失能老人照护缺口及其影响因素研究——基于CHARLS 2020数据的实证分析

Care Gaps among Disabled Older Adults and Their Determinants—An Empirical Analysis Based on CHARLS 2020 Data

摘要: 随着人口老龄化程度加深，失能老人照护问题日益突出。功能失能并不必然意味着照护需求得到满足，部分失能老人可能因家庭支持不足、配偶缺位或服务供给不足而面临照护缺口。本文基于CHARLS 2020数据，以60岁及以上存在ADL或IADL功能困难的老年人为研究对象，构造照护缺口变量，使用Logit模型考察失能老人照护缺口的规模及其影响因素。研究发现：60岁及以上老人中任一ADL/IADL项目存在困难的比例为43.2%；在失能老人样本中，42.1%当前没有照护者。IADL失能得分在基准模型、异质性分析和稳健性检验中均显著降低照护缺口概率，说明做饭、购物、吃药、管钱等工具性生活困难更稳定地解释了照护缺口差异；相比之下，ADL连续得分在Logit模型中不显著。有配偶显著降低照护缺口概率，农村失能老人照护缺口概率显著高于城市。本文建议建立基于功能评估的失能老人识别机制，将无照护者失能老人作为居家养老服务重点对象，并加强农村地区长期照护服务供给。

Abstract: With the deepening of population aging, the provision of care for older adults with disabilities has become an increasingly salient challenge. Functional disability does not necessarily imply that care needs are met; some disabled older adults may experience a care gap due to insufficient family support, absence of a spouse, or inadequate service supply. Drawing on the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study focuses on older adults aged 60 and above who report difficulty with any activity of daily living (ADL) or instrumental activity of daily living (IADL). A care gap variable is constructed, and a Logit model is employed to examine the magnitude and determinants of care gaps among disabled older adults. The findings reveal that 43.2% of older adults aged 60 and above experience difficulty with at least one ADL or IADL item. Within the subsample of disabled older adults, 42.1% currently have no caregiver. The IADL disability score significantly reduces the probability of a care gap in the baseline model, heterogeneity analysis, and robustness checks, indicating that difficulties in instrumental activities—such as meal preparation, shopping, medication management, and handling finances—more consistently account for variations in the care gap. In contrast, the continuous ADL score is not statistically significant in the Logit model. Having a spouse significantly reduces the probability of a care gap, and rural disabled older adults face a significantly higher probability of a care gap than their urban counterparts. This paper suggests establishing an identification mechanism for disabled older adults based on functional assessment, prioritizing those without caregivers as key targets of home-based elderly care services, and strengthening the supply of long-term care services in rural areas.