“医养指数”导向下社区养老居住设施空间模式研究

“Medical-nursing combined care” and “Aging in place” have become the development trend of residential facility for the aged in community against the background of the rapid development of the providing for the aged in our country. However, there are problems such as sever lack of total number of nursing beds, high vacancy rate of some facilities, as well as unreasonable space design caused by uncertainty of pattern and content of medical-nursing combined care during the construction of residential facility for the aged. The contradiction between demand side and supply side is prominent. This project aims at the research of difference and quantification of various influencing factors involved in community medical-nursing combined care, and proposes the concept and calculation method of “the index of medical-nursing combined care”. The index could reflect the differences of the senior citizens’ needs for medical care in different age groups, physical conditions and disease types, as well as the differences in the structure of the elderly population in different communities. Effective demands are translated into quantitative indicators such as facility scale and combined elements by using the index. And on this basis space design strategies of residential facility for the aged are summarized to meet the needs of elderly. According to the current situation of existing resources in community, it puts forward the appropriate combined pathway and method. At last the quantitative indicators-design methods coupling analysis is carried out so as to construct the menu of spatial pattern corresponding to community environment, which could provide advice for scientific design of medical-nursing combined care residential facility for the aged in community.

在我国养老事业快速发展的大背景下，“医养结合”与“原址养老”已成为社区养老居住设施的发展趋势。但在当前养老居住设施的发展建设中既存在养老床位总数严重不足与部分设施床位空置率过高的问题，还存在对医养结合的模式、内容把握不清导致空间设计不合理的问题，需求侧与供给侧矛盾突出。本项目针对社区医养结合的各种影响因素进行差异性和定量化研究，提出“医养指数”的概念及计算方法。“医养指数”能够反映不同年龄段、身体状况和病类老年人对医疗护理需求的差异，以及不同社区老年人口结构等诸多因素的差异，利用“医养指数”将有效需求转译为设施规模、医养结合要素等量化指标，归纳出满足老年人医养需求的设施空间设计策略。根据社区既有资源现状，提出医养结合的途径与方法。对量化指标和设计方法进行耦合分析，构建与社区环境相适应的空间模式菜单，为社区医养结合养老居住设施的科学化设计提供依据。

我国正处于迅速老龄化的过程中，老年人医护需求迫切。在社区建设医养结合养老居住设施已经成为发展趋势，既满足了老年人“居家养老”需求，又能充分借助国家大力发展的社区医疗资源。然而在当前养老居住设施规划建设中，存在床位严重不足和床位空置率过高两种现象并存的问题，需求侧与供给侧矛盾突出。本项目对社区医养结合的各种影响因素进行了差异性和定量化分析，提出“医养指数”的概念及计算方法。“医养指数”能够反映不同年龄段、不同身体状况和不同病类的老年人对医疗护理需求的差异。根据不同社区老年人口结构等因素，利用“医养指数”将有效需求转译为设施规模、医养结合要素等量化指标。研究得出：不同年龄段老年人医养护理需求呈现复杂的非线性关系。人的衰老过程和患病机理有其规律性，可通过大量调查统计计算，用一个指标体系表述这种非线性关系，即提出医养指数。利用医养指数结合社区老年人年龄结构，便可较精准地计算出设施规模。其中，社区老年人医养护理的客观需求大于主观需求，这是因为一部分家庭有家庭病床或经适老化改造，选择居家医养护理。对此，医养设施的床位可采用主观需求量，但医护设备、医药和护理人员仍应采用客观需求量，以备上门医护服务。本项目于2020年4月至9月期间调查收集了西安市17个社区3789名老年人相关数据。调查结果显示，老年人慢性病患病率为80.89%，共病率为47.11%。需求程度为保健需求(2.714)>医疗需求(1.940)>康复需求(1.372)；慢病管理(2.832)>心理健康(2.596)>运动处方(2.042)>应急医疗(1.957)>日常医疗(1.928)>康复护理(1.037)。本研究利用医养指数方法，对西安一些社区进行计算，表明即便是两社区老年人总数接近，但年龄结构不同，计算结果就有很大不同，更精准地反映了实际需求，解决了供需矛盾，取得很好的经济效益和社会效益。医养指数也可以应用于一个区域或城市总体医养需求的计算，可用以科学指导社区养老建筑的规划设计。