Health, Social, and Functional Characteristics of Older Adults With Continuing Care Needs: Implications for Integrated Care

Measuring the continuing care needs of inpatients in rural China

BACKGROUND

International experience shows that the suitability of a high-performance healthcare system for its given purposes is reflected in its ability to provide a continuum of services that match the changing health status of the given population. Although many low- and middle-income countries have sought to bring movement away from hospital-centered and towards patient-centered healthcare, such efforts have often had poor results, and one of the major reasons for this is the inability to accurately identify which inpatients need continuing care and what kind of continuing of care is needed.

OBJECTIVES

To measure and assess the continuing care needs of discharged patients and its influencing factors in rural China.

METHODS

Data were obtained from the hospital database of Medical Center M in County Z from May to July 2022. County Z is a county of 1 million people in central China. The database includes basic patient information, disease-related information, and information on readiness for hospital discharge. Factors related to the need for continuing care were included in the analysis. The Readiness for Hospital Discharge Scale was used to assess the need for continuing care. The statistical data are expressed in terms of both frequency and composition ratio. Finally, linear regression was used to analyze the factors influencing the need for continuing care.

RESULTS

The analysis included a total of 3,791 patients, 123 of whom (3.25%) had continuing nursing needs. The need of continuing nursing was related to patients' age group, mode of admission, occupation and major diagnostic categories (P < 0.05).

CONCLUSIONS

Developing continuing care is an important initiative for bridging the fragmentation of health services, and an appropriate supply system for continuing care, interconnected with inpatient services, should be established in rural areas in China as soon as possible. And provide more appropriate care for patients in need.

Latent classes and related predictors of demand for home-and community-based integrated care for older Chinese adults

Background

Home-and community-based integrated care has been developing rapidly in China in recent years. However, empirical research on the demand from older people is insufficient. Most studies have failed to identify or differentiate the heterogeneity of older people, resulting in poor understanding of their needs and fragmentation of services. This study seeks to identify latent classes of demand for home-and community-based integrated care among older Chinese adults and the predictors that differentiate these demands.

Methods

From January to March 2021, a questionnaire was administered to older people (aged ≥60 years) in community-based service centers for older people in six districts of Changsha City, Hunan Province. Participants were selected through purposive and incidental sampling. Latent profile analysis was used to categorize older people's demand for home-and community-based integrated care. By extending Andersen's behavioral model of health service use, and running multinomial logistic regression analyses, we explored which factors influenced the latent classes of demand.

Results

A total of 382 older people were included in the analyses: 64.4% were women and 33.5% were aged 80-89. The demand from older people for home-and community-based integrated care was classified into four latent classes: high health and social interaction demand (30% - 115/382); high comprehensive demand (23% - 88/382); high care service demand (26% - 100/382), and high social participation and low care demand (21% - 79/382). Taking this last class as the reference group, the other three latent classes differed significantly in the factors of predisposition, enabling, need, and perception of aging.

Conclusion

The demand from older people for home-and community-based integrated care is multifaceted and heterogeneous. Services for older people should be designed with different sub-models of integrated care.

Older Adults' Demand for Integrated Care and Its Influencing Factors: A Scoping Review

Introduction:

Integration has become a major concern for governments, healthcare and aged care systems in many countries. However, the research on and implementation of integrated care in China started relatively late, and there is no review on the needs of older adults with regard to integrated care and the influencing factors. Therefore, this paper aims to provide a scoping review by searching, evaluating, and summarizing the Chinese and international literature on the need for and the factors influencing integrated care for older people. In addition, this review highlights evidence of the gap between China and the world in integrated care.

Methods:

Using a framework proposed by Arksey and O’Malley, a systematic search of 12 domestic and international databases was conducted. Of the 890 original studies retrieved, those that met the established inclusion criteria were screened and scored using the Ekman quality assessment tool. The qualitative description method was used to summarize the demand for integrated care for older adults and the influencing factors.

Results:

A total of 49 papers were included. These studies were from eleven countries on five continents (most commonly China and the US) and were mostly cross-sectional quantitative studies that surveyed the integrated care needs of older people living in homes/communities or long-term care facilities. The analysis shows that existing research on the integrated care needs of older people in China adopts a single perspective and is inadequate and unsystematic in its assessment; the integrated care needs of older adults and the factors influencing them are multifaceted; and both in China and internationally, the community-home care scenario most consistently meets the needs and expectations of older adults.

Conclusion:

Although there is no uniform definition of integrated care in China or abroad and each country has its own national definition and system of integrated care, there are certain commonalities regarding the needs of older adults and the factors that influence them across countries. Our research reveals a gap between China and the international community in terms of integrated care.

Measuring Processes of Integrated Care for Hospital to Home Transitions

Background:

Integrated care is a promising approach to improve transitions from hospital for older adults. Measures of integrated care tend to be survey-based or outcomes focused. This study determined the feasibility of using hospital chart data to measure integrated processes of care.

Methods:

This paper reports on two objectives: 1) the development of an integrated care transition framework and associated features of care; 2) a pilot study to test if the features could be applied to 214 hospital patient charts.

Results:

Twenty-four features were tested, and fifteen features could be reliably measured using chart review. Of these, the percent of patients classified as receiving integrated care varied widely across the items, from 0.05% to 84.1%.

Discussion:

The framework presented in this paper can guide measurement of system and clinical delivery of integrated care transitions. In combination with other tools, chart review can provide perspective on day-to-day care delivery not otherwise accessible, and highlight areas requiring practice change.

Conclusion:

Multiple measurement perspectives are needed to improve our understanding of how integrated care is being implemented. While chart review cannot address the full breadth of integrated care, it can help understand how processes of care are being implemented in routine daily care.

Age-friendly communities for older persons with intellectual disabilities

Purpose

The life expectancy for persons with intellectual disabilities (ID) has increased significantly, resulting in an increasing number of aging persons with ID. To promote healthy and active aging of persons with ID, discussions on new initiatives to design age-friendly communities have begun at local and international levels. The purpose of this paper, a qualitative research study, is to identify features of an age-friendly community, and facilitators and barriers from the perspectives of older adults with mild ID and their caregivers who live in the city of Winnipeg in Canada.

Design/methodology/approach

Seven older persons with mild ID were interviewed, and 15 caregivers participated in focus group discussions. All participants were asked questions about features of community living and their experiences in eight broad topic areas (i.e. transportation, housing, social participation, respect and social inclusion, opportunities for community involvement, communication and information, community support and healthcare services, and outdoor spaces and buildings).

Findings

The results indicated that many of the current features of the city of Winnipeg do not adequately address the needs of aging persons with ID; specifically, participants revealed that issues related to accessibility, social participation, social disrespect and inclusion, and lack of resources were important barriers to independence.

Originality/value

The findings will increase awareness of the needs of aging persons with ID and inform programme planning, service delivery, coordination of community-based services and policies to support healthy and active aging for this vulnerable population.