Disability and Care Needs Among Older Americans
Disability and Care Needs Among Older Americans
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DOI：
10.1111/1468-0009.12076
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发表时间：
2014-09-01
影响因子：
6.6
通讯作者：
Spillman, Brenda C.
中科院分区：
文献类型：
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作者：
Freedman, Vicki A.;Spillman, Brenda C.
近一半的老年医疗保险受益人在没有援助或在此类活动中得到帮助的情况下难以开展日常活动。这种帮助通常来自非正式的照顾者。相当多的老年人生活在家里或养老院以外的支持性环境中，经历着与未得到满足的需求有关的不良后果。随着持续护理从养老院转移，需要制定战略来改善基于社区的长期护理服务和支持，以帮助老年人和提供最多护理的非正式照顾者。背景随着美国老年人数量的增加，老年依赖的成本预计将在未来几十年迅速增长。为了提供相关政策讨论的背景，我们对全国老年样本的活动限制和援助、护理资源和未得到满足的需求进行了调查。方法我们分析了2011年全国健康和老龄化趋势研究，这是一项新的全国性小组研究，涉及8000多名联邦医疗保险参与者。发现近一半的老年人，即1800万人，在过去一个月的日常活动中遇到困难或得到帮助。总共有四分之一接受帮助的老年人生活在支持性护理(15%)或养老院(10%)环境中。近300万人在养老院以外的环境中接受了3次或3次以上的自理或活动援助，这一水平的人中收入较低的比例不成比例。在养老院以外的环境中，几乎所有老年人都至少有一名潜在的非正式护理网络成员(家庭或家庭成员或密友)，网络成员的平均数量为4名。非正式援助的水平，主要来自家庭照顾者，对于在社区接受帮助(每月164小时)和生活在支持性护理环境(每月50小时)的老年人来说是相当可观的。几乎所有接受帮助的人都接受了非正式护理，大约十分之三的人接受了有偿护理。在那些在养老院以外的环境中有困难或接受帮助的人中，32%的人在上个月有与未得到满足的需求有关的不良后果；对于有付费照顾者的社区居民，这一数字接近60%。结论老年人口，特别是那些没有经济资源的人，有大量的晚年护理需求。改善长期服务和支持并减少未得到满足的需求的政策可以使老年人和照顾他们的人受益。
Nearly half of elderly Medicare beneficiaries have difficulty performing daily activities without assistance or receive help with such activities. This help is most often from informal caregivers. Substantial numbers of older adults living at home or in supportive settings other than nursing homes experience adverse consequences related to unmet need. With continuing care shifts away from nursing homes, strategies are needed to improve community-based long-term care services and supports to aid both older adults and the informal caregivers who provide most care.ContextThe cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults.MethodsWe analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees.FindingsNearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%.ConclusionsThe older populationespecially those with few economic resourceshas substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them.