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Yu Y, Zhang J, Petrovic M, Zhang X, Zhang WH. Utilization of home- and community-based services among older adults worldwide: A systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104774. [PMID: 38703696 DOI: 10.1016/j.ijnurstu.2024.104774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To identify and categorize home- and community-based services used by older adults and the distribution of their utilization, and to examine their utilization patterns in terms of region, time trends, and older adults' characteristics. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic search of six databases for studies published up to January 12, 2023, and performed meta-analyses and subgroup analyses to identify the utilization of home- and community-based services and analyze utilization patterns concerning region, time trends, and individual characteristics. RESULTS We included 42 studies from 10 countries worldwide, involving a total of 2,942,069 older adults. Home- and community-based services were grouped into three categories: health services, social services, and family caregiver services. Regional differences were consistently evident across all three categories of services, reflecting diverse patterns of home- and community-based service adoption worldwide. Notably, there was a significant increase in the utilization of social services, as distinct from health services and family caregiver services, during the post-2010 period (2010-2018) in comparison with the pre-2010 period (before 2010). In addition, age and cognitive function also played an important role in the utilization of home- and community-based services. CONCLUSION These findings highlight the importance of tailoring home- and community-based services to specific populations and understanding the needs of older adults over time. Further research should be undertaken to gain a deeper understanding of the reasons behind these variations and differences and to provide more targeted and effective services to older adults worldwide.
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Affiliation(s)
- Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium; The Research Center for Medical Sociology, Tsinghua University, Beijing 100084, China
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Xudong Zhang
- Faculty of Management and Economics, Kunming University of Science and Technology, Kunming 650092, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium; School of Public Health, Université libre de Bruxelles (ULB), Brussels 1070, Belgium.
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Aierken A, Ding X, Pan Y, Chen Y, Li Y. Association between dependency on community resources and social support among elderly people living in rural areas in China: a cross-sectional study. BMC Geriatr 2022; 22:589. [PMID: 35842579 PMCID: PMC9288718 DOI: 10.1186/s12877-022-03247-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of dependency personality disorder (DPD) is high among elderly people living in rural areas. This study aims to explore the association between dependency on community resources and social support among elderly individuals living in rural areas. METHODS A cross-sectional study was conducted in 26 locations in China. A total of 1160 participants aged ≥ 60 years were selected using a complex multistage sampling design. All data were obtained using questionnaires via face-to-face interviews. DPD was measured using the Minnesota Multiphasic Personality Inventory-II in the standardized Chinese version. Self-efficacy was assessed using the Chinese version of the General Self-Efficacy Scale. Social support was measured using the Chinese version of the questionnaires of the Older American Resources and Services scale. Community services and resources comprised 44 items. The association between DPD and levels of social support and self-efficacy was evaluated using a logistic regression model. The association between social support and self-efficacy was assessed using analysis of covariance. RESULTS Univariate analysis results showed that elderly people living in rural areas had higher DPD scores and lower levels of self-efficacy compared with those living in urban areas (P < 0.001). Logistic regression analysis showed that DPD was positively associated with the received frequencies of community health service, contracted family doctor services, and regular lectures on health knowledge among the elderly people with odd ratios of 1.58 (P < 0.001), 2.03 (P = 0.013), and 2.67 (P = 0.005), respectively. Logistic regression analysis showed significant interaction between social support and self-efficacy effect on DPD was found in the additive model (P < 0.001). CONCLUSION DPD was associated mainly with the community resources among elderly people living in rural areas. Social support and self-efficacy were commonly associated with DPD through a synergistic effect. These results suggest that DPD among elderly people may be reduced through effective social support to directly and indirectly promote the elderly's use of community resources and improve their self-efficacy.
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Affiliation(s)
- Ayizuhere Aierken
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - XiWen Ding
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - YiYang Pan
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - Yuan Chen
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China
| | - Ying Li
- Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, Zhejiang, China.
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van den Bulck AOE, Elissen AMJ, Metzelthin SF, de Korte MH, Verhoeven GS, de Witte-Breure TAT, van der Weij LC, Mikkers MC, Ruwaard D. Identifying client characteristics to predict homecare use more accurately: a Delphi-study involving nurses and homecare purchasing specialists. BMC Health Serv Res 2022; 22:394. [PMID: 35337315 PMCID: PMC8957197 DOI: 10.1186/s12913-022-07733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Case-mix based prospective payment of homecare is being implemented in several countries to work towards more efficient and client-centred homecare. However, existing models can only explain a limited part of variance in homecare use, due to their reliance on health- and function-related client data. It is unclear which predictors could improve predictive power of existing case-mix models. The aim of this study was therefore to identify relevant predictors of homecare use by utilizing the expertise of district nurses and health insurers. Methods We conducted a two-round Delphi-study according to the RAND/UCLA Appropriateness Method. In the first round, participants assessed the relevance of eleven client characteristics that are commonly included in existing case-mix models for predicting homecare use, using a 9-Point Likert scale. Furthermore, participants were also allowed to suggest missing characteristics that they considered relevant. These items were grouped and a selection of the most relevant items was made. In the second round, after an expert panel meeting, participants re-assessed relevance of pre-existing characteristics that were assessed uncertain and of eleven suggested client characteristics. In both rounds, median and inter-quartile ranges were calculated to determine relevance. Results Twenty-two participants (16 district nurses and 6 insurers) suggested 53 unique client characteristics (grouped from 142 characteristics initially). In the second round, relevance of the client characteristics was assessed by 12 nurses and 5 health insurers. Of a total of 22 characteristics, 10 client characteristics were assessed as being relevant and 12 as uncertain. None was found irrelevant for predicting homecare use. Most of the client characteristics from the category ‘Daily functioning’ were assessed as uncertain. Client characteristics in other categories – i.e. ‘Physical health status’, ‘Mental health status and behaviour’, ‘Health literacy’, ‘Social environment and network’, and ‘Other’ – were more frequently considered relevant. Conclusion According to district nurses and health insurers, homecare use could be predicted better by including other more holistic predictors in case-mix classification, such as on mental functioning and social network. The challenge remains, however, to operationalize the new characteristics and keep stakeholders on board when developing and implementing case-mix classification for homecare prospective payment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07733-9.
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Affiliation(s)
- Anne O E van den Bulck
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Arianne M J Elissen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Silke F Metzelthin
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Maud H de Korte
- Department of Economics, Tilburg University, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.,Dutch Healthcare Authority (NZa), P.O. Box 3017, 3502 GA, Utrecht, The Netherlands
| | - Gertjan S Verhoeven
- Department of Economics, Tilburg University, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.,Dutch Healthcare Authority (NZa), P.O. Box 3017, 3502 GA, Utrecht, The Netherlands
| | | | | | - Misja C Mikkers
- Department of Economics, Tilburg University, P.O. Box 90153, 5037 AB, Tilburg, The Netherlands.,Dutch Healthcare Authority (NZa), P.O. Box 3017, 3502 GA, Utrecht, The Netherlands.,Tilburg Law and Economics Center (TILEC), Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI), P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Zhang W, Sun H. Formal and informal care received by middle-aged and older adults with chronic conditions in Canada: CLSA data. PLoS One 2020; 15:e0235774. [PMID: 32634161 PMCID: PMC7340302 DOI: 10.1371/journal.pone.0235774] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Background Middle-aged and older adults are more likely to suffer from chronic conditions, which can increase their need for both formal and informal care. This study seeks to assess and compare the extent to which the use of formal and informal care is attributed to different chronic conditions among middle-aged and older women and men in Canada. Methods We used baseline data from the Canadian Longitudinal Study on Aging (CLSA). Outcomes of interest were the number of hours of formal care and informal care received during the past 12 months. All chronic conditions were first classified according to existing classification frameworks. If total formal and informal care hours for a particular condition differed greatly from other conditions, we considered it as a stand-alone classification. We used a two-part model consisting of a logistic regression for the probability of receiving formal/informal care and a generalized linear model for the hours of formal/informal care for those who received care. Results Our final analytic sample was 23,206 women and 22,903 men who did not have missing data. Among the 16 chronic conditions considered, multiple sclerosis, memory problems, Parkinsonism, and stroke had the greatest average marginal effects on overall hours of formal care among women (53.07, 13.95, 9.13 and 8.14 incremental hours annually, respectively) and men (152.17, 8.13, 13.95 and 6.00 incremental hours). Similarly, the average marginal effects of these four conditions on informal care were the greatest (77.78, 29.52, 26.18 and 34.95 incremental hours for women and 133.94, 34.99, 104.86 and 17.85 incremental hours for men). Conclusions Chronic conditions, especially multiple sclerosis, Parkinsonism, memory problems, and stroke, are associated with substantial time of formal and informal care in middle-aged and older women and men. Findings will help decision-makers assess the potential impact of chronic disease prevention and management programs in an aging population.
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Affiliation(s)
- Wei Zhang
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- * E-mail:
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Vingare EL, Umb Carlsson Õ. Adaptation to care dependency in community care. QUALITY IN AGEING AND OLDER ADULTS 2017. [DOI: 10.1108/qaoa-05-2017-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore the lived experiences of adapting to care dependency among adults receiving health and social care in ordinary housing.
Design/methodology/approach
This was done by conducting a phenomenological study by interviewing ten adults, receiving home care services in ordinary housing.
Findings
Participants not only adapted by becoming a “good patient” but they had four strategies they used: sociability, distance, competence and compliance, contributing to a sense of dignity and personal safety.
Research limitations/implications
Further research is needed regarding how to preserve quality of care with adults with various ways of adapting to care dependency.
Practical implications
The relationship between professionals and adults in care dependency is a dynamic process where a need for understanding different modes of adaptation is vital. Good treatment and quality care may be different things to different adults, depending on what aspects of the process of adaptation concern them the most, and depending on their individual adaptation strategy.
Originality/value
This paper contributes to the understanding of modes of adaptation to care dependency from the perspective of adults indicating that working person centered may include respecting strategies not traditionally being associated with “the good patient.”
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