Healthiness of survival and quality of death among oldest old in China using fuzzy sets

Quality of death among older adults in China: The role of medical expenditure and timely medical treatment

Medical expenses in the last year of life consume a large portion of healthcare expenditures, yet little is known about the relationship between medical expenditures in the last year of life and quality of death. Few empirical studies have investigated the association between timely medical treatment before dying and quality of death. This study aimed to examine the associations between medical expenditures in the last year of life, timely medical treatment before dying, and quality of death. Data derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the largest national representative study of the oldest-old in China. Results from multinomial logistic regression suggested that higher medical expenses in the last year of life and lack of timely medical treatment before dying are associated with lower quality of death. These findings highlight an urgent need for strengthening education on death and dying, developing hospice and palliative care services, and improving pain management at the end of life in China.

Longitudinal interplays between basic psychological need satisfaction and sleep among older adults in China

RATIONALE

Older people's sleep and associated health implications loom large in aging societies. Self-determination theory indicates lagged or immediate interplays between subjective sleep and satisfaction of basic psychological needs (for autonomy, relatedness, and competence). However, little is known about their longitudinal dynamics in later life.

OBJECTIVE

This study investigated longitudinal reciprocities between satisfaction of basic psychological needs and subjective sleep for older people and controlled for six sociodemographic and health-related covariates.

METHOD

Three waves of data from the Chinese Longitudinal Healthy Longevity Survey (2011, 2014, and 2017) were analyzed using Structural Equation Modelling (N = 2,834, 52.68% women, Mean age = 78.36). Participants reported sleep quality and duration, satisfaction of basic psychological needs, and sociodemographic and health characteristics. Four competing models were examined: Model A conceptualized lagged effects of sleep on need satisfaction and vice versa (i.e. cross-lagged design), Model B described immediate needs' effects on sleep but lagged opposite effects, Model C reversed Model B's specifications, and Model D portrayed concurrent feedback loops.

RESULTS

It was found that satisfaction of psychological needs and sleep quality declined over the seven-year span, but sleep length only fluctuated trivially. All models fitted the data well, where better sleep quality consistently predicted higher levels of need satisfaction, especially for relatedness and competence. Sleep interacted most robustly with relatedness: Models A, B, and C revealed positive lagged or immediate reciprocities between sleep quality and relatedness, and Model D yielded negative feedback loops between sleep length and relatedness.

CONCLUSIONS

The study identified longitudinal immediate or lagged interplays between need satisfaction and sleep for older people, especially concerning relatedness need. Implementation of need-supportive interventions and promotion of healthy sleep habits are necessary for healthy aging.

Predicting death quality from life prior to death among older Chinese in a retrospective cohort study

Background

The pursuit of a good death is crucial in aging societies. This retrospective cohort study investigated the relation between life prior to death and quality of death among older Chinese.

Methods

End-of-life data reported by relatives of participants (aged 54 and over) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) who deceased between January 2011 and June 2019 were utilized. Life prior to death included health condition (morbid or not) and physical functioning (a latent factor with six indicators). Quality of death was assessed by painlessness and consciousness at death. Confirmatory Factor Analysis was employed to examine the factor structure of physical functioning and Structural Equation Modeling to explore associations between life prior to death and death quality based on sex and residence location.

Results

Freedom from chronic diseases was found to contribute to high-quality deaths (i.e., being painless and conscious) both directly and indirectly by enhancing physical functioning. Men and women diverged toward end-of-life: women were moderately less liable to illnesses and thus less painful at death. Yet, men functioned much better, and more often remained conscious when dying. Location's effect was weaker: although rural residents were more prone to painful deaths than urban dwellers, this urban-rural divide was slightly narrowed by rural settlers' relative health, which also indirectly led to their slight advantage in consciousness at death.

Conclusions

The results suggested that different dimensions of life prior to death predicted quality of death. Additionally, morbidity's effect on functioning and death quality stresses health management's role in improving end-of-life experiences.

Orofacial pain among Chinese older adults in the last year of life

OBJECTIVE

To examine the prevalence of orofacial pain and associated factors in Chinese older adults at the end of life.

METHODS

This cross-sectional study included 1646 participants (65 years or older) in their last year of life from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the 6-month prevalence questions to measure two specific orofacial pain symptoms: toothache, and jaw or facial pain. Logistic regression analyses were used to examine factors, such as socioeconomic status, health behaviours and chronic diseases, that were associated with these two orofacial pain symptoms in the last year of life.

RESULTS

The 6-month prevalence estimates for toothache and jaw pain or facial pain for older adults in the last year of life were 14.1% and 4.5% respectively. Higher socioeconomic status was associated with lower odds of toothache and jaw pain or facial pain. Smoking was associated with high odds of toothache. Participants who brushed their teeth at least once a day were more likely to have toothache and jaw or facial pain than those who did not. Having any chronic conditions was associated with higher odds of toothache and jaw or facial pain. Older adults who had at least one tooth were more likely to have jaw or facial pain than those without any teeth.

CONCLUSION

A considerable proportion of Chinese older adults in their last year of life reported toothache and/or jaw pain or facial pain. These findings suggest that appropriate measures need to be taken to address the oral health needs in these vulnerable individuals, especially those of low socioeconomic status and chronic conditions.

The effect of different classification of hospitals on medical expenditure from perspective of classification of hospitals framework: evidence from China

Background

Different classification of hospitals (COH) have an important impact on medical expenditures in China. The objective of this study is to examine the impact of COH on medical expenditures with the hope of providing insights into appropriate care and resource allocation.

Methods

From the perspective of COH framework, using the Urban Employee Basic Medical Insurance (UEBMI) data of Chengdu City from 2011 to 2015, with sample size of 488,623 hospitalized patients, our study empirically analyzed the effect of COH on medical expenditure by multivariate regression modeling.

Results

The average medical expenditure was 5468.86 Yuan (CNY), the average expenditure of drug, diagnostic testing, medical consumables, nursing care, bed, surgery and blood expenditures were 1980.06 Yuan (CNY), 1536.27 Yuan (CNY), 500.01 Yuan (CNY), 166.23 Yuan (CNY), 221.98 Yuan (CNY), 983.18 Yuan (CNY) and 1733.21 Yuan (CNY) respectively. Patients included in the analysis were mainly elderly, with an average age of 86.65 years old. Female and male gender were split evenly. The influence of COH on total medical expenditures was significantly negative (p < 0.001). The reimbursement ratio of UEBMI had a significantly positive (p < 0.001) effect on various types of medical expenditures, indicating that the higher the reimbursement ratio was, the higher the medical expenditures would be.

Conclusions

COH influenced medical expenditures significantly. In consideration of reducing medical expenditures, the government should not only start from the supply side of healthcare services, but also focus on addressing the demand side.

Risk Profiles for Falls among Older Adults: New Directions for Prevention

OBJECTIVE

To address whether neighborhood factors, together with older adults' levels of health and functioning, suggest new combinations of risk factors for falls and new directions for prevention. To explore the utility of Grade-of-Membership (GoM) analysis to conduct this descriptive analysis.

METHOD

This is a cross-sectional, descriptive study of 884 people aged ≥65 years from Alameda County, CA, Cook County, IL, Allegheny County, PA, and Wake and Durham counties, NC. Interviews focused on neighborhood characteristics, physical and cognitive function, walking, and falls and injuries. Four risk profiles (higher order interactions of individual and neighborhood factors) were derived from GoM analysis.

RESULTS

Profiles 1 and 2 reflect previous results showing that frail older adults are likely to fall indoors (Profile 1); healthy older adults are likely to fall outdoors (Profile 2). Profile 3 identifies the falls risk for older with mild cognitive impairment living in moderately walkable neighborhoods. Profile 4 identifies the risk found for healthy older adults living in neighborhoods with low walkability.

DISCUSSION

Neighborhood walkability, in combination with levels of health and functioning, is associated with both indoor and outdoor falls. Descriptive results suggest possible research hypotheses and new directions for prevention, based on individual and neighborhood factors.