四川轻化工大学学报(社会科学版)

中国老龄化程度正持续加深,"十四五"时期将进入中度老龄化阶段。为应对日益加重的养老压力,我国提出"9073"养老模式,重点构建居家社区机构相协调、医养康养相结合的养老服务体系,实现97%的养老服务直接或间接依托于社区养老服务体系来提供。值得关注的是,伴随着深度老龄化而来的还有令人堪忧的老年心理健康问题。随着生活水平、社会关系与身体状况的改变,老年群体容易出现抑郁、自卑等负面情绪,长此以往还会对老年身体起反噬作用。鉴于此背景,该研究旨在测量全面客观的老年心理健康,并揭示我国社区养老精神慰藉服务对老年人心理健康影响,推进完善社区居家养老服务。基于2018年中国老年健康影响因素跟踪调查(CLHLS)数据的14,312个样本个体,由孤独感、生活满意度、认知能力、参与活动四个指标测量出潜变量老年人心理健康,并检验聊天解闷、娱乐活动、处理纠纷这三项精神慰藉类社区养老服务对老年人心理健康的影响。目前这三项社区精神慰藉养老服务的覆盖率低于30%,而希望获得精神慰藉服务的老人高于67%,说明我国社区精神慰藉养老服务还存在较大的供给缺口。进一步运用多指标多因素模型(MIMIC)的估计结果显示,三项社区精神慰藉养老服务对老年人心理健康均具有显著的正向影响,影响大小依次为娱乐活动服务、处理纠纷服务、聊天解闷服务,而生活照料、医疗保健类社区养老服务对老年人心理健康的影响并不显著。在此基础上,针对不同户籍、是否独居、是否失能开展异质性分析,发现部分社区心理服务对农村、独居和失能老人的影响并不显著。以上实证结果表明,社区精神慰藉服务对老年人心理健康具有不可替代的正面作用,一方面要积极提高社区养老心理服务的覆盖水平和服务质量,在实施过程中,重点开展老年娱乐活动项目,推崇亲人和固定义工陪伴文化,避免流于形式的"快餐式"聊天陪伴服务;另一方面,加强关注老年弱势群体,针对独居与失能老人设计差异化的上门社区养老服务。

China's aging phenomenon is deepening, During the 14 th Five-Year Plan period, China will enter the stage of moderate aging. In order to cope with the increasing pressure on the elderly, China puts forward the "9073" mode of providing for the aged, which is to focus on building a system of elderly care services that coordinates home and community and combines medical care with health care and can realize97% of the elderly care services can be provided directly or indirectly by the community elderly care service system. It is worth noting, with the deepened aging, there is worrying about mental health of the elderly. With the changes of living conditions, social relations and physical conditions, the elderly are prone to depression,inferiority and other negative emotions, which will be harmful to the health of the elderly. In view of this background, this study aims to build a comprehensive and objective mental health model for the elderly, reveal the impact of spiritual consolation services for the elderly in community care on the mental health of the elderly, and promote the improvement of community home-based care services. Based on 14312 valid samples of the CLHLS data in 2018, four indicators, i.e. loneliness, life satisfaction, cognitive ability, and social activities, are used to measure multi-dimensional mental health, and to test the three community spiritual comfort services: chatting, entertainment, and dispute resolution for the elderly by using the multi-index and multi-factor(MIMIC) structural equation model. At present, the coverage rate of these three community spiritual comfort services is less than 30%, while more than 67% of the elderly hope to receive spiritual comfort services, indicating that there is still a large supply gap in community spiritual comfort services for the elderly in China. Furthermore, the estimation results from the multi-index and multi-factor(MIMIC) structural equation model show that community spiritual comfort services for the elderly have a significant positive impact on the mental health of the elderly, and the order of influence is entertainment, dispute resolution and chatting. While the life care and medical care of community elderly care services have no significant positive impact on the mental health of the elderly. And there are different results for differently registered residence,no matter whether they live alone or not, or no matter whether they are disabled or not. The above empirical results show that community spiritual comfort service has an irreplaceable positive effect on the mental health of the elderly. On the one hand, we should actively improve the coverage level and service quality of community psychological service for the aged. In the process of implementation, we should focus on the elderly entertainment projects, praise highly the culture of family members' and regular volunteers' company, and avoid the "fast food" chat service. On the other hand, we should pay more attention to the vulnerable groups of the elderly, and design differentiated home-based community care services for the elderly living alone and disabled.