康复辅助器具对老年人的健康促进效应研究

关键词：康复辅助器具  现代医学模式  健康促进  日常生活活动能力

Keywords:assistive devices  modern medical model  health promotion  activities of daily living

摘要：

      摘要 目的：评估康复辅助器具（以下简称“辅具”）对老年人日常生活活动能力（ADL）的干预效果，及其在城乡之间、私营与非私营部门之间的异质效应。明确辅具在促进老年人健康、社会融合等方面的重要意义，为普惠性辅具政策制定提供现实依据。 方法：以积极健康观和现代医学模式的互动关系为理论基础，将生理健康、心理健康和社会健康纳入同一分析框架，基于2021年世界卫生组织rATA调查数据，将整体样本按其功能障碍类型分为基础性日常生活活动能力（BADL）和工具性日常生活活动能力（IADL）两组，采用广义有序Logit模型分别估计得到辅具在日常生活活动能力上的边际效应。 结果：辅具显著提高了老年人的日常生活活动能力（ADLs）（P<0.01）。具体来看，辅具使老年人处于严重BADL障碍状态的概率降低了0.322个百分点（P<0.01），并使其处于“基本不存在IADL障碍”状态的概率提高了2.871个百分点（P<0.01）。其中，辅具使农村老年人处于严重BADL障碍状态的概率降低了0.347个百分点（P<0.01），而使城市老年人处于“基本不存在IADL障碍”状态的概率提高了3.511个百分点（P<0.01）。此外，私营部门提供的辅具使老年人处于“基本不存在IADL障碍”状态的概率提高了2.721个百分点（P<0.01），其促进效果显著高于政府和非营利机构。最后，老年人获得辅具的距离远近会影响其IADL促进效果（P<0.01）。 结论：辅具不仅能够满足老年人的基本生存需要，还能提高其在独立生活、处理信息和与人沟通等方面的能力。现阶段应完善辅具的设计理念和适配供给，以推动中国康复辅助器具产业迈向高质量发展。

Abstract:

      Abstract Objective： To assess the intervention effect of assistive devices on activities of daily living （ADL） in older adults and their heterogeneous effects between urban and rural areas and between private and non-private sectors. To clarify the significance of assistive devices in promoting the health and social integration of the elderly， thus providing a realistic basis for the policy formulation of universal assistive devices. Method： Based on the interaction relationship between positive health and modern medical model， this study integrated physical health， mental health and social health into the same analysis framework. Using data from the 2021 WHO rATA survey，the overall sample was divided into basic activities of daily living (BADL) and instrumental activities of daily living (IADL)， and the generalized ordered logit model was used to estimate the marginal effect of assistive devices on daily living activities. Result： Assistive devices significantly improved older adults’ ADLs(P<0.01). Specifically, the use of assistive devices reduced the probability of severe BADL limitation by 0.322 percentage points (P<0.01) and increased the probability of having no IADL limitation by 2.871 percentage points (P<0.01). Among rural older adults, assistive devices reduced the probability of severe BADL limitation by 0.347 percentage points (P<0.01), whereas among urban older adults, they increased the probability of having no IADL limitation by 3.511 percentage points (P<0.01). In addition, assistive devices provided by the private sector increased the probability of having no IADL limitation by 2.721 percentage points (P<0.01), and this effect was significantly greater than that of devices provided by the government and nonprofit organizations. Finally, the distance older adults needed to travel to obtain assistive devices significantly affected the promoting effect of assistive devices on IADL (P<0.01). Conclusion： Assistive devices can not only meet the basic survival needs of people with dysfunction， but also improve their abilities to live independently， process information and communicate with people. At the present stage， the design concept and adaptive supply of assistive devices should be improved to promote the high-quality development of the rehabilitation assistive devices industry in China.