Long-term care system for older adults in China: policy landscape, challenges, and future prospects

Moderate drinking benefits cognitive health in middle-aged and older Chinese: A latent class growth model analysis based on CHARLS

While alcohol use among older population is linked to various health risks, recent studies indicate potential benefits from moderate consumption, highlighting a contentious debate regarding its impact on health in this demographic. This study aims to identify distinct trajectories of alcohol use among middle-aged and older adults in China and examine their associations with multidimensional health outcomes, including cardiovascular, cognitive, and psychological health. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), tracking a sample of 10,927 participants (54.33 % female; mean age = 57.61, SD = 8.95) through five waves of data collection. Latent Class Growth Modeling (LCGM) was employed to analyze alcohol use trajectories. Health outcomes were assessed through self-reported health measures and clinical data including lipoprotein levels. Four distinct alcohol use trajectories were identified: Moderate (6.3 %), Decreasing (11.0 %), Increasing (6.9 %), and Constantly Low (75.8 %). The Moderate trajectory was associated with significant higher cognitive scores compared to Increasing (p = .027) and Constantly Low group (p = .012). Moreover, higher levels of high density lipoprotein were linked with the Increasing and Decreasing trajectories, suggesting a protective cardiovascular effect. The findings highlight the complexity of alcohol use behaviors among older adults in China and underscore the need for targeted health interventions. Understanding the nuanced impacts of different drinking patterns on multidimensional health outcomes can aid in developing more effective public health strategies and clinical practices tailored to the needs of aging populations. Further research is recommended to explore the causal relationships and long-term health impacts of these trajectories.

The temporal trend in frailty prevalence from 2011 to 2020 and disparities by equity factors among middle-aged and older people in China: A population-based study

BACKGROUND

Frailty is a challenging issue in China, however the prevalence of frailty across different population groups and whether this is changing over time remain unclear.

METHODS

Unstandardized and age-and sex-standardized prevalence of frailty (95 % confidence interval (95 % CI)) (Frailty Index) in the overall sample and for subgroups defined by equity factors (PROGRESS-Plus framework) from 2011 to 2020 were estimated using analyses of cross-sectional surveys in adults aged 45 and older participating in 5 waves (N = 16,784 to 18,904 across waves) of the China Health and Retirement Longitudinal Studies (CHARLS). Poisson regression was used to estimate prevalence ratios (PRs) of frailty by equity factors.

RESULTS

Unstandardized prevalence of frailty increased from 13.6 % (13.0 %-14.1 %) in 2011 to 18.7 % (18.1 %-19.3 %) in 2020.The standardized prevalence increased from 13.5 % (13.0 %-14.0 %) in 2011 to 16.3 % (15.8 %-16.9 %) in 2020. Frailty was consistently more prevalent at advanced ages, in rural areas, among females, as well as those less educated, without social engagement, and non-drinkers. Based on the Poisson regression model, non-north region, being female and older, lower education, having no social engagement, smoking and non-drinking, and higher household capital consumption were associated with higher prevalence.

CONCLUSIONS

The prevalence of frailty among the middle-aged and older population in China has increased. There will be an associated health and social care cost. Interventions targeted at older adults, those in rural areas, women, as well as those less educated, having no social engagement, and non-drinkers to mitigate the negative effects of frailty may be warranted.

The impact of long-term care insurance on household expenditures of the elderly: Evidence from China

This study aims to investigate the impact of China's long-term care insurance (LTCI) pilot on household expenditures of the elderly. Utilizing the China Health and Retirement Longitudinal Study (CHARLS) 2015-2020 three-period longitudinal panel data, we examine the policy effects of LTCI using the Differences-in-Differences (DID) approach. The results indicate that the implementation of LTCI significantly reduces medical (p<0.05) and healthcare expenditures (p<0.05) for elderly households, while substantially increasing non-medical healthcare expenditures (p<0.01) and total expenditures (p<0.01). This effect is more pronounced for older households in rural areas or with lower levels of education. Furthermore, the improvement in household expenditures is strongly associated with the health status of the elderly and intergenerational economic support. These findings provide empirical evidence that LTCI enhances household expenditures and the quality of life for the elderly, which is crucial for the development of LTCI in China and other middle-income developing countries.

Long-term trends and future projections of liver cancer burden in China from 1990 to 2030

Liver cancer remains a significant public health issue in China, exhibiting high incidence, mortality, and burden. Understanding its temporal trends and projections is essential for designing targeted prevention and treatment strategies. This study analyzes long-term trends in liver cancer incidence, prevalence, mortality, and burden from 1990 to 2021, assessing age, period, and cohort effects, and projecting future trends. Data on liver cancer incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed from 1990 to 2021. Joinpoint regression analysis, age-period-cohort (APC) analysis, and BAPC modeling were applied to examine trends and project future trends. Decomposition analysis examined contributions of aging, epidemiological changes, and population growth. The study also compared China's liver cancer trends with global data. From 1990 to 2021, China experienced a decrease in age-standardized rates for liver cancer incidence, prevalence, mortality, and burden. Notably, Age-standardized incidence rates (ASIR) exhibited a decline after 2016, with a significant reduction in the male population. In 2021, there were 196,637 new cases of liver cancer in China, with a higher burden in males. ASIR were 14.34 per 100,000 for males and 4.89 per 100,000 for females. Mortality also followed a declining trend, with a notable decrease in age-standardized mortality rates. The age-standardized mortality rate (ASMR) for males was 12.4 per 100,000, significantly higher than for females (4.57 per 100,000) in 2021. Additionally, the age-standardized prevalence rate (ASPR) was 20.0 for males and 6.64 for females, with 265,539 total cases. The burden, measured by DALYs, YLDs, and YLLs, also showed a notable decline in age-standardized rates and significant gender disparities. Despite this, the absolute number of cases, deaths, and DALYs has continued to rise due to population growth and aging, with males bearing a significantly higher burden than females. The study also highlights the impact of aging, population growth, and epidemiological changes on liver cancer incidence and mortality in China. Projections for 2030 suggest a continued decrease in liver cancer incidence, especially among females, reflecting the effectiveness of public health interventions and medical advancements. However, gender disparities remain significant, and further efforts are needed to reduce the overall liver cancer burden, with an emphasis on early detection and prevention strategies.

A Systematic Review of Frailty Interventions in Community-Based Low and Middle-Income Settings

Objective

To synthesise evidence on the effectiveness of frailty interventions among prefrail and frail community-dwelling older adults living in low and middle-income countries (LMICs).

Methods

The four electronic databases, Embase, Ovid MEDLINE, Global Health, and APA PsycINFO, were searched until 25 September 2023. This review's protocol was registered on PROSPERO (CRD42022309998). There was no publication time or language restriction. Inclusion criteria included randomised controlled trials and other intervention types of frailty interventions that focussed on community-dwelling older adults (mean age of at least 60 years) with prefrail or frail living in LMICs. The meta-analysis could not be conducted because of the heterogeneity of frailty interventions.

Results

This systematic review included fifteen studies: eleven were single-domain interventions (exercise, nutritional supplementation, and nurse home visits), and four were multidomain interventions (exercise plus nutrition and exercise plus mindfulness). Some evidence from high-quality studies showed that physical exercise interventions successfully addressed frailty.

Conclusion

This systematic review highlights the scarcity of evidence on frailty interventions in LMICs, making it difficult to evaluate their effectiveness. Additional research is needed to focus on specific types of interventions.

Influence of Echocardiographic Criteria on the Prevalence and Prognostic Implication of Left Ventricular Hypertrophy: A Nationwide Population-Based Study

BACKGROUND

Echocardiographic criteria of left ventricular hypertrophy (LVH) recommended in the international guidelines are derived from a White population, which could be less accurate in estimating LVH burden in other ethnic groups. Given that LVH is an important prognostic factor, assessing its burden using ethnically specific criteria has important implications. We sought to evaluate the prevalence and prognostic implications of LVH based on the EMINCA (Echocardiographic Measurements in Normal Chinese Adults) study criteria and the international guidelines.

METHODS AND RESULTS

Nationally representative populations aged ≥35 years (n=20 210; mean age, 56.0 years; 53.3% women) were enrolled from the China Hypertension Survey 2012 to 2015. The EMINCA study criteria for LVH were left ventricular mass index >109 g/m2 for men and >105 g/m2 for women; and the international guidelines criteria were left ventricular mass index >115 g/m2 for men and >95 g/m2 for women. Prevalence of LVH defined by the EMINCA study and international guidelines was 8.3% (≈56.8 million) and 11.7% (≈80.1 million), respectively. LVH defined by the EMINCA study was associated with adjusted hazard ratio (HR) of 1.55 (95% CI, 1.19-2.01; P<0.001) for cardiovascular death and 1.14 (95% CI, 0.95-1.37; P=0.16) for all-cause death. LVH defined by the international guidelines was associated with adjusted HR of 1.31 (95% CI, 1.00-1.72; P=0.047) for cardiovascular death and 1.12 (95% CI, 0.94-1.34; P=0.22) for all-cause death.

CONCLUSIONS

LVH diagnosis based on both criteria was independently associated with cardiovascular death. However, the prevalence of LVH in a general Chinese population varies significantly by the echocardiographic criteria.

Impact of long-term care insurance on medical expenditure and utilization and the comparison between different pilot schemes: evidence from China

OBJECTIVE

This study investigates the effect of long-term care insurance (LTCI) on medical expenditure and utilization in China and compares the effects between different pilot schemes.

METHODS

We used four-wave data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018, covering 19 cities piloted by national government or local governments. We applied a staggered difference-in-differences (DID) strategy to identify the effect of LTCI. Heterogeneity tests were used to identify the effects of different pilot schemes.

RESULTS

We found that LTCI implementation significantly reduces inpatient expenditure, annual inpatient visits, and monthly outpatient visits by 13.4%, 0.033, and 0.072, respectively. The effects of LTCI become more pronounced in pilot cities with government subsidies in financing or higher reimbursement ceilings. Compared to pilot schemes covering UEBMI & URRBMI program, the schemes only covering UEBMI program could significantly reduce inpatient and outpatient frequency by 0.029 and 0.069. Pilot schemes with more service items had lower outpatient frequency (β = -0.146), and pilot schemes with fewer service items had lower inpatient expenditure and frequency (β = -0.226 and β = -0.049).

CONCLUSION

In general, this study found that LTCI implementation could effectively reduce the expenditure and utilization of medical services. The effects of different pilot schemes vary significantly. The results of this study further supplement the existing empirical evidence on the effect of LTCI and provide important policy implications for the future development of LTCI in China and other developing countries.

China's Social Health Insurance in the Era of Rapid Population Aging

Importance

This Special Communication addresses one of the most pressing health policy issues: the impact of population aging on the sustainability of social health insurance systems. It presents a comprehensive review of China's achievements as of 2024 in improving social health insurance schemes. Drawing on the most recent administrative and projection data, the challenges posed by demographic shifts, policy initiatives related to the long-term care system over the past decade, and its potential to alleviate pressure on health care resources are examined herein.

Observations

Over the past 3 decades, China has made significant progress in achieving universal health coverage through social health insurance schemes. These efforts have increased health care access and reduced out-of-pocket expenditures, leading to notable improvements in health outcomes and financial risk protection. However, China's rapidly aging population is driving up demand for intensive and costly care services, placing considerable pressure on the financial sustainability of its social health insurance funds. Additionally, low fertility rates and a rising dependency ratio have introduced new challenges in providing long-term care. Recent initiatives include integrating health care with long-term care services and introducing long-term care insurance programs, though these efforts remain in the experimental phase.

Conclusions and Relevance

In response to the evolving demographic landscape, maintaining a delicate balance between expanding health care benefits and ensuring financial sustainability will be crucial for the continued success of the health care system. Further research and evaluation of ongoing pilot programs will be essential in refining these strategies and achieving a more resilient and equitable system for health and long-term care for older adults. As the global population continues to age, the lessons learned from China's approach to health care and care for older adults will offer valuable insights for other developing countries facing similar demographic challenges.

Absence of care among community-dwelling older adults with dementia and functional limitations

Assistance with daily activities is crucial for persons living with dementia and functional limitations, yet many face substantial challenges in accessing adequate care and support. Using harmonized longitudinal survey data (2012-2018) from the United States, England, 18 European countries, Israel and China, we found that at least one-fifth of persons with dementia and functional limitations received no personal assistance for basic activities of daily living or instrumental activities of daily living, regardless of regional development level. Care gaps were widespread across both basic activities of daily living or instrumental activities of daily living limitations, as well as for informal and formal care. Disparities were evident, with less educated people more likely to lack formal care, whereas those living alone often lacked informal support, resulting in the absence of any care. Alarmingly, care availability showed no improvement over time. Our findings underscore the urgent need for policies to address inequities and ensure critical access to care services for this vulnerable population worldwide.

Changes of filial responsibility norms under public long-term care insurance in China

AIM

The public long-term care insurance (LTCI) scheme offers a potential solution to growing long-term care needs. This study investigated its effects on perceived filial responsibility norms and evaluated the heterogeneity of these effects.

METHODS

Using data from the 2014, 2016, 2018, and 2020 waves of the China Longitudinal Aging Social Survey, we focused on 10 042 older adults aged 60 and above living in communities. The quasi-experimental design of staggered difference-in-differences analyses with propensity score matching was employed to assess the policy effects.

RESULTS

The LTCI scheme significantly influenced perceived filial responsibility norms, reducing the likelihood of older adults believing that children should bear primary responsibility for their care by 6%. This effect was more pronounced among older adults who were more educated, lived with their children, or were in better health.

CONCLUSION

The implementation of the public LTCI scheme has had a negative impact on traditional filial piety in China. These findings highlight the importance for countries adopting LTCI or similar policies to develop strategies that prevent the excessive erosion of this cultural value. Geriatr Gerontol Int 2025; 25: 606-619.

Effect of family doctor contract services on non-communicable disease management among the elderly: a systematic review and meta-analysis

Objective

The aim of this meta-analysis was to examine the effect of family doctor contract service on managing non-communicable diseases (NCDs) among elderly patients.

Methods

Chinese and English articles published up to 15 July 2022 were systematically searched. Relevant randomized controlled studies (RCTs) were extracted from seven databases: PubMed, Coherence, Embase, Web of Science, CNKI, Wanfang Data, and WeiPu. All these studies have evaluated the effect of family doctor contract services on chronic disease management among the elderly. A meta-analysis was conducted using either random or fixed effects. Mean difference and risk ratio were used to analyze quantitative and qualitative data, respectively.

Results

We identified that 25 independent studies, involving 4,046 elderly patients with chronic diseases across China, were eligible for meta-analysis. The results from these RCTs indicated that family doctors could disseminate knowledge about NCDs to elderly patients, improve their disease management abilities (including drug compliance, healthy diet, regular exercise, non-smoking, and non-drinking), lower blood pressure and blood glucose levels, reduce BMI, and increase quality of life and patient satisfaction (P < 0.05).

Conclusion

Family doctor contract services could improve health management for elderly patients with NCDs and should be promoted in China.

High-content screening identifies ganoderic acid A as a senotherapeutic to prevent cellular senescence and extend healthspan in preclinical models

Accumulated senescent cells during the aging process are a key driver of functional decline and age-related disorders. Here, we identify ganoderic acid A (GAA) as a potent anti-senescent compound with low toxicity and favorable drug properties through high-content screening. GAA, a major natural component of Ganoderma lucidum, possesses broad-spectrum geroprotective activity across various species. In C. elegans, GAA treatment extends lifespan and healthspan as effectively as rapamycin. Administration of GAA also mitigates the accumulation of senescent cells and physiological decline in multiple organs of irradiation-stimulated premature aging mice, natural aged mice, and western diet-induced obese mice. Notably, GAA displays a capability to enhance physical function and adapts to conditional changes in metabolic demand as mice aged. Mechanistically, GAA directly binds to TCOF1 to maintain ribosome homeostasis and thereby alleviate cellular senescence. These findings suggest a feasible senotherapeutic strategy for protecting against cellular senescence and age-related pathologies.

Evaluation of long-term care insurance pilot city policies in China: a cross-sectional study

Background

The acceleration of China's aging process makes examining policy experiences from LTCI pilot cities highly significant for advancing the LTCI system in China and other emerging nations.

Methods

Policy documents were gathered using Citespace 6.3.R1, with primary data sources obtained from official government websites. A comparative study of LTCI policies in pilot cities was conducted, focusing on policy support, participation scope, financing channels, benefit provision, care conditions, and management structures to evaluate the programs' logic.

Results

Pilot cities have developed distinct approaches in the LTCI development process. However, issues persist, including a singular financing channel, misalignment between benefit provision supply and demand, substandard care quality, and the need for improved management effectiveness.

Discussion

Establishing a sustainable LTCI system requires implementing an independent financing mechanism and a standardized financial model, developing an efficient LTCI service supply framework, strengthening LTCI oversight and administration, and fostering the commercial insurance market.

Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study

BACKGROUND

The emergence of eHealth services could contribute to improving individuals' quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults' use of eHealth services.

OBJECTIVE

This study aimed to understand the perspectives of older adults (aged ≥65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups.

METHODS

This study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32%), nonimmigrants residing in rural areas (n=9, 36%), and Iranian immigrants residing in cities (n=8, 32%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory.

RESULTS

Interacting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64%), had insufficient digital skills (15/25, 60%), and experienced usability issues (15/25, 60%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults' interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults' needs to the design of eHealth services (10/25, 40%) and by supporting their digital skills (19/25, 76%).

CONCLUSIONS

Some older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults' needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults.

Influential Attributes on Medical Expense for Korean Older Adults Based on Mental Accounting: Panel Data Analysis Using Korean Longitudinal Study of Aging Data

Backgrounds: Korean society is entering an aging society, and this phenomenon indicates the need for preparation for aging in Korean society. In such a situation, exploring the characteristics of the elderly can be considered important for preparation. The objective of this study is to identify the determinants of medical expenses among older adults in South Korea. The key factors analyzed include food, leisure, and housing expenses, as well as lifestyle choices such as drinking and smoking. Method: Data from the Korean Longitudinal Study of Aging, covering 7374 observations from the years 2018 and 2020, are adopted for statistical analysis. This research explores the inverted-U-shape effect of food, leisure, and housing expenditures on medical costs, grounded in the concepts of diminishing marginal utility and mental accounting. A quadratic panel regression analysis is used to test the hypotheses, controlling for variables such as birth year, gender, and personal assets. Results: The results show that food and housing expenses have an inverted-U relationship with medical expenditures based on diminishing marginal utility and mental accounting as the theoretical foundation. However, leisure expenses, drinking, and smoking do not significantly affect medical expenses. Furthermore, this study identifies the optimal expenditure levels for maximizing medical spending through the first-order condition. Conclusions: These findings provide important insights for the development of policies aimed at improving the financial well-being of older adults in South Korea. Moreover, this study contributes to the literature by applying the concepts of mental accounting and the law of diminishing marginal utility to better understand the financial behavior of older adults.

Spatial equity and factors that influence the distribution of elderly care institutions in China

BACKGROUND

With China becoming an aging society, the number of elderly care institutions (ECIs) is continuously increasing in response to the growing population of older persons. However, regional disparities may lead to an uneven distribution of ECIs, which could affect equity in care. This study identified the limiting factors in the development of ECIs across different regions, thereby promoting equity in accessing care for the older population.

METHODS

This study utilised point-of-interest data on ECIs in China from 2018 to 2022. The spatiotemporal distribution of ECIs and the causes of disparities were assessed along four dimensions-economy, population, society, and environment-using research methods such as the standard deviation ellipse, rank-size rule, and multiscale geographically weighted regression.

RESULTS

There were significant differences between the ECIs of the eastern and western regions in China. The eastern region had a denser distribution and higher concentrations in primary cities. The proportion of the older population, regional economic development, and household income are crucial for a balanced distribution of ECIs, whereas the environmental impact is relatively minor.

CONCLUSIONS

The number of ECIs in China continues to increase, but improvements in regional disparities remain insignificant. The construction of ECIs is influenced by various factors; in underdeveloped regions, government initiatives are crucial for promoting equity in care for older persons.

Technology for sustainable living: The impact of digital inclusion on the health of China's elderly living alone

Enhancing elderly health has become an important measure for coping with population ageing and building a healthy China. Among them, older adults living alone seem to suffer from greater loneliness and psychological stress. We analyzed data from the China Health and Retirement Longitudinal Study in 2015, 2018, and 2020, and carried out an empirical investigation into the impact of digital inclusion on the health of elderly individuals living alone, using two-way fixed effects models and two-stage least squares. The findings suggest that digital inclusion could positively impact the health of older people living alone. Specifically, for a one-standard-deviation increase in digital inclusion, the depression scale score decreases by 0.48 (α = -0.21, p < 0.01); the cognitive function score increases by 0.27(α = 0.12, p < 0.01); the instrumental activities of daily living score would decrease by 0.11 (α = -0.05, p < 0.01). An increase of 1 in the digital inclusion score decreases the self-rated health score by 0.02 (α = -0.02, p < 0.01). It can significantly enhance the health status of elderly people who live alone through mechanisms of improving life satisfaction, increasing the utilization of preventive health care services, and promoting social participation. Subsequent analyses identified varying effects of digital inclusion on older adults living alone, influenced by their income and education levels. In particular, digital inclusion substantially enhanced instrument activities of daily living among the aged who lived alone and with higher income and educational backgrounds. However it had no significant effect on older people living alone with lower incomes and educational backgrounds. The insights from this study could be invaluable for policymakers in promoting broader adoption of digital technologies among older adults living alone.

Analysis of promotion and obstacles in long-term care grading services for home-based older adults with disabilities in China

Long-term care (LTC) grading services refers to professional assessors using specific tools to systematically evaluate people with long-term care needs,develop and implement graded service standards that align with the care needs of individuals based on their varying levels of disability.It has been nearly a decade since China initiated home-based long-term care for the disabled elderly; however, challenges remain, such as the lack of detailed graded service standards and inadequate allocation of medical and nursing resources. This study aimed to gain insights into factors about influencing the current system by understanding the perspectives of those directly involved in providing care and to promote LTC services for older adults with disabilities in China.Using purposive sampling, nurses and certified nursing assistants were selected as participants for this qualitative study. Data were analysed using deductive method, guided by the Association Standard for Long-Term Care Grading Services for the Elderly, the Consolidated Framework for Implementation Research, and the Capability, Opportunity, and Motivation-Behavior (COM-B) model.This study identifies five themes-innovation, external and internal environmental factors, personal characteristics, and implementation process-along with five promoting and six obstacle factors. It explores nurses and certified nursing assistants perspectives on home-based long-term care grading for individuals with disabilities, offering a theoretical basis for a Chinese-specific long-term care model.

Adverse events and contributing factors in Chinese nursing homes: a multisite cross-sectional study

Background

Adverse events in nursing homes, which are unintended incidents causing unnecessary harm to older residents. Previous studies in Chinese populations often focused on adverse events in hospitals, rather than residents in nursing homes. Additionally, they tended to focus on single incident rather than multiple types of adverse events. This study aims to assess the occurrence and contributing factors of multiple adverse events perceived by staff in Chinese nursing homes.

Methods

A cross-sectional survey was conducted among 691 frontline staff from 11 nursing homes in Southern China (August 2021-January 2022). Data were collected using a General Information Questionnaire, the Adverse Event Reporting Awareness Scale, and the Adverse Event Reporting Habit Scale. Logistic regression models were employed to analyze the contributing factors of adverse events.

Results

A total of 13 types of adverse events were screened out in nursing homes, and 477 (69.0%) participants reported that the adverse events "had happened" in the past year. The most common events were falls, unplanned extubation, and pressure sores. Clinical staff were 2.06 times more likely than frontline workers to report adverse events (95% CI = 1.13-3.76). Increased awareness (OR = 1.24, 95% CI = 1.15-1.34) and habitual reporting of adverse events (OR = 1.04, 95% CI = 1.01-1.08) were positively associated with higher reporting rates.

Conclusion

A significant proportion of staff reported adverse events, with clinical staff and those with better reporting habits noting higher occurrences. To enhance resident safety, nursing homes must prioritize preventing high-risk adverse events. Targeting frontline workers with lower reporting awareness and habits is crucial for effective interventions.

Exploring public attitudes of continuing care retirement communities in China: a sentiment analysis of China's social media Weibo

Introduction

The traditional family responsibility system faces challenges as China undergoes rapid demographic shifts with an increasingly older population. Recognizing the potential of market-driven senior care, Continuing Care Retirement Communities (CCRCs) have emerged as a significant alternative. However, cultural stigmas and concerns about the quality, services, and health of older adults in these facilities raise questions over their broad acceptance.

Methods

This study examines public sentiment toward CCRCs through sentiment analysis of 1,027,295 pre-processed Weibo posts. Utilizing Natural Language Processing (NLP) combined with fine-grained sentiment analysis and the Term Frequency-Inverse Document Frequency algorithm, the attitudes and emotions reflected in each data point are analyzed, identifying key contributing factors, and exploring the underlying reasons.

Results and discussion

The results reveal a predominantly positive sentiment toward CCRCs, emphasizing factors such as the living environment and government involvement. However, areas of concern, such as potential fraud and health and safety issues, remain. These findings both shed light on the public's acceptance or resistance to CCRCs for stakeholders and highlight the potential of social media analysis in shaping older people's care perceptions in today's China.

Fueling the development of elderly care services in China with digital technology: A provincial panel data analysis

Background

The global demographic shift towards an aging population presents significant challenges to elderly care cervices, which encompass the range of services designed to meet the health and social needs of older adults. Particularly in China, the aging society's diverse needs are often met with service inadequacies and inefficient resource allocation within the elderly care cervices framework.

Objective

This study aims to investigate the transformative potential of digital technology, which includes innovations such as e-commerce, cloud computing, and artificial intelligence, on elderly care cervices in China. The objective is to assess the impact of digital technology on service quality, resource allocation, and operational efficiency within the elderly care cervices domain.

Methods

Employing Stata software, the study conducts an analysis of panel data from 30 Chinese provinces over the period from 2014 to 2021, examining the integration and application of digital technology within elderly care cervices to identify trends and correlations.

Results

The findings reveal that the integration of digital technology significantly enhances elderly care cervices, improving resource allocation and personalizing care, which in turn boosts the quality of life for the elderly. Specifically, a one-percentage point increase in the development and adoption of digital technology within elderly care cervices is associated with a 21.5 percentage point increase in care quality.

Conclusion

This research underscores the pivotal role of digital technology in revolutionizing elderly care cervices. The findings offer a strategic guide for policymakers and stakeholders to effectively harness digital technology, addressing the challenges posed by an aging society and enhancing the efficiency and accessibility of elderly care cervices in China. The application of digital technology in elderly care cervices is set to become a cornerstone in the future of elderly care, ensuring that the needs of the aging population are met with innovative and compassionate solutions.

Establishing primary care physician commitment in Canadian long-term care homes: a protocol for a modified e-Delphi study

INTRODUCTION

The delivery of medical services by primary care physicians (PCPs) in long-term care (LTC) homes lacks consistency. There is no Canadian standard for PCP commitment in the LTC home setting, which can influence the quality of care delivered and resident health outcomes. The PCP's commitment to LTC practice is theorised as the proportion of a physician's practice dedicated to LTC, the number of residents for whom they provide care and the time spent on individual resident encounters. We aim to establish consensus on expectations concerning PCP commitment in Canadian LTC homes.

METHODS AND ANALYSIS

We describe a protocol for a two-round modified e-Delphi study assessing the consensus of an expert panel, guided by the RAND methodological guidance for conducting Delphi panels and the ACcurate COnsensus Reporting Document (ACCORD) guideline for healthcare-based consensus studies. We will recruit pan-Canadian experts who demonstrate extensive knowledge and experience in medical care delivery and medical practice models in the Canadian LTC sector. A literature review will generate a candidate list of statements constituting PCP commitment. The first round evaluates the relevance and feasibility of candidate statements through an online questionnaire. Panellists may also write open-ended, qualitative responses to add rationales, suggest alternatives and share new ideas. We will then host a virtual synchronous meeting to have an in-depth discussion about the results from round one. A second questionnaire will be distributed to evaluate the remaining statements that have not reached consensus, and any new statements added based on the same criteria.

ETHICS AND DISSEMINATION

The Hamilton Integrated Research Ethics Board (Project ID #17321) approved our study. The findings will be disseminated through manuscripts, presentations, and the lead author's thesis.

TRIAL REGISTRATION NUMBER

The ISRCTN Registry: #35125526.

Becoming eligible for long-term care insurance in China brought more ageing at home: evidence from a pilot city

Person-centered long-term care systems, integral to healthy ageing, should empower older people to achieve ageing in place. Yet evidence on the impact of the design of long-term care systems on older people's choice of place of ageing, especially that from developing countries, is limited. Taking the introduction of Long-Term Care Insurance (LTCI) in City X of China as a policy shock, we examined the impact of becoming eligible for LTCI on program beneficiaries' choice of place of ageing-institution or home-before they started to receive any actual benefit. Based on our analysis of the administrative data of all LTCI applicants between July 2017 and September 2020 from City X, we found that becoming eligible for LTCI increased an older-person's probability of choosing home as her place of ageing even before she received any benefit by ∼16%, and this positive impact was larger for those insured, of higher education level, or of higher disability grade. By bringing more ageing in place, LTCI in City X promoted healthy ageing. Our study suggests that the specifics of the LTCI program, such as who could receive subsidies, family values, and family members' engagement in the labor market, could all work together to shape the substitution pattern between home and institutional care.

A matching method for elderly care service personnel with multiple types of service expectations

With the rapid growth of the global aging population, the problem of providing for the elderly has become increasingly prominent. As a new model of providing for the elderly in China, home-based care has attracted more and more attention from all walks of life. The research on how to realize reasonable and effective matching between elderly care service personnel and the elderly under the home care model deserves attention and has important practical significance. In this paper, a matching method for elderly care service personnel considering multi-type service expectations is proposed. This approach involves first obtaining the actual values of the expectation indexes for each other, as well as the expectation requirements of the elderly and the service personnel. Next, we compute the satisfaction of the elderly and the service personnel for each other based on the elastic service expectation type, and finally, we make a decision about whom to choose based on the inelastic service expectation indexes. On this basis, the situation is considered that there are sufficient and insufficient elderly care service personnel, the two-sided matching models are constructed, respectively, and the optimal matching results are obtained by solving the models. Finally, an example is given to illustrate the feasibility and effectiveness of the proposed method.

Gender differences in later life: Labor supply responses to spousal disability

This study uses panel data from the 2011, 2013, 2015, 2018, and 2020 China Health and Retirement Longitudinal Study to examine the labor supply effects of spousal disability in later life. Employing a staggered difference-in-differences strategy, we provide causal evidence of gender-specific impacts, with a significant and enduring negative effect on female employment lasting over eight years, in contrast to minimal changes for males. The negative effect on female employment is particularly pronounced among low-educated individuals, those with agricultural hukou, and those influenced by stronger Confucian cultural norms. Mechanism analysis attributes the gender disparity to the caregiving effect and the health effect, with females experiencing increased caregiving responsibilities and health deterioration. We do not find enough evidence to support the added worker effect and the joint leisure effect. Furthermore, following the death of a disabled spouse, both genders exhibit an increased withdrawal from the labor market, with females increasingly assuming grandchild care responsibilities. These findings reveal the persistent gender differences in later life and suggest that policy interventions should prioritize the equitable allocation of social welfare resources to mitigate caregiving burdens faced by older women.

Innovative Dual-Decoupling CNN With Layer-Wise Temporal-Spatial Attention for Sensor-Based Human Activity Recognition

Human Activity Recognition (HAR) is essential for monitoring and analyzing human behavior, particularly in health applications such as fall detection and chronic disease management. Traditional methods, even those incorporating attention mechanisms, often oversimplify the complex temporal and spatial dependencies in sensor data by processing features uniformly, leading to inadequate modeling of high-dimensional interactions. To address these limitations, we propose a novel framework: the Temporal-Spatial Feature Decoupling Unit with Layer-wise Training Convolutional Neural Network (CNN-TSFDU-LW). Our model enhances HAR accuracy by decoupling temporal and spatial dependencies, facilitating more precise feature extraction and reducing computational overhead. The TSFDU mechanism enables parallel processing of temporal and spatial features, thereby enriching the learned representations. Furthermore, layer-wise training with a local error function allows for independent updates of each CNN layer, reducing the number of parameters and improving memory efficiency without compromising performance. Experiments on four benchmark datasets (UCI-HAR, PAMAP2, UNIMIB-SHAR, and USC-HAD) demonstrate accuracy improvements ranging from 0.9% to 4.19% over state-of-the-art methods while simultaneously reducing computational complexity. Specifically, our framework achieves accuracy rates of 97.90% on UCI-HAR, 94.34% on PAMAP2, 78.90% on UNIMIB-SHAR, and 94.71% on USC-HAD, underscoring its effectiveness in complex HAR tasks. In conclusion, the CNN-TSFDU-LW framework represents a significant advancement in sensor-based HAR, delivering both improved accuracy and computational efficiency, with promising potential for enhancing health monitoring applications.

Evolutionary game model for the behavior of private sectors in elderly healthcare public-private partnership under the condition of information asymmetry

Chinese elderly healthcare services face problems of poor service quality, difficulty in eliminating hidden quality risks, and inadequate government supervision, primarily due to information asymmetry and insufficient supervision among providers, users, and regulatory bodies. The study addresses two key questions: How does information asymmetry influence private sector strategies in elderly healthcare public-private partnership (PPP), and what regulatory models can overcome the potential shortcomings? The study examines the influence of information asymmetry, particularly on "experience" and "credence," crucial for governance and service quality in elderly healthcare PPPs in China. By developing the novel methodology of evolutionary game theory and employing MATLAB simulations, this study analyzes private sector behavior under two distinct regulatory models. The research findings reveal a significant disparity, under the traditional "single" model; private sectors often prioritize low-quality services driven by self-interest or inadequate penalties, while the collaborative model incentivizes them to deliver higher-quality services influenced by factors such as public participation, reputational incentives, and penalties. Therefore, the paper proposed a multifaceted regulatory model based on strengthening third-party evaluation mechanisms, encouraging public participation, and refining reward and penalty systems. This proposed model will not only significantly contribute to regulatory effectiveness and quality services within elderly healthcare PPP projects, but will also serve as a reference point for government decision-makers responsible for quality services within PPP projects.

Preferences of Integrated Care and the Influencing Factors Among Chinese Community-Dwelling Older Adults

Objective

Population aging and epidemiological transition have prompted requests for integrating health and social care. The goal of meeting complex care needs necessitates the understanding of preferred patterns among older adults. The study aimed to elicit the preferred care patterns and the influencing factors of integrated health and social care among community-dwelling older adults in multiple regions of China.

Methods

From a national survey, 1184 community-dwelling older adults in three cities across China were included in the study. Individual characteristics and preferred care patterns were measured. Five preferred care patterns were classified, including Home-based health and social care, Community-based health and social care, Home-based health care but community-based social care, Community-based health care but home-based social care, and Institution-based health and social care. Multivariate logistic regression and random forest model were applied to obtain reliable results.

Results

Overall, approximately half of the participants (47.7%) in the survey preferred Home-based health and social care and more than a quarter of participants (25.6%) preferred Community-based health and social care, followed by Institution-based health and social care (14.4%). A relatively small fraction of participants reported preferences for Home-based health care but community-based social care (8.0%) and Community-based health care but home-based social care (4.2%). Gender, age, education, living arrangement, resident city, income per month, access to medication, and self-care capability were significantly associated with older adults' preferences (p<0.05 each). Education, living arrangement, age, resident city, and income per month were the most relevant predictors, followed by gender, number of chronic diseases, self-care capability, and access to medication.

Conclusion

To effectively meet care needs, efforts should focus on home- and community-based care. Since the preferred care patterns were characterized by obvious variability, policymakers and service providers should carefully consider the differences in making tailored strategies.

A specific role of village doctors in reducing disparities: a quantile regression analysis of end-of-life medical care

BACKGROUND

In developing countries, the delivery of medical care to rural residents has been experiencing long-standing challenges and disparities. Since the 1960s, China has established the village doctors' system to provide preventive and primary care to improve rural residents' health. Nevertheless, how village doctors affect the medical spending and the end-of-life (EOL) quality for older people in rural China has not received sufficient attention. Family care has long been the mainstream of old age care in rural China, the accessibility to appropriate medical care is hence crucial. Village doctors are the most accessible medical care providers for rural older people. As a result, this study aims to uncover the importance of village doctors in EOL medical care for rural older people in China.

METHODS

The analysis is based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which has national representativeness and contains information about the oldest old at an average age of 80 in China, with available information from 2002 to 2019. We adopt the quantile regression to illustrate the heterogeneous impacts of village doctors on the EOL medical care spending from the distribution perspective. We then employ the ordered logit model and ordinary least squares regression to estimate the effects of village doctors on rural older people's EOL life quality measured by the status before dying and the number of bedridden days.

RESULTS

We find that the EOL medical care spending is significantly increased by the presence of village doctors, especially high-quality ones. The disparities in the EOL medical care in rural and urban China are significantly reduced by high-quality village doctors. However, high-quality village doctors are still insufficient to meet the needs of rural older people regarding the high-end EOL medical care. The empirical results suggest that village doctors can significantly improve older people's quality of life before death in rural China.

CONCLUSION

Our analysis highlights the importance of village doctors in providing EOL medical care to older people in rural China. It is crucial for governments to improve the village doctors' system, so that older residents in rural China can obtain high-quality EOL medical care services in their own communities and have a better quality of life before death.

Assessing the gap: Resource efficiency of institutionalised elderly care in urban and rural China

OBJECTIVES

The allocation of resources in elderly care institutions is directly linked to the well-being, quality of life and sustainable development of public health for the elderly. However, a disparity in elderly care resources between urban and rural areas exists. Therefore, this study aimed to explore resource allocation efficiency in China's urban and rural institutional elderly care.

STUDY DESIGN

Employing a mixed-methods approach, the research integrated quantitative analysis with spatial-temporal assessments to investigate spatial-temporal evolution patterns of resource allocation efficiency.

METHODS

A Projection Pursuit Evaluation Model (PPM) utilising an Accelerated Genetic Algorithm was applied to measure the input and output of urban and rural elderly care institutions. Data Envelopment Analysis (DEA) was used to visualise the static and dynamic efficiency. Spatial analysis techniques determined the spatial evolution of resources.

RESULTS

Significant disparities in resource allocation between urban and rural areas were identified, with rural areas facing declining numbers of elderly care institutions despite having a larger ageing population. The efficiency analysis revealed room for improvement in both urban and rural settings, emphasising the need to strengthen management and technology in elderly care institutions.

CONCLUSIONS

Addressing the challenges of elderly care in China requires policy reform, enhanced government support and stimulation of private investment, particularly in rural areas. A shift towards quality-focused elderly care and strategic investments is crucial for equitable and efficient service provision across China.

Prevalence and influencing factors of skin tears in older adults: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the prevalence and influencing factors of skin tears in older adults.

METHODS

The Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, WanFang Data, and CBM databases were searched to collect studies related to the prevalence and influencing factors of skin tears in older adults, and the search period was from inception to October 29, 2024. The examined literature was independently screened, data extracted, and evaluated for risk of bias, and the meta-analysis was performed using Stata17.0.

RESULTS

A total of 23 studies with a sample size of 59,489 older adults were included. Meta-analysis showed that the prevalence of skin tears in older adults was 6.5 % (95 % CI: 4.7 %-8.4 %, P < 0.01). A history of skin tears (OR = 9.30, 95 % CI: 1.66-52.25, P = 0.012), purpura (OR = 3.26, 95 % CI: 2.14-4.98, P < 0.01), and a risk of having a pressure injury (OR = 2.60, 95 % CI: 1.10-6.13, P = 0.029) were associated with skin tears in older adults.

CONCLUSIONS

Current evidence suggests that older adults have a high prevalence of skin tears. Skin tears in older adults are influenced by a history of skin tears, purpura, and a risk of having a pressure injury. Early screening should be conducted on the influencing factors of skin tears, and targeted intervention measures should be developed to reduce the impact of adverse outcomes on older adults and optimize the management of skin tears.

Why are people with dementia overlooked in long-term care insurance policy in Guangzhou, China?

BACKGROUND AND OBJECTIVES

There is a growing demand for dementia care to be funded by long-term care insurance (LTCI). However, evidence indicates that people with dementia are overlooked in China's LTCI policy and empirical research on this issue is notably scarce. Among the first seven LTCI pilot cities that officially enrolled people with dementia, Guangzhou is unique for roll-back LTCI policies related to eligibility criteria and benefits. This study aims to explore why people with dementia are overlooked in China's LTCI policy, using Guangzhou as a case study.

METHODS

Semi-structured interviews were conducted with stakeholders involved in LTCI need assessment and care delivery in Guangzhou. Eight LTCI assessment specialists, 22 formal caregivers, and six informal caregivers were interviewed from December 2021 to October 2022. Data was analyzed using NVivo 11.0 software and the Gilbert welfare framework to identify themes.

RESULTS

Interviewees reported that need assessment lacked a clear definition, were poorly supervised, and had high moral hazards. Challenges to care delivery included unprofessionalism of formal caregivers, shortage of resources, unprepared informal caregivers, a lack of a supportive environment and the negative impact of COVID-19. DISCUSSION AND IMPLICATIONS: People with dementia are overlooked in LTCI policy which may result from difficulties in implementing dementia-related assessment criteria, and hampered service delivery due to a shortage of skilled caregivers. These issues need to be carefully considered before scaling up the coverage of LTCI policy nationwide.

Mapping an evidence-based end-of-life care framework for older adults in Chinese nursing homes: protocol for a scoping review

INTRODUCTION

End-of-life care is essential for older adults aged ≥60, particularly those residing in long-term care facilities, such as nursing homes, which are known for their home-like environments compared with hospitals. Due to potential limitations in medical resources, collaboration with external healthcare providers is crucial to ensure comprehensive services within these settings. Previous studies have primarily focused on team-based models for end-of-life care in hospitals and home-based settings. However, there is a lack of sufficient evidence on practices in such facilities, particularly for Chinese older adults. The aim of this scoping review is to map the existing literature and inform the development of an appropriate care framework for end-of-life care in nursing homes. The focus of this article will be on the scope of services, guidelines for decision making, roles within interdisciplinary teams, and the practical feasibility of care provision.

METHODS AND ANALYSIS

A systematic search will be conducted across nine electronic databases: PubMed, Scopus, EMBASE, Cochrane, PsycINFO, ERIC, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The search will identify literature published in English and Chinese from January 2012 onwards. Articles will be selected based on their relevance to older adults aged ≥60 with disabilities or life-threatening chronic conditions receiving end-of-life care in nursing homes or similar settings. The data extraction process will be guided by the Canadian Hospice Palliative Care Association model (CHPCA) and the Respectful Death model. Qualitative data analysis will be performed using a framework method and thematic analysis, employing both inductive and deductive approaches, with three reviewers participating in the review process.

ETHICS AND DISSEMINATION

Ethical approval is not required because the data for this review is obtained from selected publicly available articles. The results will be disseminated through publications in peer-reviewed journals and presented at relevant conferences. Furthermore, the findings will be shared with policymakers and healthcare professionals engaged in end-of-life care to inform practice and decision making.

STUDY REGISTRATION

The review protocol has been registered on osf.io (https://osf.io/3u4mp).

Evaluating the impact of a pilot programme for home- and community-based services on long-term care needs among older adults in China

China is facing escalating demand for long-term care (LTC), prompting the central government to launch a 5-year pilot programme to strengthen home- and community-based services (HCBS) from 2016 to 2020. However, the effects of this pilot programme on LTC needs remain unknown. This study aimed to evaluate the programme's impact on LTC needs of older adults. Using panel data from the China Health and Retirement Longitudinal Study (N = 3,327), we evaluated the effects of the programme using a combined approach of propensity score matching and difference-in-differences. We found that the implementation of the HCBS programme reduced the number of unmet needs for assistance with instrumental activities of daily living (IADL) and delayed the progression of IADL limitations among older adults. However, no significant impact was found on the number of unmet needs for assistance with activities of daily living (ADL) or the progression of ADL limitations. Heterogeneity analysis showed that the effects of the HCBS programme on ADL and IADL limitations were weaker among those living in the Eastern region, and the effects on ADL limitations were stronger among those living with other people in the same household. Our findings suggest that implementing the HCBS programme can effectively address unmet care needs and delay the decline in functional capability among older adults. However, special attention should be paid to older adults living alone to mitigate the inequalities in functional limitations.

Disease Burden of Parkinson's Disease in Asia and Its 34 Countries and Territories from 1990 to 2021: Findings from the Global Burden of Disease Study 2021

INTRODUCTION

The increasing global population and aging have made Parkinson's disease (PD) a significant public health concern. Comprehensive evaluations of PD burden trends in Asian subregions and countries are lacking. This study investigated PD burden in Asia from 1990 to 2021, categorized by age, sex, and region.

METHODS

Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were analyzed to assess the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) across five Asian subregions and 34 countries/territories, using joinpoint regression, decomposition analysis, frontier analysis, and Bayesian models to examine changes, influencing factors, and predict future trends.

RESULTS

In 2021, the age-standardized PD incidence and prevalence in Asia were higher than the global average, particularly in East Asia (24.16 and 243.46/100,000, respectively). From 1990 to 2021, the incidence of PD in Asia rose by 198.01%, its prevalence rose by 284.35%, mortality rose by 111.27%, and DALY rose by 144.45%. Males consistently presented a greater PD burden than females did, with a growing sex gap over time. PD burden increased with age, especially among those aged 65 years and older. Population aging was the primary driver of new PD cases, and increasing etiological factors led to more patients. Inequalities in the PD burden have increased between high- and low-income areas, with low-income regions being more affected. By 2036, PD incidence is projected to increase in all subregions except the high-income Asia-Pacific region, with males experiencing a higher rate of increase.

CONCLUSION

The PD burden in Asia has significantly increased over the past three decades, particularly in middle-aged and elderly males, middle- and low-SDI countries, and individuals already suffering from PD. The increasing incidence and aging population necessitate the reallocation of medical resources, improved chronic disease management systems, stronger public health interventions, and sustainable development efforts. Research into etiological factors, pathogenesis, early diagnosis, preventive interventions, and regional management is critical.

Motivations behind end-of-life care: a qualitative study of Iranian nurses' experiences

BACKGROUND

Providing high-quality end-of-life care is currently a paramount health priority. Given that the standard of care is intrinsically linked to nurses' motivations, it is becoming too imperative to explore the contributing factors Consequently, this study was undertaken to elucidate the experiences of Iranian nurses regarding their motivation for delivering end-of-life care.

METHODS

This research is a qualitative, descriptive inquiry employing conventional content analysis, carried out at two governmental hospitals in Gorgan, northern Iran, from February to July 2023. 12 nurses were purposefully selected to participate in the study, ensuring maximal diversity. The data were collected through semi structured interviews and analyzed using Graneheim and Lundman's five-step method. The coding process was facilitated by the useof MAXQDA version 10 software. To establish rigor, the four criteria outlined by Guba and Lincoln were applied.

RESULTS

the participants included eight women and four men with an average age of 39.6 ± 6.31 years. The data analysis yielded five main categories and fifteen subcategories. The main categories were: "The Foundations of professional care in nursing", "Core Drivers in Optimal End-of-Life Care", "Family Involvement in End-of-Life Care", "Incorporating Spiritualism in Care" and "Dominant motivational Issues Within the Caregiving Atmosphere".

CONCLUSIONS

This study delineates the experiences that influence the provision of end-of-life care from the perspective of Iranian nurses. Innate traits such as empathy and a passion for nursing, in addition to nurses' moral compass and spiritual beliefs, serve as pivotal motivational stimuli. Leveraging these findings can be instrumental in shaping healthcare practices and policies to enhance the quality of end-of-life care.

Inequalities in Unmet Needs for Healthcare Services Among Middle-Aged and Older Adults in China

Unmet needs for healthcare services are widely recognized as an indicator of inequalities in healthcare access and utilization. This study estimated inequalities in unmet needs for healthcare services as well as their contributing factors and reasons among middle-aged and older adults in China. Results indicated that 30.47% and 5.69% of the middle-aged and older population in China reported unmet needs for outpatient and inpatient services, respectively. Mostly pro-poor inequalities concerned unmet needs for both rural and urban residents. The coverage of public health insurance and individuals' health status contributed most to the inequalities in the unmet needs identified. The most prevalent reason for unmet needs was affordability, especially for poor or rural respondents. Despite the rapid development of universal healthcare, unmet needs for healthcare services still existed and remained high among people living in rural areas and with low incomes in China. Policy interventions should focus on improving the public health insurance system and targeting financial barriers to obtaining care, particularly vulnerable populations in China.

Combination of ultrasound guided superficial cervical plexus block and local infiltration for oromaxillofacial surgeries: a case series

Introduction

When elderly patients have underlying diseases combined with oromaxillofacial diseases requiring surgical treatment, the application of conventional general anesthesia (GA) for oromaxillofacial surgical diseases has become a risk due to underlying disease reasons. The objective of this study was to evaluate the efficacy and safety of ultrasound-guided superficial cervical plexus block (SCPB) anesthesia combined with local infiltration anesthesia (LIA) for partial oral and maxillofacial surgery (OMFS) in patients who with risk for GA due to underlying disease.

Methods

The clinical data of 7 high risk patients with OMFS treated with SCPB anesthesia combined with LIA were retrospectively analyzed. All seven surgeries were performed on one side of the neck. All patients were given ultrasound-guided SCPB anesthesia by the same anesthesiologist, LIA by the same surgeon, and surgery was performed under continuous Electrocardiogram (ECG) monitoring.

Results

Seven patients had stable vital signs and no significant postoperative complications. The results of this study indicated that SCPB anesthesia combined with LIA is a safe and effective anesthesia technique with a high success rate and patient tolerance.

Discussion

For patients with OMFS who have a risk for GA due to underlying diseases, ultrasound-guided cervical superficial plexus block anesthesia combined with LIA is a safe and effective alternative to conventional GA.

Utilization of home-based care and its buffering effects between dementia caregiving intensity and caregiver burden in China

BACKGROUND

Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited.

METHODS

Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden.

RESULTS

A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (β = 0.26, p < .001; β = 0.16, p < .01). However, attendance and time of supervision tasks were not significant predictors of burden. HBC services in China comprised four dimensions: Referral service, Household care, Skilled care, and Mental health service. While these did not directly predict caregiver burden, they moderated the associations between ADL-based tasks and caregiver burden (β=-0.25, p < .001; β=-0.24, p < .001; β=-0.23, p < .001; β=-0.20, p < .001), between time of ADL-based tasks and caregiver burden (β=-0.17, p < .001; β=-0.18, p < .001; β=-0.17, p < .001; β=-0.15, p < .01), and between the attendance at supervision tasks and caregiver burden (β=-0.11, p < .05; β=-0.20, p < .001; β=-0.17, p < .001; β=-0.17, p < .001). Only Referral service buffered the relationship between supervision time and caregiver burden (β = -0.13, p < .01).

CONCLUSION

Informal caregivers of PwDs face high caregiving intensity and burden. HBC services may moderate this relationship, with different services playing varying roles. Further research is essential to explore the impact of supervision levels and develop effective strategies to enhance HBC services for dementia caregiving in China.

Health Effect of Elderly Family Planning Subsidy on Older Chinese with Only One Child

The decades-long one-child policy in China has led to a growing number of older individuals with only one child. The Elderly Family Planning Subsidy (EFPS) policy was introduced to provide extra financial support to this group and was expanded nationwide in 2012. This study investigated the relationship between EFPS use and health among EFPS-eligible older Chinese using data from the China Health and Retirement Longitudinal Study. A total of 1,981 respondents were eligible for EFPS (i.e. aged 60 and above, had only one child, or were rural residents with two daughters). Respondents self-reported if they received EFPS in 2011, 2013, and 2015 and were followed up to 2018. Propensity score matching was used to match EFPS non-users with users based on their probability of using EFPS. Among the EFPS-eligible respondents, 256 (12.92%) used the benefit. Analysis revealed no significant differences between EFPS users and non-users with respect to mortality and other health outcomes (i.e. self-reported health, cognition, activities of daily living, chronic diseases, and depressive symptoms). Findings do not provide evidence that EFPS improved the short-term health of older Chinese with only one child.

Understanding Organizational Resilience of Care Homes for Older People During COVID-19 in China: A Qualitative Study with Post-Pandemic Policy Implications

The COVID-19 pandemic presented unprecedented challenges for residential care homes for older people. However, the obstacles they faced and their resilience strategies have received insufficient research attention. This study, focusing on 13 residential care homes in Southeast China, addressed this research gap. The homes were visited between February and March 2023; 38 staff members (managers, nurses, social workers, and care workers) were interviewed. Thematic analysis revealed that the homes faced multidimensional challenges, including infection risks, declining mental health among residents, heavy workloads, and financial difficulties. Despite these challenges, they exhibited organizational resilience, primarily in their ability to cope with immediate issues during the pandemic, although their capacity to anticipate and adapt was weak. Factors influencing organizational resilience included their knowledge base, critical resources, a stable team with high morale and motivation, better integration of healthcare services, and government anti-COVID policies. This research highlights valuable insights for improving the quality of care in residential care homes in the post-pandemic era and in aiding policymakers and administrators in strengthening the organizational resilience of residential care homes in future crises.

Challenges in Accessing Community-Based Rehabilitation and Long-Term Care for Older Adult Stroke Survivors and Their Caregivers: A Qualitative Study

Background and Objectives

While extensive research has examined the rehabilitation challenges faced by stroke survivors, there is limited literature addressing the difficulties encountered by older adult stroke survivors and their caregivers in accessing rehabilitation and long-term care within the Chinese community. This study aimed to investigate the specific challenges related to access, quality, and coordination of rehabilitation and long-term care experienced by older adult stroke survivors and their caregivers within the Chinese community.

Methods

A qualitative phenomenological design was employed to explore the lived experiences of stroke survivors and their caregivers within the Chinese community. A purposive sampling method was used to recruit participants from June to August 2023. Participants engaged in face-to-face semi-structured interviews. The data were analyzed using an inductive thematic analysis approach to identify and understand key themes and sub-themes.

Results

The study involved 38 participants, consisting of 21 older adult stroke survivors (13 males, 8 females) and 17 family caregivers (7 males, 10 females), recruited from five Chinese community health service stations. The analysis identified four distinct themes and 11 sub-themes that encapsulated the challenges faced by participants. These themes include (1) Difficulties in accessing medical services (insufficient medical resources, lack of rehabilitation resources, and time-consuming processes), (2) Challenges in daily life (inconvenience in daily mobility, inadequate financial support, and difficulties in applying for home care services), (3) Psychosocial stress (loneliness, powerlessness, and worry about burdening others), (4) Insufficient information (lack of awareness of available community services, and limited public health education activities).

Conclusion

Older adult stroke survivors and their caregivers in Chinese communities face significant challenges. To improve their well-being and quality of life, it is crucial to address these challenges through enhanced access to healthcare, better support for daily living, and more effective information dissemination. Meeting these needs requires a coordinated effort from healthcare providers, community stakeholders, and policymakers to develop and implement effective, long-term care solutions.

From Online to Offline: How Different Sources of Online Health Information Seeking Affect Patient-Centered Communication in Chinese Older Adults? The Roles of Patient Activation and Patient-Provider Discussion of Online Health Information

Despite the increasing prevalence of online health information seeking (OHIS) among older adults, its impact on patient-centered communication (PCC) outcomes remains unclear. Drawing from Street's ecological framework of communication in medical encounters, the present study examined the mediation role of patient activation in the relationship between OHIS across three media channels - social media, search engines, and mobile health applications (mHealth apps) - and PCC. Furthermore, it examines the moderation effect of patient-provider discussions of online health information. A national survey of 916 older Chinese adults aged 60-78 was conducted. The findings indicate that OHIS across the three channels can indirectly enhance PCC through patient activation. Moreover, OHIS via mHealth apps is positively associated with PCC, while the relationship between OHIS via social media/search engines and PCC is not significant. The interaction between patients and healthcare providers regarding online health information positively moderated all indirect paths. Notably, a great proportion of older adults (77.7%) engaged in discussions about online health information with healthcare providers. These findings emphasize the importance of considering various media channels and highlight the pivotal role of patient activation in bridging the gap between OHIS and satisfactory healthcare interactions, especially in the Chinese context.

Does Social Support Alleviate the Caregiving Burden of Adult Children? Evidence from Chinese Long-Term Care Insurance Pilot Program

In China, and many other developed nations, public long-term care insurance (LTCI) is a commonly adopted approach to meet long-term care needs, but its impact on the burden of family caregivers remains uncertain. This study investigated whether a parent having LTCI alleviates the caregiver burden for the adult child caregiver. Data derived from the 2011, 2013, and 2018 China Health and Retirement Longitudinal Study (N = 4595 adult child caregivers). Guided by the stress-appraisal model, Difference-in-Difference (DID) methods were used to investigate the spillover effects of LTCI on caregiver stressors and burden. The results show that having public LTCI in place in a location is associated with reduced caregiver burden among adult child caregivers through its effects on secondary stressors (wealth, health, and sleep problems) and hours of caregiving. Findings suggest that the LTCI is an effective form of social support for aiding family caregivers and alleviating their burden.

Multilevel Factors Influencing the Requirement for Geriatric Nursing by Older Adults Living With HIV: A Cross-Sectional Study

Objectives

People living with HIV are aging. This study aimed to assess the factors influencing the requirements for geriatric nursing of older adults living with HIV (OALHIV).

Methods

Convenience sampling was used to conduct a survey on the 295 OALHIV aged over 50 in Luzhou, China.

Results

OALHIV had few needs for living care needs. Most people indicate a requirement for reducing medical costs. Regarding psychological comfort needs, disease privacy and confidentiality were the greatest requirement. Multivariable regression analyses found that social support had a positive influence on the requirements for geriatric nursing.

Conclusion

It is necessary to provide more social support for OALHIV. Most importantly, China should incorporate OALHIV into national pension security plan, integrate various resources and improve social security for them.

The impact of long-term care insurance on healthcare utilization and expenditures among middle-aged and older Chinese adults: a quasi-experiment study

BACKGROUND

Long-term care insurance (LTCI) is essential to alleviate the challenges of rapid aging. Research on LTCI in developing countries is limited and conclusions remain controversial. This study aims to empirically evaluate how the LTCI pilot in selected cities influences healthcare utilization and expenditures among middle-aged and older Chinese adults.

METHODS

Data was from 2013, 2015, and 2018 China Health and Retirement Longitudinal Study. 167 LTCI and 8225 non-LTCI group participants were identified. Propensity score matching difference-in-difference method was used to evaluate the net effect of LTCI. The robustness of the findings was tested using a placebo test.

RESULTS

In the pilot cities, around 17.8% of the population had LTCI coverage, with approximately 59.9% participating in urban employee medical insurance and 81.4% being urban residents. LTCI significantly reduced the monthly out-of-pocket outpatient expenditure by 313.764 yuan (P < 0.05), but had no significant effects on the inpatient utilization and expenditure. Further analysis of vulnerable subgroup revealed that LTCI decreased monthly outpatient visits frequency, total outpatient expenditure, and out-of-pocket outpatient expenditure by 0.523 times, 643.500 yuan, and 302.367 yuan, respectively (P < 0.05). Robustness tests confirmed the stability of these results.

CONCLUSIONS

The LTCI coverage rate has remained low. While LTCI has contributed to reducing outpatient utilization and expenditure, its impact on controlling inpatient-related outcomes is limited. It is recommended to broaden LTCI coverage beyond existing participants to encompass more vulnerable populations, and improve awareness and quality of LTCI services to achieve a significant effect on inpatient care.

Linking personal initiative and family help as well as social support: a case study of learning challenges and solutions for older adults in rural China during the COVID-19 pandemic

Background

The sudden outbreak of the COVID-19 Pandemic has caused serious damage to the continuous learning of older adults around the world. While the existing literature focused more on older adults' learning in developed countries, few studies explored older adults' learning in developing countries with low social and cultural capital.

Methods

This study took family-school cooperation in China as the platform and explored learning challenges and solutions through unstructured interviews with 12 older adults.

Results

The study found that due to policies of working and studying from home, older adults face obstacles in accessing physical learning institutions and digital learning knowledge, skills, and psychology. I further found that the older adults were not forced to accept the challenge passively, but created a lifelong learning model with Chinese characteristics by building self-learning based on personal initiative, developing sustainable intergenerational learning rooted in Chinese family culture, and participating in online learning in schools and enterprises under the government guidance.

Conclusion

This study provided new knowledge for understanding the learning challenges and solutions of older adults in rural China. It is emphasized that policy value and practice enlightenment were highlighted and discussed in conversations with active aging, intergenerational learning, and harmonious societies.

Inequity in the utilization of the home and community integrated healthcare and daily care services in older adults with limited mobility in China

BACKGROUND

This study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services ("home and community care services" for short) among older adults in China and to investigate the inequity in services utilization.

METHODS

Cross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.

RESULTS

About 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.

CONCLUSIONS

This current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.