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Gao X, Tang Y. Association Between Community Elderly Care Services and the Physical and Emotional Burden of Family Caregivers of Older Adults: Evidence from Beijing, China. Int J Aging Hum Dev 2024; 99:247-262. [PMID: 38460958 DOI: 10.1177/00914150241238140] [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] [Indexed: 03/11/2024]
Abstract
The rate of usage of community elderly care services in China is low, and past studies about the effects of these services on caregiver burden domestically are few. This study used a large sample of Beijing census data (n = 55,634) to examine the impact of these services on caregiver burden. Logistic regression and propensity score matching were used to estimate the effects. The results showed that meal assistance, respite care, and spiritual comfort are all significantly associated with a lower likelihood of perceived emotional burden among caregivers, while only respite care is very significantly associated with a lower likelihood of feeling physically burdened. However, the effects of these services on caregiver burden also depend on the activities of daily living performance and location of residence of the care recipients. The practical implications for policy makers are discussed.
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Affiliation(s)
- Xiuwen Gao
- Postdoctoral Research Station of Theoretical Economics, Shenzhen University, China
| | - Yong Tang
- School of Government, Shenzhen University, China
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Chen T, Wei Y, Wang W, Yu Y, Shen X. Evaluating community-embedded elder care: A case study of supply and demand in Hangzhou, China. J Eval Clin Pract 2024; 30:1143-1152. [PMID: 38812124 DOI: 10.1111/jep.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION With China's urbanization and demographic shifts significantly affecting elder care, this study examines the alignment of community-based elder care services in Hangzhou's Hemu Community. It addresses the gap in understanding how these services meet the needs of an aging population in a rapidly changing social context. METHODS A comprehensive mixed-methods approach was utilized, involving interviews with community residents, observations of elder care service operations and thorough document analysis. The objective was to evaluate the adequacy, utilization and satisfaction levels concerning these elder care services. RESULTS The research identified that, although the services generally meet the community's needs, there are notable challenges in content specificity, quality assurance and promotional efforts. These challenges lead to resistance among older adults. Additionally, issues with service visibility and the lack of robust feedback mechanisms were noted. CONCLUSION This study highlights the critical need for a cooperative strategy involving government, community organizations, social entities and businesses in enhancing elder care services. It suggests that improvements in service visibility, content quality and targeted promotion are crucial to address the evolving needs of the aging population and to reduce reluctance in service utilization.
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Affiliation(s)
- Tianhao Chen
- Development Strategy and Cooperation Center, Zhejiang Lab, Hangzhou, China
- Zhejiang Laboratory of Philosophy and Social Sciences - Laboratory of Intelligent Society and Governance, Zhejiang Lab, Hangzhou, China
| | - Yujun Wei
- Development Strategy and Cooperation Center, Zhejiang Lab, Hangzhou, China
- Zhejiang Laboratory of Philosophy and Social Sciences - Laboratory of Intelligent Society and Governance, Zhejiang Lab, Hangzhou, China
| | - Wenyan Wang
- College of Education, Zhejiang University, Hangzhou, China
| | - Yayang Yu
- FESCO Adecco Zhejiang, Hangzhou, China
| | - Xinyi Shen
- China Search (Asia) Limited, Prosperity Millennia Plaza, Quarry Bay, Hong Kong, China
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Mei Q, Li W, Feng H, Zhang J, Li J, Yin J, Lukacs-Kornek V, Kurts C, Dai S, Zhao X, Ai Q, Yu C, Xu F, Xi X, Liu F, Song D, Wang Y, Zhong L, Ashford JW, Ashford C, Liu X, Wang H. Chinese hospital staff in anxiety and depression: Not only comfort patients but also should be comforted - A nationwide cross-sectional study. J Affect Disord 2024; 360:126-136. [PMID: 38815757 DOI: 10.1016/j.jad.2024.05.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Healthcare professionals are in short supply worldwide, especially in China, which can result in increased stress in the work environment and allostatic load for Chinese hospital staff. This study aimed to investigate the prevalence of anxiety and depressive symptoms and their relationship with total stress, allostatic overload, sleep quality, and episodic memory among Chinese hospital staff. METHOD In this cross-sectional study, self-assessments including Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire-9 (PHQ-9), PsychoSocial Index (PSI), Pittsburgh Sleeping Quality Index (PSQI), and MemTrax test were used to evaluate participants' anxiety symptoms, depressive symptoms, total stress, allostatic load/overload, sleep quality, and episodic memory. RESULTS A total of 9433 hospital staff from 304 cities participated. Anxiety prevalence was 21.0 % (95 % confidential interval (CI) 20.2 %, 21.8 %), while the prevalence of depressive symptoms was at 21.4 % (95 % CI 20.5 %, 22.2 %). 79.8 % (95 % CI 79.0 %, 80.6 %) of the hospital staff had allostatic overload. Poor sleep quality affected 50.4 % of participants, and 32.1 % experienced poor episodic memory. LIMITATIONS This study utilized a convenience sampling approach, relying on an online survey as its data collection method. CONCLUSIONS Hospital staff in China are facing a stressful environment with a high prevalence of anxiety and depressive symptoms, significant allostatic overload, poor sleep quality, and compromised episodic memory. It is imperative that local management and community structures enhance their support and care for these essential workers, enabling them to manage and withstand the stresses of their professional roles effectively.
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Affiliation(s)
- Qi Mei
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China; Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanling Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijing Feng
- Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Junyan Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Jian Li
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich Wilhelms University, Bonn, Germany
| | - Junping Yin
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich Wilhelms University, Bonn, Germany
| | - Veronika Lukacs-Kornek
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich Wilhelms University, Bonn, Germany
| | - Christian Kurts
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich Wilhelms University, Bonn, Germany
| | - Shujuan Dai
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China; Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming, China
| | - Xiaoxiao Zhao
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China; Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming, China
| | - Qinglong Ai
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China; Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming, China
| | - Chunlei Yu
- Department of Neurology, The Affiliated Anning First People's Hospital, Kunming University of Science and Technology, Kunming, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Chengdu, China
| | - Xiaoting Xi
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fang Liu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - DaoYuan Song
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, China
| | | | - Lianmei Zhong
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China; Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming, China
| | - John Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto HCS, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Xiaolei Liu
- Department of Neurology, The First Affiliated Hospital of Kunming Medical University, Kunming, China; Yunnan Provincial Clinical Research Center for Neurological Disease, Kunming, China; Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Hongxing Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Chen Y, Zhang Z, Yang E, Qing H, Wei Y, Tang S. The effect of family physician team processes on chronic disease management performance from a structural network perspective. BMC PRIMARY CARE 2024; 25:292. [PMID: 39127629 PMCID: PMC11316317 DOI: 10.1186/s12875-024-02550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE The family physician team has become the core carrier for delivery primary health care in China. This study aimed to measure the effect of the network structural characteristics of family physician team processes on health performance. Strategic recommendations for optimizing the family physician team processes with a view to improving performance were presented. METHODS A cross-sectional survey was conducted from October to December 2021 in Qianjiang in Hubei Province and Changsha in Hunan Province. Task performance, contextual performance, social networks, and sociodemographic characteristics were collected. Social network analysis was conducted to calculate density and centralization, then hierarchical linear regression analysis was employed to explore the relationship between the network structural characteristics of family physician team processes and performance. RESULTS In total, 88 family physician teams attended in this investigation. The transition processes of family physician team showed a distinctive low density (0.272 ± 0.112), high centralization (0.866 ± 0.197) network structure. For family physician team, the density of action processes significantly and positively affected task performance (B = 0.600, P < 0.05); the centralization of action processes positively affected task performance (B = 0.604, P < 0.01); the density of action processes positively affected contextual performance (B = 0.545, P < 0.01); the density of interpersonal processes significantly and positively affected contextual performance (B = 0.326, P < 0.05). CONCLUSION The network density and centralization of family physician team processes have positive effects on chronic disease management performance. The results from this study help to enhance our conceptual understanding of social network and its implications for team-dynamics. Optimizing family physician team processes is an effective way to strengthen the construction of family physician team and promote the quality and efficiency of family physician-contracted service. It is recommended to strengthen the management of team processes, enhance the internal collaboration mechanism, and optimize the centralized network structure of family physician team.
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Affiliation(s)
- Yixiang Chen
- Nanyang Central Hospital, Nanyang, Henan, 473000, China
| | - Ziyang Zhang
- Nanyang Central Hospital, Nanyang, Henan, 473000, China
| | - En Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Hua Qing
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Yilin Wei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Nie XY, Dong XX, Lu H, Li DL, Zhao CH, Huang Y, Pan CW. Multimorbidity patterns and the risk of falls among older adults: a community-based study in China. BMC Geriatr 2024; 24:660. [PMID: 39112944 PMCID: PMC11304791 DOI: 10.1186/s12877-024-05245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Due to the high prevalence of multimorbidity and realistic health service demands for fall prevention, there is growing interest in the association between multimorbidity and falls. Our study aimed to identify multimorbidity patterns among Chinese older adults and explore the association between multimorbidity patterns and falls. METHODS Data from 4,579 Chinese community-dwelling older adults was included in this analysis. Information regarding falls and 10 chronic conditions was collected. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of individual chronic disease or multimorbidity patterns with falls. RESULTS Among 4,579 participants, 368 (8.0%) were defined as fallers, including 92 (2.0%) frequent fallers, and multimorbidity affected 2,503 (54.7%) participants. Older adults with multimorbidity were more likely to be fallers [odds ratio (OR) = 1.3, P = 0.02] and frequent fallers (OR = 1.7, P = 0.04). Three multimorbidity patterns were identified (i.e., cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases), and the associations between psycho-cognitive diseases/organic diseases and prevalent falls or frequent falls were found to be significant. CONCLUSIONS The psycho-cognitive disease pattern and organic disease pattern are significantly associated with falls. Therefore, more attention should be paid to patients with psycho-cognitive diseases and timely, targeted diagnostic and treatment services should be provided in fall prevention.
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Affiliation(s)
- Xin-Yi Nie
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xing-Xuan Dong
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Heng Lu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Chun-Hua Zhao
- Department of General Medicine, Medical Big Data Center, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China
| | - Yueqing Huang
- Department of General Medicine, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, China.
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
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Bai G. Sources of Social Support and Depressive Symptoms Among Chinese Older Adults: A Moderated Mediation of Social Adaptation and Filial Piety. Int J Aging Hum Dev 2024:914150241268166. [PMID: 39105296 DOI: 10.1177/00914150241268166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
This study examined the mediating effect of social adaptation on the associations between sources of social support and depressive symptoms among Chinese older adults, and explored how filial piety moderated these associations in different ways. Data were drawn from the China Longitudinal Aging Social Survey in 2018 (N = 6617). Regression analysis and bootstrap test were used to assess the mechanisms underlying the inconsistency between different sources of social support and depressive symptoms. We found that social support, except for pension, significantly affected depressive symptoms through social adaptation. Moreover, filial piety positively moderated the mediating effect of social adaptation on the association between social support inside the family and depressive symptoms, while negatively moderating it in regard to social support outside the family, except for pension, and depressive symptoms. The results showed filial piety may affect the extent to which older adults convert different sources of social support into personal subjective welfare.
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Affiliation(s)
- Ge Bai
- School of Marxism, Chengdu University of Technology, Chengdu City, China
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Zhou X, Yi J, Bai L, Jiang M, Peng W, Liao J, Wang H, Hou X. Toward a Medication Information Literacy Indicator System for Older Adults: A Delphi Study. Health Expect 2024; 27:e14127. [PMID: 38940704 PMCID: PMC11212333 DOI: 10.1111/hex.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/11/2024] [Accepted: 06/16/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages. METHODS This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator. RESULTS The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults. CONCLUSIONS This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults. PATIENT OR PUBLIC CONTRIBUTION Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.
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Affiliation(s)
- Xiaoyu Zhou
- College of Medical InformaticsChongqing Medical UniversityChongqingChina
| | - Jia Yi
- College of Medical InformaticsChongqing Medical UniversityChongqingChina
| | - Li Bai
- Department of Science and EducationHospital of Zigong Mental Health CentralSichuanChina
| | - Mengyao Jiang
- College of Medical InformaticsChongqing Medical UniversityChongqingChina
| | - Wei Peng
- Department of EndocrinologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jing Liao
- College of Medical InformaticsChongqing Medical UniversityChongqingChina
| | - Hang Wang
- College of Medical InformaticsChongqing Medical UniversityChongqingChina
| | - Xiaorong Hou
- College of Medical InformaticsChongqing Medical UniversityChongqingChina
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Su W, Lin Y, Yang L, Zhang W, Dong Z, Zhang J. Prevalence and influencing factors of chronic diseases among the elderly in Southwest China: A cross-sectional study based on community in urban and rural areas. Prev Med Rep 2024; 44:102799. [PMID: 39045092 PMCID: PMC11263618 DOI: 10.1016/j.pmedr.2024.102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
Objective To explore the influencing factors affecting chronic diseases of elderly in Kunming. Methods Data were collected from November 2020 to August 2021.The crosssectional study based on community was adopted. And hierarchical random sampling was used. A face to face questionnaire survey was conducted among the respondents or family caregivers. The contents we collected mainly include general demographic characteristics and other related influencing factors, self-reported chronic diseases and disability status. Results 1161 elderly were investigated in total. The percentage of non-communicable chronic disease among the rural elderly was higher than that of urban elderly. Binary logistic regression analysis showed that in urban areas, female (OR: 0.592;95 %CI:0.396 ∼ 0.885), not in marriage (OR:1.643;95 %CI:1.093 ∼ 2.470)and not very satisfied with family support (OR:1.858;95 %CI:1.115 ∼ 3.096) are the influencing factors of chronic disease, while in rural areas are not in marriage (OR:1.961;95 %CI:1.021 ∼ 3.763), more health-promoting behavior (OR:0.582;95%CI:0.350 ∼ 0.970), not very satisfied with family support (OR:1.858;95 %CI:1.115 ∼ 3.096), age 70-79 (OR:1.805;95 %CI:1.705 ∼ 3.031), age 80 and above (OR:2.081;95 %CI:1.010 ∼ 4.288), empty nest family (OR:0.389;95 %CI:0.186 ∼ 0.811)and personal monthly income 2001-3000 (OR:0.353;95CI%:0.180 ∼ 0.693). The influencing factors of urban-rural multimorbidity and non-communicable chronic disease with disability also exist differences at individual, family and social levels. Conclusions The prevalence rate of non-communicable chronic diseases among the elderly in Yunnan Province is not optimistic. Personal, family and social factors would affect the non-communicable chronic diseases of the elderly and there exist difference in influencing factor of non-communicable chronic disease between urban and rural areas.
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Affiliation(s)
- Wenqian Su
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yan Lin
- Department of Otolaryngology, The First Affiliation Hospital of Kunming Medical University, Kunming, China
| | - Lingli Yang
- Department of Science and Technology Education, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenyang Zhang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Zhengjiao Dong
- Department of Nutrition, The Sixth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingjing Zhang
- School of Public Health, Kunming Medical University, Kunming, China
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Wang W, Roumell E, Xu C, Lu Z. Home Through Their Eyes: A Qualitative Exploration of the Meaning of Home for Persons With Dementia and Impact of Physical Environment During Meaning-Making. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae107. [PMID: 38863436 DOI: 10.1093/geronb/gbae107] [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: 01/03/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVES This study aimed to examine the meaning of home for persons with dementia and the role of the physical environment during their meaning-making process. In response to a growing number of persons with dementia, there has been a strong advocacy for prioritizing the development of dementia-friendly environments within design practice and research agendas, for which "home" has become one of the important loci. However, of the limited studies on the meaning of home from the perspective of those individuals who continue to live in their own homes after developing dementia, even fewer addressed this issue within the Chinese context. METHODS Five dyads, persons with dementia and their family caregivers, participated in the qualitative phenomenology study. Ten home visits-2 visits per dyad-were conducted, during which interview data, photographs, and field notes were collected. Phenomenological analysis was applied within and across the data sets. RESULTS Three key themes emerged-"Three Dimensions of Home" revealed that "home" goes beyond physical residence and immediate family connections, including meaningful objects and places, enduring relationships, self-identity, and lived experiences.; "The Impact of Physical Environment" and "The Impact of Cognitive Impairment" showed the complex interactions between the environment, cognitive impairment, and meaning-making. DISCUSSION An exploration of the essence of meaning of home within the Chinese context, in person-environment relationships with dementia progression, and implications for future research and practice on dementia-related environments and care were further discussed. This study contributes insights into enhancing the well-being of persons with dementia and benefiting their caregivers.
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Affiliation(s)
- Wenjin Wang
- Department of Landscape Architecture & Urban Planning, Texas A&M University, College Station, Texas, USA
| | - Elizabeth Roumell
- Department of Educational Administration & Human Resource Development, Texas A&M University, College Station, Texas, USA
| | - Chuanyue Xu
- Department of Architecture, Texas A&M University, College Station, Texas, USA
| | - Zhipeng Lu
- Department of Architecture, Texas A&M University, College Station, Texas, USA
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Xiao S, Bi Y, Chen W. What factors preventing the older adults in China from living longer: a machine learning study. BMC Geriatr 2024; 24:625. [PMID: 39039463 PMCID: PMC11265125 DOI: 10.1186/s12877-024-05214-8] [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: 03/28/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The fact that most older people do not live long means that they do not have more time to pursue self-actualization and contribute value to society. Although there are many studies on the longevity of the elderly, the limitations of traditional statistics lack the good ability to study together the important influencing factors and build a simple and effective prediction model. METHODS Based on the the data of Chinese Longitudinal Healthy Longevity Survey (CLHLS), 2008-2018 cohort and 2014-2018 cohort were selected and 16 features were filtered and integrated. Five machine learning algorithms, Elastic-Net Regression (ENR), Decision Tree (DT), Random Forest (RF), K-Nearest Neighbor (KNN), and eXtreme Gradient Boosting (XGBoost), were used to develop models and assessed by internal validation with CLHLS 2008-2018 cohort and temporal validation with CLHLS 2014-2018 cohort. Besides, the best performing model was explained and according to the variable importance results, simpler models would be developed. RESULTS The results showed that the model developed by XGBoost algorithm had the best performance with AUC of 0.788 in internal validation and 0.806 in temporal validation. Instrumental activity of daily living (IADL), leisure activity, marital status, sex, activity of daily living (ADL), cognitive function, overall plant-based diet index (PDI) and psychological resilience, 8 features were more important in the model. Finally, with these 8 features simpler models were developed, it was found that the model performance did not decrease in both internal and temporal validation. CONCLUSIONS The study indicated that the importance of these 8 factors for predicting the death of elderly people in China and built a simple machine learning model with good predictive performance. It can inspire future key research directions to promote longevity of the elderly, as well as in practical life to make the elderly healthy longevity, or timely end-of-life care for the elderly, and can use predictive model to aid decision-making.
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Affiliation(s)
- Shiyin Xiao
- School of Psychology, Guizhou Normal University, Guiyang, China
- Center for Big Data Research in Psychology, Guizhou Normal University, Guiyang, China
| | - Yajie Bi
- School of Psychology, Guizhou Normal University, Guiyang, China
- Center for Big Data Research in Psychology, Guizhou Normal University, Guiyang, China
| | - Wei Chen
- School of Psychology, Guizhou Normal University, Guiyang, China.
- Center for Big Data Research in Psychology, Guizhou Normal University, Guiyang, China.
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Wang Y. The impact of "Aging with Medical and Caregiving" on family caregiving-Evidence from China's pilot cities for integrating medical and caregiving. Geriatr Nurs 2024; 58:144-154. [PMID: 38810291 DOI: 10.1016/j.gerinurse.2024.05.026] [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: 01/19/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
Easing the pressure on family caregiving and addressing the shortage of manpower for family caregiving are significant challenges that China faces in responding to its aging population. This study utilizes data from the 2015 and 2020 China Health and Retirement Longitudinal Study (CHARLS) and employs a Difference-in-Difference method to investigate the impact of pilot policies that integration of medical and caregiving for aging individuals. The findings reveal that these pilot programs are successful in reducing the amount of time spent on family caregiving and the financial burden placed on families, effectively relieving the pressure associated with family caregiving. However, the effects of these programs differ depending on the level of disability, household registration, and the geographical location of the participants. Further analysis suggests that these pilot programs achieve these positive outcomes by increasing government investment in health and wellness funds and providing in-family medical and caregiving services.
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Affiliation(s)
- Yunhui Wang
- School of Public Administration, Sichuan University, Chengdu, China.
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Wang Z, Shi Y, Shao L, Xie X, Li X, Zhang J. Adverse event reporting attitude and its individual and organizational predictors among nursing staff: A multisite study in Chinese nursing homes. Geriatr Nurs 2024; 58:104-110. [PMID: 38788557 DOI: 10.1016/j.gerinurse.2024.05.015] [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: 01/30/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
This study explored the status of adverse event reporting attitudes and its predictors among nursing staff in Chinese nursing homes. A cross-sectional study was conducted with 475 nursing staff, and they completed sociodemographic and facility-related questionnaire, Incident Reporting Attitude Scale, Adverse Event Reporting Awareness Scale, and Nursing Home Survey on Patient Safety Culture. Univariate analysis and multiple linear regression models were performed. The mean score for adverse event reporting attitude was 125.87 (SD=15.35). The predictors included individual variables, such as education level (β=0.129, p = 0.001) and working years (β=-0.102, p = 0.007), and organizational variables, such as patient safety culture (β=0.503, p < 0.001) and adverse event reporting awareness (β=0.261, p < 0.001). These factors explained 35.3 % of total variance. Managers in nursing homes should strengthen team-targeted education and training for nursing staff with longer working years and lower educational backgrounds. Meanwhile, a simplified and non-punitive reporting system should be established to create positive safety management climate.
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Affiliation(s)
- Zhangan Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ying Shi
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Lu Shao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xiyan Xie
- Department of Nursing, Home for the Aged Guangzhou, Guangdong, China
| | - Xiaozhen Li
- Department of Health Management, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - June Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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13
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He X, Wang J, Liang Y. Developing integrated person-centered care quality indicators for home health agencies in Shanghai, China: A modified Delphi-analytic hierarchy process study. Geriatr Nurs 2024; 58:1-7. [PMID: 38704927 DOI: 10.1016/j.gerinurse.2024.04.025] [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: 01/02/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To develop person-centered integrated care quality indicators for home health agencies in Shanghai, China. DESIGN The study combined the Delphi method and the analytic hierarchy process (AHP). MATERIAL AND METHODS The Delphi consultation questionnaire was distributed to experts in home healthcare in Shanghai, China. A panel of experts with experience in home healthcare in Shanghai, China, was selected. Purposive sampling was used to choose experts. In this study, ten experts were selected from within sub-fields of home healthcare, including nursing, health policy, quality improvement, person-centered care (PCC), and integrated care. RESULTS The authority coefficient (Cr) in this study was 0.835. The coordination degree of experts' opinions, which is expressed by Kendall coordination coefficient W (a higher value, better coordination of the item), ranged from 0.352 to 0.386 (p < 0.001). The consistency ratio (CR) values for each level were less than 0.1. The quality indicator system included three first-level indicators, 15 second-level indicators, and 56 third-level indicators. CONCLUSIONS A person-centered integrated care quality indicator system was developed for home health agencies. The findings from this study enable nurses, managers, and policymakers in home and community-based settings to evaluate person-centered integrated care quality using a robust framework. In addition, these indicators can also be used as a standardized tool to guide the development of long-term care services and supports (LTSS) for home-bound elderly.
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Affiliation(s)
- Xiaolin He
- Department of Social Policy, Shanghai Administration Institute, Shanghai, China
| | - Jiali Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Liang
- School of Nursing, Fudan University, Shanghai, China.
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Luo C, Yang C, Yuan R, Liu Q, Li P, He Y. Barriers and facilitators to technology acceptance of socially assistive robots in older adults - A qualitative study based on the capability, opportunity, and motivation behavior model (COM-B) and stakeholder perspectives. Geriatr Nurs 2024; 58:162-170. [PMID: 38815538 DOI: 10.1016/j.gerinurse.2024.05.025] [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: 02/15/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
This study aimed to identify barriers and facilitators to older adults' acceptance of socially assistive robots from a stakeholder perspective. We enlisted 36 distinct stakeholders, including older adult, nurses, retirement home managers, and employees from robotics companies. Data collection was conducted through semi-structured interviews. The research findings were mapped onto the Capability, Opportunity, Motivation-Behavior (COM-B) model. We obtained a total of 14 facilitators and barriers. (1) Capability: High technological familiarity (Facilitator); insufficient technical experience and low level of education (Barriers). (2) Motivation: Strong interest in new things, perceived convenience usefulness, and emotional support (Facilitators); concerns about technical reliability, perceived lack of ease of use, inability to establish emotional connection, and low level of need (Barriers). (3) Opportunity: Insufficient policy support and economic capacity, robotics technical problems (Barriers). Collaborative efforts among stakeholders are vital for fostering an environment conducive to socially assistive robot adoption, maximizing its potential to improve older adults' well-being.
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Affiliation(s)
- Chuhong Luo
- School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Can Yang
- School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Rong Yuan
- School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Qian Liu
- School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Pingshuang Li
- School of Medicine, Hunan Normal University, Changsha, 410013, China
| | - Ying He
- School of Medicine, Hunan Normal University, Changsha, 410013, China.
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15
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Tan HC, Zeng LJ, Yang SJ, Hou LS, Wu JH, Cai XH, Heng F, Gu XY, Zhong Y, Dong BR, Dou QY. Deep learning model for the prediction of all-cause mortality among long term care people in China: a prospective cohort study. Sci Rep 2024; 14:14639. [PMID: 38918463 PMCID: PMC11199641 DOI: 10.1038/s41598-024-65601-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
This study aimed to develop a deep learning model to predict the risk stratification of all-cause death for older people with disability, providing guidance for long-term care plans. Based on the government-led long-term care insurance program in a pilot city of China from 2017 and followed up to 2021, the study included 42,353 disabled adults aged over 65, with 25,071 assigned to the training set and 17,282 to the validation set. The administrative data (including baseline characteristics, underlying medical conditions, and all-cause mortality) were collected to develop a deep learning model by least absolute shrinkage and selection operator. After a median follow-up time of 14 months, 17,565 (41.5%) deaths were recorded. Thirty predictors were identified and included in the final models for disability-related deaths. Physical disability (mobility, incontinence, feeding), adverse events (pressure ulcers and falls from bed), and cancer were related to poor prognosis. A total of 10,127, 25,140 and 7086 individuals were classified into low-, medium-, and high-risk groups, with actual risk probabilities of death of 9.5%, 45.8%, and 85.5%, respectively. This deep learning model could facilitate the prevention of risk factors and provide guidance for long-term care model planning based on risk stratification.
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Affiliation(s)
- Huai-Cheng Tan
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Jun Zeng
- Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Shu-Juan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Li-Sha Hou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Jin-Hui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Xin-Hui Cai
- Department of Mathematics and Statistics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Fei Heng
- Department of Mathematics and Statistics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Xu-Yu Gu
- School of Medicine, Southeast University, Nanjing, China
| | - Yue Zhong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bi-Rong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China
| | - Qing-Yu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, China.
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Liu X, Yu HJ, Zhang MZ, Yang HG, Chen R, Zhao L, He QQ. The transition of eldercare responsibility and traditional filial piety concepts and its urban-rural differences in China: an age-period-cohort analysis from 2006 to 2017. BMC Public Health 2024; 24:1669. [PMID: 38909187 PMCID: PMC11193898 DOI: 10.1186/s12889-024-19175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/17/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND With rapid urbanization, massive migration, and non-family-based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006-2017). METHODS Old-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models. RESULTS Among 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79-0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33-1.41) and self-based (OR = 1.55, 95% CI: 1.47-1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents' primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging. CONCLUSIONS The traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being.
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Affiliation(s)
- Xiangxiang Liu
- National Clinical Research Center for Infectious Diseases, Shenzhen Third People' s Hospital, Shenzhen, China
| | - Hong-Jie Yu
- School of Public Health, Wuhan University, Wuhan, China.
| | - Min-Zhe Zhang
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Rui Chen
- School of Public Health, Wuhan University, Wuhan, China
| | - Litao Zhao
- East Asian Institute, National University of Singapore, Singapore, Singapore
| | - Qi-Qiang He
- School of Public Health, Wuhan University, Wuhan, China.
- Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan, China.
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17
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Zhai S, Zhang Z, Zhang R, Peng Y, Zhang J, Zhang Y, Jin Q, Zhou J, Chen J. Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing. BMC Public Health 2024; 24:1657. [PMID: 38907192 PMCID: PMC11191137 DOI: 10.1186/s12889-024-18878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks. METHODS Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach. RESULTS Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy. CONCLUSIONS The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.
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Affiliation(s)
- Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Zhiying Zhang
- Outpatient Office, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yingchun Peng
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China.
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Yiyao Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, No.26, Huangcun West Street, Daxing District, Beijing, 102600, China
| | - Jiaojiao Zhou
- Fengtai District Xiluoyuan Community Health Service Centre, Beijing, 100077, China
| | - Jingjing Chen
- Huairou District Liulimiao Community Health Service Centre, Beijing, 101499, China
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18
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Leng A, Liu J, Maitland E, Li S, Nicholas S, Ma B, Wang J. Older adults preferences for long-term caregivers in China: a discrete choice experiment. Public Health 2024; 231:158-165. [PMID: 38692091 DOI: 10.1016/j.puhe.2024.03.022] [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: 11/03/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Understanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults' preferences for long-term caregivers. STUDY DESIGN This is a cross-sectional study. METHODS A national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50-70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models. RESULTS Older adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance. CONCLUSION QoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system.
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Affiliation(s)
- Anli Leng
- School of Political Science and Public Administration, Shandong University, 72 Binhai Rd, Qingdao 266237, China; Smart State Governance Lab, Center for Health Preferences Research, Shandong University, Wenhuaxi Rd, Jinan 250012, China.
| | - Jin Liu
- School of Political Science and Public Administration, Shandong University, 72 Binhai Rd, Qingdao 266237, China.
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool L697ZH, England.
| | - Shunping Li
- School of Public Health, Shandong University, Wenhuaxi Rd, Jinan 250012, China; Center for Health Preferences Research, Shandong University, Wenhuaxi Rd, Jinan 250012, China.
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia; Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh Sydney NSW 2015, Australia.
| | - Ben Ma
- School of Political Science and Public Administration, Shandong University, 72 Binhai Rd, Qingdao 266237, China.
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, 54 Dongsi Lishi Hutong, Beijing, 100010, China; Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuhan, 430072, China.
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Zeng L, Zhong Y, Chen Y, Zhou M, Zhao S, Wu J, Dong B, Dou Q. Effect of long-term care insurance in a pilot city of China: Health benefits among 12,930 disabled older adults. Arch Gerontol Geriatr 2024; 121:105358. [PMID: 38341956 DOI: 10.1016/j.archger.2024.105358] [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: 10/26/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The surge of disabled older people have brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. METHODS This was a prospective observational study based on data from the government-led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyze the impact of LTCI on mortality. RESULTS A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. LTCI implementation significantly reduced mortality by 5.10 % (95 % CI, -9.30 % to -0.90 %) and extended the survival time by 33.74 days (95 % CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participated in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. CONCLUSIONS LTCI implementation had a favorable impact on the mortality and physical ability of participants.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zhong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, China
| | - Mei Zhou
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Qingyu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China.
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20
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Zhong Y, Feng C, Hou L, Yang M, Zhang X, Wu J, Dong B, Jia P, Yang S, Dou Q. Disability level's impact on blood pressure-mortality association in older long-term care adults: evidence from a large Chinese cohort study. BMC Geriatr 2024; 24:478. [PMID: 38822230 PMCID: PMC11143654 DOI: 10.1186/s12877-024-05094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Evidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality in older adults in long-term care setting with different levels of disability. METHODS This prospective cohort study was based on the government-led long-term care programme in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. BP was measured during the baseline survey by trained medical personnel using electronic sphygmomanometers. Disability profile was assessed using the Barthel index. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality. RESULTS The associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10-1.33), compared to SBP between 135 and 150 mmHg. In severe disability group, SBP < 150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16-1.27), compared to SBP between 150 and 170 mmHg. The associations were robust in subgroup analyses in terms of age, gender, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18-1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11-1.20) in severe disability group both demonstrated an increased all-cause mortality risk. CONCLUSION The optimal SBP range was found to be higher in older individuals in long-term care with severe disability (150-170mmHg) compared to those with mild to moderate disability (135-150mmHg). This study provides new evidence that antihypertensive treatment should be administered cautiously in severe disability group in long-term care setting. Additionally, assessment of disability using the Barthel index can serve as a valuable tool in customizing the optimal BP management strategy. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration Number: ChiCTR2100049973).
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Affiliation(s)
- Yue Zhong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanteng Feng
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lisha Hou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xinjun Zhang
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
- International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China.
| | - Qingyu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
- West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Li Y, Luo L, Dong H. Delivering Integrated Community Care for the Elderly: A Qualitative Case Study in Southern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:680. [PMID: 38928927 PMCID: PMC11203458 DOI: 10.3390/ijerph21060680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
The rapid aging and increasing care demands among the elderly population present challenges to China's health and social care system. The concept of aging in place has prompted the implementation of integrated community care (ICC) in the country. This study aims to provide empirical insights into the practices of integrated care policies and approaches at the community level. Data for this study were collected through six months of participatory observations at a local community health service center in a southern Chinese city. Semi-structured interviews were conducted with the multidisciplinary community care team to gather frontline formal caregiver perceptions of ICC, thereby facilitating a better understanding of the obstacles and opportunities. Qualitative analysis revealed four themes: the ICC delivery model and development strategies within the community care scheme, the person-centered guiding principle, and the challenges and struggles encountered by formal caregivers within China's current ICC system. The case study presented herein serves as a notable example of the pivotal role of primary care in the successful implementation of elderly care within a community setting. The adoption of a private organization-led approach to medico-social integration care in the community holds significant potential as a service delivery model for effectively addressing a wide range of elderly care issues.
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Affiliation(s)
- Yiqiao Li
- School of Marxism, South China Normal University, Guangzhou 510631, China;
| | - Lan Luo
- Huangpu Hongshanjie Community Health Service Center, Guangzhou 510725, China
| | - Hongying Dong
- School of Marxism, South China Normal University, Guangzhou 510631, China;
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Zhang Z. Do Health and Housing Attributes Motivate Residential Moves Among Older Chinese Adults? Evidence From an 8‑Year Follow‑up Study. Innov Aging 2024; 8:igae049. [PMID: 38867764 PMCID: PMC11167399 DOI: 10.1093/geroni/igae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Indexed: 06/14/2024] Open
Abstract
Background and Objectives Despite the widespread belief in aging-in-place as the preferred housing arrangement for older adults, they are increasingly embracing moving. The person-environment fit theory explains that environmental changes due to residential moves can pose health risks, discouraging older people from moving. However, it also suggests that moves may be suitable when living conditions no longer meet their physical needs. The correlation between older people's health, housing, and their subsequent moving or staying actions in China remains underexplored. Research Design and Methods Using alternative operating variables of key concepts and the China Family Panel Studies 2012-2018 data sets, this study examines the effects of health and housing status on older people's residential moves in China. The study outlines changes in health indicators and housing characteristics during multiple moves, as well as examines the relationship between the health and housing status of older adults and moving over a relatively long period of time using both regression models with lagged explanatory variables and fixed effects binary choice models. Results The results reveal that: (1) higher rates of subsequent moves were observed among older adults with better self-rated health, positive self-rated health changes, and no ADL impairment, but no significant associations were found between most health variables and moving; and (2) the correlation between older persons' house ownership/type and their residential moves was significant and consistent over time, steady and lasting. Discussion and Implications Potential mechanisms explaining the association between specific housing types and ownership statuses on moving are discussed. The findings encourage a focus on the positive benefits of moving in later life and how to provide additional housing options for older individuals.
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Affiliation(s)
- Ziqi Zhang
- Department of Architecture, School of Design, Shanghai Jiao Tong University, Shanghai, China
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Zhou X, Du F, Peng W, Bai L, Peng L, Hou X. Building Medication Profiles in the Elderly: a Qualitative Study Based on Medication Information Literacy in a Long-Term Care Facility. Clin Interv Aging 2024; 19:779-793. [PMID: 38751855 PMCID: PMC11095403 DOI: 10.2147/cia.s454620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents. Material and Methods In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants' understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents. Results The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile. Conclusion This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.
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Affiliation(s)
- Xiaoyu Zhou
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
| | - Fei Du
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
| | - Wei Peng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, People’s Republic of China
| | - Li Bai
- Hospital of Zigong Mental Health Central, Sichuan, 643021, People’s Republic of China
| | - Leyi Peng
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
| | - Xiaorong Hou
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Chongqing Engineering Research Center for Clinical Big Data and Drug Evaluation, Chongqing, 400016, People’s Republic of China
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Zhang J, Shen Z, Tong X, Sun X, Yao N. Availability of family care resources, bathing assistance and toileting assistance among older adults with functional limitations: an evidence-based study from China. BMC Geriatr 2024; 24:419. [PMID: 38730380 PMCID: PMC11088109 DOI: 10.1186/s12877-024-05047-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND An aging population has contributed to an increasing prevalence of functional limitations among older adults. Family support plays a crucial role in toileting and bathing assistance. Yet, the relationship between availability of family care resources and such actual assistance remains insufficiently explored. Our study aims to describe availability of family care resources and identify the association between availability of family care resources and toileting assistance or bathing assistance. METHODS This study employed a cross-sectional analysis of data from the 2018 National Survey of the China Health and Retirement Longitudinal Study (CHARLS). The availability of family care resources was assessed using measurements of spouse availability, adult child availability, and living arrangement. Bathing assistance and toileting assistance were measured based on self-reported receipt of such assistance. Descriptive statistics were used to depict the overall and subgroup situation of availability of family care resources. Multivariable logistic models were employed to investigate the relationship between availability of family care resources and the receipt of toileting assistance or bathing assistance. RESULTS Among the sample of older adults with functional limitations, 69% had a spouse, 63% had at least one adult child, and 80% resided with family members. Among those with bathing disability, 13% reported lacking bathing assistance, and among those with toileting disability, 54% reported lacking toileting assistance. Participants with 1-2 adult children had lower odds of receiving toileting assistance (OR: 0.28, 95% CI: 0.09, 0.91, p= 0.034) compared to those with three or more adult children. Spouse availability and living arrangement did not exhibit statistically significant associations with toileting assistance. Participants without a spouse had lower odds of receiving bathing assistance (OR: 0.27, 95% CI: 0.09-0.78, p= 0.016) in comparison to those with a spouse; however, adult child availability and living arrangement did not display statistically significant associations with bathing assistance. CONCLUSION The present findings suggest a gap in family commitment when it comes to assisting older adults with functional limitations in bathing/toileting. To address this, policymakers are encouraged to prioritize the implementation of proactive mechanisms for identifying family caregivers, alongside incentives to enhance their engagement in practical caregiving activities. Furthermore, it is crucial to emphasize the prioritization of affordable and easily accessible formal toileting/bathing assistance options for older adults who lack sufficient family care resources.
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Affiliation(s)
- Jinxin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Zi Shen
- Zibo First Hospital, Zibo, Shandong, 255200, China
| | - Xiyang Tong
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, Shandong, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
| | - Nengliang Yao
- Home Centered Care Institute, Schaumburg, IL, USA
- University of Virginia, Charlottesville, VA, USA
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Qi X, Dong Z, Xie W, Yang L, Li J. Professional attractiveness among long-term care workers in nursing homes in China: a cross-sectional study. BMC Health Serv Res 2024; 24:548. [PMID: 38684977 PMCID: PMC11059582 DOI: 10.1186/s12913-024-11023-x] [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: 10/22/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The population aging trend and the shortage of elderly care workers require the long-term care profession to become more attractive. However, the professional attractiveness among long-term care workers has yet to be extensively studied. This study aims to identify the factors that influence the attractiveness of the long-term care profession for nursing home (NH) care workers.. METHODS A cross-sectional study was conducted in more than 50 NHs. Perception of professional attractiveness among long-term care workers and potential associated factors were measured using the Attractive Work Questionnaire (AWQ) and structural instruments including the Fraboni Scale of Ageism (FSA) and the Maslach Burnout Inventory (MBI). A multiple linear regression method was employed to explore the influence of potential independent variables on professional attractiveness. RESULTS The overall response rate was 99%. The results showed the score of professional attractiveness (185.37 ± 20.034), as well as the scores of each component (99.26 ± 11.258 for work condition, 30.13 ± 3.583 for work content, and 55.99 ± 7.074 for job satisfaction). Findings of multiple linear regression analysis indicated that age(β = 0.129, p<.05), years of work(β = 0.156, p<.05), 12-hour shifts(β = 0.185, p<.05), and training times per year(β = 0.148, p<.05) positively associated with long-term care workers perceived professional attractiveness. Whereas only ageism(β=-0.267, p<.05) significantly and negatively influenced professional attractiveness. CONCLUSIONS The perceived professional attractiveness of long-term care workers in NHs was acceptable. Age, years of work, shifts, training opportunities, and ageism contributed to the professional attractiveness of nursing home care workers in China. Target intervention measures should be taken to enhance the attractiveness of long-term care careers so as to avoid the shortage of long-term care workers.
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Affiliation(s)
- Xiaojing Qi
- Department of Nursing, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Ziyan Dong
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Xie
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liuqing Yang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Li
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Chen M, Hooimeijer P. Understanding the Institutional Logics of China's Community-Based Intervention for Older People. J Aging Soc Policy 2024:1-20. [PMID: 38678313 DOI: 10.1080/08959420.2024.2347809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
Community-based policies have gained global popularity, signaling a paradigm shift from individual responsibility for healthy aging to an approach involving community-based intervention. Learning from Western experience, China has also experimented with this form of intervention. It has policy interventions aimed at providing community-based facilities and services that enable older people to age in place. However, the institutional foundations of Chinese communities differ greatly from those in Western countries. Implementing a critical realist case study focusing on a community-based program in Beijing, this study aims to examine the institutional logics that contribute toward a contextually appropriate community-based policy intervention in China. We identified three institutional logics. First, the Confucian moral obligation of benevolence requires authorities to provide social welfare for vulnerable citizens. Second, China's community-based interventions are state-led territorialized provisions prioritizing communities rather than individuals. Third, community-based social policies are subordinate to economic growth objectives. This study contributes to the understanding of contextually appropriate community-based policy interventions in China.
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Affiliation(s)
- Mengyuan Chen
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Pieter Hooimeijer
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
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Xu X, Li Y, Mi H. Life expectancy, long-term care demand and dynamic financing mechanism simulation: an empirical study of Zhejiang Pilot, China. BMC Health Serv Res 2024; 24:469. [PMID: 38622660 PMCID: PMC11017606 DOI: 10.1186/s12913-024-10875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND China has piloted Long-Term Care Insurance (LTCI) to address increasing care demand. However, many cities neglected adjusting LTCI premiums since the pilot, risking the long-term sustainability of LTCI. Therefore, using Zhejiang Province as a case, this study simulated mortality-adjusted long-term care demand and the balance of LTCI funds through dynamic financing mechanism under diverse life expectancy and disability scenarios. METHODS Three-parameter log-quadratic model was used to estimate the mortality from 1990 to 2020. Mortality with predicted interval from 2020 to 2080 was projected by Lee-Carter method extended with rotation. Cohort-component projection model was used to simulate the number of older population with different degrees of disability. Disability data of the older people is sourced from China Health and Retirement Longitudinal Study 2018. The balance of LTCI fund was simulated by dynamic financing actuarial model. RESULTS Life expectancy of Zhejiang for male (female) is from 80.46 (84.66) years in 2020 to 89.39 [86.61, 91.74] (91.24 [88.90, 93.25]) years in 2080. The number of long-term care demand with severe disability in Zhejiang demonstrates an increasing trend from 285 [276, 295] thousand in 2023 to 1027 [634, 1657] thousand in 2080 under predicted mean of life expectancy. LTCI fund in Zhejiang will become accumulated surplus from 2024 to 2080 when annual premium growth rate is 5.25% [4.20%, 6.25%] under various disability scenarios, which is much higher than the annual growth of unit cost of long-term care services (2.25%). The accumulated balance of LTCI fund is sensitive with life expectancy. CONCLUSIONS Dynamic growth of LTCI premium is essential in dealing with current deficit around 2050 and realizing Zhejiang's LTCI sustainability in the long-run. The importance of dynamic monitoring disability and mortality information is emphasized to respond immediately to the increase of premiums. LTCI should strike a balance between expanding coverage and controlling financing scale. This study provides implications for developing countries to establish or pilot LTCI schemes.
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Affiliation(s)
- Xueying Xu
- School of International Studies, Zhejiang University, Hangzhou, China
| | - Yichao Li
- School of Public Affairs, Zhejiang University, Hangzhou, China.
| | - Hong Mi
- School of Public Affairs, Zhejiang University, Hangzhou, China
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Wu F, Chen W, Wan R, Lu J, Yu Q, Tu Q. Perceived HRM and turnover intentions of elderly care workers: perspective from person-job fit and institutional ownership. BMC Nurs 2024; 23:242. [PMID: 38622615 PMCID: PMC11020918 DOI: 10.1186/s12912-024-01926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Although the phenomenon of high turnover rate in the elderly care industry has existed for a long time, there are few studies that have constructed frameworks to comprehensively analyze the strength of the effects of various factors on the turnover intention of elderly care workers.. This study analyzed the impact of different types of perceived human resource management practices on elderly care workers' turnover intentions and whether this relationship is moderated by person-job fit and ownership of elderly care institutions. METHODS This is a cross-sectional and regional survey study. The study included questionnaire survey data from a total of 305 elderly care workers from 42 elderly care institutions in 21 provinces in China during June to September 2021. Descriptive statistics, Pearson correlation coefficient, multiple regression, and heterogeneity analyses were performed. RESULTS Perceived work environment ( β =-0.5164, p< 0.01), perceived occupational protection ( β =-0.3390, p< 0.01), perceived welfare benefits ( β = -0.2620, p< 0.01) and perceived competency training ( β = -0.1421, p< 0.1) were all significantly and negatively related to turnover intentions, the quality of perceived work environment has the greatest impact on elderly care workers' turnover intentions. Under the moderating effects of person-job fit and ownership of elderly care institutions, there existed heterogeneity between perceived human resource management and turnover intentions among elderly care workers. High level of person-job fit and elderly care institutions' public feature can effectively weaken the negative impact of each type of perceived human resource management on turnover intention among elderly care workers. CONCLUSIONS The managers of elderly care institutions should optimize the management mechanism, typically pay attention to elderly care workers' working environment, formulate and improve the professional standards and job requirements for elderly care workers, promote the public welfare value of nursing care services, and strengthen the sense of honor and responsibility of elderly care workers to reduce the turnover rate.
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Affiliation(s)
- Fang Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, Jiangsu, 211198, China.
| | - Wei Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, Jiangsu, 211198, China
| | - Ruyi Wan
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, Jiangsu, 211198, China
| | - Jiatong Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, Jiangsu, 211198, China
| | - Qianqian Yu
- School of International Pharmaceutical Business, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, Jiangsu, 211198, China
| | - Qilei Tu
- Beijing College of Social Administration, No.2 Yanling Rd, East Yanjiao Development Zone, Beijing, 101601, China
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Yu B, Jia P, Dou Q, Yang S. Toward a prognostic model for all-cause mortality among old people with disability in long-term care in China. Arch Gerontol Geriatr 2024; 119:105324. [PMID: 38266531 DOI: 10.1016/j.archger.2023.105324] [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: 09/16/2023] [Revised: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Current prognostic model of all-cause mortality may not be applicable for old people with disability in long-term care due to the absence of injury- and care-related predictors. We aimed to develop a prognostic model specifically tailored to this population, based on comprehensive predictors. METHOD We conducted a prospective study involving 41,004 participants aged ≥60 with disability in long-term care across 16 study sites in Southwest China from 2017 to 2021. Participants' demographics, clinical characteristics, disability status, and injury- and care-related information at baseline were used as candidate predictors. We employed a LASSO Cox regression model to develop the prognostic model using the training set (70 % of participants), and the predictive performance was validated in the validation set (30 % of participants). The prognostic index (PI) scores of the prognostic model were used to quantify mortality risk. RESULTS At the end of the 4-year follow-up, 17,797 deaths (43.4 %) were observed. The prognostic model revealed several powerful and robust predictors of mortality across the total sample and subgroups, including higher age, living with comorbidities, physical and perceptual disability, and living with pressure sores. Non-professional care was an additional predictor in older participants. The risk of death for participants in the highest quartile of PI scores was approximately four-fold higher compared to those in the lowest quartile. CONCLUSIONS We developed and validated a prognostic model that can be practically utilized to identify individuals and populations at risk of death among old people with disability in long-term care.
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Affiliation(s)
- Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University- The Hong Kong Polytechnic University, Chengdu, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Peng Jia
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, China; Hubei Luojia Laboratory, Wuhan, China; School of Public Health, Wuhan University, Wuhan, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Shujuan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, China; Department of Clinical Medical College, Affiliated Hospital of Chengdu University, Chengdu, China; Respiratory Department, Chengdu Seventh People's Hospital, Chengdu, China.
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30
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Liu Q, Yih B. Geriatric Nursing: Relationship Among Death Attitude, Meaning in Life, and Career Choice Motivation. J Nurs Res 2024; 32:e322. [PMID: 38488155 DOI: 10.1097/jnr.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Aging populations require higher quality care. However, few undergraduate nursing students choose careers in aged care. Negative death attitudes and loss of meaning in life may reduce motivation to choose geriatric nursing (GN) as a career. The relationships among these variables have yet to be clarified in the literature. PURPOSE The purpose of this study was to investigate the relationships among death attitude, meaning in life, and motivation to choose a career in GN among undergraduate nursing students in China. METHODS This cross-sectional study was conducted using an online survey. Five hundred ninety-five final-year undergraduate nursing students in four nursing schools completed the Career Choice Motivation Questionnaire for Geriatric Nursing, Death Attitude Profile-Revised, and Meaning in Life Questionnaire. A t test, analysis of variance, Pearson's correlation, and multiple linear regression model were used to analyze the data using SPSS Version 22.0. RESULTS The mean Career Choice Motivation Questionnaire for Geriatric Nursing item score was 3.15 ( SD = 0.49; 1-5 points), indicating the participants were moderately motivated to choose GN as a career. The multiple linear regression revealed statistically significant associations among death attitude, meaning in life, and motivation to care for older adults, explaining 14.5% of the total variance ( R2 = .15, F = 9.01, p < .001). Perceiving meaning in life, having escape acceptance, and having approach acceptance were each shown to be positively associated with choosing a career in GN. Conversely, fear of death and death avoidance were found to be negatively associated with choosing this career path. CONCLUSIONS Death attitude and perceptions regarding the meaning of life are associated with the motivation of nursing students to care for older adults.
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Affiliation(s)
- Qiushi Liu
- PhD, Professor, School of Nursing, Jining Medical University, Jining, Shandong, People's Republic of China
| | - Bongsook Yih
- PhD, Professor, Post Graduate School of Nursing, Sehan University, Republic of Korea
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Li Q, Chen Y, Zhang Y, Liu X. Evaluation of China's long-term care insurance policies. Front Public Health 2024; 12:1252817. [PMID: 38605882 PMCID: PMC11007106 DOI: 10.3389/fpubh.2024.1252817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system. Methods We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China. Results Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment. Discussion The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.
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Affiliation(s)
- Qiang Li
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
| | - Yiwen Chen
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
| | - Yongmei Zhang
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
- School of Economics and Management, Shandong Agricultural Engineering University, Jinan, China
| | - Xue Liu
- College of Economics and Management, Shandong Agricultural University, Tai’an, China
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32
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Kattouw CE, Aase K, Viksveen P. How do the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home? A qualitative interview study with multiple stakeholders. FRONTIERS IN HEALTH SERVICES 2024; 4:1294320. [PMID: 38577152 PMCID: PMC10991764 DOI: 10.3389/frhs.2024.1294320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Introduction Often, homecare services are task-focused rather than person-based and fragmented instead of integrated. Consequently, several stakeholders have requested a transformation of the service ecosystem for senior citizens living at home. This transformation may be facilitated by an idealized design approach. However, few studies have applied such an approach. Moreover, previous research did not assess the ways in which the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home. Therefore, the purpose of this study is to gain an understanding of how the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home, according to different stakeholders. Methods Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study (2019-2020): senior citizens, carers, healthcare professionals and managers. A directed qualitative content analysis was applied, guided by a four-category framework for the preferred service ecosystem. Results All stakeholder groups highlighted several limitations that hindered continuity of the services. There was also agreement on deficiencies in professionals' competence, yet professionals themselves did not focus on this as a significant aspect. Managers emphasised the importance of professionals' reablement competence, which was also considered to be deficient in the current homecare services. Contrary to the other stakeholder groups, most senior citizens seemed satisfied with the practical and social support they received. Together with carers, they also explained why they thought some professionals lack compassion. Their dependency on professionals may limit them in sharing honestly their opinions and preferences during care provision. Involvement of senior citizens in improvement of the current services was limited. Insufficient time and resources, as well as a complex organisation impacted the existing homecare services, and therefore served as barriers to the preferred service ecosystem. Discussion In this study there were different degrees of correspondence between the existing homecare services and the preferred service ecosystem according to four stakeholder groups. To develop the preferred service ecosystem, aspects such as predictability, adaptivity, and relationships are key, as well as continuous involvement of senior citizens and other stakeholders. The four-category framework applied in this study served as a tool to assess the existing homecare services.
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Affiliation(s)
- Christophe Eward Kattouw
- SHARE—Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Chen M, Bolt G, Hooimeijer P. The impact of residential environment on older people's capabilities to live independently: a survey in Beijing. BMC Public Health 2024; 24:843. [PMID: 38500091 PMCID: PMC10949666 DOI: 10.1186/s12889-024-18262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Studies have shown how environmental factors influence older people's health and functional limitations, which are crucial for achieving healthy aging. However, such a healthy aging model has been criticized for defining health as an absence of disease, because chronic conditions cannot be reversed through medical treatments. In response to such critiques, this study refers to Huber's positive health definition, arguing that health should not be defined as the absence of disease but as the ability to adapt and self-manage in the face of social, physical, and emotional challenges. There is a need to develop a community-based approach to healthy aging that considers how the residential environment enables older people to adapt and self-manage. Drawing on Sen's capability approach, this study proposes that such a community-based approach should provide a supportive environment to enable older people's capabilities to live independently. METHODS Using hierarchical multiple regression analysis of data from 650 older people (60 years and older) surveyed in Beijing, we unravel which features of the residential environment support older people' s capabilities to live independently and how these impacts differ depending on older people's frailty levels. RESULTS The results show that four environmental factors, namely perceived accessibility (B = 0.238, p < 0.001 for physical capability, B = 0.126, p < 0.001 for social capability, B = 0.195, p < 0.001 for psychological capability), pleasant surroundings (B = 0.079, p < 0.05 for physical capability, B = 0.065, p < 0.05 for social capability), meeting opportunities (B = 0.256, p < 0.001 for social capability, B = 0.188, p < 0,001 for psychological capability, and life convenience B = 0.089, p < 0.05 for physical capability, B = 0.153, p < 0.001 for psychological capability) positively affect older people's capabilities to live independently. These four environmental factors cause differences in older people's capabilities between different neighborhood types. Moderation analysis shows that meeting opportunities are more relevant for frail older people (B = 0.090, p < 0.001 for social capability, B = 0.086, p < 0.01 for psychological capability). CONCLUSIONS This study contributes to the literature by emphasizing the role of supportive residential environments in enabling older people to live independently. Furthermore, we identify four environmental factors that support older people's capabilities. Results can be used to develop effective community-based environmental support to enable older people to live independently.
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Affiliation(s)
- Mengyuan Chen
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8a, 3584CB, Utrecht, The Netherlands.
| | - Gideon Bolt
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8a, 3584CB, Utrecht, The Netherlands
| | - Pieter Hooimeijer
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Princetonlaan 8a, 3584CB, Utrecht, The Netherlands
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Zhu R, Hou W, Wang L, Zhang C, Guo X, Luo D, Wang F. Willingness to purchase institutionalised elderly services and influencing factors among Chinese older adults: a nationwide cross-sectional study. BMJ Open 2024; 14:e082548. [PMID: 38471688 DOI: 10.1136/bmjopen-2023-082548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES In view of the serious ageing of China's population and the low desire of elderly people to purchase institutionalised elderly care services, we explored the willingness of Chinese elderly people to purchase institutionalised elderly care services and its influencing factors. DESIGN This was a cross-sectional study. Three multivariate logistic regression analysis models of the willingness of elderly people to purchase institutionalised elderly care services were established (model 1: 'reluctance - willingness'; model 2: 'reluctance - hesitation'; and model 3: 'hesitation - willingness') to explore the factors that influence elderly people's willingness to purchase institutionalised elderly care services. SETTING This study was based on the 2022 Psychology and Behaviour Investigation of Chinese Residents database. PARTICIPANTS Research data from 4123 older adults who met the requirements of this study were screened from the database. RESULTS Of the 4123 respondents, roughly equal numbers had negative and positive attitudes towards purchasing institutionalised senior care services (1125, 27.3% vs 1079, 26.2%, respectively), and 1919 (46.5%) had hesitant attitudes. The analysis of model 1 showed that medical insurance participation, the number of children and siblings, chronic diseases and per capita monthly household income had an influential effect on the willingness of elderly people to purchase institutional care. In model 2, we found that factors such as per capita monthly household income and anxiety led to hesitancy among older adults to purchase institutionalised senior care services. In model 3, we further found that social support and health literacy led to a shift from hesitation to willingness to purchase institutionalised elderly care services. CONCLUSION The number of children, number of siblings, per capita monthly income of the family, medical insurance participation, health status, health literacy and social support were found to be the main factors influencing the purchase of institutionalised care by elderly individuals.
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Affiliation(s)
- Rui Zhu
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Wenjie Hou
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Lingmeng Wang
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Chenchen Zhang
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Xing Guo
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Dan Luo
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
| | - Fuzhi Wang
- School of Nursing, Bengbu Medical College, Bengbu, Anhui, China
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Li J, Wang Q, Zhou X. Health literacy, worry about unmet needs for medical care, and psychological well-being among older Chinese adults. Geriatr Gerontol Int 2024; 24 Suppl 1:202-207. [PMID: 38050461 DOI: 10.1111/ggi.14754] [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: 09/03/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
AIM This study aims to examine the relationship between older adults' health literacy and their psychological well-being and the role of worry about future unmet needs for medical care in mediating this relationship. METHODS We adopted a sample of 965 older Chinese people aged 60+ (49.74% female) from the 2021 Chinese General Social Survey. A series of structural equation models (SEMs) were performed. Health literacy was measured by three items regarding older people's ability to understand medical professionals, ask them questions, and read medical instructions. A single-item question was adopted to measure participants' worry about unmet needs for future medical care. Psychological well-being was measured by three items regarding emotional problems and depressed or anxious mood in the past 4 weeks. RESULTS Worry about future unmet needs for medical care mediates the relationship between lack of health literacy and Chinese older people's psychological well-being. The indirect effect accounts for 22.3% of the total effect. The SEM model has a satisfactory model fit (goodness of fit index = 1.000, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.009, standardized root mean square residual = 0.023, chi-square test = 50.96, P = 0.321). CONCLUSIONS The findings of this study underscore the importance of improving communication quality between healthcare providers and older adults. Clinical interventions that promote health literacy and address worries about unmet needs for medical services may benefit older adults. Geriatr Gerontol Int 2024; 24: 202-207.
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Affiliation(s)
- Jia Li
- Department of Social Work, Faculty of Social Science, The Chinese University of Hong Kong, Hong Kong, HKSAR, China
| | - Qi Wang
- School of Graduate Studies and Institute of Policy Studies, Lingnan University, Hong Kong, HKSAR, China
| | - Xiaochen Zhou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, HKSAR, China
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Kong F, Yu L, Hou Y, Zhu L, Zhou J, Huang L, Lv Y, Wang L, Zhang L, Yang Y, Ying Y. Efficacy of Internet-Based Cognitive Behavioral Therapy for Subthreshold Depression Among Older Adults in Institutional Long-Term Care Settings: Pragmatic Randomized Controlled Trial. J Med Internet Res 2024; 26:e40187. [PMID: 38427424 PMCID: PMC10943436 DOI: 10.2196/40187] [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: 06/09/2022] [Revised: 01/03/2023] [Accepted: 01/31/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Subthreshold depression (sD) is prevalent in older populations in long-term care (LTC) settings, but psychological therapy in LTC settings in China is not readily available. Thus, internet-based cognitive behavioral therapy (ICBT) may be suitable for this population, but research on the efficacy of ICBT for older adults with sD, especially those living in LTC settings, is limited. OBJECTIVE This study aimed to evaluate the efficacy and acceptability of ICBT treatment for sD among LTC residents in China. We also examined whether ICBT is as effective as group-based cognitive behavioral therapy (CBT) for treating sD in this population. METHODS We conducted a pragmatic randomized controlled trial, which included 18 LTC institutions. A total of 354 participants were randomized to ICBT, group-based CBT, or a waiting list and were followed up for 12 months. The primary outcome was self-reported depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D). Secondary outcomes were the scores of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item (GAD-7), and Geriatric Depression Scale (GDS). A mixed-effects model was used to assess the efficacy of ICBT. RESULTS The ICBT group showed a significant improvement in self-reported depressive symptoms, which was maintained at the 12-month follow-up (all P<.001). The ICBT group exhibited a significantly larger reduction in the scores of the CES-D (Cohen d=0.07, 95% CI 0.04-0.09; P=.01), PHQ-9 (d=0.30, 95% CI 0.28-0.33; P<.001), GDS (d=0.10, 95% CI 0.08-0.13; P<.001), and GAD-7 (d=0.19, 95% CI 0.17-0.22; P<.001) compared with a waiting list at postintervention. ICBT had significantly stronger effects than CBT on the PHQ-9 and GAD-7 at postintervention (d=0.15, 95% CI 0.13-0.17; P<.001 and d=0.21, 95% CI 0.19-0.23; P<.001, respectively), 6-month follow-up (d=0.18, 95% CI 0.16-0.21; P<.001 and d=0.18, 95% CI 0.15-0.21; P<.001, respectively), and 12-month follow-up (d=0.15, 95% CI 0.11-0.19; P<.001 and d=0.18, 95% CI 0.14-0.21; P<.001, respectively). CONCLUSIONS ICBT is a relatively effective and acceptable intervention for reducing depressive symptoms among Chinese LTC residents with sD. These findings indicate the usefulness of ICBT application for sD in LTC settings. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000030697; https://www.chictr.org.cn/showproj.aspx?proj=50781.
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Affiliation(s)
- Fanqian Kong
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Libo Yu
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | | | - Lijie Zhu
- Pfizer Research and Development Co, Ltd, Shanghai, China
| | - Jing Zhou
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Lingjie Huang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Yueer Lv
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Li Wang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Li Zhang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Yiling Yang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Yuchen Ying
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
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Wang S, Hu W. Implementing age-friendly policies in China: Assessing the impact on older adults' self-rated health. Soc Sci Med 2024; 344:116637. [PMID: 38330633 DOI: 10.1016/j.socscimed.2024.116637] [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: 06/06/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
Using prefecture-level policy documents (2008-2018) and the China Health and Retirement Longitudinal Study (2011-2018), this study used fixed-effects regressions to examine the associations between the maturity of two age-friendly policies, i.e., old age care (OAC) and preferential treatment (PT) policies for older adults, and the self-rated health (SRH) of older adults. We use policy duration and policy density to measure policy maturity. The results showed positive relationships exist between the density of OAC and PT policy and older adults' SRH, whereas long policy duration often relates to lower SRH. Policy duration and policy density work synergistically. Furthermore, heterogeneity analyses indicated that older adults aged over 75 years, male, those with physical or mental impairment, and living in rural areas and in the first- and second-tier cities benefit significantly from denser OAC policy. The SRH of older adults suffering from physical disabilities or mental problems and living in rural areas is positively associated with denser PT policy. From a policy perspective, our findings suggest that age-friendly policies should be updated over time and be place- and characteristic-tailored.
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Affiliation(s)
- Shuhong Wang
- Department of Public and International Affairs, City University of Hong Kong, Hong Kong SAR, China.
| | - Wanyang Hu
- Department of Public and International Affairs, City University of Hong Kong, Hong Kong SAR, China.
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Gu S, Jia C, Shen F, Wang X, Wang X, Gu H. The effects of community-based home health care on the physical and mental health of older adults with chronic diseases. Qual Life Res 2024; 33:691-703. [PMID: 38032396 DOI: 10.1007/s11136-023-03555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE This study aimed to explore the effects of community-based home health care (HHC) on the physical and mental health of older adults with chronic diseases in China. METHODS The study data were retrieved from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Ordinary least squares regression model was used to assess the effects of community-based HHC on the health. Entropy balancing was used to test the robustness of the regression results. RESULTS A total of 5571 older adults with chronic diseases were included. The results showed that older adults who had received community-based HHC reported significantly better self-rated health (coefficient = 0.051, 95%CI [0.004, 0.098]), less physical discomfort (coefficient = - 0.021, 95%CI [- 0.042, - 0.001]), lower depression scores (coefficient = - 0.263, 95%CI [- 0.490, - 0.037]), and lower anxiety scores (coefficient = - 0.233, 95%CI [- 0.379, - 0.088]) compared with those who had not received community-based HHC. Overall, community-based HHC conferred greater positive effects on the health of rural older adults, older adults with multiple chronic diseases, and older adults with low incomes. CONCLUSION Community-based HHC was beneficial for improving self-rated health and reducing physical discomfort, depression, and anxiety in older adults with chronic diseases, thus improving their quality of life. It is important to promote its development nationwide in China.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
| | - Cangcang Jia
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fangfang Shen
- General Practice Department, Daguang Road Community Healthcare Center, Nanjing, Jiangsu, China
| | - Xiaoyong Wang
- Health Insurance Office, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaoling Wang
- Department of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, 163 Xianlin Road, Nanjing, 210023, Jiangsu, China.
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Kong EH, Kim S, Kim M, Lee K, Choi H. Nursing students' experiences regarding physical restraint use in long-term care facilities: A qualitative descriptive study. NURSE EDUCATION TODAY 2024; 133:106086. [PMID: 38154216 DOI: 10.1016/j.nedt.2023.106086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Despite many harmful effects, physical restraints are still used in long-term care facilities. Most existing studies have focused on staff. Nursing students observe staff's use of restraints during gerontological nursing practicums, but there are few studies on nursing students' experiences regarding restraint use in long-term care settings. OBJECTIVE This study aimed to explore nursing students' experiences with physical restraint use in order to enhance nursing education and improve care quality in long-term care facilities. METHODS Using convenience sampling method, three nursing schools from three provinces were recruited. Twenty-six senior undergraduate nursing students who had taken a gerontological nursing practicum course participated in this study. A qualitative descriptive method was utilized to provide a clear account of the students' experiences. In-depth interviews were conducted using a semi-structured interview guide. Thematic analysis was used for data analysis. RESULTS Four themes were identified, which included overuse of restraints, ambivalent response to restraints, becoming accustomed to restraints, and lack of education regarding restraints. Students frequently observed the use of various restraints, which elicited both negative and positive responses, ultimately leading to their desensitization to the overuse of restraints. They expressed a lack of knowledge and educational needs regarding restraint reduction. CONCLUSION Nursing students encountered the overuse of various restraints, exhibited ambivalent responses, and became desensitized to this practice in long-term care facilities. They perceived a lack of education and educational needs regarding restraint reduction. This study adds important new knowledge to existing literature and provides important insights into restraint use in long-term care facilities. Future studies need to develop and evaluate educational programs for restraint-free and person-centered care targeting nursing students. Long-term care facilities should offer organizational support and implement continuous mandatory training to promote restraint-free care.
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Affiliation(s)
- Eun-Hi Kong
- Gachon University, College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea.
| | - Seonho Kim
- Chungbuk National University, Department of Nursing, Chungdae-ro 1, Seowon-Gu, Cheongju-si, Chungbuk 28644, Republic of Korea.
| | - Myoungsuk Kim
- Kangwon National University, College of Nursing, 1 Gangwondaehakgil, Chuncheon-Si, Gangwon-Do 24341, Republic of Korea
| | - Kayoung Lee
- Gachon University, College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea.
| | - Heeseung Choi
- Seoul National University, College of Nursing and Research Institute of Nursing, 103 Daehak-ro, Jongno-Gu, #512, Seoul 03080, Republic of Korea.
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Fu D, Wang F, Gao B, Bai Q, Liu G, Zhu J. The influence of different sources of anticipated instrumental support on depressive symptoms in older adults. Front Public Health 2024; 12:1278901. [PMID: 38351956 PMCID: PMC10861699 DOI: 10.3389/fpubh.2024.1278901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
Objective This study investigated how anticipated instrumental support sources and intergenerational support influence depressive symptoms in older Chinese adults. Methods We employed binary logistic regression on data from 7,117 adults aged ≥60 in the 2018 China Health and Retirement Longitudinal Study, controlling for gender, marital status, and self-rated health. Results 38.89% of respondents exhibited depressive symptoms. Anticipated support from spouse and children, spouse only, children only, or other sources showed 52, 25, 46, and 40% lower odds of depression, respectively, compared with no anticipated support. Those providing financial support had 36% higher odds of depression than those without exchanges. However, those receiving financial support, receiving instrumental support, and receiving and providing financial and emotional support had 19, 14, 23, and 24% lower odds of depression. Conclusion Different anticipated instrumental support sources and intergenerational support influenced depression odds in older adults, suggesting potential benefits in promoting such support systems.
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Affiliation(s)
| | | | | | | | - Guilin Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Jinghui Zhu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
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Tian Y, Fan L, Zhou M, Du W. Impact of long-term care insurance on health inequality in older adults in China based on the concentration index approach. Int Health 2024; 16:83-90. [PMID: 37039047 PMCID: PMC10759298 DOI: 10.1093/inthealth/ihad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Several studies have shown that social security would reduce health inequalities. However, little was known about the relationship between long-term care insurance and health inequality. We aimed to evaluate the impact of long-term care insurance on health status and health inequality in older adults using a nationally representative cohort. METHODS Based on four waves of data from the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, 2015 and 2018), we used the staggered difference in difference (DID) design with the order probit regression models and the concentration index approach as well as decomposition analysis to assess the contribution of long-term care insurance towards residents' health status and health inequality in older adults aged ≥65 y. We further used the semi-parametric DID model for robustness testing. RESULTS Long-term care insurance demonstrated its role, improving self-assessed health in the study population (βcoefficient: 0.090, 95% CI 0.087 to 0.092, p<0.001). The estimation results of the semi-parametric DID were consistent with those of the staggered DID. The income-related health concentration index was 0.0005, having a contribution rate of 1.639% to health inequality in older adults. Decomposition analysis revealed that different policies and residential areas were more influential on the observed health inequalities. CONCLUSIONS The findings implied that long-term care insurance has widened the health inequality while improving health status in older adults. Additional investment in more comprehensive insurance coverage and increased accessibility to enhance implementation of long-term care insurance is warranted to close the gap.
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Affiliation(s)
- Yong Tian
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Lijun Fan
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Menghan Zhou
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Wei Du
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
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Wang Y. Can adult children's education prevent parental health decline in the short term and long term? Evidence from rural China. J Biosoc Sci 2024; 56:155-181. [PMID: 37309644 DOI: 10.1017/s0021932023000111] [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] [Indexed: 06/14/2023]
Abstract
This paper presents the first evidence of the causal relationship between adult children's schooling and changes in parental health in the short and long term. By using supply-side variation in schooling as an instrument for adult children's education and a representative dataset for rural China, we find that adult children' education has a positive influence on the long-term changes in parental health, with limited evidence of any short-term effect. Our results remain consistent after a variety of sensitivity tests. The heterogeneous analyses show differences in socio-economic status and gender, with low-educated parents and mothers being the primary beneficiaries of children's schooling. Potential mechanisms for the long-term effects of adult children's education on changes in parental health include better chronic disease management, improved access to health, sanitation, and clean fuel facilities, improved psychological well-being, and reduced smoking behaviours.
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Affiliation(s)
- Yiru Wang
- Southwestern University of Finance and Economics, Chengdu, China
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Huang Y, Zhang R, Zhao Q, Wang X, Ge L, Zhang S, Yang Q, Zhang C, Zhang X, Chen C. Pathways to Improve Provision of Home and Community-Based Services-A Configurational Approach Based on a Fuzzy-Set Qualitative Comparative Analysis From China. J Appl Gerontol 2024; 43:89-100. [PMID: 38041624 DOI: 10.1177/07334648231197029] [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] [Indexed: 12/03/2023] Open
Abstract
Providing home and community-based services (HCBS) is critical for active and healthy aging. However, in China, the positive factors for improving HCBS provision are unclear, limiting its contribution to improving older adults' quality of life and promoting active and healthy aging. Therefore, this study examines the configurations that produce differences in HCBS and identifies multiple pathways for improving them and narrowing regional disparities. Using data from multiple datasets comprising 23 cases, we performed configuration analysis using fuzzy-set qualitative comparative analysis. Four pathways producing high HCBS provision and three pathways producing low HCBS provision were found. Different combinations of the aging population, economic development, institutional support, financial support, and development of multiple stakeholders influence HCBS provision. Thus, measures based on the main factor characteristics should be implemented to improve the HCBS provision level.
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Affiliation(s)
- Yunyun Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Rujia Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Qianru Zhao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Wang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Lizheng Ge
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Songjia Zhang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Qingren Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | | | - Xiangyang Zhang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
- Institute for County Chronic Disease Health Management Research, Wenzhou Medical University, Taizhou, China
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Boateng EA, Agyapomah R, Amankwaa I, Dzomeku VM, Peprah LO. Perspectives of Family Caregivers on Healthcare Provided to Older Adults With Hypertension and/or Diabetes Mellitus in Ghana. Gerontol Geriatr Med 2024; 10:23337214241261534. [PMID: 38899054 PMCID: PMC11186387 DOI: 10.1177/23337214241261534] [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: 03/06/2024] [Revised: 05/05/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
This study explored the perspectives of family caregivers of older adults with hypertension and/or diabetes mellitus on the care provided to their kin when they visit the hospital. A qualitative research approach was used to conduct the study using family members providing informal care for older adults with hypertension and/or diabetes mellitus at a teaching hospital in Ghana. A total of 20 participants were purposively sampled, interviewed, and data was analyzed using reflexive thematic analysis. Family caregivers mainly had perceptions that their older adult kin had poor interactions with the healthcare system because of some healthcare workers' negative attitudes, inadequate facilities at the clinics, and lack of geriatric care services at the facility. This notwithstanding, family caregivers also derived some benefits from accompanying their kin to the hospital. Practice and education in gerontological nursing must be employed to pragmatically meet the unique healthcare needs of older adults in Ghana with a focus on geriatrics units and standalone programs of study to prepare specialized healthcare professionals to provide comprehensive services to older adults. For a thorough understanding of issues of older adult care in the country, their perspectives on this subject should also be explored in future studies.
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Fu L, Tian T, Wang B, Lu Z, Bian J, Zhang W, Wu X, Li X, Siow RC, Fang EF, He N, Zou H. Global, regional, and national burden of HIV and other sexually transmitted infections in older adults aged 60-89 years from 1990 to 2019: results from the Global Burden of Disease Study 2019. THE LANCET. HEALTHY LONGEVITY 2024; 5:e17-e30. [PMID: 38183996 DOI: 10.1016/s2666-7568(23)00214-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Sexually active older adults are often more susceptible to HIV and other sexually transmitted infections (STIs) due to various health conditions (especially a weakened immune system) and low use of condoms. We aimed to assess the global, regional, and national burdens and trends of HIV and other STIs in older adults from 1990 to 2019. METHODS We retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 on the incidence and disability-adjusted life-years (DALYs) of HIV and other STIs (syphilis, chlamydia, gonorrhoea, trichomoniasis, and genital herpes) for older adults aged 60-89 years in 204 countries and territories from 1990 to 2019. Estimated annual percentage changes in the age-standardised incidence and DALY rates of HIV and other STIs, by age, sex, and Socio-demographic Index (SDI), were calculated to quantify the temporal trends. Spearman correlation analysis was used to examine the relationship between age-standardised rates and SDI. FINDINGS In 2019, among older adults globally, there were an estimated 77 327 (95% uncertainty interval 59 443 to 97 648) new cases of HIV (age-standardised incidence rate 7·6 [5·9 to 9·6] per 100 000 population) and 26 414 267 (19 777 666 to 34 860 678) new cases of other STIs (2607·1 [1952·1 to 3440·8] per 100 000). The age-standardised incidence rate decreased by an average of 2·02% per year (95% CI -2·38 to -1·66) for HIV and remained stable for other STIs (-0·02% [-0·06 to 0·01]) from 1990 to 2019. The number of DALYs globally in 2019 was 1 905 099 (95% UI 1 670 056 to 2 242 807) for HIV and 132 033 (95% UI 83 512 to 225 630) for the other STIs. The age-standardised DALY rate remained stable from 1990 to 2019, with an average change of 0·97% (95% CI -0·54 to 2·50) per year globally for HIV but decreased by an annual average of 1·55% (95% CI -1·66 to -1·43) for other STIs. Despite the global decrease in the age-standardised incidence rate of HIV in older people from 1990 to 2019, many regions showed increases, with the largest increases seen in eastern Europe (average annual change 17·84% [14·16 to 21·63], central Asia (14·26% [11·35 to 17·25]), and high-income Asia Pacific (7·52% [6·54 to 8·51]). Regionally, the age-standardised incidence and DALY rates of HIV and other STIs decreased with increases in the SDI. INTERPRETATION Although the incidence and DALY rates of HIV and STIs either declined or remained stable from 1990 to 2019, there were regional and demographic disparities. Health-care providers should be aware of the effects of ageing societies and other societal factors on the risk of HIV and other STIs in older adults, and develop age-appropriate interventions. The disparities in the allocation of health-care resources for older adults among regions of different SDIs should be addressed. FUNDING Natural Science Foundation of China, Fujian Province's Third Batch of Flexible Introduction of High-Level Medical Talent Teams, Science and Technology Innovation Team (Tianshan Innovation Team) Project of Xinjiang Uighur Autonomous Region, Cure Alzheimer's Fund, Helse Sør-Øst, the Research Council of Norway, Molecule/VitaDAO, NordForsk Foundation, Akershus University Hospital, the Civitan Norges Forskningsfond for Alzheimers Sykdom, the Czech Republic-Norway KAPPA programme, and the Rosa Sløyfe/Norwegian Cancer Society & Norwegian Breast Cancer Society.
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Affiliation(s)
- Leiwen Fu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Tian Tian
- School of Public Health, Xinjiang Medical University, Ürümqi, China
| | - Bingyi Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Junye Bian
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weijie Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Xinyi Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Richard C Siow
- Ageing Research at King's (ARK) and School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Evandro Fei Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Oslo, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | - Na He
- School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Huachun Zou
- School of Public Health and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China; School of Public Health, Southwest Medical University, Luzhou, China; Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
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Xie X, Qiao X, Huang CC, Cheung SP. Mindfulness and loneliness in retired older adults in China: mediation effects of positive and negative affect. Aging Ment Health 2024; 28:188-195. [PMID: 37493469 DOI: 10.1080/13607863.2023.2240261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
Objectives: Drawing from the mindfulness framework and the broaden-and-build theory, this study investigates the extent to which mindfulness influences loneliness and whether the relation is mediated by positive and negative affect.Method: Data were collected from 748 retired older adults aged 60 and above in Chengdu, China in 2022. Loneliness and mindfulness were measured by the UCLA loneliness scale and by the short-form version of the Five Facet Mindfulness Questionnaire, while the positive and negative affect was assessed by the International Positive and Negative Affect Schedule.Results: The results of this study show that mindfulness was positively associated with positive affect (β = 0.37, p<.001), negatively related to negative affect (β=-0.21, p<.001) and loneliness (β=-0.13, p<.001), and had an indirect effect on loneliness via positive and negative affect (β=-0.20, p<.001).Conclusion: The findings suggest that mindfulness could be a positive resource for improving mental health and reducing loneliness among retired older adults in China.
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Affiliation(s)
- Xiaoxia Xie
- Research Institute of Social Development, Southwestern University of Finance & Economics, Chengdu, Sichuan Province, China
| | - Xingyong Qiao
- Research Institute of Social Development, Southwestern University of Finance & Economics, Chengdu, Sichuan Province, China
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Cheng Y, Cheng L, Zhu F, Xiang Y, Duan S, Luo J, Lei L, Cai H, Hu T. New measure of functional tooth loss for successful Oral ageing: a cross-sectional study. BMC Geriatr 2023; 23:859. [PMID: 38102557 PMCID: PMC10722707 DOI: 10.1186/s12877-023-04570-1] [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: 02/12/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This cross-sectional study evaluated the impacts of functional tooth loss on oral health-related quality of life (OHRQoL) among elderly people compared with the impacts of several common indicators of oral health. Additionally, the cut-off of functional tooth loss needed for a better OHRQoL was investigated to establish a new measure for successful oral ageing. METHODS Data from people aged 65-74 were extracted from the Fourth National Oral Health Survey in Sichuan, China. Functional tooth loss was defined as both natural tooth loss and nonfunctional teeth, such as third molars, residual roots, and removable dentures. The cut-offs of tooth loss were first identified as 12, based on the previous definition of functional dentition (≥20 natural teeth except the third molars), and 14, 16, or 18 for further investigation. OHRQoL was evaluated by the standardized Geriatric Oral Health Assessment Index (sGOHAI) score. Logistic regression was performed to estimate the impacts on OHRQoL. Additionally, subgroup analyses were conducted using the stratified chi-square test to explore the effect of functional tooth loss at each position. RESULTS The mean GOHAI score of the 744 participants was 48.25 ± 7.62. Elderly people who had lost ≤12 functional teeth had greater odds of reporting a higher sGOHAI score than those who had lost more functional teeth (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05-2.11). No significant difference in the sGOHAI score was detected between people who had lost 13-16 functional teeth and those who had lost ≤12 functional teeth (0.61, 0.35-1.07). The loss of second premolars and first and second molars had great impacts on the sGOHAI score when ≤12 or ≤ 16 functional teeth had been lost. CONCLUSIONS Compared with natural tooth loss, functional dentition and occluding pairs, functional tooth loss can be a better indicator of OHRQoL in the elderly population. Sixteen remaining functional teeth seem to be sufficient to maintain good OHRQoL and successful oral ageing despite that number being previously acknowledged as ≥20 teeth.
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Affiliation(s)
- Yiting Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Li Cheng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Fangzhi Zhu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Yong Xiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Shaoying Duan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Jingjing Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Lei Lei
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - He Cai
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China.
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
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Chen S, Li L, Jiao L, Wang C. Long-term care insurance and the future of healthy aging in China. NATURE AGING 2023; 3:1465-1468. [PMID: 38093139 DOI: 10.1038/s43587-023-00540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Linye Li
- Chinese Academy of Social Sciences, Beijing, China
| | - Lirui Jiao
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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Yang L, Wei W, Wu Y, Zhu S, Zeng X, Wang R, Zhang M, Lin X, Zhou C. The experiences of caring for disabled older adults in long-term: A qualitative study from the perspective of spousal caregivers. Chronic Illn 2023; 19:848-861. [PMID: 36594348 DOI: 10.1177/17423953221148972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore the care experiences of spouses as long-term and primary caregivers for disabled older adults in China. METHODS A descriptive phenomenological method was used in this study, as well as purposive and convenient sampling. Semi-structured interviews were conducted with 15 spousal caregivers in Guangdong, China, from March to December 2021. Interview audio-recordings were transcribed verbatim and data were analyzed using Colaizzi's phenomenological analysis method. RESULTS We identified four themes from the data: spousal care motivation; sacrifices in caregiving; obstacles in caregiving; spousal caregivers' positive experiences. CONCLUSIONS Spouses took responsibility for providing care for their disabled partners regardless of their willingness. They had positive experiences while providing care, but negative experiences were dominant, especially for spouses of severely disabled older adults. Spouses are always perfect in caregiving roles, although they may also need medical assistance. To prevent a decline in spousal caregivers' quality of life and relieve their care burdens, health care providers should support them as soon as possible or offer formal care for disabled older adults. It is necessary to intervene considering disabled older adults and their spousal caregivers as a unit to empower their confidence in coping with life together.
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Affiliation(s)
- Lingli Yang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Wei Wei
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Shunfang Zhu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaoli Zeng
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Run Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Mi Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaolu Lin
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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50
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Sun W, Jones JA, Gamber M. A Turning Point for China's Population: No Child and Long Illness. Aging Dis 2023; 14:1950-1952. [PMID: 37199591 PMCID: PMC10676787 DOI: 10.14336/ad.2023.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/26/2023] [Indexed: 05/19/2023] Open
Affiliation(s)
- Wenjie Sun
- Department of Rural Health, Oklahoma State University Center for Health Sciences, Tulsa, OK74135, USA.
| | - Jeffery A Jones
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA.
| | - Michelle Gamber
- School of Health Professions, Shenandoah University, Winchester, Virginia.
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