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Zhang L, Shen S, Zhang W, Fang Y. What determines informal care need among community-dwelling older adults in China? Results from a longitudinal study. BMC Geriatr 2024; 24:597. [PMID: 38997678 PMCID: PMC11241955 DOI: 10.1186/s12877-024-04843-3] [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: 06/22/2023] [Accepted: 02/23/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND With an intensified aging population and an associated upsurge of informal care need in China, there is an ongoing discussion around what factors influence this need among older adults. Most existing studies are cross-sectional and do not focus on older people living in the community. Conversely, this study empirically explores the factors that affect informal care need of Chinese community-dwelling older individuals based on longitudinal data. METHODS This study constructed panel data using the China Health and Retirement Longitudinal Research Study (CHARLS) from 2011 to 2018 for analysis. Generalized linear mixed models were used to analyze the factors affecting reception of informal care, and linear mixed models were used to analyze the factors affecting informal care sources and intensity. RESULTS During the follow-up period, 7542, 6386, 5087, and 4052 older adults were included in 2011-2018, respectively. The proportion receiving informal care increased from 19.92 to 30.78%, and the proportion receiving high-intensity care increased from 6.42 to 8.42% during this period. Disability (estimate = 4.27, P < 0.001) and living arrangement (estimate = 0.42, P < 0.001) were the critical determinants of informal care need. The rural older adults reported a greater tendency to receive informal care (estimate = 0.14, P < 0.001). However, financial support from children did not affect informal care need (P > 0.05). CONCLUSIONS At present, there is a great demand for the manpower and intensity of informal care, and the cost of informal care is on the rise. There are differences in informal care needs of special older groups, such as the oldest-old, living alone and severely disabled. In the future, the region should promote the balance of urban and rural care service resources, rationally tilt economic support resources to rural areas, reduce the inequality of long-term care resources, improve the informal care support system, and provide a strong community guarantee for the local aging of the older adults.
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Affiliation(s)
- Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China
| | - Shuyuan Shen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China
| | - Wenzheng Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China.
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Wang L, Liu J. The impact of long-term care insurance on family care for older adults: The mediating role of intergenerational financial support. PLoS One 2024; 19:e0299974. [PMID: 38781177 PMCID: PMC11115205 DOI: 10.1371/journal.pone.0299974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/19/2024] [Indexed: 05/25/2024] Open
Abstract
Rapid population aging has been placing heavy tolls on Chinese family caregivers. Previous empirical evidence from multiple countries have shown that establishing national long-term care insurance was effective in reducing family care burdens. Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) wave 2011 to 2018, this study examined the effects of implementing the pilot long-term care insurance program on family care received by the Chinese older adults, by using a time-varying Difference-in-Differences (DID) method. The results showed that: (1) the implementation of the pilot long-term care insurance program has led to a 17.2% decline in general for family care received by the Chinese older adults. (2) The effect of participating in the pilot program on family care received differed by respondent's household registration, health status, marital status, and possesion of retirement pension, and were specifically pronounced among those who were urban residents, having spouse, living with disabilities, and living with no retirement pension. (3) Further results from the mechanism analyses showed that the pilot long-term care insurance program decreased the level of family care by reducing the dual intergenerational financial support between older adults and their adult children. (4) Although participating in the pilot program decreased older adult's dependence on their adult children, their physical and mental health status were not negatively affected. This study contributes to the existing literature by evaluating the effects of implementing the pilot long-term care insurance program on family care received by the Chinese older adults, and lends supports to the previous studies that participating in long-term care insurance significantly reduces old adults' demand for family care, but not in sacrifice of their physical and mental well-being.
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Affiliation(s)
- Lianjie Wang
- Department of Sociology, Jiangnan University, Wuxi, China
| | - Jing Liu
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou, China
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Su Q, Wang Y, Fan L. The Impact of Informal Care on Healthcare Utilization of Older Adults with Functional Limitations in China. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-16. [PMID: 38600766 DOI: 10.1080/01634372.2024.2338061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Our study examines the impact of informal care on healthcare utilization, focusing on caregiver types, urban-rural, and gender differences. Analyzing data from the China Health and Retirement Longitudinal Study and using fixed effects models, we discovered complementary effects between informal care and healthcare. Specifically, spousal care increased inpatient care use, adult child care boosted both inpatient and outpatient use, and dual care from children and spouses showed the most significant impact on healthcare use. The association between informal care and healthcare use varied across gender or urban-rural residence. Our findings highlight the importance of caregivers in accessing healthcare services.
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Affiliation(s)
- Qing Su
- School of Public Health, Southeast University, Nanjing, China
| | - Yanshang Wang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing, China
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Xiao C, Patrician PA, Montgomery AP, Wang Y, Jablonski R, Markaki A. Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis. BMC Nurs 2024; 23:115. [PMID: 38347512 PMCID: PMC10863110 DOI: 10.1186/s12912-024-01789-0] [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: 07/20/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs. PURPOSE To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework. METHODS A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis. FINDINGS Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity. CONCLUSION Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.
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Affiliation(s)
- Chunhong Xiao
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA.
| | - Patricia A Patrician
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Aoyjai P Montgomery
- University of Alabama at Birmingham School of Public Health, 1665, 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Youhua Wang
- College of State Governance, Southwest University, No. 2 Tianshen Road, Chongqing, 400715, Beibei District, China
| | - Rita Jablonski
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
| | - Adelais Markaki
- University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, Birmingham, AL, 35294-1210, USA
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Jia Q, Duan Y, Gong R, Jiang M, You D, Qu Y. Living arrangements and depression of the older adults- evidence from the Chinese longitudinal healthy longevity survey. BMC Public Health 2023; 23:1870. [PMID: 37759168 PMCID: PMC10523833 DOI: 10.1186/s12889-023-16730-4] [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: 01/25/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The mental health and living arrangements of older adults are worthy of attention. Previous studies have pointed out that the living arrangements may be related to older adults' depression. However, it has not been found that studies concern the relationship between actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality and depression in older adults, so we carried out this study. METHODS The data from the Chinese longitudinal healthy longevity survey were used in this study. With the older adults' depression as the dependent variable and the living arrangement related variables as the independent variable, we constructed three binary-logistic regression analysis models to explore the potential relationship between living arrangement related variables and depression in older adults. RESULTS We found that the actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality are significantly correlated with depression in older adults. Specifically, older adults living alone or only with the spouse are at greater risk of depression. Older adults who prefer living alone or only with the spouse are at relatively low risk of depression. Older adults whose living arrangement preferences do not match reality have a higher risk of depression. CONCLUSION The living arrangement related variables are significantly correlated with depression in older adults. In addition to the actual living arrangements, living arrangement preferences and whether the living arrangement preferences fit with reality are also related to the depression of older adults.
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Affiliation(s)
- Qingwen Jia
- Organization and Personnel Department, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yanhan Duan
- Medicine-Education Coordinateion and Medical Education Research Center, Hebei Medical University, Shijiazhuang, China
| | - Rui Gong
- Department of Adult Internal Medicine, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Meijun Jiang
- Graduate School, Hebei Medical University, Shijiazhuang, China
| | - Dianping You
- Party and Government Integrated Office, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yi Qu
- Scientific Research Division, Children's Hospital of Hebei Province, 133 Jianhua Street, Yuhua District, Shijiazhuang, Hebei, China.
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Does informal care reduce health care utilisation in older age? Evidence from China. Soc Sci Med 2022; 306:115123. [PMID: 35724586 DOI: 10.1016/j.socscimed.2022.115123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 05/08/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022]
Abstract
Studies in Western countries suggest that receiving informal care from family members may reduce utilisation of health care services. This hypothesis has not been examined in China, where the population is ageing rapidly. We assess the impact of informal care from offspring (children and grandchildren) on health care utilisation and expenditures among older people in China. Data are drawn from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Using lagged model with the instrumental variable approach, we find that the impact of informal care is different by type of health care: More hours of informal care from offspring reduces overall health care utilisation, and in particular, outpatient care utilisation, but it increases inpatient care utilisation and expenditures. Our results suggest that informal care reduces the demand for outpatient care but increases the demand for inpatient care, possible reflecting the fact that the latter involves more advanced procedures for which informal care is not a substitute but a complement. Results highlight the need for incorporating health care impacts in the analysis and evaluation of policies that affect informal care provision.
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