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Abstract：
BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.
METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.
RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).
CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.
METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.
RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).
CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.
摘要：
背景：世界卫生组织（WHO）发布了老年人综合护理（ICOPE）框架，以帮助医疗保健提供者应对人口老龄化危机。然而,关于老年人需求和环境补偿能力的相关证据是有限的。这项研究首次报告了中国西部地区ICOPE需求水平，包括医疗资源地理可及性（GAMR）对ICOPE需求的影响以及健康状况的潜在机制。
方法：通过多阶段分层整群抽样，对1200名60岁及以上的成年人进行横断面问卷调查，以获取相关数据，包括ICOPE需求，健康状况,和GAMR。使用倾向评分匹配（PSM）分析了GAMR对老年人和不同健康状况人群ICOPE需求的影响。
结果：在前瞻性研究参与者中，1043符合研究条件。所有参与者的ICOPE需求平均得分为3.68（标准差[SD]=0.78）。在调整高和低GAMR组之间的协变量(1:1匹配)后，低GAMR组的ICOPE需求显著高于高GAMR组(治疗后的平均治疗效果[ATT]=0.270,p<0.05)。对于良好和不良的自我评估的健康状况，低GAMR组的ICOPE需求显著高于高GAMR组(ATT=0.345,p<0.05;ATT=0.190,p<0.05)。对于慢性病，低GAMR组老年多患病率患者的ICOPE需求明显高于高GAMR组（ATT=0.318，p<0.01）。
结论：中国西部老年人对ICOPE的需求相对较高。低GAMR是该地区ICOPE需求增长的关键因素。它加速了患有多种疾病和自我健康感知的老年人的需求释放。
方法：通过多阶段分层整群抽样，对1200名60岁及以上的成年人进行横断面问卷调查，以获取相关数据，包括ICOPE需求，健康状况,和GAMR。使用倾向评分匹配（PSM）分析了GAMR对老年人和不同健康状况人群ICOPE需求的影响。
结果：在前瞻性研究参与者中，1043符合研究条件。所有参与者的ICOPE需求平均得分为3.68（标准差[SD]=0.78）。在调整高和低GAMR组之间的协变量(1:1匹配)后，低GAMR组的ICOPE需求显著高于高GAMR组(治疗后的平均治疗效果[ATT]=0.270,p<0.05)。对于良好和不良的自我评估的健康状况，低GAMR组的ICOPE需求显著高于高GAMR组(ATT=0.345,p<0.05;ATT=0.190,p<0.05)。对于慢性病，低GAMR组老年多患病率患者的ICOPE需求明显高于高GAMR组（ATT=0.318，p<0.01）。
结论：中国西部老年人对ICOPE的需求相对较高。低GAMR是该地区ICOPE需求增长的关键因素。它加速了患有多种疾病和自我健康感知的老年人的需求释放。
