| BackgroundThe need for health services is one of the important criteria for optimizing the allocation of health resources,and the two week prevalence rate and chronic disease prevalence rate are important indicators reflecting the need for health services.With the aging of the population and the change of the traditional nuclear family structure,the number of elderly living alone is rising,which has brought many problems and challenges to the health service security system and the health of the elderly.Understanding the health service needs of the elderly under different living arrangements have important reference significance for the formulation of government health policies and the rational allocation of health resources.Therefore,this study was based on the perspective of health ecology to understand the health service needs of the elderly with different living arrangements,so as to meet the health needs of the elderly in the context of aging.ObjectivesTo understand the current situation of health service needs of the elderly with different living arrangements,and based on the health ecological model,analyze the influencing factors of health service needs of the elderly with different living arrangements,explore the relevant influencing factors for the differences in health service needs of elderly people with different living arrangements,so as to provide a reference basis for formulating relevant health policies and promoting healthy aging.MethodsThis study used a multi-stage random cluster sampling method and selected 3896 elderly people over the age of 60 in Tai’an City as the research subjects for a questionnaire survey.The survey mainly included personal basic information,two week illness status,chronic disease prevalence,etc.Binary logistic regression was used to analyze the influencing factors,and Shapley value decomposition method was used to determine the contribution degree of each influencing factor.In addition,Fairlie decomposition method was used to analyze the main factors affecting the differences in health service needs of elderly people with different living arrangements.ResultsThe results of this study showed that the two-week prevalence rate and chronic disease prevalence rate of the elderly in Tai’an were 75.46%and 73.79%.The two-week prevalence rate of the elderly living alone(79.42%)was higher than that of the elderly non-living alone(74.77%),the chronic disease prevalence rate of the elderly living alone(77.53%)was higher than that of the elderly non-living alone(73.14%),and the difference was statistically significant.From the perspective of personal characteristics,age and BMI were related to the health service needs of the elderly non-living alone.The two-week prevalence rate and chronic disease prevalence rate of the elderly non-living alone at the age of 60-64 were lower.The two-week prevalence rate of the overweight and obese elderly non-living alone(overweight:OR=1.49,95%CI:1.25～1.78;obesity:OR=3.10,95%CI:2.30～4.18)and the chronic disease prevalence rate(overweight:OR=1.57,95%CI:1.32-1.88;obesity:OR=3.33,95%CI:2.48～4.47)were higher than those with normal BMI index.From the perspective of personal behavior and psychological status,depression tendency,sleep quality and alcohol consumption were the common influencing factors of the two-week prevalence rate and chronic disease prevalence rate of the elderly who are not living alone and living alone.The two-week prevalence rate of the elderly with depression tendency(non-living alone:OR=1.85,95%CI:1.42～2.39;living alone:OR=2.29,95%CI:1.21～4.32)and the chronic disease prevalence rate(non-living alone:OR=1.64,95%CI:1.28～2.11;living alone:OR=2.45,95%CI:1.33～4.53)were higher,The twoweek prevalence rate of elderly people with sleep disorders(non-living alone:OR=2.00,95%CI:1.62～2.48;living alone:OR=2.06,95%CI:1.23～3.45)and the prevalence rate of chronic diseases(non-living alone:OR=1.90,95%CI:1.54～2.33;living alone:OR=1.97,95%CI:1.20～3.24)were higher than those without sleep disorders.The two-week prevalence rate(non-living alone:OR=0.71,95%CI:0.56～0.89;living alone:OR=0.49,95%CI:0.27～0.90)and the prevalence of chronic diseases(non-living alone:OR=0.71,95%CI:0.57～0.90;living alone:OR=0.46,95%CI:0.25～0.84)of drinking elderly people were lower than that of nondrinkers;The two-week prevalence rate(OR=0.75,95%CI:0.58～0.96)and chronic diseases(OR=0.73,95%CI:0.57～0.93)in the elderly non-living alone who smoke was lower,and the two-week prevalence rate(OR=0.80,95%CI:0.64～0.99)and chronic disease prevalence rate(OR=0.79,95%CI:0.64～0.98)of the elderly non-living alone who eat more vegetables and fruits were lower than those who do not.From the perspective of living and working conditions,the two-week prevalence rate(OR=1.46,95%CI:1.19～1.80)and chronic disease prevalence(OR=1.56,95%CI:1.27～1.90)among the elderly living alone in urban areas was higher than that in rural areas;The prevalence of chronic diseases in the elderly living alone with poor self-rated economic status was higher than that with good self-rated economic status(OR=2.51,95%CI:1.04～6.06).From the perspective of policy conditions,the two-week prevalence rate(OR=1.52,95%CI:1.23～1.88)and chronic disease prevalence rate(OR=1.49,95%CI:1.21～1.84)of the elderly non-living alone who contracted with family doctors were higher than those who did not contract.The top five influencing factors for the two week prevalence rate of elderly non-living alone ranked in order of contribution rate were sleep quality(25.40%),depression tendency(18.20%),BMI(16.86%),age(15.96%),and alcohol consumption(5.76%);among the elderly living alone,the sleep quality(38.71%),depression tendency(37.22%),and alcohol consumption(24.07%)were ranked in order.The top five influencing factors for the prevalence of chronic diseases among non-living alone elderly people ranked in order of contribution rate were sleep quality(22.45%),BMI(20.87%),age(16.41%),depression tendency(14.70%),and place of residence(7.46%);among the elderly living alone,the order was sleep quality(34.81%),depression tendency(33.85%),alcohol consumption(21.85%),and self-rated economic status(9.50%).Conclusions and recommendations:Compared with the elderly non-living alone,the elderly living alone had a higher demand for health services.Depressive tendency,sleep quality and alcohol consumption were the common influencing factors of the health service needs of the elderly living alone and nonliving alone.Age,BMI,smoking,eating more vegetables and fruits,residence,and contracted family doctors were the unique influencing factors of the health service needs of the elderly non-living alone.Self-rated economic status was the unique influencing factors of the prevalence of chronic diseases of the elderly living alone.Age,education level,alcohol consumption,sleep quality,and depression tendency were the main factors that affected the differences in health service needs of elderly people with different living arrangements.Based on the above conclusions,the following suggestions were put forward:(1)Pay attention to the health service needs of the elderly living alone and strengthen the role of family support;(2)Pay attention to the elderly patients with chronic diseases and strengthen the management of chronic diseases;(3)Pay attention to the mental health of the elderly and the role of sleep quality;(4)Improve the social welfare security system for the elderly and strengthen the economic support for the elderly living alone;(5)Popularize health knowledge and advocate healthy lifestyle. |
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