Differential Analysis of Disability in Different Settings in China: Based on a Survey of 23 922 Older Adults

Background With the increasing of older adults with disability, it is urgent to understand the disability status of older adults in different settings and to improve the long-term care service model from professional institutions to communities and families. Objective To investigate the disability status of older adults in different settings (hospitals, nursing facilities, and communities) , compare and analyze the differences in the disability status of the elderly in different settings. Methods The multi-stage sampling method was used in this study from January 2022 to January 2023. At the first stage, one or two provinces were conveniently selected in East China, South China, Central China, North China, and Southwest China; at the second stage, 3 tertiary hospitals, 2 secondary hospitals, 2 community health centers, and 1 nursing facility were conveniently selected as the study sites in each province. Older adults in 27 tertiary hospitals, 18 secondary hospitals, 18 community health service centers, and 9 nursing facilities in 9 provinces and cities (Beijing, Hunan, Jiangsu, Guangdong, Fujian, Xinjiang Uygur Autonomous Region, Guizhou, Hainan, and Sichuan) were finally included as study subjects. Barthel Index (BI) was used to evaluate basic activity of daily living (BADL) . Lawton-Brody Instrumental Activity of Daily Living scale was used to evaluate instrumental activity of daily living (IADL) . The Logistic regression analysis was used to explore the association of settings with BADL disability degree, IADL disability degree and functional disability in different aspects for older adults. Results A total of 27 344 questionnaires were collected and 23 922 were valid, with a valid recovery rate of 87.5%. There were 10 318 cases (43.1%) disabled in BADL, and the top three disabled BADL functions were bed-chair transfers, ascend and descend stairs, mobility on level surfaces. The incidence of BADL disability in various places was 29.0% in communities, 74.9% in elderly care institutions, 54.0% in secondary hospitals, and 44.6% in tertiary hospitals. Besides, 19 200 (80.3%) cases were disabled in IADL and the top three disabled IADL functions were mode of transportation, housekeeping and shopping. The incidence of IADL disability in various places was 74.6% in communities, 96.4% in elderly care institutions, 83.6% in secondary hospitals, and 81.1% in tertiary hospitals. Different settings were the influencing factor for the disability degree and functional disability types (P