关键词: 老年人, 长期照护, 分级评估, 综合评价法

Abstract: Objective　To develop an integrative long-term care services grading model for the elderly receiving home-based care，community-based care，or nursing facility-based care. Methods　Item pool was established on the basis of literature review，theoretical analysis and qualitative interview. Delphi method was used to screen the items to form the Integrative Long-term Care Services Grading Questionnaire for the Elderly（ILCSGQE）.Then the questionnaire was used to a survey，and according to the results，its items were revised，then the item system was determined finally，and the reliability and validity of the model〔Integrative Long-term Care Services Grading Model for the Elderly（ILCSGME） 〕 with the item system derived from the questionnaire was tested. Comprehensive scoring method，trisection method，and cluster analysis were used to calculate the total score，item grading of the ILCSGME，and dependency state grading covered by the ILCSGME，respectively. Results　The final item system of the ILCSGME consists of 7 first-tier items and 119 second-tier items. The Cronbach's α for the 7 first-tier items ranged from 0.782 to 0.986，and the re-measured Pearson correlation coefficients were 0.917-0.980（P<0.05）. 4 first-tier items，activities of daily living，cognitive ability，fall risk and pressure ulcer risk were selected from the most widely used and mature scales. But other 3 first-tier items，medical and nursing services，abnormal manifestations/symptoms and needs of self-care knowledge were developed by our research team. The results of Bartlett's sphericity test ranged from 0.745 to 0.883. The common factors extracted by principal component analysis were 4，3 and 1 in turn，explaining 68.044%，59.492% and 65.395% of the total variance，respectively. After confirmatory factor analysis，the revised common factors were 4，4 and 3，respectively. The weights of the 7 first-tier items were 0.24，0.15，0.15，0.12，0.12，0.11 and 0.11，respectively. The total score calculated by the comprehensive scoring method were divided into 5 grades：independent，low dependency，medium dependency，high dependency and very high dependency. The higher the grade，the lower the total score was，indicating the intensity or difficulty of care for the elderly is greater.Conclusion　The 7 first-tier items in the ILCSGME were proved to have good reliability and validity. The comprehensive scoring method was easy to use when calculating the total score of the model，and the division of assessment for all grades of dependency state was good. So the model can comprehensively，concretely and accurately assess the dependence state of elderly people，and can provide an aid for the study of the classified pricing system of long-term care insurance.

Key words: Aged, Long-term care, Classification evaluation, Comprehensive evaluation