Dilemmas in caring for older adults in Zhejiang Province, China: a qualitative study

Cross-cultural metathemes of Chinese and Japanese university students' perspective on parental care

Introduction

Due to declining birthrates and aging populations, parental care is going to place a greater burden on younger generations in the future, especially in East Asia where it is more common for children to provide care regardless of whether there is a national long-term care insurance program. Therefore, it has become important to understand the younger generation's views on parental care.

Methods

An explorative, metathematic qualitative study design was used. Data collection relied on semi-structured interviews, of which 19 Chinese and 19 Japanese university students were conducted from December 2021 to July 2022 using a snowball sampling method. Metatheme analysis was then used to identify broad cross-cultural metathemes and inter-relationships on parental care.

Results

Three parental care metathemes were identified for the perspectives of parental care: distrust of leaving parental care to others, responsibility to care for their parents, and importance of parent-child interactions about parental care.

Conclusion

To improve social support for care, both countries must improve long-term care service delivery and healthcare systems and ensure that there is a trusting relationship between healthcare professionals and the public. Governments should also ensure that adult children receive assistance to balance their work, life, and parental care responsibilities. The findings provide several practical suggestions for improving healthcare systems in China and Japan through the younger generations' views.

Understanding and Addressing Older Adults' Loneliness: The Social Relationship Expectations Framework

Loneliness is an experience resulting from a perceived discrepancy between expected and actual social relationships. Although this discrepancy is widely considered the "core mechanism" of loneliness, previous research and interventions have not sufficiently addressed what older adults specifically expect from their social relationships. To address this gap and to help situate research on older adults' loneliness within broader life span developmental theories, we propose a theoretical framework that outlines six key social relationship expectations of older adults based on research from psychology, gerontology, and anthropology: availability of social contacts, receiving care and support, intimacy and understanding, enjoyment and shared interests, generativity and contribution, and being respected and valued. We further argue that a complete understanding of loneliness across the life span requires attention to the powerful impacts of contextual factors (e.g., culture, functional limitations, social network changes) on the expression and fulfillment of older adults' universal and age-specific relationship expectations. The proposed Social Relationship Expectations Framework may fruitfully inform future loneliness research and interventions for a heterogeneous aging population.

Intersections between the culture of Xiao (孝) and caring for older relatives in China: perspectives of United Kingdom-based Chinese students on future care for their parents

Emphasis placed on Xiao (孝; filial piety) in Chinese culture highlights parents' investment in their children with the expectation of being cared for when older. An increasing number of Chinese students come to the United Kingdom (UK) to study, with the majority returning home and likely to become future care-givers for their parents. Little attention has been paid to the implications of transnational mobility of Chinese students on the reciprocal aspects of future care responsibility. With the uniquely changing family structure due to consequences of the One-Child Policy, we conducted proactive research on the opportunities and challenges that Chinese transnational students anticipate they may face in future care-giving for elderly parents. Hence, this study's aim was to make a novel contribution to knowledge through exploration of the perspectives of Chinese students in England on intergenerational ties and filial obligations. Adopting a social constructivist philosophical position, we conducted three focus groups with 19 UK-based Chinese students, using a semi-structured topic guide with informed consent. Interviews were translated, transcribed and analysed using reflective thematic analysis, capturing semantic and latent meanings, and employed a descriptive and interpretative approach. Six themes were discovered, revealing a ‘culture of duty’ where familial obligation and societal expectations were prominent. Prospective care-givers anticipated a future dilemma between balancing work commitments and providing care as mandated by Xiao. Furthermore, it appeared that lack of preparedness might further exacerbate barriers faced when accessing support. We surmised that the changing demographics and absence of formal support could compound stressors over time, especially if cognitive dissonance arises as realities of life do not fit with societal expectations. Our findings imply that policy makers, practitioners and the government will need to adequately support prospective family care-givers who are returnees in caring for older generations.

"They will only remember us during elections": The culture of government support to Nigerian older adults and policy implications

Governments are obliged to ensure the healthy living, well-being, and life satisfaction of every citizen. This, however, has not been achieved in Nigeria, especially with regard to older adults. Despite the notable shift in the country's demographic stance, few studies have investigated the government's roles in addressing the support to Nigerian older adults given that inadequate support is a risk factor for general poor health conditions and high mortality rates. This study, therefore, sought to investigate views on available government support to older adults in Nnewi, South-East Nigeria. Focus Group Discussion and In-depth interviews were adopted to collect data from older adults. The generated data were subjected to a thematic method of analysis. Findings show that Nigerian older adults are usually remembered during political activities, such as electioneering and election. However, the support is not all-inclusive but reserved for those who could actively participate in these political activities. To achieve the African Union and the 2030 global agenda's commitment to "leave no one behind," the study recommends social policies that address all-inclusive support and care for Nigeria older adults. Social workers' intervention will also be crucial to facilitate the formulation and implementation of welfare policies and programmes for the support and well-being of older adults.

Why do older adults living alone in cities cease seeking assistance? A qualitative study in China

Background

Against the background of an aging population, older adults living alone in cities are increasingly dependent. However, their use of home and community-based services in China is unsatisfactory. This study attempted to figure out why older adults living alone in cities do not actively seek assistance in China.

Methods

In-depth interviews were conducted. A total of 29 older adults were recruited. Content analysis was used to analyze the interview data.

Results

Three themes were identified. (1) Desire for independence, despite hardship: The lives of older adults involve many inconveniences, but they preferred to solve problems by themselves, instead of asking for help; (2) Desire to not overburden jiaren (meaning family in Chinese): older adults did not want to disturb families or burden children with caring responsibilities. Moreover, previous experience of failing to obtain care made them reluctant to seek help from jiaren; (3) Desire to not bother wairen (meaning people other than family in Chinese): The lack of trust caused by being unfamiliar with wairen, and the fear of being a burden to others if they were not able to reciprocate, made older adults reluctant to seek help from wairen.

Conclusions

Changes in social, economic, and demographic structures have led to gradual failure of family care. Older adults accustomed to an “acquaintance society” have not yet adapted to seeking help from the community. When addressing the problem of care for older adults living alone in cities, it is important to focus on the profound impact of social change.

Current Status and Challenges of Community-Based Elderly Care Centers in Chongqing, China: A Cross-Sectional Study

PURPOSE

China is facing various societal pressures owing to its rapidly aging population. In order to provide evidence-based suggestions to promote elderly care, this study investigated the community-based elderly care centres (CBECCs) in Chongqing of China, focusing on the site selections, physical environment, facilities, and operation.

METHODS

All CBECCs in a district of Chongqing were analysed via a single-stage cluster sampling survey design. Descriptive statistics were used to analyse the data.

RESULTS

A total of 69 CBECCs (60 government-run and 9 collective-run centres) were identified and analysed. Most site selections were reasonable. CBECCs that were located inside of apartment complexes with entrance guards, not located on main roads, and near a market were more popular. Only 4 (13.3%) CBECCs that were not located on the ground floor were equipped with elevators. A small number of CBECCs were near a noise pollution (10.1%) or far from a medical institution (11.6%). Nearly half (42.7%) of CBECCs only had an indoor area of <200 m2. Nearly all CBECCs had sufficient ventilation, natural lighting, and sufficient floor-to-floor height. 51.5% and 88.4% of the CBECCs fully met the criteria of 'four rooms and one canteen' and 'eight functional zones', but no significant difference was found in terms of the number of people served per month between the CBECCs that met the criteria and those that did not. A quarter of the CBECCs were operated by part-time staff. Only half provided home services (54.5%). The median of average number of people they served every month was 100 (interquartile range = 10-300).

CONCLUSION

Certain problems existed in the current CBECCs. Better elderly care especially calls for adequate elevator establishment, sufficient indoor and outdoor space, appropriate facilities and service, qualified managers and caregivers. A feasible and evidence-based plan to optimize the physical environment and facilities, functional layout and service provision is crucial to improve the CBECC service.

Current status on the ability of the elderly in rural China: implications for future nursing and policy

Background

Aging is a global problem, and the ability assessment of the elderly plays an important role in the formulation of pension policies. It's necessary to evaluate the ability of the elderly in rural China to provide insights into future nursing care and policy making.

Methods

The elderly in 20 rural villages were selected by convenience sampling. We used "Elderly Ability Evaluation Form" issued by the Ministry of Civil Affairs of China as survey tool. The characteristics and score differences of the elderly of different ability level were compared and analyzed. And logistic regression analyses were conducted to identify the potential risk factors for disability in the elderly.

Results

A total of 2,878 elders were included, of which there were 1,916 elders with intact ability, 866 elders with mild disability, 42 elders with moderate disability, 54 elders with severe disability. The incidence of disability among respondents was 33.43%. There were significantly statistical differences in the dimensions of activities of daily living, mental state, perception and communication, and social participation among elders with intact ability, mild, moderate and severe disability (all P<0.05). The age, education level, marital status and living situations were all corrected to the scores on the activities of daily living, mental state, perception and communication, and social participation among elders (all P<0.05), and the elderly with age ≥75 years, illiteracy, unmarried and live alone had higher risk for disability (all P<0.05).

Conclusions

The current situation of the ability level of the elderly in rural China seems to be worrying, and it's necessary to establish a long-term nursing care system and aging policy to meet the needs of the elderly with regards to those potential influencing factors.