基于安德森模型的高龄居家失能老年人生活满意度及其影响因素

Life Satisfaction and Its Influencing Factors among Home-Dwelling Older Adults with Disabilities: An Analysis Based on the Anderson Model

摘要: 本研究基于CLHLS2018年数据，依托安德森健康行为模型，从环境因素、个人特征与医疗行为三个维度系统考察了居家高龄失能老年人生活满意度的影响因素。结果表明，老年人的生活满意度呈现“半数满意、两成不满、三成无法回答”的特点。“无法回答”并非随机缺失，而是特定弱势群体的需求“失声”预警，尤其集中于女性、百岁以上、农村、单身、未念过书、重度失能、医疗保障及就医条件较差的人群。安德森模型中年龄、户籍、失能程度，生重病时能否及时就医等因素显著影响老年人的生活满意度。异质性分析进一步发现，对于重度失能群体，上述常规因素的解释力下降。建议政策要充分关注“无法回答”背后的群体，完善非传统主观福祉评估工具；构建“照护分级、服务分层”的精准化服务体系并优先提升农村急重症救治可及性。

Abstract: Based on data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study draws on Andersen’s behavioral model of health services use to explore the factors influencing life satisfaction among home-dwelling older adults with disabilities, with a focus on environmental factors, individual characteristics, and healthcare behaviors. The results reveal a distinct pattern: approximately half of the respondents reported being satisfied, one-fifth expressed dissatisfaction, and nearly one-third were unable to provide a definitive answer. Importantly, the “unable to answer” category does not represent random missing data, but rather signals a form of informative nonresponse that may reflect the systematic exclusion of particularly vulnerable groups from conventional subjective well-being assessments. This pattern is especially pronounced among women, centenarians, rural residents, unmarried individuals, those with no formal education, persons with severe functional limitations, and those with limited medical security and poor access to healthcare. The analysis shows that age, household registration (hukou) status, level of disability, and access to timely medical care when seriously ill are significantly associated with life satisfaction. Heterogeneity analyses further indicate that the explanatory power of these conventional factors weakens considerably among those with severe disabilities. These findings suggest that policy interventions should pay greater attention to subgroups who are disproportionately represented in the “unable to answer” category, develop alternative tools for assessing subjective well-being beyond standard survey measures, establish a differentiated support system based on care level and service tier, and prioritize improvements in the accessibility of emergency and acute care services in rural areas.