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Wang Y, Wu B, Yang W. Can formal home and community-based care substitute informal care? Evidence from Chinese Longitudinal Healthy Longevity Survey. BMC Geriatr 2024; 24:730. [PMID: 39227765 PMCID: PMC11373235 DOI: 10.1186/s12877-024-05312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Formal home and community-based care are often considered as the preferable option to institutional care, offering older individuals the convenience of receiving care in their homes. Although research has found that these services may alleviate the burden on informal caregivers, there is a lack of research on which specific types of formal home and community-based care influence informal care provision. METHODS Employing fixed-effects and quantile regression models, this study seeks to explore the effects that various formal home and community-based care services have on reducing the burden of informal care. This study draws data from the Chinese Longitudinal Healthy Longevity Survey 2005, 2008, 2011, 2014, and 2018. RESULTS Our findings indicate that two types of formal care substantially influence the provision of informal care. The availability of daily living assistance services correlates with reduced informal caregiving hours, especially for those with extensive care needs. The availability of community-based health care services is linked to a reduction in the direct expenses incurred from informal caregiving, especially for those incurring greater direct caregiving costs. These effects are more prominent among urban residents. Other services, such as mental health support and legal advice services, do not demonstrate significant effects on reducing informal care hours and costs. CONCLUSIONS Daily living assistance and community-based health care services play a crucial role in benefiting informal caregivers. It is important to prioritize the expansion of these services, especially among those with greater care needs.
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Affiliation(s)
- Yixiao Wang
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Wei Yang
- Department of Global Health and Social Medicine, King's College London, London, WC2R 2LS, UK.
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Chen S, Chen X, Hou X, Fang H, Liu GG, Yan LL. Temporal trends and disparities of population attributable fractions of modifiable risk factors for dementia in China: a time-series study of the China health and retirement longitudinal study (2011-2018). THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 47:101106. [PMID: 38872868 PMCID: PMC11170192 DOI: 10.1016/j.lanwpc.2024.101106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/06/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
Background In China, dementia poses a significant public health challenge, exacerbated by an ageing population and lifestyle changes. This study assesses the temporal trends and disparities in the population-attributable fractions (PAFs) of modifiable risk factors (MRFs) for new-onset dementia from 2011 to 2018. Methods We used data from the China Health and Retirement Longitudinal Study (CHARLS), covering 75,214 person-waves. We calculated PAFs for 12 MRFs identified by the Lancet Commission (including six early-to mid-life factors and six late-life factors). We also determined the individual weighted PAFs (IW-PAFs) for each risk factor. Subgroup analyses were conducted by sex, socio-economic status (SES), and geographic location. Findings The overall PAF for dementia MRFs had a slight increase from 45.36% in 2011 to 52.46% in 2018, yet this change wasn't statistically significant. During 2011-2018, the most contributing modifiable risk was low education (average IW-PAF 11.3%), followed by depression, hypertension, smoking, and physical inactivity. Over the eight-year period, IW-PAFs for risk factors like low education, hypertension, hearing loss, smoking, and air pollution showed decreasing trends, while others increased, but none of these changes were statistically significant. Sex-specific analysis revealed higher IW-PAFs for traumatic brain injury (TBI), social isolation, and depression in women, and for alcohol and smoking in men. The decline in IW-PAF for men's hearing loss were significant. Lower-income individuals had higher overall MRF PAFs, largely due to later-life factors like depression. Early-life factors, such as TBI and low education, also contributed to SES disparities. Rural areas reported higher overall MRF PAFs, driven by factors like depression, low education, and hearing loss. The study also found that the gap in MRF PAFs across different SES groups or regions either remained constant or increased over the study period. Interpretation The study reveals a slight but non-significant increase in dementia's MRF PAF in China, underscoring the persistent relevance of these risk factors. The findings highlight the need for targeted public health strategies, considering the demographic and regional differences, to effectively tackle and reduce dementia risk in China's diverse population. Funding This work was supported by the PKU Young Scholarship in Global Health and Development.
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Affiliation(s)
- Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Xi Chen
- School of Public Health, Yale University, New Haven, CT, United States
| | | | - Hai Fang
- Institute for Global Health and Development, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Gordon G. Liu
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Lijing L. Yan
- Institute for Global Health and Development, Peking University, Beijing, China
- Global Health Research Center, Duke Kunshan University, Jiangsu, China
- School of Public Health, Wuhan University, Wuhan, China
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Shi C, Chan WK, Yang J. Choice of formal and informal care among community-dwelling older people with or without dementia under a long-term care insurance pilot program in China. Australas J Ageing 2024; 43:248-255. [PMID: 38270222 DOI: 10.1111/ajag.13277] [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: 02/23/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study examines the use of publicly funded formal and informal care among community-dwelling long-term care insurance (LTCI) beneficiaries in China and how dementia differentiates the choice of care. METHODS Using administrative data from a LTCI pilot scheme in Guangzhou (n = 2043), we conducted a multinomial logistic regression to examine the association between dementia and the choice of family members (informal unpaid care), domestic helpers (informal paid care) and care workers (formal care), controlling for demographics, living environment and intensity of paid care hours. RESULTS Most LTCI beneficiaries chose a family member (65%), followed by a domestic helper (21%) and a care worker (14%). After controlling for covariates, LTCI beneficiaries with dementia were more likely than their counterparts without dementia to choose care provided by a care worker (RRR: 1.73) or a living-in helper (RRR: 1.43) than a family member. CONCLUSIONS A preference for informal care was observed among LTCI beneficiaries in China. Those with dementia were more likely than those without dementia to use care provided by non-family caregivers. The pilot scheme findings provide further insight into care recipients' preferences for service utilisation and how dementia impacts these preferences, which should be considered in future policy and service provision.
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Affiliation(s)
- Cheng Shi
- School of Graduate Studies, Lingnan University, Hong Kong SAR, China
- Institute of Policy Studies, Lingnan University, Hong Kong SAR, China
- Center for Social Welfare Studies, Beijing Normal University, Beijing, China
| | - Wing-Kit Chan
- Center for Chinese Public Administration Research/School of Government, Sun Yat-sen University, Guangzhou, China
| | - Jianwei Yang
- School of Graduate Studies, Lingnan University, Hong Kong SAR, China
- School of Management, Wuhan Donghu University, Wuhan, China
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4
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Luo J, Li B, Li J, Ren Z. Examining the impact of Co-residence with a daughter-in-law on older adult health in China: Evidence from a frailty index-based study. SSM Popul Health 2024; 26:101649. [PMID: 38516530 PMCID: PMC10955668 DOI: 10.1016/j.ssmph.2024.101649] [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: 12/12/2023] [Revised: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Background The increasing geriatric population and variation in the disease spectrum among older adults in China contribute to a growing demand for more aged adult care in Chinese society. Relevant studies have shown that living arrangements with various family members have variable impacts on the older adult's health. This study employs the Frailty Index as a unified measurement standard to assess the overall health levels, integrating the specific "in-law relationships" into the research on living arrangements and the health of older adults. Methods This study used data from the China Longitudinal Aging Social Survey 2016-2018. OLS and Quantile Regression were used to investigate the in-law relationship on older adult health and whether this impact is homogeneous across older individuals with varying infirmity levels. The study used a lag model and propensity score matching to compensate for potential endogeneity concerns. Results The study found that residing with a daughter-in-law (20.22%) had a significant positive correlation with the frailty index (β=0.0088, P<0.001), indicating that the relationship between parents-in-law and daughters-in-law can influence the health of the older adult. This impact is nonlinear and non-homogeneous for older adult people with various levels of frailty, exhibiting an approximately decreasing and then increasing U-shaped distribution, which denotes that older adult people with different health conditions have distinct demands for intergenerational care. In addition, this impact varies among older adult groups of disparate genders, urban and rural areas, and age groups. Conclusion This study investigates the impact of "in-law relationships" within living arrangements on the health of older adults. It shows that co-residing with a daughter-in-law has adverse effects on the health of older adults. Therefore, the study suggests that when the health and economic conditions of the elderly permit, a "live-near-but-not-with" living arrangement with their children can be considered.
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Affiliation(s)
- Juan Luo
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
| | - Ben Li
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
| | - Jiarong Li
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
| | - Zhenpeng Ren
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
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Liu Y, Du S, Liu C, Xue T, Tang Y. Preference of primary care patients for home-based healthcare and support services: a discrete choice experiment in China. Front Public Health 2024; 12:1324776. [PMID: 38699415 PMCID: PMC11063295 DOI: 10.3389/fpubh.2024.1324776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Importance This research, utilizing discrete choice experiments, examines the preferences and willingness to pay for home-based healthcare and support services among residents in China, a country grappling with severe aging population, an area often underexplored in international scholarship. Objectives This study aims to solicit the preferences of primary care patients for home-based healthcare and support services in China. Design setting and participants A discrete choice experiment (DCE) was conducted on 312 primary care patients recruited from 13 community health centers in Wuhan and Kunming between January and May 2023. The experimental choice sets were generated using NGene, covering five attributes: Scope of services, health professionals, institutions, insurance reimbursements, and visiting fees. Main outcomes and measures The choice sets were further divided into three blocks, and each participant was asked to complete one block containing 12 choice tasks. Mixed logit models were established to estimate the relevant importance coefficients of and willingness to pay for different choices, while Latent Class Logit (LCL) modeling was conducted to capture possible preferences heterogeneity. Results The relevant importance of the scope of services reached 67.33%, compared with 19.84% for service institutions and 12.42% for health professionals. Overall, respondents preferred physician-led diagnostic and treatment services. LCL categorized the respondents into three groups: Group one (60.20%) was most concerned about the scope of services, prioritizing disease diagnosis and treatment over preventive care and mental health, while group two (16.60%) was most concerned about care providers (hospitals and medical doctors were preferred), and group three (23.20%) was most concerned about financial burdens. Conclusion Primary care patients prefer physical health and medical interventions for home-based healthcare and support services. However, heterogeneity in preferences is evident, indicating potential disparities in healthcare and support at home services in China.
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Affiliation(s)
- Yaqing Liu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sixian Du
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Tianqin Xue
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqing Tang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
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Xu X, Li Y, Mi H. Life expectancy, long-term care demand and dynamic financing mechanism simulation: an empirical study of Zhejiang Pilot, China. BMC Health Serv Res 2024; 24:469. [PMID: 38622660 PMCID: PMC11017606 DOI: 10.1186/s12913-024-10875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND China has piloted Long-Term Care Insurance (LTCI) to address increasing care demand. However, many cities neglected adjusting LTCI premiums since the pilot, risking the long-term sustainability of LTCI. Therefore, using Zhejiang Province as a case, this study simulated mortality-adjusted long-term care demand and the balance of LTCI funds through dynamic financing mechanism under diverse life expectancy and disability scenarios. METHODS Three-parameter log-quadratic model was used to estimate the mortality from 1990 to 2020. Mortality with predicted interval from 2020 to 2080 was projected by Lee-Carter method extended with rotation. Cohort-component projection model was used to simulate the number of older population with different degrees of disability. Disability data of the older people is sourced from China Health and Retirement Longitudinal Study 2018. The balance of LTCI fund was simulated by dynamic financing actuarial model. RESULTS Life expectancy of Zhejiang for male (female) is from 80.46 (84.66) years in 2020 to 89.39 [86.61, 91.74] (91.24 [88.90, 93.25]) years in 2080. The number of long-term care demand with severe disability in Zhejiang demonstrates an increasing trend from 285 [276, 295] thousand in 2023 to 1027 [634, 1657] thousand in 2080 under predicted mean of life expectancy. LTCI fund in Zhejiang will become accumulated surplus from 2024 to 2080 when annual premium growth rate is 5.25% [4.20%, 6.25%] under various disability scenarios, which is much higher than the annual growth of unit cost of long-term care services (2.25%). The accumulated balance of LTCI fund is sensitive with life expectancy. CONCLUSIONS Dynamic growth of LTCI premium is essential in dealing with current deficit around 2050 and realizing Zhejiang's LTCI sustainability in the long-run. The importance of dynamic monitoring disability and mortality information is emphasized to respond immediately to the increase of premiums. LTCI should strike a balance between expanding coverage and controlling financing scale. This study provides implications for developing countries to establish or pilot LTCI schemes.
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Affiliation(s)
- Xueying Xu
- School of International Studies, Zhejiang University, Hangzhou, China
| | - Yichao Li
- School of Public Affairs, Zhejiang University, Hangzhou, China.
| | - Hong Mi
- School of Public Affairs, Zhejiang University, Hangzhou, China
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7
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Jiang MM, Xiao MF, Zhang JW, Yang MF. Middle-aged and older people's preference for medical-elderly care integrated institutions in China: a discrete choice experiment study. BMC Nurs 2024; 23:32. [PMID: 38200515 PMCID: PMC10777634 DOI: 10.1186/s12912-023-01696-w] [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: 10/01/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND With the continuing impact of the aging population, medical-elderly care integrated institutions, as a way to bear the pressure of medical and elderly care, effectively ensure the quality of life of the elderly in their later years. OBJECTIVES To explore the preferences of medical-elderly care integrated institutions among Chinese middle-aged and older people and to provide a reference for establishing elderly-oriented development of medical-elderly care integrated institutions. METHODS In this study, a discrete choice experiment (DCE) was used to investigate the preferences of people aged 45 years and older in medical-elderly care integrated institutions in China from October 20, 2022, to November 10, 2022. A mixed logit regression model was used to analyze the DCE data. Participants' willingness to pay for each attribute was also calculated. RESULTS Data from 420 participants who provided valid responses were included in the analysis. In terms of the choice preference, moderate service quality (vs. poor service quality: β = 1.707, p < 0.001, 95% CI 1.343 ~ 2.071) and high medical technology level (vs. low medical technology level: β = 1.535, p < 0.001, 95% CI 1.240 ~ 1.830) were the most important attributes to middle-aged and older people, followed by monthly cost, environmental facilities, the convenience of transportation, and entertainment activities. Regarding the willingness to pay, participants were more willing to pay for service quality and medical technology level than for other attributes. They were willing to pay $3156 and $2838 more for "poor service quality" and "low medical technology level," respectively, to receive "moderate service quality " (p = 0.007, 95% CI 963 ~ 5349) and "high medical technology level" (p = 0.005, 95% CI 852 ~ 4824). CONCLUSIONS The state should attach great importance to the development of medical-elderly care integrated services industry, actively optimize the model of the medical-elderly care integrated service, improve the facilities, and create a healthy environment. At the same time, give full play to the role of medical insurance, long-term care insurance, and commercial insurance, so as to improve the comprehensive quality of life of the elderly. PUBLIC CONTRIBUTION The design of the experimental selection was guided by 10 experts in the field, 5 Chinese government officials, and interviews and focus group discussions, without whose participation this study would not have been possible.
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Affiliation(s)
- Mao-Min Jiang
- School of Public Affairs, Xiamen University, Xiamen, Fujian province, China
| | - Mei-Fang Xiao
- School of Nursing, Gannan Medical University, Ganzhou, Jiangxi province, China
| | - Jia-Wen Zhang
- Xiamen Institute of Software Technology, Xiamen, China, Fujian province.
- School of Education, Silliman University, Negros Oriental province, Dumaguete, Philippines.
| | - Mei-Fang Yang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan province, China.
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Yu Y, Zhang J, Chen C, Petrovic M, Pei X, Zhang WH. Longitudinal Association Between Perceived Availability of Home- and Community-Based Services and All-Cause Mortality Among Chinese Older Adults: A National Cohort Study. J Aging Soc Policy 2023:1-36. [PMID: 37889943 DOI: 10.1080/08959420.2023.2265771] [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: 02/13/2023] [Accepted: 06/30/2023] [Indexed: 10/29/2023]
Abstract
Home- and community-based services (HCBS) may contribute to lowering mortality and enhancing quality of life among older adults. Limited research, however, has examined this relationship in the Chinese context. This study explored the longitudinal association between perceived availability of HCBS and all-cause mortality among Chinese older adults. This cohort study included 8,102 individuals aged 65 years and older from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. HCBS included daily life assistance, medical care services, emotional support and social services, and reconciliation and legal aid services. The association between perceived availability of HCBS and all-cause mortality was investigated using Cox proportional hazards models. Emotional support and social services were negatively associated with all-cause mortality (HR = 0.86, 95% CI: 0.78 ~ 0.95, P = .004). Daily life assistance, medical care services, and reconciliation and legal aid services were not significantly associated with all-cause mortality. Providing community-level emotional support and social services may reduce the risk of death. Focusing on the mental health and social well-being of older adults is just as important as caring for their physical health.
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Affiliation(s)
- Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jun Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- The Research Center for Medical Sociology, Tsinghua University, Beijing, China
| | - Chun Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Xiaomei Pei
- Department of Sociology, School of Social Sciences, Tsinghua University, Beijing, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
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Menhas R, Yang L, Danish Nisar R. Community-based social healthcare practices in China for healthy aging: a social prescription perspective analysis. Front Public Health 2023; 11:1252157. [PMID: 37849719 PMCID: PMC10578489 DOI: 10.3389/fpubh.2023.1252157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023] Open
Abstract
Background The global population is aging, and the number of people suffering from chronic diseases is increasing. In response to these trends, community-enhanced social healthcare practices are a novel paradigm of social prescribing that aims to improve both the community's and the individual's level of health by combining community involvement, organizational change, and individual-level practice. Objective The study examined the state of community-based social healthcare practices using the lens of social prescription in China with an eye on promoting healthy aging there. Method Thematic analysis approach was used in this investigation. A social prescription lens was used to conduct an open-ended theme study of China's community-based social healthcare practices for healthy aging. The research was conducted in Yiwu in Zhejiang Province, P. R. China. A sample of 24 "comprehensive evaluation team members (CETM)" was chosen using a purposive selection strategy. Results In the context of the social prescription, we analyzed social healthcare practices for healthy aging at the community level. All the comprehensive evaluation team members described community social healthcare practices under the paradigm of social prescription. After analyzing the community social healthcare practices under the paradigm of social prescription, six main themes (E-Social Prescription, Nature-based Social Prescription, Healthy Living Social Prescription, Culture-based Social Prescription, Health Screening Social Prescription, and Health Education Social Prescription) emerged for healthy aging at the community level. Conclusion Social prescribing links individuals to non-clinical services and activities, typically provided by the nonprofit and community sectors. Community-based social healthcare practices under social prescription can be an efficient and cost-effective way to assist patients with chronic diseases in managing their illnesses and enhancing their overall health and wellbeing.
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Affiliation(s)
- Rashid Menhas
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Lili Yang
- Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Rana Danish Nisar
- Department of Politics and International Relations (DPIR), University of Sargodha, Sargodha, Pakistan
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10
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Liang H, Wang B, Wu Y, Zhang Q, Xiang N, Yue Z, Liu E. The association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services: 2008 ~ 2018. Int J Equity Health 2023; 22:46. [PMID: 36918878 PMCID: PMC10012597 DOI: 10.1186/s12939-023-01856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The changes in demographic and family structures have weakened the traditional norms of filial piety and intergenerational relationships dramatically. This study aims to examine the dynamic association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services. METHODS Data was derived from the 2008-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is a longitudinal survey of a nationally representative sample of individuals aged 60 and over. Random effects model was used to assess the association between financial support and informal care provision of adult children to their parents. RESULTS It was found that financial support showed an upward trend while informal care provision showed a download trend from 2008 to 2018. The result indicated a significant and negative association between financial support and informal care provision of adult children to their parents (B = -0.500, 95% confidence interval (CI) = -0.761 to -0.239). And the association was significant among elderly people who were from urban areas (B = -0.628, 95% CI = -0.970 to -0.287), co-resided with adult children (B = -0.596, 95% CI = -0.939 to -0.253), and had community-based services (B = -0.659, 95% CI = -1.004 to -0.315). CONCLUSION Financial support was negatively associated with informal care provision of adult children to their parents in China, and the association has differences in household registration, residence arrangement and community-based care services. It is suggested that policymakers should prioritize planning interventions for elderly care services and establish a family caregiver support system.
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Affiliation(s)
- Hang Liang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Boyu Wang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Yanli Wu
- Center for Social Security, Wuhan University, Wuhan, 430072, China
| | - Qilin Zhang
- Center for Social Security, Wuhan University, Wuhan, 430072, China
| | - Nan Xiang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Zhang Yue
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Erpeng Liu
- Institute of Income Distribution and Public Finance, Zhongnan University of Economics and Law, No. 182 Nanhu Rd, Wuhan, 430073, China.
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11
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Li Y. Social care for disabled elderly women in urban China: The roles of the community. Soc Sci Med 2022; 314:115473. [PMID: 36332530 DOI: 10.1016/j.socscimed.2022.115473] [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: 07/14/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
This article analyses the provision of community care for urban disabled elderly women. With the emergence of an aging society in China and the empty nest syndrome in Chinese families, the number of elderly people who cannot take care of themselves is increasing. With the reduction in family size and the weakening of the home care function, traditional family care in China is facing immense challenges. On the one hand, a growing number of disabled elderly women are in urgent need of care; they encounter many difficulties in daily life, including poor health status, the loss of their spouse and living alone, an inability to support themselves economically, the lack of a spiritual life, and a significant reliance on their children to take care of them. On the other hand, the family's function of providing for the elderly has been weakened, and the traditional way of care is affected by the changes in modern society. Based on a qualitative study in Beijing, this article examines the demand for care from disabled elderly women and the current supply of community care. It puts forward a community-centred and targeted assistance model and social work intervention. This study argues that the community care system for disabled elderly women in urban areas should focus on four aspects, namely living care, medical care, spiritual consolation, and emergency assistance; and the protection mechanism should be improved to support disabled elderly women from three aspects: a protection system, a fund guarantee and services from health and social cafe staff and social workers.
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Affiliation(s)
- Yan Li
- School of Government, Nanjing University, Nanjing, Jiangsu, China.
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Socioeconomic inequality of long-term care for older people with and without dementia in England. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Ensuring distributive fairness in the long-term care sector is vitally important in the context of global population ageing and rising care needs. This study, part of the DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) programme, investigates socioeconomic inequality and inequity in the utilisation of long-term care for older people with and without dementia in England. The data come from three waves of the English Longitudinal Study of Ageing (ELSA, Waves 6–8, N = 16,458). We find that older people with dementia have higher levels of care needs and a lower socioeconomic status than those without dementia. The distribution of formal and informal care is strongly pro-poor. When care needs are controlled for, there is no significant inequality of formal or informal care among people with dementia, nor of informal care among people without dementia, but there is a significant pro-rich distribution of formal care among people without dementia. Unmet care needs are significantly concentrated among poorer people, both with and without dementia. We argue that the long-term care system in England plays a constructive role in promoting socioeconomic equality of long-term care for people with dementia, but support for older people with lower financial means and substantial care needs remains insufficient. Increased government support for older people is needed to break the circle between care inequality and health inequality.
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Krings MF, van Wijngaarden JDH, Yuan S, Huijsman R. China's Elder Care Policies 1994-2020: A Narrative Document Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106141. [PMID: 35627677 PMCID: PMC9141963 DOI: 10.3390/ijerph19106141] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
Until the 1980s, institutional elder care was virtually unknown in China. In a few decades, China had to construct a universal social safety net and assure basic elderly care. China’s government has been facing several challenges: the eroding traditional family care, the funding to assure care services for the older population, as well as the shortage of care delivery services and nursing staff. This paper examines China’s Five-Year Policy Plans from 1994 to 2020. Our narrative review analysis focuses on six main topics revealed in these policies: care infrastructure, community involvement, home-based care, filial piety, active aging and elder industry. Based on this analysis, we identified several successive and often simultaneously strategic steps that China introduced to contend with the aging challenge. In Western countries, elder care policies have been shifting to the home care approach. China introduced home care as the elder care cornerstone and encouraged the revival of the filial piety tradition. Although China has a unique approach, the care policies for the aged population in China and Western countries are converging by emphasizing home-based care, informal care and healthy aging.
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Affiliation(s)
- Marion F. Krings
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 738, 3000 DR Rotterdam, The Netherlands; (M.F.K.); (J.D.H.v.W.); (R.H.)
| | - Jeroen D. H. van Wijngaarden
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 738, 3000 DR Rotterdam, The Netherlands; (M.F.K.); (J.D.H.v.W.); (R.H.)
| | - Shasha Yuan
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
- Correspondence:
| | - Robbert Huijsman
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 738, 3000 DR Rotterdam, The Netherlands; (M.F.K.); (J.D.H.v.W.); (R.H.)
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Care poverty among older adults in East Asia: a comparison of unmet care needs between China and Taiwan. Arch Gerontol Geriatr 2022; 102:104738. [DOI: 10.1016/j.archger.2022.104738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
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Gong N, Meng Y, Hu Q, Du Q, Wu X, Zou W, Zhu M, Chen J, Luo L, Cheng Y, Zhang M. Obstacles to access to community care in urban senior-only households: a qualitative study. BMC Geriatr 2022; 22:122. [PMID: 35164708 PMCID: PMC8842867 DOI: 10.1186/s12877-022-02816-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/01/2022] [Indexed: 01/02/2023] Open
Abstract
Background The increased number of older adults living alone has created a substantial care need. However, the utilization rate of services and facilities to meet these needs are surprisingly low. Many of older adults experience difficulties accessing these services, although it remains unclear how these obstacles impede access to services. This study explored the obstacles and difficulties experienced by urban older adults in seeking community care. Methods A phenomenological study was carried out and participatory observation and in-depth interviews were employed to investigate the process of seeking care of older adults in urban communities. A total of 18 urban community-dwelling older adults aged 75 years and over were included. Data collected were analysed by content analysis. Results We identified the pathways by which senior-only households sought community care and encountered obstacles. (1) lack of community care information: older adults did not know where and how to get services, even though the care institutions scattered throughout the community; (2) limited mobility: older adults often suffered from various chronic diseases, which physically hindered their access to care resources; (3) complex process of achieving care: the functional fragmentation and geographical dispersion of care institutions made the care-seeking process challenging and confusing for older adults; (4) incomprehension of needs expression: limited interaction time and communication barriers between staff of institutions and the older adults were the final obstacle. Only by surmounting these obstacles one by one can older adults access the care resources effectively. Conclusions When older adults in the community initiated calls for help, they encountered several obstacles. Their physiological and social disadvantages limited their ability to seek care physically. Lack of integration and clear guidance in the process of providing community care exacerbated these difficulties. Reform of care services should focus on the visibility and accessibility of services for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02816-y.
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Affiliation(s)
- Ni Gong
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Ya Meng
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Qin Hu
- School of Sociology and Anthropology, Sun Yat-sen University, Xingang West Road, Haizhu District, Guangzhou, 510399, Guangdong, China
| | - Qianqian Du
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Xiaoyu Wu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Wenjie Zou
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Mengyao Zhu
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Jiayan Chen
- Qizhi Social Work Service Center, Tianhe District, Guangzhou, Guangdong, China
| | - Lan Luo
- Hongshan Street Community Health Service Center, Huangpu District, Guangzhou, Guangdong, China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-sen University, Xingang West Road, Haizhu District, Guangzhou, 510399, Guangdong, China.
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
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Predebon ML, Ramos G, Pizzol FLFD, Santos NOD, Paskulin LMG, Rosset I. Global functionality and associated factors in the older adults followed by Home Care in Primary Health Care. Rev Lat Am Enfermagem 2021; 29:e3476. [PMID: 34730759 PMCID: PMC8570251 DOI: 10.1590/1518-8345.5026.3476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/08/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: to analyze the association of global functionality with the main functional systems and the sociodemographic variables of older adults followed by Home Care in Primary Health Care. Method: a cross-sectional study with 124 older people developed through home interviews. Functionality was assessed by Basic Activities of Daily Living (Barthel) and Instrumental Activities of Daily Living (Lawton and Brody); the main functional systems were assessed using the Mini-Mental State Exam, by the Timed Up and Go test, by the Geriatric Depression Scale (15 items), and questionnaire with sociodemographic variables. Bivariate and multivariate analyses were applied (Poisson Regression). Results: 46% of the older adults showed moderate/severe/total dependence for basic activities and instrumental activities had a median of 12. In the multivariate analysis, there was an association between moderate/severe/total dependence on basic activities with cognitive decline (p=0.021) and bedridden/wheelchair users (p=0.014). Regarding the dependence on instrumental activities, there was an association with age ≥80 years (p=0.006), single/divorced marital status (p=0.013), cognitive decline (p=0.001), bedridden/wheelchair (p=0.020), and Timed Up and Go ≥20 seconds (p=0.048). Conclusion: the decline in cognitive and mobility was associated with poor functionality in basic and instrumental activities. The findings highlight the need to monitor Home Care for these individuals and serve as guidelines for health actions.
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Affiliation(s)
| | - Gilmara Ramos
- Hospital Moinhos de Ventos, Unidade de Internação, Porto Alegre, RS, Brazil
| | | | | | - Lisiane Manganelli Girardi Paskulin
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Coordenação do Grupo de Enfermagem, Porto Alegre, RS, Brazil
| | - Idiane Rosset
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Enfermagem em Atenção Primária em Saúde, Porto Alegre, RS, Brazil
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Zhang Y, Liu P, Pan Y, Li Y, Zhang L, Li Y, Ma L. Reliability and Validity of the Function Impairment Screening Tool in Chinese Older Adults. Front Med (Lausanne) 2021; 8:720607. [PMID: 34722565 PMCID: PMC8548427 DOI: 10.3389/fmed.2021.720607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Physical function gradually decreases with age in older adults, affecting their independence and quality of life and leaving them prone to adverse outcomes. Despite the importance of assessing function for older adults, most studies have focused on disability and paid less attention to functional impairment. Thus, given the lack of valid and practical methods for evaluating functional impairment for older adults, we developed the function impairment screening tool (FIST) using the Delphi method. Objective: This study aimed to evaluate the reliability and validity of the FIST in Chinese older adults. Methods: A total of 489 participants aged 60 years or older, and who had completed the FIST were included. A subgroup of 50 participants completed the FIST a second time, 1 week after the first round, and the test–retest reliability was evaluated using the intraclass correlation coefficient (ICC). Reliability was tested using Cronbach's alpha. Validity was examined using exploratory factor analysis. Criterion-related validity was assessed using correlations between the FIST and the Barthel Index activities of daily living (ADL), Lawton, and Brody instrumental activities of daily living (LB-IADL). Results: The Cronbach's alpha coefficient for the FIST was 0.930 (P < 0.001). The test–retest reliability was good, with an ICC of 0.928 (95% confidence interval [0.874, 0.960]). Exploratory factor analyses revealed one factor accounting for 60.14% of the scale's variance and the load values of every item were >0.4 (0.489–0.872). The correlation coefficient was 0.572 (P < 0.001) between the FIST score and ADL, and was 0.793 (P < 0.001) between the FIST score and IADL. The FIST score was positively correlated with walking speed (r = 0.475, P < 0.001) and grip strength (r = 0.307, P < 0.001), and negatively correlated with age (r = −0.588, P < 0.001) and Fried frailty phenotype (r = −0.594, P < 0.001). Conclusion: The FIST is a reliable and valid instrument for assessing physical function impairment in older adults.
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Affiliation(s)
- Yaxin Zhang
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Pan Liu
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yiming Pan
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Zhang
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yun Li
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lina Ma
- Department of Geriatrics, China National Clinical Research Center for Geriatric Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
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Hu B, Wei M. Childhood Adversities and Unmet Needs of Older Chinese Adults: The Mediation Effects of Family Relationships. Res Aging 2021; 44:465-476. [PMID: 34644508 PMCID: PMC9039319 DOI: 10.1177/01640275211048237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ensuring equality and adequacy of care for older adults is vitally important. This study investigates the relationships between childhood adversities and unmet long-term care needs of older adults in China and the mediation effects of family relationships. The data came from a nationally representative sample of older Chinese adults aged 60 and over with long-term care needs (N = 2186). We conducted mediation analyses and decomposed the total effects of childhood adversities on unmet needs into direct and indirect effects. The probability of unmet needs is significantly higher among older adults experiencing childhood adversities. Satisfaction with marriage mediates the association between childhood adversities and unmet personal care needs. Relationships with children mediate the association between childhood adversities and unmet domestic care needs. The causes of unmet needs can be traced back to early life, which underscores the importance of concerted efforts in family, education and long-term care policies to tackle unmet needs.
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Affiliation(s)
- Bo Hu
- Care Policy and Evaluation Centre (CPEC), Department of Health Policy, 4905London School of Economics and Political Science, London, UK
| | - Mingyu Wei
- School of Arts and Cultures, 5994Newcastle University, Newcastle, UK
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Miao X, Bai W, Zhao Y, Yang LN, Yuan W, Zhang A, Hu X. Unmet health needs and associated factors among 1727 rural community-dwelling older adults: A cross-sectional study. Geriatr Nurs 2021; 42:772-775. [PMID: 33906085 DOI: 10.1016/j.gerinurse.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Abstract
AIM To investigate the needed, unneeded and unmet health care services among rural community-dwelling older adults in China and examine the influencing factors, aiming to facilitate the global development of the home care system for a healthier world. METHODS This cross-sectional study investigated rural areas in three provinces in Western China. A total of 1727 rural community-dwelling older adults were enrolled. The needed, unneeded and unmet health care services were assessed by the Supply and Demand of Health Care Services (SD-HCS) questionnaire for older adults. RESULTS Respect (73%, 1265/1727) was the most needed. The other top 9 needed mainly belonged to the divisions of health monitoring and information regarding chronic diseases. Re-employment or part-time jobs (71%, 1230/1727) was the most unneeded. All five protection and safety items were the most unmet but needed. Religion was the main influencing factor of those health care services that were less unmet but needed. CONCLUSIONS Respect was basic for older adults, and chronic disease management was in great demand among rural community-dwelling older adults. Due to low willingness and the crisis workforce, a more flexible retirement policy is needed in rural China. It is urgent to improve the emergency care system in rural areas. Last but not least, more research is needed to explore the association between religion and health.
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Affiliation(s)
- Xiaohui Miao
- Innovation Center of Nursing Research, West China School of Medicine/West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041 Sichuan, China; Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Wenhui Bai
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yipu Zhao
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Li-Na Yang
- Department of Nursing, the First People's Hospital of Yinchuan, Yinchuan, Ningxia, China
| | - Weiqun Yuan
- Department of Nursing, Guizhou People's Hospital, Guiyang, Guizhou, China
| | - Ailing Zhang
- Department of Nursing, Yunnan Older People Hospital, Kunming, Yunnan, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, West China School of Medicine/West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041 Sichuan, China.
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20
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Mah JC, Stevens SJ, Keefe JM, Rockwood K, Andrew MK. Social factors influencing utilization of home care in community-dwelling older adults: a scoping review. BMC Geriatr 2021; 21:145. [PMID: 33639856 PMCID: PMC7912889 DOI: 10.1186/s12877-021-02069-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/01/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Older adults want to live at home as long as possible, even in the face of circumstances that limit their autonomy. Home care services reflect this emergent preference, allowing older adults to 'age in place' in familiar settings rather than receiving care for chronic health conditions or ageing needs in an institutionalized setting. Numerous social factors, generally studied in isolation, have been associated with home care utilization. Even so, social circumstances are complex and how these factors collectively influence home care use patterns remains unclear. OBJECTIVES To provide a broad and comprehensive overview of the social factors influencing home care utilization; and to evaluate the influence of discrete social factors on patterns of home care utilization in community-dwelling older adults in high-income countries. METHODS A scoping review was conducted of six electronic databases for records published between 2010 and 2020; additional records were obtained from hand searching review articles, reference lists of included studies and documents from international organisations. A narrative synthesis was presented, complemented by vote counting per social factor, harvest plots and an evaluation of aggregated findings to determine consistency across studies. RESULTS A total of 2,365 records were identified, of which 66 met inclusion criteria. There were 35 discrete social factors grouped into four levels of influence using a socio-ecological model (individual, relationship, community and societal levels) and grouped according to outcome of interest (home care propensity and intensity). Across all studies, social factors consistently showing any association (positive, negative, or equivocal in pattern) with home care propensity were: age, ethnicity/race, self-assessed health, insurance, housing ownership, housing problems, marital status, household income, children, informal caregiving, social networks and urban/rural area. Age, education, personal finances, living arrangements and housing ownership were associated with home care intensity, also with variable patterns in utilization. Additional community and societal level factors were identified as relevant but lacking consistency across the literature; these included rurality, availability of community services, methods of financing home care systems, and cultural determinants. CONCLUSION This is the first literature review bringing together a wide range of reported social factors that influence home care utilization. It confirms social factors do influence home care utilization in complex interactions, distinguishes level of influences at which these factors affect patterns of use and discusses policy implications for home care reform.
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Affiliation(s)
- Jasmine C Mah
- Department of Health Policy, London School of Economics and Political Sciences, London, UK.
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Susan J Stevens
- Faculty of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
- Continuing Care, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Janice M Keefe
- Faculty of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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Hu B. Trajectories of informal care intensity among the oldest-old Chinese. Soc Sci Med 2020; 266:113338. [DOI: 10.1016/j.socscimed.2020.113338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022]
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