 0.551 5.672 0.017 3.717 1.262~10.950 疾病诊断 1.262 0.419 9.081 0.003 3.531 1.554~8.021 年龄段 1.798 0.452 15.805 ＜0.001 0.166 0.068~0.402 肥胖程度=低于正常值 1.769 0.716 6.111 0.013 0.170 0.042~0.693 轻度失能 疾病诊断 1.185 0.345 11.793 0.001 0.306 0.155~0.601 婚姻状况=未婚/离婚 1.751 0.738 5.628 0.018 0.174 0.041~0.738 肥胖程度=轻度肥胖 1.711 0.851 4.047 0.044 0.181 0.034~0.957 民族=东乡族 17.985 0.528 1 159.420 ＜0.001 6.467×107 2.296×107~1.820×108 中度失能 疾病诊断 1.420 0.361 15.495 ＜0.001 0.242 0.119~0.490 年龄段 1.497 0.434 11.903 0.001 4.466 1.909~10.450 婚姻状况=已婚 1.319 0.510 6.686 0.010 0.267 0.098~0.727 民族=回族 0.918 0.313 8.585 0.003 2.504 1.355~4.626 民族=东乡族 18.129 0.555 1 067.877 ＜0.001 7.474×107 2.519×107~2.217×108 中重度失能 疾病诊断 1.462 0.377 15.040 ＜0.001 0.232 0.111~0.485 年龄段 1.875 0.439 18.244 ＜0.001 6.523 2.759~15.424 婚姻状况=已婚 1.214 0.522 5.406 0.020 0.297 0.107~0.826 婚姻状况=未婚/离婚 2.038 0.918 4.930 0.026 0.130 0.022~0.787 肥胖程度=低于正常值 1.422 0.695 4.185 0.041 4.144 1.061~116.180 民族=回族 0.691 0.326 4.499 0.034 1.995 1.054~3.776 民族=东乡族 18.115 0.622 847.623 ＜0.001 7.364×107 2.175×107~2.493×108 重度失能 婚姻状况=已婚 1.313 0.551 5.672 0.017 0.269 0.091~0.793 疾病诊断 1.262 0.419 9.081 0.003 0.283 0.125~0.643 肥胖程度=低于正常值 1.769 0.716 6.111 0.013 5.867 1.443~23.862 年龄段 1.798 0.452 15.805 ＜0.001 6.036 2.488~14.643
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表 5 老年人照护危险事件、健康相关问题的多分类无序logistic回归分析
Table 5. Multivariate disordered logistic regression analysis of care risk events and health-related problems in elderly people
能力等级 相关因素 B SE Wald χ2 P值 OR值 95% CI 能力完好 关节活动度=不灵活 2.853 0.628 20.662 ＜0.001 0.058 0.017~0.197 牙齿缺损松动 1.302 0.462 7.946 0.005 0.272 0.110~0.672 压疮 3.774 1.802 4.384 0.036 0.023 0.001~0.786 轻度失能 关节活动度=不灵活 2.484 0.567 19.220 ＜0.001 11.988 3.949~36.394 牙齿缺损松动 1.301 0.372 12.233 ＜0.001 3.673 1.772~7.613 清理呼吸道无效 1.669 0.681 6.010 0.014 0.188 0.050~0.716 跌倒 13.632 0.183 5 520.481 ＜0.001 8.321×106 5.808×106~1.192×107 中度失能 牙齿缺损松动 1.739 0.392 19.655 ＜0.001 5.690 2.639~12.270 清理呼吸道无效 1.557 0.786 3.918 0.048 0.211 0.045~0.985 关节活动度=不灵活 3.152 0.579 29.676 ＜0.001 23.389 7.524~72.706 跌倒 13.977 0.122 1.320×104 ＜0.001 1.176×106 9.263×105~1.492×106 中重度失能 牙齿缺损松动 1.745 0.418 17.384 ＜0.001 5.724 2.521~12.998 疼痛情况=有 4.133 1.337 9.554 0.002 431.120 4.537~857.703 关节活动度=不灵活 3.491 0.600 33.912 ＜0.001 5.724 2.521~12.998 重度失能 关节活动度=不灵活 2.853 0.628 20.662 ＜0.001 17.337 5.067~59.320 牙齿缺损松动 1.302 0.462 7.946 0.005 3.678 1.487~9.096 压疮 3.774 1.802 4.384 0.036 43.535 1.273~1 488.906
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