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Duru EE, Ben-Umeh KC, Mattingly TJ. Cost of long-term care and balancing caregiver wellbeing: a narrative review. Expert Rev Pharmacoecon Outcomes Res 2024:1-15. [PMID: 39030716 DOI: 10.1080/14737167.2024.2383406] [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: 04/13/2024] [Accepted: 07/18/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Long-term care (LTC) refers to care and support services that are required by individuals who lack the ability to perform important daily routines and may be dependent on others for personal, social, and medical needs over a sustained period of time. LTC may be broadly categorized into formal and informal care, where formal care is provided by professionals who are compensated to provide these services and informal care captures the care services provided without compensation by family members, friends, or other unpaid individuals. AREAS COVERED In this narrative review, we identify and synthesize evidence to evaluate the cost of long-term care while balancing the needs of caregivers. We searched Embase and EconLit for studies published from 2010 to November 2023. Our search strategy used a combination of keywords such as 'long-term care,' 'caregiver burden,' 'caregiver support,' 'cost of care,' and 'caregiver wellbeing.' We include both formal and informal LTC, as well as predictors of caregiver wellbeing. EXPERT COMMENTARY This review highlights the global variability in LTC costs and the significant burden on caregivers, emphasizing the need for policy interventions and comprehensive insurance schemes. Future research should focus on standardized assessment tools, intervention effectiveness, and integrating caregiver support into healthcare models, ensuring holistic and sustainable LTC solutions.
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Affiliation(s)
- Emeka Elvis Duru
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| | - Kenechukwu C Ben-Umeh
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| | - T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
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Zhou J, Walker A. Adult children and older people's demand for community care services in urban China. Australas J Ageing 2024; 43:239-247. [PMID: 37792447 DOI: 10.1111/ajag.13242] [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: 05/22/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES This paper has two objectives. First, it assesses whether the existing informal care provided by adult children has an impact on older people's propensity to demand community care services. Second, it compares the different statuses of sons and daughters in the formal/informal support trade-off. METHODS The paper is based on an analysis of data from the 2018 wave of the China Longitudinal Ageing Social Survey, within the framework of a revised version of Andersen's model, and applies multilevel models to analyse the effects of adult children's gender, numbers and the quality of their support, on older people's willingness to purchase community care services. RESULTS Older people who had sons as well as daughters demanded fewer services, while the number of sons increased service demand. Regarding sons, community care services compensated for economic support, daily life care and spiritual consolation, but did so only in respect of daily life care from daughters. CONCLUSIONS Many families have only one son or one daughter as a result of the one-child policy and therefore often require support from formal care services. Moreover, there is a distinct gender division and an influential filial culture governing the impact of services on the support provided by adult children. Because ageing in place depends on both informal family support and formal services, this key policy goal is at risk if the latter provides insufficient support to the former.
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Affiliation(s)
- Junshan Zhou
- School of Criminology, People's Public Security University of China, Beijing, China
| | - Alan Walker
- Department of Sociological Studies, The University of Sheffield, Sheffield, UK
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Wang P, Niu M, Chen Y, Wang S, Wu C, Zhao D, Wang P, Yang H, Guo P. Developing Family-Community Interactive program for the disabled older adults at home: a study protocol. BMC Geriatr 2023; 23:609. [PMID: 37773100 PMCID: PMC10540501 DOI: 10.1186/s12877-023-04273-7] [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: 03/12/2022] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND With an aging population and the influence of traditional culture, the number of disabled older adults at home is increasing. Meanwhile, their care needs are also increasing. The cooperation between family and community can effectively improve the quality of home care for the disabled older adults. At present, there is a lack of research on the interaction between family and community in home care for disabled older adults. METHODS The aim of this study is to determine the experience and demands of the interaction for disabled older adults, family and community, construct an interaction program among disabled older adults, family and community, and improve the quality of life. From may 2022 to July 2022, This study will select disabled older adults families from seven communities in Henan provinces. The researchers, after training, will conduct semi-structured interview to collect research data. According to the integration results of qualitative research, the interactive program is constructed and revised using the Delphi expert consultation method. Then the participants will be selected to accept the intervention of the interactive program and evaluated through questionnaires. DISCUSSION Both family and community play an important role in the care of the disabled older adults at home. There is some evidence indicating the benefits of cooperation between family and community on disabled older adults. This study will take a step further and constructs a interaction program about how to create a positive and interactive home-based older adults care environment. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Registry on April 19, 2021, number ChiCTR2100045584.
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Affiliation(s)
- Peng Wang
- Medical School of Huanghe Science and Technology University, Zhengzhou, China
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Meilan Niu
- Medical School of Huanghe Science and Technology University, Zhengzhou, China
| | - Ying Chen
- Huanghuai University School of Medicine, Zhumadian, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chuqiao Wu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Di Zhao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Panpan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Huashan Yang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China.
| | - Panpan Guo
- Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
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Wang J, Yang Q, Wu B. Effects of Care Arrangement on the Age of Institutionalization among Community-dwelling Chinese Older Adults. J Aging Soc Policy 2023; 35:595-610. [PMID: 32033523 DOI: 10.1080/08959420.2020.1726720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023]
Abstract
Early and unnecessary institutionalization of older adults can be a heavy burden on the country and taxpayers. It is crucial to understand factors impacting the age of institutionalization of older adults in China. This study examined care arrangements of older adults in China and the relationship between these arrangements and the age of relocation to long-term care facilities (institutionalization). Results show that care arrangements affect the age of institutionalization among community-dwelling Chinese older adults. Those who were primarily cared for by sons and daughter-in-laws tended to be institutionalized at a significantly later age compared to those who were cared for by their spouses. Those who were primarily cared for by other relatives and friends, by domestic helpers, and those with no caregivers tended to have significantly earlier institutionalization compared to those who were cared for by their spouses. However, the number of older adults living in empty nest families is increasing rapidly. Traditional family support for older adults has been shrinking due to fewer children, out-migration of adult children from rural to urban areas, and increased employment of women in China. There is an acute shortage of competent and qualified elder care workers. Most Chinese domestic helpers started their work with limited or even no training, risking the safety of themselves and their employers. In addition to increasing and optimizing the investment in the elder care industry, legal protection and policy support for the elderly and domestic helpers are urgently needed to address these key issues.
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Affiliation(s)
- Jing Wang
- Fudan University School of Nursing, Shanghai, China
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Qing Yang
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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Sun C, Meng D. Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China. Front Public Health 2023; 11:1170594. [PMID: 37342270 PMCID: PMC10277793 DOI: 10.3389/fpubh.2023.1170594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role. Methods We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS). Results This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care. Conclusion This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.
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Kuramoto Y, Nabeshima H, Khan MSR, Kadoya Y. The Association of Caregivers' Socio-Economic Conditions with Family Caregiving Norms: Evidence from China. Behav Sci (Basel) 2023; 13:bs13050362. [PMID: 37232599 DOI: 10.3390/bs13050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Similar to her neighboring country, Japan, China faces significant difficulties in providing long-term care to the elderly. Female household members who traditionally provided necessary caregiving are no longer available as much as in the past due to the demographic and socioeconomic changes over the past few decades. Against this backdrop, we investigated how socioeconomic factors affect the perception of family caregiving norms in China, using an international comparative household dataset that allowed us to compare China with Japan, the latter being extensively investigated. We used ordered probit regression to estimate the model equation. Our results show that rural residency, household assets, and government dependency are positively associated with the perception of care. A notable difference from the Japanese results is that rural residents have a rather positive perception of family caregiving norms. Furthermore, urban-rural subsample analyses revealed that women in rural areas perceive caregiving negatively.
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Affiliation(s)
- Yu Kuramoto
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima 7398525, Japan
| | - Honoka Nabeshima
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima 7398525, Japan
| | | | - Yoshihiko Kadoya
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima 7398525, Japan
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Liang H, Wang B, Wu Y, Zhang Q, Xiang N, Yue Z, Liu E. The association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services: 2008 ~ 2018. Int J Equity Health 2023; 22:46. [PMID: 36918878 PMCID: PMC10012597 DOI: 10.1186/s12939-023-01856-z] [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: 07/19/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The changes in demographic and family structures have weakened the traditional norms of filial piety and intergenerational relationships dramatically. This study aims to examine the dynamic association between financial support of adult children to their parents and informal care provision in China and its differences in household registration, residence arrangement and community-based care services. METHODS Data was derived from the 2008-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is a longitudinal survey of a nationally representative sample of individuals aged 60 and over. Random effects model was used to assess the association between financial support and informal care provision of adult children to their parents. RESULTS It was found that financial support showed an upward trend while informal care provision showed a download trend from 2008 to 2018. The result indicated a significant and negative association between financial support and informal care provision of adult children to their parents (B = -0.500, 95% confidence interval (CI) = -0.761 to -0.239). And the association was significant among elderly people who were from urban areas (B = -0.628, 95% CI = -0.970 to -0.287), co-resided with adult children (B = -0.596, 95% CI = -0.939 to -0.253), and had community-based services (B = -0.659, 95% CI = -1.004 to -0.315). CONCLUSION Financial support was negatively associated with informal care provision of adult children to their parents in China, and the association has differences in household registration, residence arrangement and community-based care services. It is suggested that policymakers should prioritize planning interventions for elderly care services and establish a family caregiver support system.
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Affiliation(s)
- Hang Liang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Boyu Wang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Yanli Wu
- Center for Social Security, Wuhan University, Wuhan, 430072, China
| | - Qilin Zhang
- Center for Social Security, Wuhan University, Wuhan, 430072, China
| | - Nan Xiang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Zhang Yue
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, 430073, China
| | - Erpeng Liu
- Institute of Income Distribution and Public Finance, Zhongnan University of Economics and Law, No. 182 Nanhu Rd, Wuhan, 430073, China.
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Yang C, Huang J, Yu J. Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3459. [PMID: 36834152 PMCID: PMC9962546 DOI: 10.3390/ijerph20043459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Long-term care (LTC) services help the elderly maintain their functional ability and live with dignity. In China, the establishment of an equitable LTC system is a primary focus of the current public health reform. This paper assesses levels of equality in resources for and utilization of LTC services between urban and rural areas and economic regions in China. METHODS We use social services data from the China Civil Affairs Statistical Yearbooks. Gini coefficients against elderly population size are calculated for the number of institutions, beds, and workers, and the concentration index (CI) against per capita disposable income is calculated for the number of disabled residents per 1000 elderly people and the number of rehabilitation and nursing services per resident. RESULTS The Gini coefficients against the elderly population in urban areas indicate relatively good equality. In rural areas, the Gini coefficients have increased rapidly from relatively low values since 2015. The CI values in both urban and rural areas are positive, indicating that utilization is concentrated in the richer population. In rural areas, the CI values for rehabilitation and nursing have remained above 0.50 for the last three years, implying high levels of income-related inequality. The negative CI values for rehabilitation and nursing services in urban areas in the Central economic region and rural areas in the Western region imply a concentration of resource utilization toward poorer groups. The Eastern region shows relatively high internal inequality. CONCLUSION Inequalities exist between urban and rural areas in the utilization of LTC services, despite similar numbers of institution and bed resources. Resource distribution and healthcare service utilization are more equal in urban areas, creating a low level of equilibrium. This urban-rural split is a source of risk for both formal and informal LTC. The Eastern region has the largest number of resources, the highest level of utilization, and the greatest internal variation. In the future, the Chinese government should enhance support for the utilization of services for the elderly with LTC needs.
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Affiliation(s)
- Changyong Yang
- Department of Sociology, Hohai University, Nanjing 211100, China
| | - Jianyuan Huang
- Population Research Institute, Hohai University, Nanjing 211100, China
| | - Jiahao Yu
- Department of Sociology, Hohai University, Nanjing 211100, China
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Yang G, Wan L, Dong H, Liang X, He Y. Utilisation willingness for institutional care by the disabled elderly and its influencing factors based on Andersen's model: a cross-sectional survey of Henan, China. BMJ Open 2022; 12:e064949. [PMID: 36600340 PMCID: PMC9743373 DOI: 10.1136/bmjopen-2022-064949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To explore the factors that influence institutional care for the disabled elderly in China and the key factors that influence individuals based on the Andersen model. DESIGN Cross-sectional survey. SETTING The research was conducted in 18 cities in Henan Province, China. MAIN OUTCOME MEASURES A multistage, stratified sampling design was employed. The χ2 test was used to compare the differences in basic information of the disabled elderly. A binary Logit model was used to examine the factors influencing the willingness to institutionalise elderly people with disabilities. The determinants of willingness to care in an institution were also explored in a stratified study by gender, age and region to identify the key differences affecting institutionalisation. The Andersen model was used as the theoretical framework to infer the impact strength of each model. RESULTS Of the 2810 disabled elderly people in Henan, China, 7.4% of the elderly had a willingness for institutional care. In the binary logistic regression analysis, whether living alone (OR (95% CI)=0.596 (0.388 to 0.916)), medical payment method (basic medical insurance for urban employees: OR (95% CI)=2.185 (1.091 to 4.377)), having mental illness (OR (95% CI)=2.078 (1.044 to 4.137)) had a statistically significant difference (p<0.05) on the impact on the willingness of the disabled elderly to receive institutional care. Validation of the fitted coefficients of the model revealed that the needs factor had the most significant effect on the enabling variable, while the predisposing factor had more minerally effect. CONCLUSIONS Several factors influence the willingness of the disabled elderly to institutionalise. Therefore, it is recommended that relevant authorities take targeted measures to focus on the disabled elderly to identify more precise elderly care services to deal with the ageing crisis.
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Affiliation(s)
- Guangmei Yang
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Leping Wan
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haiying Dong
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoxiao Liang
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yan He
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
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Chen L, Zheng Y, Wen W, Chu L. Long-term Care Expenditures and the Red Herring Hypothesis: Evidence from the Oldest-old in China. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-022-09394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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Deng X, Liao J, Peng R, Chen J. The Impact of Long-Term Care Insurance on Medical Utilization and Expenditures: Evidence from Jingmen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12275. [PMID: 36231574 PMCID: PMC9564761 DOI: 10.3390/ijerph191912275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate the impact of long-term care insurance (LTCI) on medical utilization and expenditures in Jingmen, a pilot city of China. The propensity score matching-difference in difference (PSM-DID) approach was employed to examine the expenses and frequency of inpatient and outpatient services before and after the implementation of the LTCI based on the 2015-2018 panel data from the China Health and Retirement Longitudinal Study (CHARLS). The results showed that the annual expenditure and frequency of the inpatient services of Jingmen residents were reduced by 1923 Yuan (287.0 USD) and 0.24 times, respectively. The impact of the LTCI varied between urban and rural areas. The annual expenditure and frequency of inpatient services in rural areas were reduced by 1600 Yuan (238.8 USD) and 0.30 times, which were lower than those (3400 Yuan (507.5 USD) and 0.20 times) in urban areas. The monthly outpatient expenses and frequency in rural areas were reduced by 300 Yuan (44.8 USD) and 0.14 times, but increased by 555 Yuan (82.8 USD) and 0.07 times in urban area. The findings indicated that the implementation of the LTCI can reduce the medical utilization and expenses, and it had a greater effect in rural areas than in urban areas. It is suggested to promote the LTCI nationwide, and more policy preference should be given to the development of the LTCI in rural areas.
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Association between Age-Friendliness of Communities and Frailty among Older Adults: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127528. [PMID: 35742777 PMCID: PMC9224492 DOI: 10.3390/ijerph19127528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/07/2023]
Abstract
An age-friendly environment is one of the measures of healthy aging. However, there is scarce evidence of the relationship between the age-friendliness of communities (AFC) and frailty status among Chinese older adults. This study aims to examine this relationship using a multilevel analysis with the data of a cross-sectional study conducted among 10,958 older adults living in 43 communities in four cities in China. The validated Age-friendly Community Evaluation Scale and Chinese frailty screening-10 Scale (CFS-10) were used to measure AFC and Frailty. Multilevel regression analyses were performed to examine the relationship between the AFC in two assessments of individual- and community-level and frailty status. After controlling for individual-level socio-demographic, health status, and lifestyle variables, compared with older adults in the lowest quartile of the individual-level perception of AFC, the frailty odds ratios for those in the top three quartiles were 0.69 (95% confidence interval [CI]: 0.56–0.83), 0.75 (95% CI: 0.61–0.91), and 0.56 (95% CI: 0.48–0.74). However, there was no association between the community-level AFC and frailty. A higher level of age-friendliness in the community is associated with lower frailty odds. Therefore, building age-friendly communities may be an important measure to prevent frailty among Chinese older adults.
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Zhang J, Wang Z, Lin L, Huang J, Dong Y, Li H. Determinants of preference for future living arrangement in disabled elders: a cross-sectional study of elderly residents in Kunshan, China. Psychogeriatrics 2022; 22:324-331. [PMID: 35191125 DOI: 10.1111/psyg.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The rapid increase in the number of disabled elders and great economic and social changes call for a synchronised development of long-term care services. The aim of this study was to identify the factors determining the preference for future living arrangements, forecasting the demand for long-term care services. METHODS A cross-sectional survey was conducted in Kunshan between June and July 2018. The stratified sampling method was used in this survey. The multinomial logistic regression model was used to explore the influencing factors. RESULTS The most preferred future living arrangement was to live at home. Individual income, number of children alive, life satisfaction and medical insurance were significantly associated with the preference for future living arrangement. CONCLUSIONS Our study suggested that home-based long-term care should be promoted to meet the expectations of the elderly and caregivers, and special attention should be given to the elderly with low individual income.
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Affiliation(s)
- Juan Zhang
- The Sixth People's Hospital of KunShan, Suzhou, China
| | - Zhuo Wang
- School of Pharmacy & School of Medicine, Changzhou University, Changzhou, China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University, Suzhou, China
| | - Jian Huang
- Kunshan Mental Health Center, Suzhou, China
| | - Yanan Dong
- Kunshan Qiandeng Town Community Health Service Center, Suzhou, China
| | - Huiling Li
- The First Affiliated Hospital of Soochow University, Suzhou, China.,School of Nursing, Soochow University, Suzhou, China
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Huang Y, Li X, Liu Z, Huo J, Guo J, Chen Y, Chen Y, Chen R. Projections of the economic burden of care for individuals with dementia in mainland China from 2010 to 2050. PLoS One 2022; 17:e0263077. [PMID: 35113895 PMCID: PMC8812891 DOI: 10.1371/journal.pone.0263077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China has stepped into an era of aging society, where the impending considerable economic burden attributed to high prevalence of dementia in the elderly appears to be one of the most important health and social issues to deal with for the country. However, population-based quantification and projections for the economic burden of dementia in China are lacking for further health action and policy making. OBJECTIVE To estimate and predict the costs of managing dementia in the elderly population aged 60 and above from 2010 to 2050 in China. METHODS Data were collected from a six-province study (n = 7072) and other multiple sources for calculation of the economic burden of dementia. With the convincing data from published studies, we quantified and projected the costs attributed to dementia in China from 2010 to 2050. RESULTS The national cost of dementia in 2010 was estimated to be US$22.8 billion by the opportunity cost method and US$26.4 billion by the proxy method. In 2050, the costs would increase to US$372.3 billion by the opportunity cost method and US$430.6 billion by the proxy method, consuming 0.53% and 0.61% of China's total GDP, respectively. A series of sensitivity analyses showed that the changes in the proportions of informal caregiving led to the most robust changes in the total burden of care for dementia in China. CONCLUSION Dementia represents an enormous burden on China's population health and economy. Due to the changes in policies and population structure, policymakers should give priority to dementia care.
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Affiliation(s)
- Yixiang Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Health Economics Association, Guangzhou, China
| | - Xiande Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zifeng Liu
- Department of Clinical Data Center, The 3 Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, Florida, United States of America
| | - Jianwei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingying Chen
- Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yanmei Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruoling Chen
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing (FEHW), University of Wolverhampton Millennium City Building, Wolverhampton, United Kingdom
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15
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Xu S, Wang Y, Yu H. The Mechanism of Human Connectedness in Relationship to Physical Health, Mental Health, and Cognitive Function Among the Elderly in Rural China. Front Psychiatry 2021; 12:702603. [PMID: 34594248 PMCID: PMC8476811 DOI: 10.3389/fpsyt.2021.702603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Elderly people face particular challenges in their everyday lives, and these are likely to be caused by physical health, mental health, cognitive function, and lack of maintaining a connection to other people. This study aims to explore a meaningful measure of human connectedness among the elderly in rural China and to examine the extent to which it impacts elderly people's physical and mental health as well as their cognitive function. Methods: Survey data were collected from 483 participants who were aged 60 and older in northeast rural China. The outcome variables included cognitive function, which was assessed by the Short Portable Mental Status Questionnaire; depressive symptoms, which were measured by the 10-item version of the Center for Epidemiologic Studies Depression Scale; and the participants' physical health, which was assessed by a 15-item checklist. On the other hand, human connectedness was constructed by perceived family support, which was measured by the Multidimensional Scale of Perceived Social Support; the sense of community, which was measured by the Brief Sense of Community Scale; and the satisfaction of connectedness with others (i.e., with family members and friends). Results: Structural equation modeling analysis confirms that perceived family support, community feelings, and perceived satisfactory connections with family and friends constitute a sufficient representation of human connectedness. Moreover, human connectedness also significantly predicted one's mental and physical well-being as well as cognitive function (b = 0.11, SD = 0.02, β = 0.50, p < 0.001; model fitting indexesX ( 16 ) 2 = 17.27, p = 0.368, CFI = 0.998, and RMSEA = 0.013). Conclusion: The present study is the first attempt to explore the latent structure of human connectedness and its positive impact on cognitive function as well as physical and mental health among elderly people. The implications and the importance of fostering a stronger social support network, especially for the aging population, are discussed.
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Affiliation(s)
- Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Hui Yu
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
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16
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Jin X, Mori T, Sato M, Watanabe T, Noguchi H, Tamiya N. Individual and regional determinants of long-term care expenditure in Japan: evidence from national long-term care claims. Eur J Public Health 2021; 30:873-878. [PMID: 32556192 PMCID: PMC7536255 DOI: 10.1093/eurpub/ckaa065] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Japan, with the oldest population in the world, faces a financial challenge caused by rising long-term care (LTC) expenditure. For policymakers to address this, it is important that we have a better understanding of how individual and regional characteristics affect LTC expenditure. METHODS We linked national LTC insurance (LTCI) claim data, covering the entire population who used LTCI services in Japan, with municipality data on an individual level. Individuals 65 years and older (n=3 876 068) who had used LTCI benefits at least once in the fiscal year (FY) 2016 were included. We examined the associations of individual and municipality characteristics regarding supply and demand of healthcare with the LTC expenditures on facility care, home and community care, and total care (the sum of both types of care), after adjusting for regional differences in LTC extra charges. RESULTS The following variables were associated with higher total expenditure; at the individual level: female, a higher care-need level, a lower income (0% co-payments) or a facility service user; at the municipality level: municipalities locating in metropolitan areas, with a higher proportion of single elderly households, more doctors per 1000 citizens, more nursing homes per 100 000 LTC benefit users or more outpatient medical spending per citizen ≥75 years old. CONCLUSIONS As we are able to identify several individual and municipality characteristics associated with higher LTC expenditure in Japan, the study offers insights into dealing with the rapidly growing LTC expenditure.
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Affiliation(s)
- Xueying Jin
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Mori
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan.,Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Mikiya Sato
- Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan.,Health Services Center, Human Personnel Group, Sumitomo Heavy Industries, Ltd, Yokosuka, Japan
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Health Services Research & Development Center, University of Tsukuba, Tsukuba, Japan
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17
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Lai X, Rong H, Ma X, Hou Z, Li S, Jing R, Zhang H, Lyu Y, Wang J, Feng H, Peng Z, Feng L, Fang H. The Economic Burden of Influenza-Like Illness among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126277. [PMID: 34200619 PMCID: PMC8296061 DOI: 10.3390/ijerph18126277] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022]
Abstract
Background: The disease burden of seasonal influenza is substantial in China, while there is still a lack of nationwide economic burden estimates. This study aims to examine influenza-like illness (ILI) prevalence, healthcare-seeking behaviors, economic impact of ILI, and its influencing factors among three priority groups during the 2018–19 influenza season. Methods: From August to October 2019, 6668 children’s caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China to participate in an on-site survey. The economic burden of ILI consisted of direct (medical or non-medical) and indirect burdens, and a two-part model was adopted to predict the influencing factors of total economic burden. Results: There were 45.73% children, 16.77% chronic disease patients, and 12.70% elderly people reporting ILI, and most participants chose outpatient service or over-the-counter (OTC) medication after ILI. The average economic burden was CNY 1647 (USD 237.2) for children, CNY 951 (USD 136.9) for chronic disease patients, and CNY 1796 (USD 258.6) for the elderly. Two-part regression showed that age, gender, whether the only child in the family, region, and household income were important predictors of ILI economic burden among children, while age, region, place of residence, basic health insurance, and household income were significant predictors of ILI economic burden among chronic disease patients and the elderly. Conclusions: A large economic burden of ILI was highlighted, especially among the elderly with less income and larger medical burdens, as well as children, with higher prevalence and higher self-payment ratio. It is important to adopt targeted interventions for high-risk groups, and this study can help national-level decision-making on the introduction of influenza vaccination as a public health project.
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Affiliation(s)
- Xiaozhen Lai
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai 200032, China;
| | - Shunping Li
- School of Health Care Management, Cheeloo College of Medicine, Shandong University, Jinan 250012, China;
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China
| | - Rize Jing
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Yun Lyu
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Jiahao Wang
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Huangyufei Feng
- School of Public Health, Peking University, Beijing 100083, China; (X.L.); (R.J.); (H.Z.); (Y.L.); (J.W.); (H.F.)
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
| | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing 102206, China;
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Correspondence: (L.F.); (H.F.); Tel.: +86-10-6525-6093 (L.F.); +86-10-8280-5702 (H.F.)
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100083, China; (H.R.); (X.M.)
- Peking University Health Science Center—Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Peking University, Beijing 100083, China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing 100083, China
- Correspondence: (L.F.); (H.F.); Tel.: +86-10-6525-6093 (L.F.); +86-10-8280-5702 (H.F.)
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Bai L, Gu S, Gu H, Xu X, Nan C, Li D, Di W. The Impact of Disability on Intergenerational Care Needs of the Elderly in China. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211018283. [PMID: 34027690 PMCID: PMC8150436 DOI: 10.1177/00469580211018283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper discussed the influence of disability and the degree of disability on the intergenerational needs of the elderly in terms of time and economy. The data is from the CLHLS in 2018. And the study discussed from 3 dimensions: nursing time, economic support, and medical cost support provided by children. The results showed that disability had a significant impact on the care time and medical expenses provided by adult children (care time: β = 45.631, P < .001; medical expenses: β = 2017.664, P < .01). Compared with the elderly with low degree of disability, the economic intergenerational care needs of the elderly with severe disability increased significantly (β = 2108.078, P < .01). The results of sub sample regression show that the intergenerational care needs of the elderly in China are restricted by objective factors and have not been met. These findings revealed the current situation of intergenerational support for the disabled in China, and emphasized that the government should establish and improve the social formal care, gradually reduce the burden of care for children with disabled elderly families, and improve the quality of life of the disabled elderly.
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Affiliation(s)
- Lan Bai
- Nanjing University, Nanjing, Jiangsu, China,Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Shuyan Gu
- Nanjing University, Nanjing, Jiangsu, China
| | - Hai Gu
- Nanjing University, Nanjing, Jiangsu, China,Hai Gu, Center for Health Policy and Management Studies, Nanjing University, 22 Hankou Road, Nanjing, Jiangsu 210093, China.
| | - Xinpeng Xu
- Nanjing University, Nanjing, Jiangsu, China
| | - Cui Nan
- Nanjing University, Nanjing, Jiangsu, China
| | - Decheng Li
- Nanjing University, Nanjing, Jiangsu, China
| | - Wu Di
- Nanjing University, Nanjing, Jiangsu, China
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19
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Li J, Lai DWL, Chappell NL. The Older, the Happier?: A Cross-Sectional Study on the "Paradox of Aging" in China. Res Aging 2021; 44:34-43. [PMID: 33626994 DOI: 10.1177/0164027521994225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The "paradox of aging" refers to the phenomenon that even though people's physical health and functions may decline when they enter later adulthood, their happiness does not necessarily. Previous studies have shown that older adults' better emotional regulation skills may contribute to the maintenance of their happiness. This study aims to examine the relationship between age, health, and happiness, and the moderating role of emotional stability. We adopted a nationally representative sample (n = 10,968) from the Chinese General Social Survey (CGSS) and performed weight-adjusted regression models with interaction terms. There is generally an S-shaped age-happiness relationship with significant urban-rural differences. Emotional stability buffers the negative association between health and happiness, and this moderating effect was stronger among older than younger adults, especially in rural China. This study calls for special attention paid to the oldest-old population in rural China and older adults' emotional regulation skills.
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Affiliation(s)
- Jia Li
- School of Public Health and Primary Health, Faculty of Medicine, 26680The Chinese University of Hong Kong
| | - Daniel W L Lai
- Faculty of Social Sciences, 26679Hong Kong Baptist University, Hong Kong
| | - Neena L Chappell
- Department of Sociology, 8205University of Victoria, British Columbia, Canada
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20
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Chen BA, Lai FC, Tsao LI, Chien HH, Chen CF, Jeng C. Decision difficulties of long-term-care facility nurses in transferring residents to the emergency department: A cross-sectional nationwide study. J Adv Nurs 2021; 77:2728-2738. [PMID: 33624335 DOI: 10.1111/jan.14802] [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: 09/02/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
AIMS To examine the level of decision difficulties of long-term-care facility (LTCF) nurses when transferring residents to the emergency department (ED) and associated influencing factors. DESIGN A cross-sectional nationwide study. METHODS The LTCFs were selected through random stratified sampling across the whole Taiwan during February 2018 to January 2019. LTCF nurses who met the selection criteria were invited to participate with two or three nurses selected from each LTCF. The Patient Transfer Decision Difficulty Scale (PTDDS) was used to measure the level of difficulty in making decisions related to the transfer of residents to the ED. Data were collected by mailing the questionnaires and asking the nurses to return the completed form in 2 weeks. Data were analysed using simple linear regression and multiple regression with stepwise methods. RESULTS In total, 618 valid questionnaires with an 85.32% response rate from 319 LTCFs were used for the data analysis. Decision difficulties that LTCF nurses experienced were moderate, the nursing personnel-bed ratio, LTCF professional training and basic life support training were predictive factors of the level of difficulty experience (scores of PTDDS) for the LTCF nurse (F = 6.81, p < .001). CONCLUSIONS Enhancing emergency training in LTCF can improve nurses' decision-making ability to refer LTCF residents to emergency treatment. IMPACT What problem did the study address? The study addressed the difficult decision LTCF nurses may experience when transferring a resident to the emergency department. What were the main findings? All LTCF nurses faced a moderate level of difficulty in decision-making. 'Transfer timing' was most often considered in the decision-making process when a resident was transferred to the ED. Where and on whom will the research have impact? Results of this study have considerable reference value for LTCF managers and nurses in the decision-making ability and suitability of transferring residents for emergency treatment.
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Affiliation(s)
- Bor-An Chen
- Emergency Department, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.,Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Fu-Chih Lai
- Post-Baccalaureate Nursing Program in Nursing and College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Lee-Ing Tsao
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hui-Hui Chien
- Nursing Department, Yuanshan Branch, Taipei Veterans General Hospital, Ilan, Taiwan
| | - Chun-Fu Chen
- Taipei Medical University-Shuang HO Hospital, Ministry of Health and Welfare
| | - Chii Jeng
- School of Nursing, Taipei Medical University, Taipei, Taiwan
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21
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Peng K, Yang M, Tian M, Chen M, Zhang J, Wu X, Ivers R, Si L. Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing. Osteoporos Int 2020; 31:1545-1553. [PMID: 32219498 DOI: 10.1007/s00198-020-05393-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED The multidisciplinary co-management program for geriatric patients with hip fracture is cost-effective in the Chinese population and it has the potential to be scaled up in China. INTRODUCTION The study aimed to investigate the cost-effectiveness of a multidisciplinary co-management program for patients with hip fracture in China. METHODS Hip fracture patients who were admitted to an orthopedic hospital in Beijing were included in the multidisciplinary co-management program. The cost-effectiveness of intervention was evaluated compared to the conventional management. A Markov microsimulation model was developed to simulate lifetime costs and effectiveness. Costs including intervention, hospitalization, medications, and long-term care costs were expressed using 2019 US dollars and the healthcare perspective was adopted. Effectiveness was evaluated using both 1-year mortality-averted and quality-adjusted life years (QALYs). Costs and effectiveness were discounted at 5% per annum. The willingness-to-pay (WTP) threshold was set at $26,481 per QALY gained which was three times gross domestic product (GDP) per capita in China. One-way and probabilistic sensitivity analyses were conducted. RESULTS The lifetime cost for the conventional management (n = 1839) and intervention group (n = 1192) was $11,975 and $13,309 respectively. The lifetime QALYs were 2.38 and 2.45 years and the first-year mortality was 17.8% and 16.1%. The incremental cost-effectiveness ratio was $19,437 per QALY gained or $78,412 per 1-year mortality-averted. Given the Chinese WTP threshold, the intervention had a 78% chance being cost-effective. The cost-effectiveness of the intervention was sensitive to cost of intervention and the proportion of patients who underwent surgery within 48 h. CONCLUSIONS The multidisciplinary co-management program for patients with hip fracture is cost-effective and it has the potential to be scaled up in the Chinese population.
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Affiliation(s)
- K Peng
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia
| | - M Yang
- Department of Orthopedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - M Tian
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - M Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - J Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- School of Public Health and Community Medicine, UNSW, Kensington, Australia
| | - X Wu
- Department of Orthopedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - R Ivers
- School of Public Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia
- School of Public Health and Community Medicine, UNSW, Kensington, Australia
| | - L Si
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW, 2042, Australia.
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22
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Urban-Rural Differences in Long-Term Care Service Status and Needs Among Home-Based Elderly People in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051701. [PMID: 32150946 PMCID: PMC7084295 DOI: 10.3390/ijerph17051701] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 01/08/2023]
Abstract
Background: Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban–rural differences. This study aims to evaluate the differences of LTC current status and needs between urban–rural areas and age groups, and to identify influencing factors causing the different LTC needs. Methods: The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs. Results: A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees (p < 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, p < 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, p < 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 < OR < 1.69, p < 0.05). Conclusions: The aged cohort in urban–rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.
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Yin H, Wardenaar KJ, Xu G, Tian H, Schoevers RA. Help-seeking behaviors among Chinese people with mental disorders: a cross-sectional study. BMC Psychiatry 2019; 19:373. [PMID: 31783825 PMCID: PMC6883558 DOI: 10.1186/s12888-019-2316-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Failure to seek treatment for mental health disorders is a serious public health concern. Unfortunately, there is little insight into help-seeking and its associated factors in China which has undergone rapid economic development in the past 30 years and has an increasing prevalence of mental disorder. Therefore, this study aimed to (1) investigate help-seeking rates in healthcare and non-healthcare settings and (2) investigate the correlates of help-seeking behavior in a large Chinese survey. METHODS Data came from the Tianjin Mental Health Survey (TJMHS), a representative sample of adult community residents in the Chinese municipality of Tianjin (n = 11,748). Of these, 1759 individuals had ≥1 axis-I diagnosis according to the Diagnostic and Statistical manual- fourth edition (DSM-IV) and were administered a Help-Seeking Questionnaire. RESULTS 15.7% of patients reported that they had ever sought help during their entire lifetime before the interview, with 4.5% seeking help in mental healthcare, 3.2% in other healthcare and 8.1% in non-healthcare settings (e.g., family, friends, and spiritual advisor). Among help-seekers, the first help was mostly sought in non-healthcare settings (58.4%), followed by healthcare (27.5%) and mental healthcare settings (24.5%). Female gender, younger age, having 7-9 years vs 0-6 years of education, a low income, a psychotic disorder and having ≥2 disorders were associated with increased help-seeking. Older age, being married and having a psychotic or organic disorder were associated with increased help-seeking in healthcare vs. non-healthcare settings. CONCLUSION A small percentage of persons with mental disorders in the Tianjin region seek help and among those who do, variations in the types of help-seeking may be partially explained by demographic and clinical characteristics.
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Affiliation(s)
- Huifang Yin
- grid.440287.dTianjin Mental Health Institute, Tianjin Anding Hospital, No. 13, Liulin Road, Hexi district, Tianjin, 300222 China ,0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Klaas J. Wardenaar
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Guangming Xu
- Tianjin Mental Health Institute, Tianjin Anding Hospital, No. 13, Liulin Road, Hexi district, Tianjin, 300222, China.
| | - Hongjun Tian
- grid.440287.dTianjin Mental Health Institute, Tianjin Anding Hospital, No. 13, Liulin Road, Hexi district, Tianjin, 300222 China
| | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China Health and Retirement Longitudinal Survey. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x1900148x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractRapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China.
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Characterising Long Term Care Needs among Chinese Older Adults with Cognitive Impairment or ADL Limitations. J Cross Cult Gerontol 2019; 35:35-47. [PMID: 31422493 DOI: 10.1007/s10823-019-09382-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Utilization willingness of institutional care between disabled and non-disabled seniors: evidence from Jiangsu, China. BMC Health Serv Res 2019; 19:410. [PMID: 31234849 PMCID: PMC6591941 DOI: 10.1186/s12913-019-4259-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to rapidly growing number of old adults and diminishing supportive functions of family in China, the issue of willingness to use institutional care is of high priority, especially for disabled seniors. The objective of this study is to compare the willingness of institutional care and its determinants between disabled and non-disabled seniors in China. METHODS 2493 seniors (60+) were randomly selected from a cross-sectional study conducted in three urban districts and three rural counties in Jiangsu Province. Binary logistic regression model was employed to examine differences towards the preference for institutional care between two subgroups, and to identify factors associated with willingness of institutional care between disabled and non-disabled seniors. RESULTS Of 2493 respondents, 402 (16.1%) were disabled seniors. Overall, 14.2% of the participants had willingness for institutional care in Jiangsu, China. The willingness for institutional care among non-disabled seniors (OR = 0.513; 95%CI 0.387-9.680) was significantly lower than that among disabled ones. The preference for institutional care of both disabled and non-disabled seniors was associated with household income. The willingness of institutional care was also related to age, education and living arrangement among disabled seniors. Meanwhile, non-disabled seniors who had non-communicable diseases were found to be more likely to choose elder care in institution. CONCLUSIONS Our findings indicated that the willingness for institutional care among disabled seniors was significantly higher than that among non-disabled ones. Household income was determinant of utilization willingness for institutionalization both in disabled and non-disable seniors. Different policies should be made or modified for disabled and non-disabled seniors separately.
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Plöthner M, Schmidt K, de Jong L, Zeidler J, Damm K. Needs and preferences of informal caregivers regarding outpatient care for the elderly: a systematic literature review. BMC Geriatr 2019; 19:82. [PMID: 30866827 PMCID: PMC6417014 DOI: 10.1186/s12877-019-1068-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 02/13/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system. METHODS A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi. RESULTS A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition. CONCLUSION To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.
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Affiliation(s)
- M. Plöthner
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - K. Schmidt
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - L. de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - J. Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
| | - K. Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159 Hannover, Germany
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Flores-Flores O, Bell R, Reynolds R, Bernabé-Ortiz A. Older adults with disability in extreme poverty in Peru: How is their access to health care? PLoS One 2018; 13:e0208441. [PMID: 30586426 PMCID: PMC6306199 DOI: 10.1371/journal.pone.0208441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/17/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Disability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown. OBJECTIVE This study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty. METHODS Secondary analysis of a national representative population based survey that utilizes information from Peru's 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru's available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported. RESULTS Data from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (p<0.05). CONCLUSIONS This study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.
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Affiliation(s)
- Oscar Flores-Flores
- Institute for Global Health, University College London, London, United Kingdom
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru
- Universidad Cientifica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
| | - Ruth Bell
- UCL Institute of Health Equity, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Rodney Reynolds
- Institute for Global Health, University College London, London, United Kingdom
| | - Antonio Bernabé-Ortiz
- CRONICAS, Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana de Ciencias Aplicadas–UPC, Lima, Perú
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wang S, Cheung DSK, Leung AYM. Overview of dementia care under the three-tier long-term care system of China. Public Health Nurs 2018; 36:199-206. [PMID: 30549090 DOI: 10.1111/phn.12573] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/22/2018] [Accepted: 11/18/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This paper provides an overview of the status of dementia care in Mainland China under the framework of the three-tier long-term care system proposed by the Chinese government, and gives the direction for service development. METHODS Official documents, annual reports of related associations, and studies conducted in Mainland China from 2006 to 2017, published both in English and Chinese were reviewed. RESULTS With the establishment of the three-tier long-term care system, the Government has invested a lot in long-term care, and improvements have been made. However, specific areas of dementia care still face challenges. DISCUSSION Strategies in improving the long-term care services have been achieved. These included training for informal caregivers at home settings, increased investment in community health centers, and increased institutional placements, etc. However, these are not enough to fulfill the needs of people with dementia and their caregivers. IMPLICATIONS FOR NURSING AND HEALTH POLICY Multiple levels of training and interaction within the framework of the three-tier long-term care system as well as more research are recommended for improving dementia care.
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Affiliation(s)
- Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Abstract
Objectives: Against the background of emerging research interest in integrating Active Aging in long-term care policies, the study investigates the relationships between community environment and engagement in social activities (paid work, domestic care, participation in community and leisure activities) by older Chinese adults. Six indicators are derived from the economic, institutional, and sociodemographic environments of the communities under analysis. Method: The first wave of the China Health and Retirement Longitudinal Study (CHARLS) is used for empirical examinations. The sample includes respondents aged 50 years and above ( n = 6,290) from 307 communities. Random-intercept multilevel logistic models are employed. Results: Economic environment is positively linked to engagement in paid work and grandparental childcare, community activities, and leisure activities. However, the effects decreased after including the indicators for the institutional and sociodemographic environments. We found that older adults are more likely to engage in community activities and leisure activities in communities and with a higher percentage of migrant population. Discussion: To integrate Active Aging in the current long-term care policies in China, the study points out that residential community environment is crucial for older Chinese to enhance and sustain their involvement in family and communities before older adults rely on long-term care facilities. In particular, the relevance of institutional and sociodemographic environment provides policy makers to rethink about how to provide community-based long-term care.
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Akiyama N, Shiroiwa T, Fukuda T, Murashima S, Hayashida K. Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records. PLoS One 2018; 13:e0190392. [PMID: 29758026 PMCID: PMC5951584 DOI: 10.1371/journal.pone.0190392] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/14/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The population is aging rapidly in many developed countries. Such countries need to respond to the growing demand and expanding costs of healthcare (HC) for the elderly. Therefore, it is important to investigate the factors correlating such HC costs. In Japan, HC is composed of two sections, namely medical care (MC) and long-term care (LTC). While many studies have examined MC and LTC costs on their own, few studies have conducted comprehensive investigations of HC costs. The aim of this study is to examine the risk factors that influence HC costs for the elderly who enroll in the LTC insurance system in Japan. METHODS The inclusion criteria in the present study are as follows: being 65 years of age, or older; certified eligibility for, and use of services offered by the LTC insurance system at home or in an institutional setting in December 2009; and being covered by the National Health Insurance (NHI) system. MC and LTC insurance data were obtained from claim records for the elderly in July and December of 2007, 2008, and 2009 (i.e., a total of six survey points). Panel data, per subject, were constructed using MC and LTC claim records. The sample included 810 subjects and 4029 observations. RESULTS We estimated a regression equation with a censored dependent variable using a Tobit model. Significant associations between MC or LTC costs and interaction terms (household composition × seasonal effects) were investigated. MC costs significantly decreased and LTC costs significantly increased among subjects living alone during winter. Income level was also a positive determinant of MC costs, while eligibility level was a positive determinant of LTC costs. CONCLUSIONS We recommend that the health policy for the elderly focus more on seasonal effects, household composition, and income level, as well as on eligibility level.
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Affiliation(s)
- Naomi Akiyama
- Iwate Medical University, School of Nursing, Iwate, Japan
- * E-mail:
| | - Takeru Shiroiwa
- Department of Health and Welfare Services, National Institute of Public Health, Wako, Saitama, Japan
| | - Takashi Fukuda
- Department of Health and Welfare Services, National Institute of Public Health, Wako, Saitama, Japan
| | | | - Kenshi Hayashida
- Department of Medical Informatics and Management, University Hospital, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study. J Aging Res 2018; 2018:4180565. [PMID: 29593906 PMCID: PMC5822901 DOI: 10.1155/2018/4180565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/14/2017] [Accepted: 11/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background Rural-urban inequality in long-term care (LTC) services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand. Methods The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method) were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs. Results The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation. Conclusions Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.
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Zhu Y, Österle A. Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status. Soc Sci Med 2017; 191:30-37. [DOI: 10.1016/j.socscimed.2017.08.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 08/03/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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Chen Z, Yang X, Song Y, Song B, Zhang Y, Liu J, Wang Q, Yu J. Challenges of Dementia Care in China. Geriatrics (Basel) 2017; 2:geriatrics2010007. [PMID: 31011017 PMCID: PMC6371088 DOI: 10.3390/geriatrics2010007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/03/2017] [Accepted: 01/13/2017] [Indexed: 11/16/2022] Open
Abstract
Dementia results in brain dysfunction, disability and dependency among affected people, causing an overwhelming burden for caregivers. China has the largest number of people with dementia worldwide and is facing severe challenges with respect to dementia care, including poor awareness of dementia in the public, inadequate knowledge of dementia for medical professionals and caregivers, an underdeveloped dementia service system, and high costs of dementia care. To address these challenges, China is taking action to increase dementia awareness and education among the public and care providers, and develop policies, services and resources for dementia care.
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Affiliation(s)
- Zheng Chen
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Xuan Yang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Yuetao Song
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Binbin Song
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Yi Zhang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Jiawen Liu
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Qing Wang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Jia Yu
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
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Patel V, Xiao S, Chen H, Hanna F, Jotheeswaran AT, Luo D, Parikh R, Sharma E, Usmani S, Yu Y, Druss BG, Saxena S. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet 2016; 388:3074-3084. [PMID: 27209149 DOI: 10.1016/s0140-6736(16)00160-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Centre for the Control of Chronic Conditions, Guragon, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
| | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fahmy Hanna
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - A T Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Rachana Parikh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Eesha Sharma
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Benjamin G Druss
- Mental Health School of Public Health: Health Policy & Management, Emory University, Atlanta, GA, USA
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Wang X, Ma Y, Wang J, Han P, Dong R, Kang L, Zhang W, Shen S, Wang J, Li D, Zhou M, Wang L, Niu K, Guo Q. Mobility and Muscle Strength Together are More Strongly Correlated with Falls in Suburb-Dwelling Older Chinese. Sci Rep 2016; 6:25420. [PMID: 27146721 PMCID: PMC4857074 DOI: 10.1038/srep25420] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/15/2016] [Indexed: 12/22/2022] Open
Abstract
Falls are common in older adults and result in adverse outcomes. Impaired mobility and poor muscle strength have been consistently identified as the main contributors to falls. We choose three easy-to-perform tests (i.e. Timed Up and Go test (TUGT), walking speed (WS) and grip strength (GS)) in order to assess mobility and muscle strength to further define their relationship with falls. This study is cross-sectional, consisting of 1092 residents over 60-year-old; 589 were female. 204 (18.68%) participants reported falling at least once in the past year. It was found that, of the three tests evaluated independently, a TUGT < 9.1750 s had the strongest association with fewer falls. When evaluating these tests as pairs, the combination of a TUGT < 9.1750 s and a WS < 0.9963 m/s was the best protective indicator of falls after adjusting for age, sex and other variables. When evaluating all three tests in conjunction with each other, the combination of a TUGT < 9.1750 s, a WS < 0.9963 m/s, and a GS > 0.3816 was most correlated with less possibility of falls. The combination of a better TUGT performance, a stronger GS, and a slower WS is the most strongly correlated with less possibility of falls.
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Affiliation(s)
- Xiuyang Wang
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.,Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Yixuan Ma
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Jiazhong Wang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Peipei Han
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Renwei Dong
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Li Kang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Wen Zhang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Suxing Shen
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Jing Wang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Dongfang Li
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Maoran Zhou
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Liancheng Wang
- Department of Rehabilitation Medicine, Tianjin Hospital, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, China.,School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.,Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
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Banks LM, Mearkle R, Mactaggart I, Walsham M, Kuper H, Blanchet K. Disability and social protection programmes in low- and middle-income countries: a systematic review. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13600818.2016.1142960] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London, UK
| | - Rachel Mearkle
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London, UK
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London, UK
| | - Matthew Walsham
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London, UK
| | - Karl Blanchet
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London, UK
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Wu C, Gao L, Chen S, Dong H. Care services for elderly people with dementia in rural China: a case study. Bull World Health Organ 2016; 94:167-73. [PMID: 26966327 PMCID: PMC4773933 DOI: 10.2471/blt.15.160929] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/08/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022] Open
Abstract
Objective To determine the state of the health and supportive services available to elderly people with dementia – and their families – in rural Lanxi county, in the province of Zhejiang, China. Methods In November 2014 and January 2015, we interviewed 14 key informants on dementia care face-to-face, using a semi-structured questionnaire. The informants included three rural physicians, an urban geriatrician, seven directors of institutions for the care of the elderly and three officials of the civil affairs bureau. We also completed in-depth interviews with five family caregivers of elderly people with dementia. Findings The interviewees indicated that there was a lack of specialized services designed specifically to address the needs of individuals with dementia and their family members. Non-psychiatric medical services and the available facilities for long-term care appeared to be ill-equipped to manage these needs. They lacked both clinical staff and standardized, evidence-based practices for the diagnosis, care, treatment and rehabilitation of patients with dementia. As care facilities often refused to admit elderly people with dementia, families were generally forced to care for elderly relatives with dementia at home. Conclusion In Lanxi county – and probably in much of rural China – more public resources are needed to support family caregivers and to improve the capacity of care facilities for the elderly to care for individuals with dementia.
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Affiliation(s)
- Christina Wu
- Center for Health Policy Studies, Zhejiang University School of Medicine, Zijingang Campus, 866 Yuhangtang Rd, Hangzhou, 310058 China
| | - Lin Gao
- Center for Health Policy Studies, Zhejiang University School of Medicine, Zijingang Campus, 866 Yuhangtang Rd, Hangzhou, 310058 China
| | - Shulin Chen
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Hengjin Dong
- Center for Health Policy Studies, Zhejiang University School of Medicine, Zijingang Campus, 866 Yuhangtang Rd, Hangzhou, 310058 China
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Yu X, Chen S, Chen X, Jia J, Li C, Liu C, Toumi M, Milea D. Clinical management and associated costs for moderate and severe Alzheimer's disease in urban China: a Delphi panel study. Transl Neurodegener 2015; 4:15. [PMID: 26301090 PMCID: PMC4546035 DOI: 10.1186/s40035-015-0038-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/09/2015] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare resource utilisation for Alzheimer’s disease (AD) in China is not well understood. This Delphi panel study aimed to describe the clinical management pathways for moderate and severe AD patients in urban China and to define the amount and cost of healthcare resources used. Methods A panel of 11 experts was recruited from urban China to participate in two rounds of preparatory interviews. In the first round, 9 physicians specialised in dementia gave a qualitative description of the clinical management of AD patients. In the second round, 2 hospital administrators were asked about the cost of AD management and care. Results from the interviews were discussed by the experts in a Delphi panel meeting, where consensus was reached on quantitative aspects of AD management, including the rate of healthcare resource utilisation, the respective unit costs and caregiving time. Results Interviewees reported that mild AD is under-recognised in China; most patients are diagnosed with moderate to severe AD. Loss of independence and agitation/aggression are the main drivers for healthcare resource utilisation and contribute to a heavier caregiver burden. It was estimated that 70 % moderate AD patients are independent/non-aggressive at the time of diagnosis, 15 % are independent/aggressive, 10 % are dependent/non-aggressive, and 5 % are dependent/aggressive. Dependent/aggressive AD patients are more likely to be hospitalised (70–90 %) than accepted in a nursing home (0–20 %), while the opposite is true for dependent/non-aggressive patients (5–35 % for hospitalisation vs. 80 % for nursing home). Independent AD patients require 1–3 hours/day of caregiver time, while dependent patients can require up to 12–15 hours/day. Experts agreed that AD complicates the management of age-related comorbidities, found in 70–80 % of all AD patients, increasing the frequency and cost of hospitalisation. Conclusions The Delphi panel approach was an efficient method of gathering data about the amount of healthcare resources used and associated costs for moderate and severe AD patients in urban China. The results of this study provide a useful source of information for decision makers to improve future healthcare policies and resource planning, as well as to perform economic evaluations of AD therapies.
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Affiliation(s)
- Xin Yu
- Institute of Mental Health, Peking University Sixth Hospital, Huayuanbeilu 51, Haidian District, Beijing, 100191 China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaochun Chen
- Fujian Institute of Geriatrics, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Jianjun Jia
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - Chunhou Li
- Medical Services Department, Peking Union Medical College Hospital, Beijing, China
| | - Cong Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Peng R, Wu B. Changes of Health Status and Institutionalization Among Older Adults in China. J Aging Health 2015; 27:1223-46. [PMID: 25903975 DOI: 10.1177/0898264315577779] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine rates of institutionalization of Chinese older adults aged 65+ and the impact of changes in health status on the likelihood of institutionalization. METHOD Using data from the 2002, 2005, 2008, and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), admission rates for each 3-year interval between waves were calculated. Logistic regression models were used to assess the changes of five health status variables as risk factors. RESULTS Between the first (2002-2005) and third (2008-2011) intervals, the institutionalization rate increased from 0.5% to 0.8%. Risk of institutionalization increased 70% for respondents with declining ability to perform activities of daily living, 53% for those with declining cognitive function, and 44% for those with increasing number of chronic diseases. DISCUSSION Development of policies and programs to improve older adults' health status is essential to delay institutionalization. Quality of workforce is also critical in meeting the care needs.
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Affiliation(s)
- Rong Peng
- National Economics Research Center and School of Economics, Guangdong University of Finance and Economics, Guangzhou, China
| | - Bei Wu
- Duke University, Durham, NC, USA
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Zhu H. Unmet needs in long-term care and their associated factors among the oldest old in China. BMC Geriatr 2015; 15:46. [PMID: 25880545 PMCID: PMC4408585 DOI: 10.1186/s12877-015-0045-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/27/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Haiyan Zhu
- Department of Sociology, Virginia Tech, 650 McBryde Hall (0137), 225 Stanger Street, Blacksburg, Virginia, 24061, USA.
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Shen S, Li J, Guo Q, Zhang W, Wang X, Fu L, Li L, An Y, Liu W, Li H, Huang T, Zhang Z, Niu K. Body mass index is associated with physical performance in suburb-dwelling older chinese: a cross-sectional study. PLoS One 2015; 10:e0119914. [PMID: 25774797 PMCID: PMC4361482 DOI: 10.1371/journal.pone.0119914] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physical performance is reported to have various beneficial effects on human health, especially in older individuals. Although such effects are associated with body mass index (BMI), the relationship between BMI and physical performance has not been clarified. DESIGN We conducted a cross-sectional study of 966 suburb-dwelling Tianjin individuals aged ≥ 60 years (average age 67.5±6.02, men 435, women 531). Mobility, balance, and muscle strength were assessed by walking speed, timed up-and-go test (TUGT), and grip strength, respectively. The subjects were categorized into three groups based on BMI (kg/m2) as follows: normal weight, 18.5 ≤ BMI ≤ 23.9; overweight, 24.0 ≤ BMI ≤ 27.9; and obese, BMI ≥ 28.0. RESULT After adjusting for all other variables, relative grip strength decreased when BMI increased in both men and women (P for trend <0.001 and <0.001, respectively). BMI may be negatively associated with TUGT performance in the women only. There was no apparent association between walking speed and BMI in either sex, but after adjusting for age, walking speed was faster when BMI increased in women (P for trend= 0.0162). CONCLUSION This study suggests that in older individuals, higher BMI is associated with poor muscle strength in both sexes.
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Affiliation(s)
- Suxing Shen
- Department of Rehabilitation Medicine, Cardiovascular Clinical College of Tianjin Medical University, TEDA International Cardiovascular Hospital, Tianjin, China
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Jing Li
- Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Disease Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Cardiovascular Clinical College of Tianjin Medical University, TEDA International Cardiovascular Hospital, Tianjin, China
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
- * E-mail:
| | - Wen Zhang
- Department of Rehabilitation Medicine, Cardiovascular Clinical College of Tianjin Medical University, TEDA International Cardiovascular Hospital, Tianjin, China
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Xiuyang Wang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Liyuan Fu
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Linke Li
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Yufang An
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Weixi Liu
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Hongyun Li
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Tao Huang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Zedan Zhang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, China
- School of Public Health, Tianjin Medical University, Tianjin, China
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Affiliation(s)
- Philip Boyer
- Department of Systems and Computer Engineering; Carleton University; Ottawa ON Canada
| | - Bashir I. Morshed
- Electrical and Computer Engineering Department; The University of Memphis; Memphis TN USA
| | - Tofy Mussivand
- Medical Devices Innovation Institute; University of Ottawa; Ottawa ON Canada
- Cardiovascular Devices Division; University of Ottawa Heart Institute; Ottawa ON Canada
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Zhang Z, Wang J, Jin M, Li M, Zhou L, Jing F, Chen K. Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People's Republic of China. Clin Interv Aging 2014; 9:771-7. [PMID: 24855346 PMCID: PMC4020881 DOI: 10.2147/cia.s58771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The People's Republic of China's population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People's Republic of China. OBJECTIVE To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People's Republic of China. METHODS We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People's Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. RESULTS We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. CONCLUSION A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services.
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Affiliation(s)
- Zhenyu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Jianbing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Mingjuan Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Mei Li
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Litao Zhou
- Quality Control Department, Zhejiang Hospital, Zhejiang, People's Republic of China
| | - Fangyuan Jing
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
| | - Kun Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China
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