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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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Zhong Y, Guo X, Liu Y, Wang Y, Wang Y, Song Y, Lu R. Old people's preference for nursing homes in East China: a discrete choice experiment. BMC Nurs 2024; 23:254. [PMID: 38649875 PMCID: PMC11034096 DOI: 10.1186/s12912-024-01907-y] [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: 11/16/2023] [Accepted: 04/01/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The aged people who live in nursing home are predicted to keep growing in the following decades. There are both quantitative imbalance and structural imbalance in the utilization of nursing homes in China. This study aimed to analyze old people's preference for nursing homes and help the government optimize resource allocation. METHODS A discrete choice experiment (DCE) was conducted and six attributes of nursing homes including monthly fee, distance from home, geographical location, medical facilities, environment of nursing homes and nursing staff were determined. Respondents were recruited from Nantong and Yangzhou city, China. In each city, two communities or villages were randomly selected. In each community/village, about 65 old people were randomly selected. Analysis was conducted using mixed logit regression models to determine preferences for potential attributes. RESULTS A total of 233 old people were included in the analysis. The findings indicated that all six attributes were statistically significant factors for participants. "Professional nursing staff" was the most important characteristic to participants, followed by "Medical facilities". Compared with female, the males preferred professional nursing staff (β = 2.939 vs. β = 2.643, P < 0.001), medical facilities (β = 1.890 vs. β = 1.498, P < 0.001), and the environment (β = 0.752, P < 0.01). For different age groups, participants aged 60-69 didn't pay attention to distance and location, while those aged 80 and above only paid attention to professional nursing staff and medical facilities. CONCLUSIONS The present study provides important insights into the characteristics of nursing home that are most preferred by old people. Authorities should take into account old people's preference in the planning, design and evaluation of nursing homes.
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Affiliation(s)
- Yaqin Zhong
- School of Public Health, Nantong University, Nantong, China
| | - Xiaojun Guo
- School of Science, Nantong University, Nantong, China
| | - Yitong Liu
- School of Public Health, Nantong University, Nantong, China
| | - Yaning Wang
- School of Public Health, Nantong University, Nantong, China
| | - Yanan Wang
- School of Public Health, Nantong University, Nantong, China
| | - Yan Song
- School of Nursing, Nantong University, Nantong, China
| | - Rujian Lu
- Third Affiliated Hospital of Nantong University, Nantong, China.
- Nantong Third People's Hospital, Nantong, China.
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Chen S, Yang J, Ma B, Meng J, Chen Y, Ma T, Zhang X, Wang Y, Huang Y, Zhao Y, Wang Y, Lu Q. Understanding community-dwelling older adults' preferences for home- and community-based services: A conjoint analysis. Int J Nurs Stud 2024; 152:104699. [PMID: 38308935 DOI: 10.1016/j.ijnurstu.2024.104699] [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: 08/01/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Older adults' preference for home- and community-based service programs has been highlighted as an essential but usually ignored ingredient in current care models. Disentangling how preferences contribute to older adults' decision-making could facilitate finding optimal ways to deliver home- and community-based services in times of increasing scarcity. OBJECTIVE To identify Chinese community-dwelling older adults' preference structure for home- and community-based services and thus to optimize service provision. METHODS Conjoint analysis, a preference-based technique, was employed to study older adults' preferences. A stepwise qualitative approach was first adopted to identify the attributes and attribute levels of home- and community-based services. Scenarios were defined through an orthogonal fractional factorial design, and a cross-sectional survey was conducted through a face-to-face, anonymous questionnaire. Conjoint analysis was performed to determine preference weights representing the relative importance of the identified attributes, and cluster analysis was performed to identify clusters of participants with similar preference structures. All data analyses were performed using SAS v9.4 and SPSS 22.0. RESULTS A total of 321 of 350 invited participants completed the questionnaire. Four attributes were identified and used to create the conjoint scenarios: care-giving attitude, price, technical care-giving skills, and the type of service provider. Care-giving attitude was the most valued attribute for older adults when making decisions (relative importance score = 48.28), followed by price (relative importance score = 21.618), technical care-giving skills (relative importance score = 19.518), and finally, the type of service provider (relative importance score = 10.585). Three preference phenotypes were identified by applying cluster analysis: "price-oriented", "comprehensively balanced", and "attitude-oriented". CONCLUSION The present study underscored the importance of considering attributes valued by Chinese older adults in the design and delivery of home- and community-based services. The preference structure, including the utility score of the attribute levels, differs among older adults. The findings could inform future research and practice and suggest incorporating flexibility during the service delivery stage.
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Affiliation(s)
- Shixiang Chen
- School of Nursing, Shandong Second Medical University, Weifang 261053, China.
| | - Jin Yang
- School of Nursing, Tianjin Medical University, Tianjin 300070, China.
| | - Bingxin Ma
- School of Nursing, Tianjin Medical University, Tianjin 300070, China.
| | - Jianan Meng
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Ying Chen
- Department of Oncology Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals, Jiangsu, China
| | - Tingting Ma
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Xiaojun Zhang
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Yulu Wang
- School of Nursing, Tianjin Medical University, Tianjin 300070, China
| | - Yaqi Huang
- School of Nursing, The Hong Kong Polytech University, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Tianjin 300070, China.
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, China.
| | - Qi Lu
- School of Nursing, Tianjin Medical University, Tianjin 300070, China.
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Ma Q, Sun F, Mi H. Long-Term Care Preferences Among Chinese Older Adults: The Role of Sociocultural Factors. J Aging Soc Policy 2023; 35:806-823. [PMID: 37838962 DOI: 10.1080/08959420.2023.2265770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/08/2023] [Indexed: 10/17/2023]
Abstract
Understanding individuals' long-term care preferences is essential to the provision of person-centered care. This study aims to describe the preferences for long-term care settings and investigates sociocultural factors associated with long-term care preferences among older Chinese adults. Responses from 22,112 older adults aged 60 years or above were analyzed using multinomial logistic regression. Four ideal long-term care settings were identified: in-home care, community day care, institutional care, and undecided long-term care arrangements. The study found that the majority of participants desired to age in place at home, regardless of their health status and social support conditions. Therefore, research and advocacy efforts are needed to inform policymakers to strategically develop home-based long-term care supports in China.
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Affiliation(s)
- Qiyini Ma
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, MI, USA
| | - Hong Mi
- School of Public Affairs, Zhejiang University, Hangzhou, China
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Cadmus EO, Adebusoye LA, Owoaje ET. Ageing in place or stuck in place: Preferred care setting for community-dwelling older persons in a low-resource country in Sub Saharan Africa. PLoS One 2023; 18:e0292939. [PMID: 37844096 PMCID: PMC10578603 DOI: 10.1371/journal.pone.0292939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Ageing in Place is the emerging social policy drive for long-term care coordination of older persons globally. This decision may be the only viable option in many low- and middle-income countries like Nigeria. Nevertheless, the risk of older persons being 'stuck in place' is high if their preferences are not considered or other alternatives are neither acceptable nor available. This study determined factors associated with the preferred care setting among community-dwelling older persons and explored their views about their choices. METHODS The study utilised a mixed-methods approach. Participants were older persons (≥ 60 years) in a selected rural and urban community in Oyo State, south-western Nigeria. Quantitative data were collected using an interviewer-administered, semi-structured questionnaire and analysed using Stata version 14 at p<0.05. Qualitative data collection involved 22 Focus Group Discussions (FGD). The discussions were audiotaped, transcribed verbatim and analysed thematically using ATLAS.ti version 8. Selected quotations were used to illustrate themes. RESULTS 1,180 participants (588 rural vs 592 urban) were interviewed with a mean age of 73.2 ±9.3 years. More rural participants preferred to AIP (61.6%) compared to urban participants (39.2%), p = 0.001. Factors associated with the decision for rural participants were older age [OR:2.07 (95%CI:1.37-3.14)], being male [OR:2.41(95%CI:1.53-3.81)] and having assistance at home [OR:1.79 (95%CI:1.15-2.79)]. In comparison, significant factors for urban participants were older age (≥70years) [OR:1.54(95%CI:1.03-2.31)] and home-ownership [OR:5.83 (95%CI:3.82-8.91)]. The FGD revealed that the traditional expectation of reciprocity of care mostly influenced the desire to AIP. Advantages include improved social connectedness, quality of care, community participation and reduced isolation. Interestingly, participants were not opposed to the option of institutional care. CONCLUSION Ageing in place is preferred and influenced by advanced age and home ownership in our setting. Information provided could guide age-friendly housing policies and community-based programmes for the care of older persons.
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Affiliation(s)
- Eniola Olubukola Cadmus
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Lawrence Adekunle Adebusoye
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - Eme Theodora Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Gonçalves J, Filipe L, Van Houtven CH. Trajectories of Disability and Long-Term Care Utilization After Acute Health Events. J Aging Soc Policy 2023:1-24. [PMID: 37811807 DOI: 10.1080/08959420.2023.2267399] [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: 02/21/2023] [Accepted: 07/11/2023] [Indexed: 10/10/2023]
Abstract
Hip fractures, strokes, and heart attacks are common acute health events that can lead to long-term disability, care utilization, and unmet needs. However, such impacts, especially in the long term, are not fully understood. Using data from the Health and Retirement Study, 1992-2018, this study examines the long-term trajectories of individuals suffering such health shocks, comparing with individuals not experiencing health shocks. Hip fracture, stroke, and heart attack are confirmed to have severe implications for disability. In most cases of stroke and heart attack, informal caregivers provide the daily support needed by survivors, whereas following hip fracture, nursing home care is more relevant. These health shocks put individuals on worse trajectories of disability, care utilization, and unmet needs. There is no long-term recovery or convergence with individuals who do not suffer shocks. Unmet need is prevalent, even pre-shock and among individuals who do not experience health shocks, emphasizing the importance of preventative care measures. These findings support policy action to ensure hospitalized individuals, especially those aged 50 and above, receive rehabilitative services and other post-acute care. Furthermore, hospitalization is an event that requires the detection and addressing of unmet care needs beyond the short run.
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Affiliation(s)
- Judite Gonçalves
- School of Public Health, Imperial College London, London, UK
- NOVA School of Business and Economics, NOVA University Lisbon, Carcavelos, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Luís Filipe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
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Wang K, Zhao J, Hu J, Liang D, Luo Y. Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach. Front Public Health 2023; 11:1257818. [PMID: 37771828 PMCID: PMC10523409 DOI: 10.3389/fpubh.2023.1257818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
Background The ageing population in China has led to a significant increase in the number of older persons with disabilities. These individuals face substantial challenges in accessing adequate activities of daily living (ADL) assistance. Unmet ADL needs among this population can result in severe health consequences and strain an already burdened care system. This study aims to identify the factors influencing unmet ADL needs of the oldest old (those aged 80 and above) with disabilities using six machine learning methods. Methods Drawing from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2017-2018 data, we employed six machine learning methods to predict unmet ADL needs among the oldest old with disabilities. The predictive effects of various factors on unmet ADL needs were explored using Shapley Additive exPlanations (SHAP). Results The Random Forest model showed the highest prediction accuracy among the six machine learning methods tested. SHAP analysis based on the Random Forest model revealed that factors such as household registration, disability class, economic rank, self-rated health, caregiver willingness, perceived control, economic satisfaction, pension, educational attainment, financial support given to children, living arrangement, number of children, and primary caregiver played significant roles in the unmet ADL needs of the oldest old with disabilities. Conclusion Our study highlights the importance of socioeconomic factors (e.g., household registration and economic rank), health status (e.g., disability class and self-rated health), and caregiving relationship factors (e.g., caregiver willingness and perceived control) in reducing unmet ADL needs among the oldest old with disabilities in China. Government interventions aimed at bridging the urban-rural divide, targeting groups with deteriorating health status, and enhancing caregiver skills are essential for ensuring the well-being of this vulnerable population. These findings can inform policy decisions and interventions to better address the unmet ADL needs among the oldest old with disabilities.
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Affiliation(s)
- Kun Wang
- Zhongnan University of Economics and Law (School of Philosophy), Wuhan, Hubei, China
- Nankai University (Zhou Enlai School of Government), Tianjin, China
| | - Jinxu Zhao
- Zhongnan University of Economics and Law (School of Philosophy), Wuhan, Hubei, China
| | - Jie Hu
- Wuhan University (School of Physics and Technology), Wuhan, Hubei, China
| | - Dan Liang
- Tongji Medical College of Huazhong University of Science and Technology (School of Medicine and Health Management), Wuhan, Hubei, China
| | - Yansong Luo
- Zhongnan University of Economics and Law (School of Philosophy), Wuhan, Hubei, China
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Schorderet C, Bastiaenen CHG, de Bie RA, Maréchal M, Vuilleumier N, Allet L. Development of a tool to assess environmental factors to support home care - a Delphi study. BMC Geriatr 2023; 23:501. [PMID: 37605112 PMCID: PMC10441718 DOI: 10.1186/s12877-023-04207-3] [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: 05/23/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Living in an adequate environment suited to one's abilities and needs is an essential condition to function in daily life. However, no complete tool currently exists to provide a rapid overview of a person's environment, both material (accommodation and auxiliary means) and social (entourage and available services). Our aim was to develop a tool to identify potentially problematic environmental factors and to determine when an in-depth assessment is necessary. METHODS Health professionals experienced in home-based treatment participated in a three-round Delphi process. The first round aimed to define which items the tool should contain, the second to collect participants' opinions on a first version of the tool, and the third to collect the participants' opinions on the adapted version of the tool. RESULTS A total of 29 people participated in the first round, 21 in the second and 18 in the third. The final tool contains 205 items divided into four categories (basic information about the inhabitant and their home, inhabitant's level of independence and autonomy, home, tools and means at the inhabitant's disposition) and two annexes (stairs to access to the home, internal staircase to the dwelling). CONCLUSIONS A complete tool allowing professionals working in patients' homes to obtain an overview of the environmental factors that could represent obstacles to the independence of the inhabitant, or to the possibility of providing quality care could be developed. This tool is very complete but relatively long. To facilitate its usability, it would be relevant that a digital version to focus on individual relevant categories be elaborated.
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Affiliation(s)
- Chloé Schorderet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.
- Department of Epidemiology, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands.
- The Sense Innovation & Research Center, Lausanne and Sion, Switzerland.
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Robert A de Bie
- Department of Epidemiology, Care and Public Health Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands
| | | | | | - Lara Allet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland
- The Sense Innovation & Research Center, Lausanne and Sion, Switzerland
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
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Skolarus L, Thrash-Sall E, Hellem AK, Giacalone M, Burke J, Lin CC, Bailey S, Corches C, Dinh M, Casetti A, Mansour M, Bowie K, Roth R, Whitfield C, Sales A. Community-Led, Cross-Sector Partnership of Housing and Health Care to Promote Aging in Place (Unite Health Project): Protocol for a Prospective Observational Study. JMIR Res Protoc 2023; 12:e47855. [PMID: 37384383 PMCID: PMC10365602 DOI: 10.2196/47855] [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: 04/05/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND For many older Americans, aging in place is their preferred living arrangement. Minoritized and socioeconomically disadvantaged older adults are up to 3 times more likely to experience disability than other groups, which increases their likelihood of being unable to age in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. One such idea is the Unite care model, a community-initiated, academic-supported, cross-sector initiative that combines 2 sectors: housing and health care. The Unite care model colocates a federally qualified health center clinic on an older adult affordable housing campus in Flint, Michigan. OBJECTIVE There are two aims to this study. Aim 1 is to evaluate the implementation of the Unite care model in terms of acceptability, adoption, and penetration. Aim 2 is to determine which older adults use the care model and whether the care model promotes aging in place through risk factor reduction and improvement in the physical and social environment. METHODS We will assess the care model using a concurrent, exploratory mixed methods design. For aim 1, acceptability will be assessed through semistructured interviews with key stakeholder groups; adoption and penetration will be assessed using housing and health care records. For aim 2, residents residing in the Unite clinic building will participate in structured outcome assessments at 6 and 12 months. Risk factor reduction will be measured by change in systolic blood pressure from baseline to 12 months and change in the physical and social environment (item counts) will also be assessed from baseline to 12 months. RESULTS Data collection for aim 1 began in July 2021 and is anticipated to end in April 2023. Data collection for aim 2 began in June 2021 and concluded in November 2022. Data analysis for aim 1 is anticipated to begin in the summer of 2023 and analysis for aim 2 will begin in the spring of 2023. CONCLUSIONS If successful, the Unite care model could serve as a new care model to promote aging in place among older adults living in poverty and older Black Americans. The results of this proposal will inform whether larger scale testing of this new model of care is warranted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47855.
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Affiliation(s)
- Lesli Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, United States
| | | | - Abby Katherine Hellem
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | - James Burke
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Chun Chieh Lin
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges Into the Future, Flint, MI, United States
| | - Casey Corches
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mackenzie Dinh
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Casetti
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Maria Mansour
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kaitlyn Bowie
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rylyn Roth
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace Whitfield
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Anne Sales
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, United States
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Irwin P, Taylor D, Keefe JM. Provincial policies affecting resident quality of life in Canadian residential long-term care. BMC Geriatr 2023; 23:362. [PMID: 37296381 PMCID: PMC10252178 DOI: 10.1186/s12877-023-04074-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: 02/25/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents' quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada. METHODS The study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains. RESULTS Overall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts. CONCLUSION The analysis provides substantive evidence of three key policy levers: situations-providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures-identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories-confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.
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Affiliation(s)
- Pamela Irwin
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS Canada
| | - Deanne Taylor
- Interior Health Authority, Kelowna, BC Canada
- Rural Coordination Centre of British Columbia, Vancouver, BC Canada
| | - Janice M. Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS Canada
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS Canada
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de Jong L, Schmidt T, Stahmeyer JT, Eberhard S, Zeidler J, Damm K. Informelle Pflege und Berufstätigkeit: Einflussfaktoren auf die Bereitschaft. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2023:S1865-9217(23)00008-9. [PMID: 37019756 DOI: 10.1016/j.zefq.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION The proportion of people in need of care will continue to rise in Germany. In 2019, the majority of people in need of care was cared for at home. Reconciling caregiving and work poses a heavy burden for many caregivers. Therefore, a monetary compensation for care is being discussed politically in order to facilitate the reconciliation of work and care. The aim of this study was to investigate whether and under which circumstances a sample of the German population is willing to care for a close relative. A particular focus was placed on the willingness to reduce working hours, the importance of the expected period of caregiving, and monetary compensation. METHODS A primary data collection was conducted in two modes using a questionnaire. A self-completion postal survey was sent out via the AOK Lower Saxony and complemented with an online survey. Data was analysed descriptively and using logistic regression. RESULTS 543 participants were included. 90% of the sample surveyed was willing to provide care for a close relative, with the majority stating that their willingness depended on various factors: both the health status and the person of the family member needing care had the greatest influence. 34% of the employed respondents were not willing to reduce their working hours, mostly for financial reasons. DISCUSSION AND CONCLUSION Many older adults want to stay in their homes for as long as possible. Thus, the willingness to provide and take over the role of informal caregiver is and will remain a central pillar of the German care system. Negotiating between informal caregiving and professional activities often creates a substantial burden. For people from lower income households monetary compensation might enhance their willingness to provide informal care. However, in order to increase the willingness to engage in informal care of people from different backgrounds and life stages, flexible approaches are needed that go beyond monetary compensation.
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de Jong L, Schmidt T, Stahmeyer JT, Eberhard S, Zeidler J, Damm K. Willingness to provide informal care to older adults in Germany: a discrete choice experiment. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:425-436. [PMID: 35689744 PMCID: PMC10060358 DOI: 10.1007/s10198-022-01483-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/12/2022] [Indexed: 06/05/2023]
Abstract
As the German population is continually aging and the majority of older adults still wish to 'age in place', the need for informal care provided by family and friends will correspondingly continue to increase. In addition, while the need for formal (professional) care services is also likely to increase, the supply already does not meet the demand in Germany today. The aim of our study is the elicitation of people's willingness to provide informal care by means of a discrete choice experiment. The self-complete postal survey was disseminated to a random sample of the German general population in Lower Saxony. Data cleansing resulted in a final sample size of 280 participants. A conditional logit and a latent class model were estimated. All attributes were judged as highly relevant by the respondents. The results revealed that an increase in the care hours per day had the greatest negative impact overall on the willingness to provide informal care in our sample. The marginal willingness-to-accept for 1 h of informal care was €14.54 when having to provide informal care for 8 h in reference to 2 h per day. This value is considerably higher than the national minimum wage of €9.82. A three-class latent class model revealed preference heterogeneity. While a monetary compensation is often discussed to increase the willingness and availability of informal care in a country, our results show that this statement could not be generalized within our entire sample.
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Affiliation(s)
- Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany.
| | - Torben Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany
| | | | - Sveja Eberhard
- Health Services Research Unit, AOK Lower Saxony, Hannover, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Str.7, 30159, Hannover, Germany
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Li Y, Zhang J, Luo H, Pei X, Wu T, Jing J. The Role of Contextual Factors in Shaping Urban Older Adults' Intention of Institutional Care in China: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4731. [PMID: 36981640 PMCID: PMC10049168 DOI: 10.3390/ijerph20064731] [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: 01/19/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This mixed-methods study explores older people's intention of institutional care and its contributing contextual factors, and the meaning given to their intention by older adults in the transitioning Chinese society. METHODS Guided by the extended Anderson model and frameworks of the ecological theory of aging, survey data collected from 1937 Chinese older adults were used. Transcripts from six focus group interviews were analyzed to incorporate the voices of the participants. RESULTS Community environment and services, health services, financial services, and regional service organizations were related to the institutional care intention of older people. The qualitative analysis showed that the reported conflicting feelings about institutional care was driven by the lack of supporting resources and age-friendly environment. The findings of this study suggested that the reported intention of Chinese older adults for institutional care may not be an ideal choice but a compromise or, in some cases, a forced choice. CONCLUSIONS Rather than treating the stated institutional intention as a simple expression of older Chinese people's likes or desires, the intention of institutional care should be understood within a framework that fully considers the influence of psycho-social factors and contextual organizations.
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Affiliation(s)
- Yuekang Li
- Brown School, Washington University in St. Louis, Saint Louis, MA 63130, USA
| | - Jinbao Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong 999077, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong 999077, China
| | - Xiaomei Pei
- Department of Sociology, Tsinghua University, Beijing 100084, China
| | - Tao Wu
- Gallup China, Beijing 100022, China
| | - Jun Jing
- Department of Sociology, Tsinghua University, Beijing 100084, China
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Buczak-Stec E, König HH, Feddern L, Hajek A. Long-Term Care Preferences and Sexual Orientation-A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:331-342.e1. [PMID: 36586720 DOI: 10.1016/j.jamda.2022.11.020] [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: 01/23/2022] [Revised: 10/28/2022] [Accepted: 11/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The number of sexual and gender minority older adults who require long-term care is steadily increasing. The purpose of this systematic review and meta-analysis was to synthesize the evidence related to preference for long-term care with regard to sexual orientation and gender identity. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS We searched PubMed/MEDLINE, Ovid/PsycINFO, and Web of Science from inception to July 2020 (updated in July 2021). Search terms embraced 3 themes (1) sexual and gender minorities, (2) long-term care, and (3) preferences. Quantitative studies of the adult population were included. METHODS Screening, data extraction, and quality assessment followed the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The proportions were pooled using meta-analysis and random effects models. RESULTS A total of 17 articles were included out of 5944 studies of potential relevance. The perception of nursing homes (NHs) that emerges from these studies is predominantly negative for heterosexuals and lesbian, gay, bisexual and trans (LGBT) individuals (n = 11). Across 6 studies (10 outcomes), the pooled estimate for the proportion of individuals with a preference to move into a NH was 10.6% [95% confidence interval (CI) 7.88%‒13.22%, I2 = 97.4%]; 13.7% (95% CI 8.6%‒18.7%) for LGBT individuals and 7.3% (95% CI 3.14%‒11.50%) for heterosexuals. LGBT-friendly NHs were preferred by between 55% and 98% of LGBT respondents. Informal care provided by partner or family was one of the preferred options (n = 6). It was preferred by 33% to 70% of various groups of LGBT respondents. CONCLUSIONS AND IMPLICATIONS The preference to move into a NH is relatively low among both heterosexuals and sexual and gender minority adults. Findings showed negligible differences in preferences to move into a NH between heterosexuals and sexual and gender minorities. LGBT-friendly long-term care facilities where every member feels welcomed and not discriminated against seem to be one of the favorable long-term care choices among LGBT individuals. This knowledge is important to inform nursing services and policy makers about the preferred long-term care options. Providing LGBT-friendly facilities is usually less expensive than providing care in newly created LGBT-only facilities.
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Affiliation(s)
- Elżbieta Buczak-Stec
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany.
| | - Hans-Helmut König
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
| | - Lukas Feddern
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
| | - André Hajek
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
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Skudlik S, Hirt J, Döringer T, Thalhammer R, Lüftl K, Prodinger B, Müller M. Challenges and care strategies associated with the admission to nursing homes in Germany: a scoping review. BMC Nurs 2023; 22:5. [PMID: 36600231 DOI: 10.1186/s12912-022-01139-y] [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: 07/25/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The admission to a nursing home is a critical life-event for affected persons as well as their families. Admission related processes are lacking adequate participation of older people and their families. To improve transitions to nursing homes, context- and country-specific knowledge about the current practice is needed. Hence, our aim was to summarize available evidence on challenges and care strategies associated with the admission to nursing homes in Germany. METHODS We conducted a scoping review and searched eight major international and German-specific electronic databases for journal articles and grey literature published in German or English language since 1995. Further inclusion criteria were focus on challenges or care strategies in the context of nursing home admissions of older persons and comprehensive and replicable information on methods and results. Posters, only-abstract publications and articles dealing with mixed populations including younger adults were excluded. Challenges and care strategies were identified and analysed by structured content analysis using the TRANSCIT model. RESULTS Twelve studies of 1,384 records were finally included. Among those, seven were qualitative studies, three quantitative observational studies and two mixed methods studies. As major challenges neglected participation of older people, psychosocial burden among family caregivers, inadequate professional cooperation and a lack of shared decision-making and evidence-based practice were identified. Identified care strategies included strengthening shared decision-making and evidence-based practice, improvement in professional cooperation, introduction of specialized transitional care staff and enabling participation for older people. CONCLUSION Although the process of nursing home admission is considered challenging and tends to neglect the needs of older people, little research is available for the German health care system. The perspective of the older people seems to be underrepresented, as most of the studies focused on caregivers and health professionals. Reported care strategies addressed important challenges, however, these were not developed and evaluated in a comprehensive and systematic way. Future research is needed to examine perspectives of all the involved groups to gain a comprehensive picture of the needs and challenges. Interventions based on existing care strategies should be systematically developed and evaluated to provide the basis of adequate support for older persons and their informal caregivers.
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Affiliation(s)
- Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany.
| | - Julian Hirt
- International Graduate Academy, Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute for Applied Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences (Formerly FHS St. Gallen), St. Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Regina Thalhammer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Katharina Lüftl
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Birgit Prodinger
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Department for Primary Care and Health Services Research, Medical Faculty, Nursing Science and Interprofessional Care, Heidelberg University, Heidelberg, Germany
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A Home-Care Service for Frail Older Adults: Findings from a Quasi-Experiment in Milan. AGEING INTERNATIONAL 2023; 48:157-168. [PMID: 34566206 PMCID: PMC8456187 DOI: 10.1007/s12126-021-09462-6] [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] [Accepted: 08/04/2021] [Indexed: 10/26/2022]
Abstract
Population aging is particularly pronounced in Italy. Recently, home-care services emerged as one of the desirable strategy when dealing with such situations of fragility. In this framework, we present the evaluation of a home-care service which was experimentally implemented by Fondazione Sacra Famiglia and Casa di Cura Ambrosiana in the 2017-2018 biennium. The service consisted of a twice-weekly nursing visit intended to monitor patient health conditions and to gather data constantly supervised by a geriatrician. The eligible population consisted of the users of San Carlo Hospital Emergency Department (91 individuals). Twenty of these individuals had access to the experimental home-care service. The results show the smaller probability of mortality for the treatment group compared to the control group, but similar probabilities in admissions to ER and in hospitalizations. These findings suggest that health home-care policies could reduce mortality by lessening the negative effects of relational isolation.
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Sánchez-Román M, Autric-Tamayo G, Fernandez-Mayoralas G, Rojo-Perez F, Agulló-Tomás MS, Sánchez-González D, Rodriguez-Rodriguez V. Social Image of Old Age, Gendered Ageism and Inclusive Places: Older People in the Media. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17031. [PMID: 36554910 PMCID: PMC9778791 DOI: 10.3390/ijerph192417031] [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: 10/27/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Ageism promotes the exclusion of older people from society by generating a negative image that they also internalize. The aim of this article is to investigate older people's social self-image, through statements broadcast on a national Spanish radio program aimed at this group. A qualitative analysis was conducted for a random sample from the sound archive for the Radio Nacional de España program Juntos Paso a Paso (Together, Step by Step) (2008-2021), using codes based on the pillars and determinants of active ageing and the three dimensions of ageism. Intercoder agreement was calculated. There were significant findings regarding ageism, gendered ageism and ageing in place, with differences according to size of municipal area. The program in question can be considered a viable secondary source for the research aim. Ageism is most commonly manifested through implicit opinions and invisibilization in family and social contexts. Care activities play a notably central role in responses related to gendered ageism. In relation to ageing in place, older people prefer their habitual environment when they have moderate care needs and accept moves to nursing homes when their needs increase.
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Affiliation(s)
- María Sánchez-Román
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | - Gadea Autric-Tamayo
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | | | - Fermina Rojo-Perez
- Grupo de Investigacion sobre Envejecimiento (GIE), IEGD, CSIC, 28037 Madrid, Spain
| | - María Silveria Agulló-Tomás
- University Institute on Gender Studies and Social Analysis Department, University Carlos III of Madrid, Getafe, 28903 Madrid, Spain
| | - Diego Sánchez-González
- Department of Geography, National Distance Education University (UNED), 28040 Madrid, Spain
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18
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Access to Long-Term Care for Minority Populations: A Systematic Review. Can J Aging 2022; 41:577-592. [PMID: 35331343 DOI: 10.1017/s0714980822000046] [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: 12/16/2022] Open
Abstract
It has been shown that there is disparity in access to long-term care and other services for minority populations. This study assessed long-term care access among older individuals belonging to minority populations including visible, ethnocultural, linguistic, and sexual minorities. Barriers and facilitators influencing admission were identified and evaluated.A search for articles from 10 databases published between January 2000 and January 2021 was conducted. Included studies evaluated factors affecting minority populations' admission to long-term care, and non-residents' perceptions of future admission. This review was registered with PROSPERO: CRD42018038662. Sixty included quantitative and qualitative studies, ranging in quality from fair to excellent. Findings suggest minority status is associated with reduced admission to long-term care, controlling for confounding variables. Barriers identified include discordant language, fear of discrimination, lack of information, and family obligations. Findings suggest that minority populations experienced barriers accessing long-term care and had unmet cultural and language needs while receiving care in this setting.
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19
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de Jong L, Zeidler J, Damm K. A systematic review to identify the use of stated preference research in the field of older adult care. Eur J Ageing 2022; 19:1005-1056. [PMID: 36692785 PMCID: PMC9729451 DOI: 10.1007/s10433-022-00738-7] [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] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
In the design of long-term care systems, preferences can serve as an essential indication to better tailor services to the needs, wishes and expectations of its consumers. The aim of this systematic review was to summarize and synthesize available evidence on long-term care preferences that have been elicited by quantitative stated-preference methods. The databases PubMed and Web of Science were searched for the period 2000 to 2020 with an extensive set of search terms. Two independent researchers judged the eligibility of studies. The final number of included studies was 66, conducted in 19 different countries. Studies were systematized according to their content focus as well as the survey method used. Irrespective of the heterogeneity of studies with respect to research focus, study population, sample size and study design, some consistent findings emerged. When presented with a set of long-term care options, the majority of study participants preferred to "age in place" and make use of informal or home-based care. With increasing severity of physical and cognitive impairments, preferences shifted toward the exclusive use of formal care. Next to the severity of care needs, the influence on preferences of a range of other independent variables such as income, family status and education were tested; however, none showed consistent effects across all studies. The inclusion of choice-based elicitation techniques provides an impression of how studies operationalized long-term care and measured preferences. Future research should investigate how preferences might change over time and generations as well as people's willingness and realistic capabilities of providing care.
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Affiliation(s)
- Lea de Jong
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str.7, 30159, Hannover, Germany.
| | - Jan Zeidler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str.7, 30159, Hannover, Germany
| | - Kathrin Damm
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str.7, 30159, Hannover, Germany
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Raemdonck E, Lambotte D, De Witte N, Gorus E. Giving voice to informal caregivers of community-dwelling older adults: A systematic review of empowerment interventions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3354-e3368. [PMID: 35899425 DOI: 10.1111/hsc.13928] [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: 10/25/2021] [Revised: 04/30/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Taking care for older adults can place informal caregivers at risk for developing health problems. Therefore, interventions aiming to empower informal caregivers have been developed. Empowerment refers to a health promotion process including strategies to improve informal caregivers' self-care behaviours, stress-management and caregiving skills. In literature, empowerment-oriented interventions often target subsamples of informal caregivers defined through the care receiver's condition. These interventions, however, do not adequately capture the complexity of care needs and might even exclude informal caregivers taking care for older people without a specific diagnosis or with a subthreshold condition. Therefore, the aim of this systematic review is to provide an overview of the content and effectiveness of empowerment-oriented interventions directed at informal caregivers of community-dwelling older adults. Following the PRISMA guidelines, a systematic review was performed by searching the following databases: PubMed, PsycINFO, EMBASE and Web of Science. From a total of 6798 unique publications, 13 intervention studies, of which seven randomised controlled trials, were eligible for inclusion. According to the Mixed Methods Appraisal Tool, eight studies scored poor. The intervention studies under review represented different domains of empowerment, with cultivation of positive feelings being the most prevalent one. Social participation and physical health received little attention in interventions. Although no adverse intervention effects were observed, the studies reported mixed results with 57 positive and 47 neutral effects. The limited number and poor quality of studies emphasise the need for future research investigating the effectiveness of empowerment-oriented interventions targeting informal caregivers of older adults.
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Affiliation(s)
- Eveline Raemdonck
- Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deborah Lambotte
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nico De Witte
- School of Healthcare, HOGENT University of Applied Sciences and Arts, Ghent, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ellen Gorus
- Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Amilon A, Kjær AA, Ladenburg J, Siren A. Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark. Soc Sci Med 2022; 311:115332. [PMID: 36084519 DOI: 10.1016/j.socscimed.2022.115332] [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: 02/08/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
Aging populations put pressure on the provision and financing of long-term care (LTC) services in many countries. The projected increase in LTC expenditures may in particular constitute a threat to the future sustainability of public budgets in welfare states, where LTC is financed through taxes. To accommodate the increasing number of 80+ year-olds in society, policy-makers and service administrators need a better understanding of care preferences among future older adults: What types of services do older citizens prefer most, and which factors shape their LTC preferences? A discrete choice experiment (DCE) was administered to a representative sample of the Danish population aged 54-64 from May to July 2019 (n = 1154), investigating which factors shape individuals' preferences and willingness-to-pay (WTP) for their future LTC. Our results reveal that respondents are willing to make additional out-of-pocket payments to supplement the care provided for free by the municipality. The WTP was highest for services such as receiving help from a regular care team ($129 per month) and an extra shower a week ($116 per month). Moreover, we find heterogeneous care preferences, with three user characteristics associated with higher WTP for services: higher education, high wealth, and a low trust in the publicly financed care system. Our results raise concerns that inequalities between relatively more- and less-resourceful older adults may increase in Scandinavian-type welfare states in the future. Such increasing inequality in service provision may undermine citizens' trust in and support of the publicly financed care system.
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Affiliation(s)
- Anna Amilon
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Agnete Aslaug Kjær
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark; Den Tværgående Analyseenhed, Københavns Kommune, Rådhuspladsen 1, 1599, Copenhagen, Denmark.
| | - Jacob Ladenburg
- The Rockwool Foundation, Ny Kongensgade 6, 1472, Copenhagen, Denmark; Technical University of Denmark, Produktionstorvet 424, 024, 2800, Kgs. Lyngby, Denmark.
| | - Anu Siren
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark; Tampere University, Arvo Ylpön katu 34, 33,520, Tampere, Finland.
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22
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Deng T, Fan Y, Wu M, Li M. Older People's Long-Term Care Preferences in China: The Impact of Living with Grandchildren on Older People's Willingness and Family Decisions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12455. [PMID: 36231755 PMCID: PMC9566612 DOI: 10.3390/ijerph191912455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this paper was to better understand the long-term care preferences of older people based on intergenerational demonstration effects and social exchange theory, derived from the literature on intergenerational family relationships. The authors relied on the 2014 China Longitudinal Ageing Social Survey database to test the study hypotheses. The results indicated that living with grandchildren was negatively related to the institutional care preferences of older people. Family members' attitudes and older people's life satisfaction significantly mediated the relationship between living with grandchildren and their institutional care preferences. Gender and marital status had potentially diverse effects on institutional care preferences. Therefore, in the context of China's culture of filial piety, social exchange, and intergenerational demonstration, motivation may help foster intergenerational exchange and reciprocity in eldercare arrangements.
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Affiliation(s)
- Tongbo Deng
- School of Public Administration, South China University of Technology, Guangzhou 510641, China
| | - Yafan Fan
- School of Public Administration, South China University of Technology, Guangzhou 510641, China
| | - Mengdi Wu
- College of Economy and Trade, Zhongkai University of Agriculture and Engineering, Guangzhou 510220, China
| | - Min Li
- School of Public Administration, South China University of Technology, Guangzhou 510641, China
- School of Business Administration, South China University of Technology, Guangzhou 510641, China
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Schorderet C, Bastiaenen CHG, Verloo H, de Bie RA, Allet L. A social network analysis to explore collaborative practice in home care: research protocol. BMC Health Serv Res 2022; 22:1174. [PMID: 36123692 PMCID: PMC9484240 DOI: 10.1186/s12913-022-08548-4] [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: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background The conceptualization of the home as a care environment and maintaining a high standard of care requires different professionals to collaborate. This study will explore collaborative practice in home care, needs and expectations of the stakeholders involved, and identify their roles and tasks. Secondly, it will investigate possible strategies to improve home care management and, more particularly, optimize collaborative practice in home care. Methods The study will be conducted during three distinct consecutive phases, within a multiphase mixed-methods design. Phase 1 will use a quantitative approach in which a social network analysis will be conducted to have an overview of collaborative practice in home care in French-speaking Switzerland. Phases 2 and 3 will be qualitative and focus on three different situations involving different locations (rural and urban) and different home care functioning (home care provided by agencies and home care providing by independent caregivers). In each situation, semi-structured interviews will be conducted with home care recipients and their home caregivers. In phase 2, results of phase 1’s network analysis will be discussed, such as roles, needs, and expectations of all stakeholders involved in home care. In phase 3, phase 2’s findings will be discussed and strategies to improve home care and to optimize collaborative practice will be explored. Discussion Over the past years, home care has grown considerably. Therefore, more and more different caregivers are involved in the recipients' homes. Since optimal coordination between these different caregivers is a prerequisite for quality and safe care, it is essential to investigate the existing collaborative practice and how it is functioning. This study will provide knowledge on roles, needs and expectations of different caregivers involved in home care. It will also allow for strategies to optimize collaborative practice and thus ensure comprehensive care for recipients. Finally, it will serve as a basis for future studies that can be conducted to address identified needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08548-4.
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Affiliation(s)
- Chloé Schorderet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland. .,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands. .,The Sense, Innovation & Research Center, Sion, Switzerland.
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Henk Verloo
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.,Service of Old Age Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Robert A de Bie
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Lara Allet
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.,The Sense, Innovation & Research Center, Sion, Switzerland.,Department of Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
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Zwar L, König HH, van der Leeden C, Lühmann D, Oey A, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Luppa M, Löbner M, Weeg D, Mösch E, Heser K, Wagner M, Maier W, Riedel-Heller SG, Scherer M, Hajek A. Do oldest old individuals perceive receipt of informal care as a restriction or support of their autonomy? Aging Ment Health 2022; 26:1862-1873. [PMID: 34338096 DOI: 10.1080/13607863.2021.1955824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Autonomy (defined as self-governance; not equivalent to independence) is relevant to well-being and psychological functioning. However, there is a lack of research on individuals aged >85 years and their perception of autonomy when receiving informal care. This study aims to answer the question if and how the receipt of informal care is associated with perceived autonomy of individuals aged over 85 years. METHOD A cross-sectional study was conducted with data from follow-up 9 of the AgeQualiDe study (2015/2016), which is a multi-centric prospective cohort study in Germany. The analytical sample included 570 participants aged >85 years and with a score of ≥ 19 on the Mini-Mental-State-Examination. Perceived autonomy was assessed with the Perceived Autonomy in Old Age Scale. Receipt of care was assessed as performance of at least one care task (help with basic and instrumental activities of daily living, and supervision) by relatives or friends. Sociodemographic information, mental health, functional level and receipt of professional ambulatory care were controlled for. RESULTS Unadjusted and adjusted linear regression analyses indicated a significant negative association between receipt of informal care and perceived autonomy. The results remained stable in sensitivity analyses; no significant interaction effect was found for gender or education. CONCLUSION Findings indicate that informal care recipients aged >85 years perceive lower autonomy compared to those not receiving care. Additional or other forms of support, and improving the care relationship and communication might be considered to support autonomy of care recipients aged >85 years.
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Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin van der Leeden
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Oey
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Birgitt Wiese
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Kathrin Heser
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Lindquist LA, Miller‐Winder AP, Schierer A, Murawski A, Opsasnick L, Curtis LM, Kim K, Ramirez‐Zohfeld V. Aspects of cognition that impact aging-in-place and long-term care planning. J Am Geriatr Soc 2022; 70:2646-2652. [PMID: 35726136 PMCID: PMC9489627 DOI: 10.1111/jgs.17927] [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: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Older adults frequently defer decisions about their aging-in-place/long-term care (AIP-LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP-LTC planning. METHODS As part of the PlanYourLifespan (PYL)-LitCog study, we longitudinally examined AIP-LTC decision-making among a cohort (LitCog) of community-based older adults (65 years and older) recruited from hospital-associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence-based online intervention that facilitates AIP-LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP-LTC decision-making. Cross-sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP-LTC decision-making. RESULTS Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non-White), subjects were more likely to have made AIP-LTC decisions if they had adequate inductive reasoning (ETS letter sets total-OR = 1.14 (95% CI = 1.03-1.27; p < 0.05)) and adequate working memory (size judgment span total-OR = 1.76 (95% CI = 1.13-2.73; p < 0.05)). There were no differences in decision-making observed in verbal abilities, long-term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision-making response at baseline. CONCLUSION Inductive reasoning and working memory are critical to AIP-LTC decision-making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP-LTC needs.
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Affiliation(s)
- Lee A. Lindquist
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Amber P. Miller‐Winder
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Allison Schierer
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Alaine Murawski
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Lauren Opsasnick
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Laura M. Curtis
- Division of Geriatrics, Feinberg School of MedicineNorthwestern UniversityChicagoIllinois
| | - Kwang‐Youn Kim
- Division of Preventative MedicineNorthwestern UniversityChicagoIllinoisUSA
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Lemos R, Lopes A, Dias I, Barros H. Portuguese Older Persons' Views about Living in a Nursing Home: Challenges to the Rehabilitation of the Image of LTC in Post-Pandemic Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10566. [PMID: 36078281 PMCID: PMC9517809 DOI: 10.3390/ijerph191710566] [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: 07/29/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
This paper addresses the broad topic of what older people think about nursing homes in Portugal. In the aftermath of the COVID-19 pandemic and considering the tragic events taking place in nursing homes, the challenge of reimagining the sector involves not only improving procedures and models of care, making sure they meet what citizens consider adequate, but also rehabilitating the image people have about nursing homes and rebuilding trust. Current and future decisions about how one meets LTC needs is influenced by the extent to which individuals see the alternatives as adequate. The paper presents evidence collected from a qualitative study run just before the COVID-19 pandemic began, with a sample of 45 community-dwelling individuals aged 60 plus, in Portugal. Opinions and views about nursing homes were collected and the results point to enduring negative aspects that are considered at odds with what constitutes adequate care. The paper discusses in length what those aspects are and concludes that future reforms of the nursing homes sector in Portugal need to consider what current and future users think and feel about that specific type of service. Debates in Portugal tend to be more focused on discussions about expanding the sector and less on aspects of quality of care. Views and opinions of interviewed participants, however, suggest that people may be more worried about quality of care.
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Affiliation(s)
- Rute Lemos
- PhD Program in Sociology, Department of Sociology, Faculty of Arts and Humanities, University of Porto, 4150-564 Porto, Portugal
| | - Alexandra Lopes
- Centre for English, Translation and Anglo-American Studies (CETAPS), 4150-564 Porto, Portugal
- Department of Sociology, Faculty of Arts and Humanities, University of Porto, 4150-564 Porto, Portugal
| | - Isabel Dias
- Department of Sociology, Faculty of Arts and Humanities, University of Porto, 4150-564 Porto, Portugal
- Institute of Sociology, University of Porto, 4150-564 Porto, Portugal
| | - Henrique Barros
- Epidemiology Research Unit, Institute for Public Health, University of Porto, 4050-600 Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Medical School, University of Porto, 4200-319 Porto, Portugal
- Laboratory for Integrative and Translational Research in Public Health, 4050-600 Porto, Portugal
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27
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Trends in long-term care use among Dutch older men and women between 1995 and 2016: is the gender gap changing? AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
This study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.
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Domhoff D, Seibert K, Stiefler S, Wolf-Ostermann K, Peschke D. Data linkage of German statutory health insurance claims data and care needs assessments preceding a population-based cohort study on nursing home admission. BMJ Open 2022; 12:e063475. [PMID: 35772817 PMCID: PMC9247689 DOI: 10.1136/bmjopen-2022-063475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We perform and evaluate record linkage of German Care Needs Assessment (CNA) data to Statutory Health Insurance (SHI) claims data. The resulting dataset should enable the identification of factors in healthcare predicting the time between the onset of long-term care dependency and the admission to a nursing home in Germany in subsequent analyses. DESIGN A deterministic record linkage was conducted using the key variables region, sex, date of birth and care level. In further steps, the underlying cause of care dependency (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10)) was added for a higher level of distinction. Before linkage, the suitability of the two datasets for these procedures was assessed. After linkage, the results of each stage were analysed and the resulting dataset was evaluated cross-sectionally with respect to bias generated through this process. SETTING The study comprises data from the German SHI and Statutory Long-Term Care Insurance. PARTICIPANTS The study cohort comprised 158 069 individuals who became care dependent in 2006. We obtained CNA data for the year 2006 including 188 935 individuals. RESULTS We could link CNAs to 66 310 individuals of the original study cohort, corresponding to 42.0%. Records from two federal states could not be matched due to missing data. Linkage rates were lower where more people shared the same attributes. The resulting dataset showed minor differences regarding age, sex and care level compared to the original cohort. CONCLUSIONS Data linkage between German SHI claims data and CNA data is feasible. Failure to link was mostly attributable to a lack of distinction between individuals using available identifiers. The resulting dataset contains relevant information from both health services provision and functional status of care dependent people and is suitable for further analyses with critical reflection of representativity.
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Affiliation(s)
- Dominik Domhoff
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Kathrin Seibert
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Susanne Stiefler
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Karin Wolf-Ostermann
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dirk Peschke
- Department of Applied Health Sciences, Hochschule für Gesundheit Bochum, Bochum, Germany
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Rapp T, Ronchetti J, Sicsic J. Impact of formal care consumption on informal care use in Europe: What is happening at the beginning of dependency? Health Policy 2022; 126:632-642. [DOI: 10.1016/j.healthpol.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 06/10/2021] [Accepted: 04/17/2022] [Indexed: 01/11/2023]
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Hajek A, König HH. How does beginning or ceasing of informal caregiving of individuals in poor health influence sleep quality? Findings from a nationally representative longitudinal study. Aging Ment Health 2022; 26:314-319. [PMID: 33307767 DOI: 10.1080/13607863.2020.1857700] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Various cross-sectional studies exist examining the association between informal caregiving and sleep quality. However, there is a lack of longitudinal studies investigating whether beginning and ceasing of informal caregiving is associated with changes in sleep quality. AIMS Investigating whether beginning and ceasing of informal caregiving of individuals in poor health is associated with changes in sleep quality in both sexes. METHODS Data were taken from a nationally representative sample of individuals ≥ 40 years in Germany from 2008 to 2017. In our analytical sample, n equaled 22,910 observations. Based on the Pittsburgh Sleep Quality Index, the sleep quality was assessed by the difficulties falling asleep during the last month, difficulties with sleep because of waking up during the last month (in both cases: (from 1 = not during the last month to 4 = three or more times a week) and the overall assessment of sleep quality during the last month (from 1 = very good to 4 = very bad). RESULTS Asymmetric fixed effects regressions showed that in men beginning to provide informal care was associated with decreased overall sleep quality (β=-.09 (95% CI: -.15 - -.03), p<.01) and an increased likelihood of difficulties because of waking up (OR: 1.54 (95% CI: 1.07-2.20), p<.05), whereas ceasing to provide informal care was not associated with the outcome measures (both, in women and in men). DISCUSSION Starting informal caregiving had deleterious effects on sleep quality in men. CONCLUSIONS Efforts to assist men in maintaining sleep quality may be beneficial.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Nakagawa T, Noguchi T, Komatsu A, Ishihara M, Saito T. Aging-in-place preferences and institutionalization among Japanese older adults: a 7-year longitudinal study. BMC Geriatr 2022; 22:66. [PMID: 35062887 PMCID: PMC8780808 DOI: 10.1186/s12877-022-02766-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background In Asia, where autonomous decision-making is not well accepted, little is known about whether and how individuals’ preferences are considered when deciding where they receive care. This study examined whether individuals preferring to age in place if confined to bed were less likely to be institutionalized, using longitudinal data of Japanese older adults. Methods We analyzed nationally representative data of 1,290 community-dwelling older adults aged 70 and above. Baseline data were collected in 1999, shortly before the long-term care insurance system was introduced. The outcome was measured as self- or proxy-reported years of institutionalization over seven years. The explanatory variable was whether individuals preferred to age in place if they were confined to bed. Participants were asked about their desired place of care (facility, home, or other) if confined to bed. Covariates were sociodemographic and health-related factors. We used Cox proportional hazards models and calculated hazard ratios (HRs) with 95% confidence intervals (CIs) to evaluate the association of aging-in-place preferences if confined to bed with institutionalization. We applied multiple imputation to deal with missing data. Results Seventy-eight respondents (6.0%) were institutionalized during the follow-up period. Compared to individuals preferring to reside in long-term care facilities if confined to bed (48.7%), those preferring to stay in their homes (39.6%) were less likely to be institutionalized, even after adjusting for relevant covariates (HR = 0.47, 95% CI 0.27–0.79 for model 1 including residential status; HR = 0.45, 95% CI 0.27–0.76 for model 2 including marital status and co-resident children). Conclusions Our findings suggest that individuals’ aging-in-place preferences tend to be considered under the long-term care insurance system. Individuals’ preferences should be shared with families and clinicians when deciding the place of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02766-5.
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Lee K, Revelli M, Dickson D, Marier P. Who Cares? Preferences for Formal and Informal Care Among Older Adults in Québec. J Appl Gerontol 2021; 41:227-234. [PMID: 34886702 DOI: 10.1177/0733464820976436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Policy makers, practitioners, and scholars are increasingly examining the types of care services (formal vs. informal) offered to older adults. This study evaluates predictors of these adults' preferences for care types in Québec, Canada, based on a province-wide survey inserted in a magazine of the largest seniors' club in Canada (FADOQ). More than twice as many respondents indicated a preference for formal rather than informal care. Multinomial logistic regressions demonstrate that older adults' past and current experiences and perceptions of formal and informal services continue to play an important role in their preference formation regarding care services. The study determined that preferring informal care is significantly more prevalent when one is accustomed to this type of care, and that men are significantly more likely to prefer informal care than women, and that lower-income individuals are less likely to favor formal care.
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Affiliation(s)
- Kyuho Lee
- Daegu University, Gyeongsan-si, Republic of Korea
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Kaambwa B, Chen G, Khadka J, Milte R, Mpundu-Kaambwa C, Woods TJ, Ratcliffe J. A preference for quality: Australian general public's willingness to pay for home and residential aged care. Soc Sci Med 2021; 289:114425. [PMID: 34673356 DOI: 10.1016/j.socscimed.2021.114425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 02/04/2023]
Abstract
In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics, College of Medicine & Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, South Australia, 5042, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, 3145, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Taylor-Jade Woods
- Health Economics, College of Medicine & Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
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Travers JL, Hirschman KB, Naylor MD. Older Adults' Goals and Expectations When Using Long-Term Services and Supports. J Appl Gerontol 2021; 41:709-717. [PMID: 34315240 DOI: 10.1177/07334648211033671] [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: 11/16/2022] Open
Abstract
OBJECTIVE Despite recent research focused on aging well, little is known regarding the goals and expectations from long-term services and supports (LTSS) use among older adults. METHODS To address this knowledge gap, interviewer-guided surveys with older adults newly receiving LTSS in home and community-based, assisted living, and nursing home settings in Philadelphia, New Jersey, and New York were conducted. RESULTS Twelve subthemes regarding the goals and expectations of 464 older adults receiving LTSS and in the context of Aging Well emerged from our analysis: maintaining function, optimizing health and circumstances, maintaining the status quo, transitioning back to the previous state, achieving independence, preserving cognitive function and capacity for psychosocial and emotional health, achieving purpose, increasing quality of life, receiving social support, increasing engagement, relieving burden, and feeling a sense of security/safety. DISCUSSION This in-depth analysis of qualitative data provides context for LTSS use among older adults.
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Affiliation(s)
| | | | - Mary D Naylor
- University of Pennsylvania School of Nursing, Philadelphia, USA
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Wieczorek E, Evers S, Kocot E, Sowada C, Pavlova M. Assessing Policy Challenges and Strategies Supporting Informal Caregivers in the European Union. J Aging Soc Policy 2021; 34:145-160. [PMID: 34128454 DOI: 10.1080/08959420.2021.1935144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cost containment and the preferences of older adults are important stimuli for encouraging the provision of informal care worldwide. Nevertheless, informal caregiving can have negative effects on caregiver's health, wellbeing, and employment opportunities. Moreover, it is questionable whether informal caregivers can substantially contribute to meeting the increasing demand for care or serve as a substitute for formally provided services. This commentary assesses strategies to remediate the negative effects of caregiving and ultimately to improve informal caregiving and to support their critical role in European long-term care systems. Cash benefits are a particularly common method of supporting informal caregivers; paid and unpaid leave, and flexible work arrangements are the most prevalent measures to support family caregivers within labor market policy, specifically. Providing training and counseling services to individuals engaged in informal care is a strategy used to support caregivers at home. Disparities in the level of support provided to informal caregivers across the European Union need to be addressed. A lack of supporting policies increases the likelihood that caregivers experience negative physical and psychosocial health problems, as well as unemployment and impoverishment.
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Affiliation(s)
- Estera Wieczorek
- MSc, Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland.,MSc, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Silvia Evers
- MSc, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Ewa Kocot
- MSc, Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Christoph Sowada
- MSc, Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Milena Pavlova
- MSc, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, Maastricht, Netherlands
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Thilo FJ, Hahn S, Halfens RJ, Heckemann B, Schols JM. Facilitating the use of personal safety alerting device with older adults: The views, experiences and roles of relatives and health care professionals. Geriatr Nurs 2021; 42:935-942. [PMID: 34130125 DOI: 10.1016/j.gerinurse.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
To explore relatives', community nurses' and general practitioners' perspectives and experiences in promoting Personal Safety Alerting Device (PSAD) use among community-dwelling older adults, we applied a qualitative study design. Altogether 15 focus groups and 11 semi-structured interviews were conducted. Data-analysis followed the Qualitative Analysis Guide of Leuven. PSAD use was considered to be complex. Relatives and health care professionals are involved in a negotiation process comprising three phases: A) waiting for a critical event in the older adult's everyday life; B) introducing the idea of a PSAD; C) deciding on and supporting PSAD use. In conclusion, the actors involved in PSAD use should be aware of the negotiation process, which is complex, dynamic, iterative and needs time. While nurses play a crucial role, they lack sufficient knowledge for comprehensive PSAD counselling. The negotiation process could serve as an example for other technologies in the context of aging in place.
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Affiliation(s)
- Friederike Js Thilo
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
| | - Sabine Hahn
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
| | - Ruud Jg Halfens
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Birgit Heckemann
- Applied Research & Development in Nursing, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jos Mga Schols
- School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; School CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
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Buczak-Stec E, König HH, Hajek A. Planning to move into a nursing home in old age: does sexual orientation matter? Age Ageing 2021; 50:974-979. [PMID: 32939532 DOI: 10.1093/ageing/afaa185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/22/2020] [Accepted: 08/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative studies showed that community-dwelling Lesbian, Gay, Bisexual and Transgender (LGBT) individuals perceive that LGBT individuals are discriminated against in nursing homes (NHs) due to their sexual orientation. Therefore, the objective of this quantitative, population-based study was to investigate the link between sexual orientation and planning to move into a NH in old age. METHODS Cross-sectional data from the most recent sixth wave of the nationally representative German Ageing Survey (n = 4,645) were used. The sexual orientation was dichotomized (heterosexual; sexual minorities including gay/lesbian, bisexual and other). Planning to move into a NH in the future (yes/no) was our outcome measure. Multiple logistic regressions were performed (adjusting for various socioeconomic, psychosocial and health-related covariates). RESULTS Regressions showed that sexual orientation was not significantly associated with plans to move to a NH. Preference to move into NH were consistently positively associated with age (OR: 1.04 (1.02-1.07), not having at least one child (OR: 2.17 (1.41-3.36)), high education (OR: 3.82 (1.32-11.11)), greater loneliness (OR: 1.44 (1.05-1.96)) and worse physical functioning (OR: 0.99 (0.98-1.00)). CONCLUSIONS Unexpectedly, our results showed that plans to move to a NH did not differ significantly between heterosexual individuals and sexual minorities. This indicates that sexual orientation does not play a significant role in shaping preferences around moving into a NH 'in general'. In contrast, other factors like age, greater loneliness and worse physical functioning were important. Those factors should be taken into account when shaping and updating policies on nursing homes.
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Affiliation(s)
- Elzbieta Buczak-Stec
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg, Germany; Hamburg Center for Health Economics, Hamburg, Germany
| | - Hans-Helmut König
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg, Germany; Hamburg Center for Health Economics, Hamburg, Germany
| | - André Hajek
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg, Germany; Hamburg Center for Health Economics, Hamburg, Germany
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Domhoff D, Seibert K, Stiefler S, Wolf-Ostermann K, Peschke D. Differences in nursing home admission between functionally defined populations in Germany and the association with quality of health care. BMC Health Serv Res 2021; 21:190. [PMID: 33653333 PMCID: PMC7923327 DOI: 10.1186/s12913-021-06196-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 02/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision. Methods We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators. Results The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive. Conclusions Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06196-8.
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Affiliation(s)
- Dominik Domhoff
- Institute for Public Health and Nursing Research, Faculty 11: Human and Health Sciences, University of Bremen, Bremen, Germany. .,High Profile Area Health Sciences, University of Bremen, Bremen, Germany.
| | - Kathrin Seibert
- Institute for Public Health and Nursing Research, Faculty 11: Human and Health Sciences, University of Bremen, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Susanne Stiefler
- Institute for Public Health and Nursing Research, Faculty 11: Human and Health Sciences, University of Bremen, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, Faculty 11: Human and Health Sciences, University of Bremen, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dirk Peschke
- Institute for Public Health and Nursing Research, Faculty 11: Human and Health Sciences, University of Bremen, Bremen, Germany.,High Profile Area Health Sciences, University of Bremen, Bremen, Germany.,Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Vrabková I, Ertingerová I, Kukuliač P. Determination of gaps in the spatial accessibility of nursing services for persons over the age of 65 with lowered self-sufficiency: Evidence from the Czech Republic. PLoS One 2021; 16:e0244991. [PMID: 33428655 PMCID: PMC7799796 DOI: 10.1371/journal.pone.0244991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
The subject of this research is one of the main preconditions for the provision of high-quality social care services for people over the age of 65 with lowered self-sufficiency. It involves the spatial accessibility of formally established nursing services examined in 76 districts of the Czech Republic. The aim of this article is to identify and evaluate the gaps in spatial accessibility of the selected residential and outpatient-clinic services at the level of districts in individual regions of the Czech Republic in 2018. A three-phase analysis was performed, including an ArcGIS network analysis, multi-criteria evaluation according to the TOPSIS method, and a correlation analysis encompassing the confidence interval gained via the Bootstrap method. Seven indicators were selected-recipients of the allowance for the care, capacity of residential and outpatient-clinic services, and four indicators of accessibility via individual and public transport within the set time intervals. The results show good availability of residential care (no gap) within 30 min. by individual and public transport in most districts (94%). However, day services centers do not have a space gap in only 28% of districts by individual transport, and 8% of districts by public transport. In the case of day care centers, 54% of districts by individual transport, and 29% of districts by public transport do not have a space gap. The results also show that the level of spatial availability of care (gaps) in the district is not related to the number of people aged 65+ with reduced self-sufficiency in the district. On the contrary, the correlation analysis shows that with the growing number of people aged 65+ with reduced self-sufficiency in the district, the capacity of residential and outpatient services increases and the gaps in spatial accessibility do not decrease.
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Affiliation(s)
- Iveta Vrabková
- Faculty of Economics, Department Public Economics, VŠB-TU Ostrava, Czech Republic
| | - Izabela Ertingerová
- Faculty of Economics, Department Public Economics, VŠB-TU Ostrava, Czech Republic
- * E-mail:
| | - Pavel Kukuliač
- Faculty of Mining and Geology, Department of Geoinformatics, VŠB-TU Ostrava, Czech Republic
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Selecting home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC) for Switzerland: A public health and healthcare providers' perspective. PLoS One 2020; 15:e0244577. [PMID: 33378348 PMCID: PMC7773259 DOI: 10.1371/journal.pone.0244577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/13/2020] [Indexed: 12/27/2022] Open
Abstract
Background Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers’ perspective. Methods First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators’ public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers’ perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index. Results 18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers’ perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically. Conclusions The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.
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Long-Term Care Preferences and Sexual Orientation: Protocol for a Systematic Review. Healthcare (Basel) 2020; 8:healthcare8040572. [PMID: 33561043 PMCID: PMC7767185 DOI: 10.3390/healthcare8040572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background: With increasing age, the health status of older individuals commonly deteriorates and their care needs greatly increase. Therefore, many individuals are in need for formal or informal long-term care. In order to plan suitable long-term care settings, it is important to know the long-term care preferences of an ageing population (both heterosexuals and sexual minorities). The aim of this study is to systematically review the literature for evidence on preferences regarding long-term care and the potential differences with regard to sexual orientation. Methods and analysis: This study protocol for a systematic review is reported according to the PRISMA-P guidelines. A comprehensive search of published studies will be conducted using PubMed, Web of Science and PsycINFO bibliographic databases. Following predefined inclusion criteria, two authors will screen the titles and abstracts of the studies independently. Afterwards, we will obtain and screen full-text articles of eligible studies using the predefined inclusion criteria. Discrepancies will be resolved by consensus or consultation with a third researcher. Data will be extracted and synthesised. Extracted data will be categorised based on study design, type of long-term care preferences and the group (sexual orientation) which is addressed. The quality of reporting of the studies included will be assessed.
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Huter K, Krick T, Domhoff D, Seibert K, Wolf-Ostermann K, Rothgang H. Effectiveness of Digital Technologies to Support Nursing Care: Results of a Scoping Review. J Multidiscip Healthc 2020; 13:1905-1926. [PMID: 33328736 PMCID: PMC7734078 DOI: 10.2147/jmdh.s286193] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022] Open
Abstract
Background The field of digital technologies being developed or applied to support nursing care is extensive. The aim of this scoping review is to provide an overview on technologies for which results on positive or negative effects on persons in need of care, caregivers or care institutions are available and to appraise the reliability of these results. Methods A scoping review design has been used to identify studies focussing on the effectiveness of digital technologies in nursing care for persons in need of care, caregivers or care institutions. The screening process included 19,510 scientific publications from 9 databases. Results A total of 123 single studies and 31 reviews were subjected to the analysis. The included technologies comprise nursing and health information technologies, such as assistive devices, information and communication technologies, sensors and robotics. The results show that there are many studies that demonstrate positive effects, but the level of evidence is mostly low and study sizes are often small. Hardly any technology has been researched intensively enough to produce conclusive results. Studies on a high level of evidence (RCTs) lack for most technological areas. Heterogeneous results in some areas indicate that effects may depend strongly on the mode and specific context into which the technologies are introduced. Conclusion Due to the limited evidence on effectiveness of digital technologies in nursing care, it is not surprising that care institutions are reluctant to put innovative technologies into practice. The scoping review indicates technology areas that should be subject to future research with higher quality studies. Research on outpatient, informal and cross-sectoral care should be intensified to further exploit the potential of digital technologies with a view to improving independence of care-recipients and unburdening formal and informal carers.
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Affiliation(s)
- Kai Huter
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany.,University of Bremen, High-Profile Area of Health Sciences, Bremen, Germany
| | - Tobias Krick
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany.,University of Bremen, High-Profile Area of Health Sciences, Bremen, Germany
| | - Dominik Domhoff
- University of Bremen, High-Profile Area of Health Sciences, Bremen, Germany.,University of Bremen, Institute for Public Health and Nursing Research, Bremen, Germany
| | - Kathrin Seibert
- University of Bremen, High-Profile Area of Health Sciences, Bremen, Germany.,University of Bremen, Institute for Public Health and Nursing Research, Bremen, Germany
| | - Karin Wolf-Ostermann
- University of Bremen, High-Profile Area of Health Sciences, Bremen, Germany.,University of Bremen, Institute for Public Health and Nursing Research, Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany.,University of Bremen, High-Profile Area of Health Sciences, Bremen, Germany
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Zwar L, Angermeyer MC, Matschinger H, Riedel-Heller SG, König HH, Hajek A. The importance of familiarity with caregiving for public caregiver stigma: Evidence from a cross-sectional study in Germany. Arch Gerontol Geriatr 2020; 93:104301. [PMID: 33260047 DOI: 10.1016/j.archger.2020.104301] [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: 09/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between familiarity with caregiving and public stigma towards informal caregivers of older individuals. MATERIAL AND METHODS The sample for this Online-Survey was identified using a quota-system based on German micro census data (N=1037; aged 18 years and older, living in Germany). Familiarity with caregiving was assessed by asking whether the participant has experience in or has friends or relatives with experience in informal or professional caregiving for individuals aged 65 years or older. Public caregiver stigma was assessed by analyzing the emotional, behavioral and cognitive reactions towards caregivers as described in a vignette. RESULTS Adjusted regressions analyses indicated that experience in providing informal care was associated with increased appreciative feelings and statements, and decreased social distance. Experience in providing professional care was associated with increased devaluing statements. Having friends or relatives who have experience in informal caregiving was associated with decreased social distance. Having friends or relatives who have experience in professional caregiving was associated with decreased devaluing feelings, increased appreciative feelings and decreased social distance. CONCLUSIONS Results indicate that familiarity with caregiving, through one's own informal care experience or through contact with informal or professional caregivers, reduced public stigma towards informal caregivers. Moreover, experience with informal care or contact with professional caregivers increased appreciation of informal caregivers. However, increased negative stigmatizing statements were indicated among participants with experience in professional caregiving. Fostering contact and cooperation between informal caregivers and non-caregivers, as well as with professional caregivers may help reduce stigmatizing reactions.
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Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | | | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany; Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Zwar L, König HH, Hajek A. The impact of receiving informal care on self-esteem and its moderation by social class. Aging Ment Health 2020; 24:1736-1745. [PMID: 31179728 DOI: 10.1080/13607863.2019.1617241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This longitudinal study aims to investigate the association between informal care receipt and self-esteem, and explore the influence of social class on this association.Method: Data from the German Ageing Survey (waves 2002, 2008, 2011, 2014; 7870 observations) drawn from community-dwelling individuals (aged 40 years and older) was used.Results: Results revealed that receiving care was not significantly associated with self-esteem. However, when the sample was stratified by social class, receipt of care was significantly associated with increased self-esteem in individuals from lower social classes (lower class, lower middle class). Moderator analysis demonstrated a significant interaction effect between belonging to the lower middle class and receipt of care.Conclusion: Our results demonstrate that care recipients can benefit from informal care regarding their self-esteem, at least if they are from lower social classes. This implies that informal care should be supported.
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Affiliation(s)
- Larissa Zwar
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kuppler M, Wagner M. Effect of Regional Long-Term Care Service Supply on Choice of Care Arrangement in Old Age. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09299-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractDepending on their place of residence, older persons have unequal access to long-term care (LTC) services. This article investigates how the county-level supply of inpatient and outpatient LTC services influences individual-level LTC choices of older persons. Administrative data on LTC service supply from the German Care Statistic are combined with representative survey data on the LTC choices of N = 1303 persons aged 80+ from the German Federal State North Rhine-Westphalia. Random utility models are applied to model the choice among three care arrangements: receiving inpatient care in an institutional setting (e.g., nursing home), receiving outpatient care in the community, and living in the community without receiving inpatient or outpatient care. The main findings are: Higher inpatient service supply increases the probability that older persons leave the community and enter institutional LTC. Higher outpatient service supply increases the probability that older persons choose to receive outpatient care in the community instead of entering institutional LTC. The results suggest that policy makers must consider the county-level LTC service supply when designing equitable LTC systems that meet the needs of older persons in a cost-effective way.
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Welberry HJ, Brodaty H, Hsu B, Barbieri S, Jorm LR. Impact of Prior Home Care on Length of Stay in Residential Care for Australians With Dementia. J Am Med Dir Assoc 2020; 21:843-850.e5. [DOI: 10.1016/j.jamda.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 02/02/2023]
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Wagner A, Schaffert R, Möckli N, Zúñiga F, Dratva J. Home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC): a systematic review. BMC Health Serv Res 2020; 20:366. [PMID: 32349757 PMCID: PMC7191714 DOI: 10.1186/s12913-020-05238-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One way of measuring the quality of home care are quality indicators (QIs) derived from data collected with the Resident Assessment Instrument-Home Care (RAI-HC). In order to produce meaningful results for quality improvement and quality comparisons across home care organizations (HCOs) and over time, RAI-HC QIs must be valid and reliable. The aim of this systematic review was to identify currently existing RAI-HC QIs and to summarize the scientific knowledge on the validity and reliability of these QIs. METHODS A systematic review was performed using the electronic databases PubMed, CINAHL, Embase, PsycINFO and Cochrane Library. Studies describing the development process or the psychometric characteristics of RAI-HC QIs were eligible. The data extraction involved a general description of the included studies as well as the identified RAI-HC QIs and information on validity and reliability. The methodological quality of the identified RAI-HC QI sets was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. RESULTS Four studies out of 659 initial hits met the inclusion criteria. The included studies described the development and validation process of three RAI-HC QI sets comprising 48 unique RAI-HC QIs, which predominantly refer to outcome of care. Overall, the validity and reliability of the identified RAI-HC QIs were not sufficiently tested. The methodological quality of the three identified RAI-HC QI sets varied across the four AIRE instrument domains. None of the QI sets reached high methodological quality, defined as scores of 50% and higher in all four AIRE instrument domains. CONCLUSIONS This is the first review that systematically summarized and appraised the available scientific evidence on the validity and reliability of RAI-HC QIs. It identified insufficient reporting of RAI-HC QIs validation processes and reliability as well as missing state-of-the-art methodologies. The review provides guidance as to what additional validity and reliability testing are needed to strengthen the scientific soundness of RAI-HC QIs. Considering that RAI-HC QIs are already implemented and used to measure and compare quality of home care, further investigations on RAI-HC QIs reliability and validity is recommended.
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Affiliation(s)
- Aylin Wagner
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland.
| | - René Schaffert
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland
| | - Nathalie Möckli
- University of Basel, Medical Faculty, Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- University of Basel, Medical Faculty, Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Julia Dratva
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland.,University of Basel, Medical Faculty, Klingelbergstrasse 61, 4056, Basel, Switzerland
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48
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Urban-Rural Differences in Long-Term Care Service Status and Needs Among Home-Based Elderly People in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051701. [PMID: 32150946 PMCID: PMC7084295 DOI: 10.3390/ijerph17051701] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 01/08/2023]
Abstract
Background: Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban–rural differences. This study aims to evaluate the differences of LTC current status and needs between urban–rural areas and age groups, and to identify influencing factors causing the different LTC needs. Methods: The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs. Results: A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees (p < 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, p < 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, p < 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 < OR < 1.69, p < 0.05). Conclusions: The aged cohort in urban–rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.
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Shi C, Hu B. Preferences for Formal Social Care in Rural and Urban China: Evidence from a National Survey. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:19-40. [PMID: 31885325 DOI: 10.1080/01634372.2019.1709246] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
This study investigates older people's preferences for social care in rural and urban China. The data come from the China Longitudinal Aging Social Survey (CLASS) which collected information from a nationally representative sample of 10,682 Chinese older people aged 60 and over in 2014. Guided by the ecological model of aging, multilevel logistic regression analyses were conducted to identify the factors associated with preferred care arrangements. We found that older people in urban China are more likely than those in rural China to accept care home services or prefer government-provided care. Educational qualifications and the number of surviving children strongly and consistently predict older people's preferences for formal care in both rural and urban China. Proximity to care home facilities and higher income are associated with an increase in the willingness to live in a care home in urban China, but they are not significant predictors of preferences for formal care in rural China. We argue that a one-size-fits-all social care policy may not be well-received in the Chinese older population. The government may want to consider social care policies where support is tailored to suit older people's varied preferences.
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Affiliation(s)
- Cheng Shi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Centre for Social Welfare Studies, Beijing Normal University, Beijing, China
| | - Bo Hu
- Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, London, UK
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50
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Using the Importance–Satisfaction Model and Service Quality Performance Matrix to Improve Long-Term Care Service Quality in Taiwan. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app10010085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study integrates the importance–satisfaction (I-S) model and service quality performance matrix (SQPM) to examine long-term care (LTC) service demands and satisfaction improvement. Many scholars have used a single model to explore project improvement. Each model has advantages, but we think they are too subjective and suggest that it is best to integrate models to determine what should be improved. We established quality attributes of service demands based on more than two sessions of discussions and expert consultations with LTC service users (older adults). The final questionnaire was divided into three parts: a demand survey, satisfaction survey, and demographics survey, and 292 valid questionnaires were collected. The questionnaire items were summarized with means and standard deviations. In this study, if only the I-S model was used to examine LTC in Taiwan, then seven service elements of the system would need to be improved. However, if only the SQPM method was used, then 16 service elements would need to be improved. Only seven service elements were identified by both methods. When time and resources are limited, it is not feasible to take comprehensiveness into account. When many projects must be improved and it is impossible to implement them at the same time, improvement priorities need to be developed. Taiwan lacks sufficient LTC resources, so it is impossible to provide enough resources for all those who need care. To use resources efficiently, the I-S model and SQPM were integrated in this study to identify areas for improvement.
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