家庭支持对老年人慢性病的影响研究

The Impact of Chronic Diseases on Family Support among the Older Adults

摘要: 在人口老龄化与老年慢性病高发背景下，既往研究多关注家庭支持对慢性病的单向影响，而反向因果被长期忽视。本文重点探析老年人慢性病状况对获得家庭支持的影响机制，为厘清代际支持逻辑、优化健康老龄化政策提供参考。基于中国健康与养老追踪调查(CHARLS) 2018年截面数据，从照料强度、来源、类型细化日常照料维度，结合情感慰藉、经济支持构建三维指标体系，采用Logit模型与倾向得分匹配法实证检验，并开展年龄、医保异质性分析。结果表明：老年人慢性病患病、共病及功能受损程度显著正向预测日常照料获取概率(37.7%~39%)，呈现典型“需求引致照料”特征；情感慰藉受慢性病影响较弱(<10%)；经济支持与慢性病关联不显著。低龄、无医保老年人的家庭支持获取对慢性病状况更敏感。研究证实，老年慢性病是家庭支持分配的关键驱动因素，应从精准匹配照料需求、提升健康自主管理能力、完善医保与社区医养协同体系三方面推进健康老龄化。

Abstract: Against population aging and high prevalence of chronic diseases among the elderly, most prior studies focus on the unidirectional effect of family support on chronic diseases, while reverse causality (chronic diseases driving family care) is largely overlooked. This study mainly explores the mechanism of chronic diseases on access to family support, providing evidence for clarifying intergenerational support logic and optimizing healthy aging policies. Using 2018 CHARLS data, daily care is refined by intensity, source and type, forming a three-dimensional index system with emotional comfort and financial support. Logit model and PSM are employed for empirical analysis, with heterogeneity tests by age and medical insurance. Results show that chronic disease status, multimorbidity and functional impairment significantly increase the probability of receiving daily care (37.7%~39%), reflecting a typical “demand-induced care” pattern; emotional comfort is weakly affected (<10%); financial support shows no significant association. Family support access among the young-old and uninsured elderly is more sensitive to chronic disease status. This study confirms that chronic diseases are key drivers of family support allocation. Policies should focus on matching care needs, enhancing health self-management, and improving integrated medical and elderly care systems.