Undermet needs for assistance in personal activities of daily living among community-dwelling oldest old in China from 2005 to 2008

Spatiotemporal evolution and influencing factors of the allocation of social care resources for the older adults in China

BACKGROUND

The reasonable allocation of social care resources for the older adults is a key measure to actively respond to population aging. This study aims to evaluate the evolutionary trend, spatial differences and influencing factors of the social elderly care resources (SECR) allocation in China.

METHODS

This study constructed a comprehensive index system consisting of three dimensions: material resources, human resources and financial resources, to measure the level of SECR in mainland China. The Kernel density estimation was used to reveal the dynamic evolution trend, and Dagum Gini Coefficient and its decomposition method were used to investigate the equity of SECR allocation. Spatial panel regression models were used to analyze the influencing factors of the allocation of SECR.

RESULTS

The level of SECR is rising from 0.197 in 2013 to 0.208 in 2019. The middle-high- and high-level areas of SECR were mainly distributed in the eastern and western China. The Gini coefficient of SECR decreased from 0.262 in 2013 to 0.249 in 2019. Per capita GDP, the proportion of social welfare expenditure in GDP and the proportion of the tertiary industry in GDP have significant positive effects on the allocation of SECR. Population aging and the development of service industry exhibit significant negative spatial spillover effects on the allocation of SECR.

CONCLUSIONS

The fairness of the allocation of SECR in China has been improved, while the spatial distribution is imbalanced. Economic development, fiscal input and the development of service industry have significant positive effects while population aging has significant negative effects on the SECR allocation.

Gender differences in caregiver attitudes and unmet needs for activities of daily living (ADL) assistance among older adults with disabilities

BACKGROUND

With a rapidly ageing population and a decline in the availability of family caregivers, the number of older adults with disabilities who have unmet long-term care needs is gradually increasing worldwide. However, whether there are gender differences in the association between primary caregivers or their attitudes and unmet needs for activities of daily living (ADL) assistance remains largely unknown.

METHODS

This study used the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), containing the data of 1187 older adults with disabilities aged 65 and older, to identify gender differences in the attitudes of primary caregivers toward the unmet needs for ADL assistance among with disabilities adults in China. Binary logistic regression analysis was conducted to determine the effects of primary caregivers and their caregiving attitudes on the unmet care experiences of older adults with ADLs. In addition, a gender-stratified analysis was conducted to compare the differences based on older adults' gender.

RESULTS

The results revealed that the lack of positive attitudes from primary caregivers might create a situation of unmet needs for ADL assistance among older adults. When family members carry the main burden of care, older adults with disabilities, especially older women, have a lower level of unmet needs for ADL assistance. Therefore, it is important to consider gender-specific interventions to improve ADL assistance among older adults.

CONCLUSIONS

The findings suggest that the presence of a family member as a caregiver has a significant effect on unmet needs for ADL assistance in women, highlighting the importance of developing an emotional bond with the caregiver. Given that the availability of informal caregivers, such as family members, is declining, it is crucial to provide financial assistance and formal services, such as paid home services and community-based care services, and reduce the burden on family caregivers to address the unmet needs for ADL assistance among older adults with disabilities in China.

Unmet needs for care for activities of daily living among older adults with functional disabilities in Vietnam

Background

Given its low-middle-income status, Vietnam is experiencing a rapidly aging population. Along with this demographic trend, the care needs of older adults, particularly those with functional disabilities, have become an emerging policy issue.

Purpose

This study examined the prevalence of unmet needs for care in activities of daily living (ADLs) among Vietnamese older adults with functional disabilities.

Methods

We used data from the Population Change and Family Planning Survey (PCS) in 2021, which was a nationally representative survey. Cross-tabulations and logistic regressions were applied to identify older adults' individual and household factors associated with their unmet care needs.

Results

Overall, 4.80% of older adults with at least one functional disability needing care to perform one or more ADLs suffered from unmet needs, of whom 2.32% did not receive any care and 3.05% received insufficient assistance. Logistic regression results revealed that age, sex, place of residence, ethnicity, marital status, education levels, and self-rated health were significantly associated with unmet needs. The higher risk of having unmet needs is associated with those in middle age (70-79), men, rural residents, ethnic minorities, currently unmarried people, those with less than a primary educational level, and those with normal or poor self-rated health.

Conclusion

Attention should be paid to vulnerable older adults, such as those living in rural areas with poor health status, in order to reduce their unmet needs for ADL assistance.

Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach

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.

Unmet Needs and Associated Factors among Community-living Older People with Disability in China: 2005-2014

Based on the Chinese Longitudinal Healthy Longevity Survey from 2005 to 2014, this study estimated the prevalence and examined risk factors of under-met needs and completely unmet needs for assistance in activities of daily living (ADLs) among community-living older people with disability in China. As of 2014, over 50% of community-living Chinese elders with disability experienced under-met needs, and nearly 5% had completely unmet needs. From 2005 to 2014, the proportion with completely unmet needs doubled for all disabled elders. Significant risk factors of under-met needs included lower per capita annual household income, more ADL limitations, living alone, and fewer living children, and those of completely unmet needs included less ADL limitations and living alone. More policy attention should be paid to address the gap between long-term care services for older persons with severe disability and supportive services for those who are relatively healthy, toward ultimately establishing a care continuum for the elderly at all stages of their life course. In addition, family care for elders with severe functional impairments should be supplemented by professional long-term care services to best meet their needs.

Instrumental support primarily provided by adult children and trajectories of depressive symptoms among older adults with disabilities in rural China

OBJECTIVES

This study aimed to examine the trajectories of depressive symptoms over a 5-year period in a sample of community-dwelling older adults with disabilities in rural China, and the association between duration of instrumental support primarily provided by adult children and the trajectories of depressive symptoms.

METHODS

Data were drawn from three waves of the China Health and Retirement Longitudinal Study (2011-2015). The sample included 1,466 older adults living in rural areas aged 60 and over who had at least one child in all three waves. Duration of instrumental support provided by adult children was measured by the number of waves that older adults received instrumental support primarily from any adult children in the data collection. Growth mixture modelling was used to identify the trajectory classes of depressive symptoms among these older adults, and logistic regression was used to examine the association between duration of instrumental support primarily provided by adult children and the trajectory classes of depressive symptoms.

RESULTS

This study identified two distinct trajectories of depressive symptoms among the respondents: high but decreasing levels of symptoms and persistently low levels of symptoms. Respondents who received a longer duration of instrumental support primarily from adult children were more likely to have high but decreasing symptoms after controlling for other covariates.

CONCLUSION

The findings have important implications for promoting the mental health of older adults with disabilities in rural China. There are still very limited long-term care services and programs are available for older adults, particularly in rural China. It is critical to develop these services at both community and institutional levels to meet the care needs of older adults and their families.

Public trust in the long-term care insurance pilot program in China: An analysis of mediating effects

Objective

This study aimed to evaluate the implementation of the long-term care insurance (LTCI) pilot program in China through an examination of public trust in the system and its associated factors of insurance awareness and satisfaction with the LTCI policy.

Method

An online survey was used to collect data from 786 participants in the city of Guangzhou, one of the pilot sites of the LTCI. Ordinal logistic regression models were used to investigate the related factors of public trust in the LTCI. Structural equation modeling (SEM) was conducted to test the mediating effect of satisfaction with LTCI policy on the relationship between insurance awareness and public trust.

Results

More than 60% of participants gave a positive evaluation of the LTCI pilot program. More than 70% of the participants recognized the important role of the program. Both an understanding of insurance and satisfaction with LTCI policies were associated with public trust. The proportion of the indirect effect with regard to the total effect of satisfaction on trust was 70.133%, greater than the direct effect of 29.867%.

Conclusions

Our findings supported the hypothesis that satisfaction with the LTCI policy plays a mediating role between insurance awareness and public trust. Optimalization of the LTCI policy was recommended to improve public trust in the LTCI program.

Assessing the Sustainability of Long-Term Care Insurance Systems Based on a Policy-Population-Economy Complex System: The Case Study of China

Although China launched long-term care insurance (LTCI) pilot program in 2016, there are great challenges associated with developing a sustainable LTCI system due to limited financial resources and a rapid increase in the aging population. This study constructed an LTCI policy−population−economics (PPE) system to assess the sustainability of the LTCI system in China. Based on the latest 76 LTCI policy documents published between 2016 and 2021, this study evaluated the strength of LTCI policy modeling in 14 pilot cities by constructing a policy modeling consistency (PMC) index containing 9 main variables and 36 sub-variables. The coupling coordination model was used to evaluate the interaction between LTCI policy, population aging, and economic development. The results showed that the PMC index ranged from 0.527 to 0.850. The policy strength of Qingdao, Nantong, and Shanghai was the highest (PMC > 0.8). Anqing, Qiqihaer, Chongqing, and Chengdu had the lowest level of policy strength (PMC < 0.6). The main policy weaknesses were the coverage of the LTCI, the sources of funds, the scope of care services, and benefit eligibility. The coupling coordination degree of PPE systems varied from 0.429 to 0.921, with a mean of 0.651. Shanghai, Nantong, and Suzhou had the highest level of coordination. The coordination between subsystems of PPE in most pilot cities (12 of 14 cities) was at a basic or low level. The findings from this study concluded that the coordination within the PPE system should be improved to develop a sustainable LTCI system. To improve the coordination of the PPE system, it is suggested that the country should maintain sustainable economic growth and modify LTCI policies based on demographic transitions and economic development.

Life Course Socioeconomic Status and Healthy Longevity in China

In 2020, China's population aged 60 or older exceeded 264 million, representing 25% of the global population in that age-group. Older adults in China experienced periods of dramatic political and social unrest in early life, as well as economic transformations leading to drastic improvements in living standards during adulthood and older age. However, the implications of life course socioeconomic status (SES) trajectories for healthy longevity in later life have not been systematically studied in China. We utilize data from the China Health and Retirement Longitudinal Study (CHARLS) to comprehensively investigate how early-life conditions and adult SES combine to influence healthy longevity in later life. We find that both childhood and adulthood SES are associated with late-life health. The largest disparities in life expectancy (LE) and disability-free LE are found between those with persistently low SES throughout life and those with consistently high SES. At age 45, the gap in total LE between the most advantaged and least advantaged groups is six years for men and five years for women. Despite China's major policy changes prioritizing equity in income and health care in recent decades, our findings suggest that dramatic health inequalities among older adults remain. Our findings extend the literature on the effect of socioeconomic patterns across the life course on gradients in later-life health and highlight continuing disparities in healthy longevity among older adults in China.

The impact of unmet needs for assistance with activities of daily living on the self-rated health and life satisfaction of Chinese community-dwelling older adults

OBJECTIVES

This study examined the associations of change in unmet needs for assistance with Activities of Daily Living (ADLs) with the self-rated health and life satisfaction of community-dwelling Chinese older adults.

METHODS

Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of change in unmet ADL needs with self-rated health and life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 ADL-limited older adults. Change in unmet ADL needs was categorized into 'Persistently Unmet,' 'Unmet at T1 Only,' 'Unmet at T2 Only,' and 'Never Unmet.' Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographics, health conditions, and social support.

RESULTS

Older adults whose ADL needs were 'Persistently Unmet,' 'Unmet at T2 Only,' or 'Never Unmet,' showed a significant decline in self-rated health, but those whose ADL needs were 'Unmet at T1 Only' exhibited a significant rise at follow-up. While life satisfaction was stable among older adults with 'Persistently Unmet' or 'Never Unmet' ADL needs, it significantly decreased among those with 'Unmet at T2 Only' ADL needs and increased among those with 'Unmet at T1 Only' ADL needs.

CONCLUSION

Unmet needs may play an even more significant role in negatively impacting life satisfaction than the ADL limitation itself. Unmet ADL needs' effects on self-rated health and life satisfaction appeared to be short-term rather than long-term. Thus, it is never too late to adequately meet older adults' ADL needs.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2045563.

Childhood Adversities and Unmet Needs of Older Chinese Adults: The Mediation Effects of Family Relationships

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.

Gender difference in unmet need for assistance with activities of daily living among disabled seniors in China : a cross-sectional study

OBJECTIVES

This study explores the gender difference in unmet need for assistance with activities of daily living among older adults with disabilities in China.

DESIGN

Logistic regression analysis was employed to examine the gender difference and identify influential factors among disabled male and female seniors.

SETTING

23 provinces throughout China.

PARTICIPANTS

A total of 1700 disabled seniors were included in the analysis.

RESULTS

Of 1700 respondents, 619 (36.4%) were disabled male seniors. Overall, the possibility of unmet need for activity of daily living assistance among disabled female seniors was significantly lower than that among male group (OR 0.728; 95% CI 0.559 to 0.948) than males. Family care resources, economic status and loneliness were influential factors among disabled seniors regardless of genders. Furthermore, disabled female seniors from rural area (p=0.011), whose primary caregiver was willing to take care of them (p=0.022), whose community could provide daily life service (p=0.002) were more likely to have unmet need. Meanwhile, disabled female seniors whose community could provide medical service(p=0.001) were less likely to report unmet need.

CONCLUSIONS

The study showed that disabled male seniors were more likely to experience unmet need compared with female ones. Reducing unmet need for assistance with activities of daily living among disabled seniors and existing gender disparities therefore requires not only universal strategy, but also targeted policies which should be made or modified for disabled seniors of different genders.

The Elderly's Demand for Community-Based Care Services and Its Determinants: A Comparison of the Elderly in the Affordable Housing Community and Commercial Housing Community of China

With the rapid aging of the world population, great pressure has been placed on the provision of community-based care in China. This paper aimed to compare the demand and its determinants for various community-based care services among the elderly in the affordable housing community (AHC) and commercial housing community (CHC) of China. Two community-based surveys were conducted separately in the AHC and CHC of Nanjing City, China. In total, 408 valid questionnaires were returned from the Daishan AHC while 8422 valid questionnaires were received from the CHCs. The chi square test indicated that the respondents in the AHC had significantly higher demands for five types of services (the meal-aid service, the cleaning-aid service, the bath-aid service, the rehabilitation therapy service, and the first-aid service) than those in the CHCs of Nanjing. Further, the Cochran–Mantel–Haenszel test showed that factors influencing the elderly's demands for these services varied across communities. Several policy implications could be obtained to improve the efficiency of community-based care provision.

Influencing Factors of Undermet Care Needs of the Chinese Disabled Oldest Old People When Their Children Are Both Caregivers and Older People: A Cross-Sectional Study

We examined the influencing factors of the undermet care needs of the Chinese disabled oldest old people when their children are both caregivers and are themselves older people. Data were obtained from a cross-sectional survey: the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. The study participants included 1617 disabled oldest old people whose primary caregiver were their children or children-in-law and were aged 60 years and over. The results showed that the prevalence of undermet needs remained high, with 49.6% disabled oldest old people reporting undermet care needs. Binary logistic regression analysis revealed that living in a rural area (OR = 1.309, 95% CI = 1.133-1.513) and a higher frailty index (OR = 1.103, 95% CI = 1.075-1.131) were significantly positively associated with higher odds for undermet care needs, while a higher annual household income (OR = 0.856, 95% CI = 0.795-0.923), more financial support from children (OR = 0.969, 95% CI = 0.941-0.997), higher care expenditures (OR = 1.044, 95% CI = 1.002-1.088), better caregiver's performance (OR = 0.282, 95% CI = 0.196-0.407) and sufficient income to pay for daily expenses (OR = 0.710, 95% CI = 0.519-0.973) were significantly inversely associated with higher odds for undermet care needs. This evidence suggests the importance of policies to establish a community-based socialized long-term care system and supporting family caregivers of the disabled oldest old people.

Home and community care for older people in urban China: Receipt of services and sources of payment

This study investigates the characteristics of Chinese older people receiving home and community care and the factors associated with the sources of payment for care services. The data come from the Social Survey of Older People in Urban China, which collected information from a random sample of 3,247 older people aged 60 and over in 10 large cities in different regions of China in 2017. Anderson's behavioural model of care utilisation is used to guide the analyses. The study identifies four striking features of the Chinese social care system. First, although disabilities are a significant predictor of receiving home and community care, a large proportion of care recipients do not have disabilities. Second, perceived proximity of care is the most important predictor, which implies high elasticity of demand for care services with regard to perceived distance and the great geographical inequality of care resources in the cities. Third, the government policies support the use of the internet to facilitate care access, but the enabling effect of the internet among older people is limited. Finally, sources of payment for care differ significantly according to people's age, living arrangements, disability and level of education. We argue that the government should consider shifting the focus of financial support from service providers to care recipients in the future.

Residential greenness, activities of daily living, and instrumental activities of daily living: A longitudinal cohort study of older adults in China

Supplemental Digital Content is available in the text.

Background:

We aimed to explore whether higher levels of residential greenness were related to lower odds of disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL).

Methods:

We included older adults 65 years of age or older from the Chinese Longitudinal Healthy Longevity Survey. Our exposure was Normalized Difference Vegetation Index in 500 m radius around residence. Our outcome was ADL and IADL. We used binary logistic regression and mixed-effects logistic regression to estimate the odds of ADL and IADL disabilities.

Results:

A total of 36,803 and 32,316 participants were included for the analysis of ADL and IADL, with 71.6% free of ADL disability and 47.3% free of IADL disability. In the logistic regression model, compared with the participants living in the lowest quartile of residential greenness, those in the highest quartile had a 28% (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.65, 0.79) lower odds of ADL disability and a 14% (OR = 0.86; 95% CI = 0.77, 0.95) lower odds of IADL disability. A similar association was found in the mixed-effects logistic regression models. During the follow-up period, 5,004 and 4,880 healthy participants developed ADL and IADL disabilities. Per 0.1-unit increase in baseline annual average Normalized Difference Vegetation Index (NDVI) was related to an OR of 0.95 of developing ADL disability (95% CI = 0.93, 0.98) and IADL disability (95% CI = 0.91, 0.98).

Conclusions:

Our study suggests that increasing green space is associated with lower odds of ADL and IADL disabilities, which may reduce caregiver burden of long-term care for Chinese older adults.

Characterising Long Term Care Needs among Chinese Older Adults with Cognitive Impairment or ADL Limitations

This study analyses long-term care needs (LTC) in the context of older adults who face limitations in activities of daily living (ADL) or with cognitive impairment (CI), and thus need aids to fulfil daily activities. Drawing on data from three waves (2002, 2005, 2008/09) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study shows that the older adults aged 65 to 99 with ADL limitation declined over the years from 8% to 5% but those with CI increased from 11% to 17%. Overall, about 16% of the older adults reported LTC needs in the baseline year of 2002, and this subsequently increased to 20% in 2008/09. Results from random-effects parametric survival-time models indicate that social factors such as low income, inadequate medical services, a lack of social support and social activities as well as being spouseless tend to significantly increase the hazard of developing LTC needs for the Chinese older adults.

Are China's oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart

BACKGROUND

China has transitioned from being one of the fastest-growing populations to among the most rapidly aging countries worldwide. In particular, the population of oldest-old individuals, those aged 80+, is projected to quadruple by 2050. The oldest-old represent a uniquely important group-they have high demand for personal assistance and the highest healthcare costs of any age group. Understanding trends in disability and longevity among the oldest-old-that is, whether successive generations are living longer and with less disability-is of great importance for policy and planning purposes.

METHODS

We utilized data from successive birth cohorts (n = 20,520) of the Chinese oldest-old born 10 years apart (the earlier cohort was interviewed in 1998 and the later cohort in 2008). Disability was defined as needing personal assistance in performing one or more of five essential activities (bathing, transferring, dressing, eating, and toileting) or being incontinent. Participants were followed for age-specific disability transitions and mortality (in 2000 and 2002 for the earlier cohort and 2011 and 2014 for the later cohort), which were then used to generate microsimulation-based multistate life tables to estimate partial life expectancy (LE) and disability-free LE (DFLE), stratified by sex and age groups (octogenarians, nonagenarians, and centenarians). We additionally explored sociodemographic heterogeneity in LE and DFLE by urban/rural residence and educational attainment.

RESULTS

More recently born Chinese octogenarians (born 1919-1928) had a longer partial LE between ages 80 and 89 than octogenarians born 1909-1918, and octogenarian women experienced an increase in partial DFLE of 0.32 years (P = 0.004) across the two birth cohorts. Although no increases in partial LE were observed among nonagenarians or centenarians, partial DFLE increased across birth cohorts, with a gain of 0.41 years (P < 0.001) among nonagenarians and 0.07 years (P = 0.050) among centenarians. Subgroup analyses revealed that gains in partial LE and DFLE primarily occurred among the urban resident population.

CONCLUSIONS

Successive generations of China's oldest-old are living with less disability as a whole, and LE is expanding among octogenarians. However, we found a widening urban-rural disparity in longevity and disability, highlighting the need to improve policies to alleviate health inequality throughout the population.

Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China

The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.

Are expectations for community mental health increasing among older adults in China?

In recent years, the Chinese government began expanding access to social services to older adults. This study examined whether older adults have increasing expectations that psychological consulting services will be provided by their communities. We analyzed the responses of participants in a prospective cohort study at 2 time points: 2005 and 2008. We utilized logistic regression with survey weights to determine whether there were any changes in attitudes toward community mental health services during the study period, and to determine the correlates of this change. The study participants had a higher expectation that their government would provide psychological consulting services in 2008 than 2005. The multiple logistic regressions conducted indicated that there was a statistically significant relationship between expectations for community-provided psychological consulting services and being a rural resident (odds ratio [OR] = 0.553, 95% confidence interval [CI] [0.353, 0.865]), change in gross regional product per capita (OR = 0.967, 95% CI [0.937, 0.997]), the interaction of those 2 variables (OR = 1.07, 95% CI [1.03, 1.11]), and increase in psychological well-being (OR = 0.971, 95% CI [0.954, 0.988]). Our study highlights the role that economic development can play in changing attitudes toward community-provided psychological consulting services. It suggests that as economic development occurs, expectations for local communities to provide mental health services will increase. (PsycINFO Database Record

Adult children’s characteristics and intergenerational financial transfers in urban China

Financial transfers between adult children and their elderly parents should be viewed as part of larger family dynamics that can also involve siblings. This is particularly likely to be the case in China, where there has been a traditional emphasis on financial support within the extended family. Using data from the 1999 ‘Study of Family Life in Urban China’ and fixed effects models, this study examines how the characteristics of adult children and their adult siblings are associated with financial transfers between them and their elderly parents. Particular attention is given to sibling differences with regard to factors such as gender, birth order, education and financial situation. The findings revealed that in urban China the traditional gender pattern is changing, in that daughters, rather than sons, now provide more financial support to their parents. However, parents still tend to give more financial assistance to sons. Children with more education (i.e., those who received more parental investment) provided greater financial support to their parents, to repay this earlier investment. Furthermore, elderly parents redistributed resources within the extended family by receiving more financial transfers from financially better-off children and giving more financial transfers to financially worse-off children. These findings suggest that the Chinese family serves as a financial buffer, with intergenerational transfers operating as a micro-level welfare system.

Family care-giving and living arrangements of functionally impaired elders in rural China

China has seen a rapid decline of the traditional multi-generational household and an increase in rural-to-urban migration, raising concerns about a possible breakdown of the informal support system. Against this background, the paper looks at family care-giving (or the absence thereof) to parents in three different living arrangements: with any child or child-in-law (co-resident); independent with at least one child living in the same community (networked); and without any children in either the household or the community (isolated). It also compares the care-giving arrangements of single elders to those living with a spouse. The sample, which is derived from the comprehensive China Health and Retirement Longitudinal Study (CHARLS), contains data on 887 functionally impaired individuals aged 60 and above. The findings suggest that married parents are mostly cared for by their spouse, even if they co-reside with adult children. Proximity to children is particularly important for single elders, who are more likely to lack a care-giver when living independently. There appears to be a hierarchy in family care responsibilities, where children step in as care-givers only when the spouse is no longer able to fulfil this role. While these findings imply a significant deviation from traditional practices and norms of ‘filial piety’, they can be interpreted as a rational adaptation to the changed economic circumstances in rural China.

A research agenda for aging in China in the 21st century

China is encountering formidable healthcare challenges brought about by the problem of aging. By 2050, there will be 400 million Chinese citizens aged 65+, 150 million of whom will be 80+. The undesirable consequences of the one-child policy, rural-to-urban migration, and expansion of the population of 'empty nest' elders are eroding the traditional family care of the elders, further exacerbating the burden borne by the current public healthcare system. The challenges of geriatric care demand prompt attention by proposing strategies for improvement in several key areas. Major diseases of the elderly that need more attention include chronic non-communicable diseases and mental health disorders. We suggest the establishment of a home care-dominated geriatric care system, and a proactive role for researchers on aging in reforming geriatric care through policy dialogs. We propose ideas for preparation of the impending aging burden and the creation of a nurturing environment conducive to healthy aging in China.

Unmet needs in long-term care and their associated factors among the oldest old in China

BACKGROUND

With a rapidly aging population and a decline in the availability of family caregivers, the number of elders in China who have unmet long-term care needs is increasing. Because unmet needs often have negative consequences, it is increasingly important to identify factors associated with unmet needs. Utilizing Andersen's behavioral model of health services use, this study examines the roles of predisposing factors (demographics), enabling factors (resources), and need (e.g., illness level) in long-term care among the oldest old in China.

METHODS

Data from three waves (2005, 2008, and 2011) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed. Four sequential, logistic regression models were designed to investigate how predisposing factors, enabling factors, and need were associated with unmet needs in long-term care.

RESULTS

Logistic regression analyses reveal that the significant factors for both rural and urban residents were economic status, someone other than a family member as the primary caregiver, caregivers' willingness to provide care, timely medication, self-rated health, and self-rated life satisfaction. Significant factors among only urban residents were age, a son/daughter-in-law as the primary caregiver, activities of daily living (ADL) disabilities expectation of access to community-based care services, and optimism. Significant factors among only rural residents were gender and cognitive function.

CONCLUSIONS

The risk of having unmet needs associated with ADL disabilities in long-term care is largely determined by the oldest old's economic status and caregivers' willingness to provide care for both rural and urban residents. Given that the availability of informal caregivers-mainly family members-is declining, it is crucial to provide financial assistance to the oldest old, to increase formal services such as paid home service and community-based care services, and to reduce family caregivers' burden in order to reduce the unmet needs of the oldest old in China.