China's rapidly aging population creates policy challenges in shaping a viable long-term care system

Evaluating community-embedded elder care: A case study of supply and demand in Hangzhou, China

INTRODUCTION

With China's urbanization and demographic shifts significantly affecting elder care, this study examines the alignment of community-based elder care services in Hangzhou's Hemu Community. It addresses the gap in understanding how these services meet the needs of an aging population in a rapidly changing social context.

METHODS

A comprehensive mixed-methods approach was utilized, involving interviews with community residents, observations of elder care service operations and thorough document analysis. The objective was to evaluate the adequacy, utilization and satisfaction levels concerning these elder care services.

RESULTS

The research identified that, although the services generally meet the community's needs, there are notable challenges in content specificity, quality assurance and promotional efforts. These challenges lead to resistance among older adults. Additionally, issues with service visibility and the lack of robust feedback mechanisms were noted.

CONCLUSION

This study highlights the critical need for a cooperative strategy involving government, community organizations, social entities and businesses in enhancing elder care services. It suggests that improvements in service visibility, content quality and targeted promotion are crucial to address the evolving needs of the aging population and to reduce reluctance in service utilization.

Who Cares for Older Adults? A Cross-National Study of Care Sources for Older Adults With Functional Limitations and Associated Determinants

The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.

Resolving conflict and promoting coordination for an integrated old-age healthcare service system in China: GMCR-AHP based decision analysis approach

China faces a healthcare challenge due to its aging population, necessitating an integrated old-age healthcare system considering multiple stakeholders' interests. Conflict and inequality may arise from varying stakeholder interests. This study develops a conflict resolution strategy for the coordination of stakeholders involved in the old-age healthcare service system, promoting harmonization and minimizing conflict to establish an equitable system meeting elderly needs. It contributes to a robust healthcare system for comprehensive, quality care. The focus of the study is to identify relevant stakeholders and decision-makers involved in developing an integrated old-age healthcare service system and explore a feasible solution through stakeholder analysis using the Mitchell score-based technique and stakeholder theory. Decision-makers' preferences are estimated using the Analytic Hierarchy Process (AHP). Solution strategies are developed through multiple stability concepts within the graph model for conflict resolution (GMCR). The conflict resolution analysis based on the integrated AHP-GMCR approach reveals that the development of an integrated old-age healthcare system is feasible by addressing potential conflicts among the stakeholders. Considering the current predicament of comprehensive medical services in China, governments should distribute authority, simplify procedures, and improve the insurance system. Furthermore, medical institutions should explore funding options, expand services, and enhance accessibility. Elderly individuals should prioritize healthy aging and seek suitable healthcare providers. Stakeholder participation is crucial for effective implementation. These recommendations enable China to advance integrated elderly care successfully, addressing challenges posed by the aging population.

Caring for a parent with dementia: The psychological well-being of adult children

BACKGROUND

Caregiving for a parent with dementia has both positive and negative influences on psychological well-being of adult children and perceived social support plays an essential role in dementia caregiving process.

OBJECTIVES

We examined how the degree of caregiving intensity influences mental health among Chinese adult children then further explored how perceived social support influences the relationship between intensity and psychological well-being.

RESEARCH DESIGN AND SETTING

Cross-sectional study in Kunming, mainland China between November 2022 and January 2023.

METHODS

We interviewed 320 adult dementia child caregivers. Linear regression and multiple mediation analysis using Hayes' process model were used to assess the relationship between caregiving intensity and psychological well-being, as well as the mediating role of perceived social support.

RESULTS

The study found that caregiving intensity was positively associated with depression and negatively associated with life satisfaction. A lack of perceived social support exacerbated these effects for the adult children. Specifically, the caregivers reported higher caregiving intensity when they perceived less family support, which is in turn associated with greater depression and lower life satisfaction among the caregivers. Likewise, those who reported higher caregiving intensity was reported lower friend support, which was in turn associated with greater depression.

CONCLUSIONS AND IMPLICATIONS

The findings emphasize the importance of social support, especially family support, and the necessity for health practitioners to provide targeted interventions on both negative and positive aspects of psychological well-being among dementia caregivers and to strengthen caregivers' resources for social support to enhance their well-being. While these findings are cross-sectional, it is logical to assume that those who perceive less support feel that their caregiving responsibilities are more intense, and that intensity could cause the caregiver to withdraw from friends.

The transition of eldercare responsibility and traditional filial piety concepts and its urban-rural differences in China: an age-period-cohort analysis from 2006 to 2017

BACKGROUND

With rapid urbanization, massive migration, and non-family-based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006-2017).

METHODS

Old-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models.

RESULTS

Among 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79-0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33-1.41) and self-based (OR = 1.55, 95% CI: 1.47-1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents' primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging.

CONCLUSIONS

The traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being.

Older adults preferences for long-term caregivers in China: a discrete choice experiment

OBJECTIVE

Understanding the preferences of old-age adults for their long-term caregivers can improve person-centred health care and the quality of long-term care (LTC). This study examines Chinese older adults' preferences for long-term caregivers.

STUDY DESIGN

This is a cross-sectional study.

METHODS

A national representative discrete choice experiment (DCE) surveyed 2031 adults aged 50-70 across 12 provinces in China. Each DCE scenario described five attributes: type of caregivers, place of LTC, contents of LTC, out-of-pocket payments, and quality of life (QoL). Preferences and the marginal willingness to pay (WTP) were derived using mixed-logit and latent class models.

RESULTS

Older adults displayed higher preferences for long-term caregivers who improve their QoL, incur lower out-of-pocket payments, and provide medical LTC services at home, with the maximum WTP of $22.832 per month. QoL was rated as the most important LTC factor, followed by the place of LTC and the type of caregivers. When the level of QoL improved from poor to good, respondents would be willing to pay $18.375 per month more (95% confidence interval: 16.858 to 20.137), and the uptake rate increased by 76.47%. There was preference heterogeneity among older people with different sex, education, family size, and knowledge of LTC insurance.

CONCLUSION

QoL was the most important factor in older Chinese adults' preference for caregivers. Home care and medical care from formal caregivers was preferred by older adults. We recommend training family caregivers, raising older people's awareness of LTC insurance, and guiding policymakers in developing people-oriented LTC and a multi-level LTC system.

The formation and evolution of vulnerability risk of rural poor groups under the perspective of social support -- based on the analysis of "sensitivity-resilience"

The anticipated sensitivity and resilience practices of the poor groups expose them to significant vulnerability risks, with social support actions arising from the return to poverty posing additional interference. To comprehensively prevent and mitigate vulnerability risks, breakthroughs in corresponding social support are essential. This study, through questionnaire surveys and semi-structured interviews, collected original data from 750 impoverished households in Lantian County, northwest China. Using a bottom-up approach, it constructed a "sensitivity-resilience" framework to assess the vulnerability and resilience mechanisms of the relatively poor groups. The research reveals that vulnerability and resilience interact in response to risk shocks. The strong livelihood dependence, capital accumulation deficiency, and sensitivity characteristics of social marginalization among rural relatively poor groups, coupled with fragmented and inefficient social support, exacerbate the degree of vulnerability risks, leading to an amplification of sensitivity and a reduction in resilience. Based on these findings, targeted at the characteristics of vulnerability risks and the fatigue factors of social support, this study proposes policy recommendations at two levels: system reengineering to reduce sensitivity and long-term reengineering to enhance resilience, aiming to prevent large-scale return to poverty.

Home care practice behavior and its influencing factors of primary care providers: a multicenter cross-sectional study in Sichuan Province, China

BACKGROUND

Primary care providers play an important role in home health care, and their practice behavior is significant for care quality and patient outcomes. This study aimed to assess the home care practice behavior of Chinese primary care providers and to explore the factors associated with the practice behavior.

METHODS

A multicenter cross-sectional design with a convenience sample was used to survey 863 registered primary care providers from 62 primary health care settings in Sichuan Province, China. Descriptive statistics, t-test or ANOVA for one-way analysis, and Pearson's correlation analyses were used to compare the differences and examine the relationships between participants' demographics and experience of home care services and practice behavior. Multiple linear regression models were performed to identify salient variables associated with the practice behavior from among demographic and home care experience.

RESULTS

The score of home care practice behavior questionnaire was 97.25 ± 21.05. The average scores for the dimensions of home visit preparation, assessment, medical care behavior and safety practice were 3.70 ± 0.95, 3.76 ± 1.02, 3.66 ± 1.03, and 3.20 ± 0.46, respectively. Home care practice behavior was associated with working years, working experience in general hospitals, work area, home care experience such as client types of home care, service frequency and willingness, explaining 21.5% of the total variance.

CONCLUSION

Chinese primary care providers had a medium to high level of home care practice behavior but poor implementation of safety practice. The results may provide clues to increased focus and implementation of safety practice, as well as providing targeted measures based on influencing factors.

The experiences and needs of older adults receiving voluntary services in Chinese nursing home organizations: a qualitative study

BACKGROUND

Older adults living in nursing home organizations are eager to get voluntary help, however, their past experiences with voluntary services are not satisfactory enough. To better carry out voluntary services and improve the effectiveness of services, it is necessary to have a deeper understanding of the experiences and needs of older adults for voluntary services.

METHODS

The purposive sampling method was used to select 14 older adults from two nursing home organizations in Hangzhou and conduct semi-structured interviews, Collaizzi's seven-step method was used to analyze the data.

RESULTS

Older adults in nursing home organizations have both beneficial experiences and unpleasant service experiences in the process of receiving voluntary services; Beneficial experiences include solving problems meeting needs and feeling warmth and care, while unpleasant service experiences include the formality that makes it difficult to benefit truly, lack of organization, regularity, sustainability, and the mismatch between service provision and actual demands. The needs for voluntary services mainly focuses on emotional comfort, Cultural and recreational, and knowledge acquisition.

CONCLUSION

Older adults in nursing home organizations have varied voluntary experiences, and their voluntary service needs are diversified. Voluntary service needs of older adults should be accurately assessed, and voluntary service activities should be focused upon.

Preference of primary care patients for home-based healthcare and support services: a discrete choice experiment in China

Importance

This research, utilizing discrete choice experiments, examines the preferences and willingness to pay for home-based healthcare and support services among residents in China, a country grappling with severe aging population, an area often underexplored in international scholarship.

Objectives

This study aims to solicit the preferences of primary care patients for home-based healthcare and support services in China.

Design setting and participants

A discrete choice experiment (DCE) was conducted on 312 primary care patients recruited from 13 community health centers in Wuhan and Kunming between January and May 2023. The experimental choice sets were generated using NGene, covering five attributes: Scope of services, health professionals, institutions, insurance reimbursements, and visiting fees.

Main outcomes and measures

The choice sets were further divided into three blocks, and each participant was asked to complete one block containing 12 choice tasks. Mixed logit models were established to estimate the relevant importance coefficients of and willingness to pay for different choices, while Latent Class Logit (LCL) modeling was conducted to capture possible preferences heterogeneity.

Results

The relevant importance of the scope of services reached 67.33%, compared with 19.84% for service institutions and 12.42% for health professionals. Overall, respondents preferred physician-led diagnostic and treatment services. LCL categorized the respondents into three groups: Group one (60.20%) was most concerned about the scope of services, prioritizing disease diagnosis and treatment over preventive care and mental health, while group two (16.60%) was most concerned about care providers (hospitals and medical doctors were preferred), and group three (23.20%) was most concerned about financial burdens.

Conclusion

Primary care patients prefer physical health and medical interventions for home-based healthcare and support services. However, heterogeneity in preferences is evident, indicating potential disparities in healthcare and support at home services in China.

Evaluation of China's long-term care insurance policies

Introduction

In response to the increasing demand for long-term care services for older people, the Chinese government has launched a pilot program for long-term care insurance (LTCI) since 2016. The objective of this study is to evaluate the performance and effectiveness of this program in China and provide recommendations for the future development and expansion of the LTCI system.

Methods

We developed a comprehensive evaluation framework to assess these LTCI policies implemented in all 49 pilot cities in China.

Results

Based on our evaluation, the average assessment score for the LTCI program across all pilot cities was 71.8 points, with scores ranging from 57.5 to 92.5 points in these cities. Furthermore, most of the pilot cities achieved higher scores in the fact-based assessment compared to the value-based assessment.

Discussion

The results suggested that the overall pilot effect regarding LTCI was favorable, but there were significant regional disparities. Moreover, in most of pilot cities, current LTCI policies were designed to alleviate both the financial burden and the burden of caring for people with disabilities that families faced. However, some challenges still remained, such as the lack of community and home-based care services, the need to expand the coverage of insurance, and the importance of diversifying funding sources.

Implementing age-friendly policies in China: Assessing the impact on older adults' self-rated health

Using prefecture-level policy documents (2008-2018) and the China Health and Retirement Longitudinal Study (2011-2018), this study used fixed-effects regressions to examine the associations between the maturity of two age-friendly policies, i.e., old age care (OAC) and preferential treatment (PT) policies for older adults, and the self-rated health (SRH) of older adults. We use policy duration and policy density to measure policy maturity. The results showed positive relationships exist between the density of OAC and PT policy and older adults' SRH, whereas long policy duration often relates to lower SRH. Policy duration and policy density work synergistically. Furthermore, heterogeneity analyses indicated that older adults aged over 75 years, male, those with physical or mental impairment, and living in rural areas and in the first- and second-tier cities benefit significantly from denser OAC policy. The SRH of older adults suffering from physical disabilities or mental problems and living in rural areas is positively associated with denser PT policy. From a policy perspective, our findings suggest that age-friendly policies should be updated over time and be place- and characteristic-tailored.

The mediating role of children's intergenerational support in association between grandparenting and cognitive function among middle-aged and older Chinese: findings from the CHARLS cohort study

OBJECTIVES

With the world's population increasing in age, there has been a significant rise in the prevalence of cognitive impairment and dementia among individuals. This study aims to investigate the association between grandparenting and cognitive function among middle-aged and older Chinese using data from 2011 to 2018 China Health and Retirement Longitudinal Study (CHARLS). Additionally, the study seeks to explore the potential mediating effect of intergenerational support from children on this relationship, using data from the CHARLS 2011 database.

METHODS

5254 participants were recruited at the baseline survey in CHARLS 2011. Subsequently, a follow-up survey was conducted over 8 years, from CHARLS 2011 to 2018, with 1472 individuals completing the follow-up survey. The CHARLS included surveys on grandparenting and cognitive assessments. Grandparenting was categorized as yes and no. The assessment of cognitive function involved the evaluation of episodic memory and mental intactness. The present study used cross-sectional and longitudinal analyses to examine the relationship between grandparenting and cognitive function. The bootstrap method assessed the mediating effect of children's intergenerational support.

RESULTS

The results of both cross-sectional and longitudinal studies indicated a positive association between grandparenting and cognitive function in middle-aged and older Chinese (B = 0.138, p < 0.05; B = 0.218, p < 0.05). Children's emotional and economic support played intermediary roles between grandparenting and cognitive function.

CONCLUSION

The results emphasized the significance of policymakers considering the consequences of intergenerational care and family support when formulating and executing social service policies targeted at the middle-aged and older population in China.

Sex Differences in the Relationship Between Emotional Support and Self-rated Health among Chinese Elderly

PURPOSE

This study aimed to explore sex differences in the association between emotional support and self-rated health among the elderly.

DESIGN

This was a cross-sectional survey based on the sub-project of China's National Basic Public Health Service Project-Health Management Services for the Elderly.

SETTING

Participants were recruited from ten rural townships in Jingyuan County, Gansu Province, Northwestern China.

SUBJECTS

1405 subjects aged 60 or above.

METHODS

Emotional support (consisting of 5 items) and self-rated health (evaluated by EQ-VAS) were investigated in this study. Multiple linear regression was conducted to consider the potential relationship.

RESULTS

The frequency of children visit and the number of providers of emotional support were positively associated with self-rated health among older women (β = 1.13, 95%CI = 0.25-2.02; β = 1.80, 95%CI = 1.01-2.58), whereas the number of close friends had a positive association with self-rated health among older men (β = 1.11, 95%CI = 0.20-2.01). The number of close relatives and the frequency of seeking emotional support were not found to be associated with self-rated health among both older men and older women.

CONCLUSION

The study has found that the relationship between emotional support and self-rated health was differed by sex, calling attention to the need for sex-specific interventions.

Utilisation of community healthcare services among older adults with disabilities in Luohu district, Shenzhen: a community-based survey

OBJECTIVE

China faces the challenge of an ageing population with disabilities. Community healthcare centres (CHCs) serve as frontline community healthcare providers for older adults with and without disabilities. Despite their significance, there is a lack of literature examining the utilisation of CHC services among older adults. This study aims to examine and compare the utilisation and satisfaction of CHC healthcare services among older adults with and without disabilities.

SETTING

Data from the 2019 Community Health Diagnosis Questionnaire, which interviewed 259 older adults residing in the Luohu district of Shenzhen, were used in the current study.

PRIMARY OUTCOME MEASURES

Participants self-reported outcomes including use of CHCs, use of home health services from CHCs and satisfaction with CHCs. Five different disability types and an integrated disability variable were assessed as independent variables. Linear probability models were used to determine the relationship between disability types and outcome variables.

RESULTS

Among 259 older adults aged 60 years and older, 70.66% self-identified as having a disability. No statistically significant associations were found between the use of CHCs, the use of home health services from CHCs and satisfaction with CHCs, and disability status. However, older adults with mobility and cognitive disabilities were more likely to receive home health services from CHCs.

CONCLUSION

Community health promotion policies should be implemented to improve access to health services for older adults with and without disabilities. In addition, CHCs should implement effective health management plans to ensure the health needs of older adults with disabilities.

Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?

BACKGROUND

This study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas.

METHODS

The data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas.

RESULTS

The prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001).

CONCLUSIONS

Our study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.

Pathways to Improve Provision of Home and Community-Based Services-A Configurational Approach Based on a Fuzzy-Set Qualitative Comparative Analysis From China

Providing home and community-based services (HCBS) is critical for active and healthy aging. However, in China, the positive factors for improving HCBS provision are unclear, limiting its contribution to improving older adults' quality of life and promoting active and healthy aging. Therefore, this study examines the configurations that produce differences in HCBS and identifies multiple pathways for improving them and narrowing regional disparities. Using data from multiple datasets comprising 23 cases, we performed configuration analysis using fuzzy-set qualitative comparative analysis. Four pathways producing high HCBS provision and three pathways producing low HCBS provision were found. Different combinations of the aging population, economic development, institutional support, financial support, and development of multiple stakeholders influence HCBS provision. Thus, measures based on the main factor characteristics should be implemented to improve the HCBS provision level.

Bridging the Gap: Investigating the Link between Inflammasomes and Postoperative Cognitive Dysfunction

Postoperative cognitive dysfunction (POCD) is a cluster of cognitive problems that may arise after surgery. POCD symptoms include memory loss, focus inattention, and communication difficulties. Inflammasomes, intracellular multiprotein complexes that control inflammation, may have a significant role in the development of POCD. It has been postulated that the NLRP3 inflammasome promotes cognitive impairment by triggering the inflammatory response in the brain. Nevertheless, there are many gaps in the current literature to understand the underlying pathophysiological mechanisms and develop future therapy. This review article underlines the limits of our current knowledge about the NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3) inflammasome and POCD. We first discuss inflammasomes and their types, structures, and functions, then summarize recent evidence of the NLRP3 inflammasome's involvement in POCD. Next, we propose a hypothesis that suggests the involvement of inflammasomes in multiple organs, including local surgical sites, blood circulation, and other peripheral organs, leading to systemic inflammation and subsequent neuronal dysfunction in the brain, resulting in POCD. Research directions are then discussed, including analyses of inflammasomes in more clinical POCD animal models and clinical trials, studies of inflammasome types that are involved in POCD, and investigations into whether inflammasomes occur at the surgical site, in circulating blood, and in peripheral organs. Finally, we discuss the potential benefits of using new technologies and approaches to study inflammasomes in POCD. A thorough investigation of inflammasomes in POCD might substantially affect clinical practice.

Aging population and digital inclusive finance, a natural experiment from china

This paper studies the role played by the digitization level of inclusive finance for the aging population. We leverage an unexpected Chinese national strategy that promotes mobile internet and other internet related integration in China to identify the impact of changes in state policies on the digitization level for inclusive finance in a regression discontinuity design. Although aging population is negatively correlated with the digitization level of inclusive finance, our empirical analysis reveals that the policy shock significantly increased the digitization level of inclusive finance among the aging population. We also find two opposite mechanisms: the income effect and the caring effect. Finally, our study suggests that the economic and social outcomes of the digitization level among aging population are bifurcated: happiness decreased but real estate investment increased.

The operational experience of private owners of small-sized care homes in China: a qualitative study

BACKGROUND

Private small-sized care homes (<50 beds)  have proliferated across China, however, until recently little was known about the characteristics of such institutions, and the challenges and the problems faced by their owners. This study aimed to explore the characteristics of small-sized, privately-owned care homes in the People's Republic of China; and to understand the motivation and challenges faced by their owners.

METHODS

This study used an interpretative phenomenological analysis approach of qualitative research. Owners of eight small-sized private care homes located in two cities of Henan Province, China, were interviewed using semi-structured interviews.

RESULTS

Four themes and eight subthemes were identified: 1. Motivation for establishing a care home business; 2. Certification and establishing a legal footing for the business; 3. Operational challenges; 4. Future business development. The study found that the development of privately owned small-sized care homes faced great challenges and critical survival problems due to policies, staffing, and management issues. There is a lack of regulations about the safety and quality of care provided for older people and a lack of legal protections for the owners of small-sized private care homes.

CONCLUSION

The study suggests that formal regulations and provisions are needed to support these smaller-sized private care homes. Monitoring is also needed to ensure the quality of care. It also suggests that there needs more support by policymakers as well as provision monitoring services to improve quality of care in these care homes. Care regulations and standards are not unique to China so findings from this study can be applied to places where there are similar situations or if there are aged care services still developing.

Factors associated with the perceived need for assistance from voluntary services in home-based older adults in Chinese urban areas: a cross-sectional study

BACKGROUND

With China's rapidly aging population, meeting the diverse care needs of senior citizens is becoming more challenging. Although voluntary social services have numerous advantages and are popular among older adults, there is little information on the need for assistance from volunteer-based social services, particularly those with a medical background, and influencing factors among urban home-based older adults. This study aimed to assess the need for assistance from voluntary services and related factors among urban home-based older adults in China.

METHODS

A cross-sectional study was conducted in 2022 on communities in four cities in China. The 27-item Home-Based Older Adults Assistance Need Scale was used to measure the assistance needs of 498 participants aged 60 and above. Multiple linear regression models were conducted to identify salient variables associated with the need for assistance from voluntary services.

RESULTS

The mean score of the need for assistance from voluntary services was 88.60 ± 24.37. The mean scores of the items examining four dimensions, namely, health maintenance, visiting communication, social intercourse, and daily life, were 3.64 ± 1.08, 3.49 ± 1.04, 3.33 ± 1.08, and 2.78 ± 1.08, respectively. The level of depression, willingness to assist older adults, attaching importance to health preservation, ability to self-comfort, desire to accept assistance from others, and the presence of more children or none at all were all positively correlated with the perceived need for assistance from voluntary services. In contrast, social care obtained from visiting medical institutions was negatively correlated. These seven factors explained 28.5% of the total variance.

CONCLUSIONS

Urban home-based older adults in China were found to have significant requirements for assistance from volunteer services, and several complex factors were associated with more significant assistance needs. These findings may encourage the extremely limited numbers of social volunteers, particularly those with a medical background, to identify priorities in providing assistance services to the large numbers of urban home-based older adults and thus improve service delivery.

Use of home and community-based services and loneliness in older people with functional limitations: a cross-sectional study

BACKGROUND

Loneliness is one of the major health problems among older adults. Among this population, home and community-based services (HCBS) have become increasingly popular. Despite its health benefits, little is known about the relationship between HCBS use and loneliness in older people with functional limitations. We aim to explore the characteristics of loneliness among older people with functional limitations and examine the association between HCBS use and loneliness in China.

METHODS

We used a cross-sectional data from the 2018 China Health and Retirement Longitudinal Study, which includes a nationally representative sample of Chinese residents aged 65 and older with functional limitations. Logistic regression models were used to examine the associations between HCBS use and loneliness, and we further used propensity score matching to address potential sample selection bias.

RESULT

In China, 46% of older people with functional limitations felt lonely and only 22% of older people with functional limitations reported using HCBS in 2018. Compared with participants who did not receive HCBS, those who received HCBS were less likely to report loneliness (OR = 0.81, 95% CI = 0.63, 0.99, p = 0.048), and the results remained significant after addressing sample selection bias using propensity score matching.

CONCLUSION

Our results showed that loneliness was common among Chinese older people with functional limitations, and the proportion of HCBS use was low. There was robust evidence to support that among older people with functional limitations, HCBS use was associated with decreased loneliness. Further policies should promote the development of broader HCBS use for older people with functional limitations to reduce their loneliness.

Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach

Background

The ageing population in China has led to a significant increase in the number of older persons with disabilities. These individuals face substantial challenges in accessing adequate activities of daily living (ADL) assistance. Unmet ADL needs among this population can result in severe health consequences and strain an already burdened care system. This study aims to identify the factors influencing unmet ADL needs of the oldest old (those aged 80 and above) with disabilities using six machine learning methods.

Methods

Drawing from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2017-2018 data, we employed six machine learning methods to predict unmet ADL needs among the oldest old with disabilities. The predictive effects of various factors on unmet ADL needs were explored using Shapley Additive exPlanations (SHAP).

Results

The Random Forest model showed the highest prediction accuracy among the six machine learning methods tested. SHAP analysis based on the Random Forest model revealed that factors such as household registration, disability class, economic rank, self-rated health, caregiver willingness, perceived control, economic satisfaction, pension, educational attainment, financial support given to children, living arrangement, number of children, and primary caregiver played significant roles in the unmet ADL needs of the oldest old with disabilities.

Conclusion

Our study highlights the importance of socioeconomic factors (e.g., household registration and economic rank), health status (e.g., disability class and self-rated health), and caregiving relationship factors (e.g., caregiver willingness and perceived control) in reducing unmet ADL needs among the oldest old with disabilities in China. Government interventions aimed at bridging the urban-rural divide, targeting groups with deteriorating health status, and enhancing caregiver skills are essential for ensuring the well-being of this vulnerable population. These findings can inform policy decisions and interventions to better address the unmet ADL needs among the oldest old with disabilities.

Unmet Needs and Associated Factors among Community-living Older People with Disability in China: 2005-2014

Based on the Chinese Longitudinal Healthy Longevity Survey from 2005 to 2014, this study estimated the prevalence and examined risk factors of under-met needs and completely unmet needs for assistance in activities of daily living (ADLs) among community-living older people with disability in China. As of 2014, over 50% of community-living Chinese elders with disability experienced under-met needs, and nearly 5% had completely unmet needs. From 2005 to 2014, the proportion with completely unmet needs doubled for all disabled elders. Significant risk factors of under-met needs included lower per capita annual household income, more ADL limitations, living alone, and fewer living children, and those of completely unmet needs included less ADL limitations and living alone. More policy attention should be paid to address the gap between long-term care services for older persons with severe disability and supportive services for those who are relatively healthy, toward ultimately establishing a care continuum for the elderly at all stages of their life course. In addition, family care for elders with severe functional impairments should be supplemented by professional long-term care services to best meet their needs.

Effects of the Long-term Care Insurance on Health Among Older Adults: A Panel Data From China

BACKGROUND

China's long-term care insurance (LTCI) has been launched since 2016 to ensure that older disabled people obtain affordable care services. However, rigorous evaluations of the health effects of China's LTCI pilots have been limited. This paper aimed to examine the effects of LTCI on health among older adults aged 60 years and above.

METHODS

Drawing from panel data of the China Health and Retirement Longitudinal Study (CHARLS), we used a propensity score matching (PSM) and difference-in-difference (DID) approach to identify the health effects of the LTCI program and reduce the selection bias. Further, heterogeneity of the effects was examined by physical and intellectual function to evaluate whether the effects differed among subgroups of older population.

RESULTS

The implementation of LTCI significantly improved self-rated health (β = 0.15, P<.05) and cognitive function (β = 0.59, P<.01) for older adults. The results were robust when keeping only those living in pilot cities (β = 0.31, P<.05 for self-rated health status; β = 0.98, P<.001 for cognitive function) or non-pilot cities (β = 0.14, P<.05 for self-rated health status; β = 0.60, P<.01 for cognitive function) as the control group. The effects of LTCI were especially manifested in older adults with physical disability (β = 0.13, P<.01 for self-rated health; β = 0.76, P<.001 for cognitive function) or intellectual disability (β = 0.16, P<.01 for self-rated health).

CONCLUSION

From a policy perspective, these findings suggested that LTCI in China could benefit the health outcomes of older adults, especially those with physical or cognitive disabilities. Policy-makers can target resources more effectively to improve health outcomes for the most vulnerable populations.

Association between home and community-based services and depressive symptoms in Chinese older adults: a multilevel analysis

BACKGROUND

As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have been increasingly important in China. However, the association between HCBSs utilization and depressive symptoms in older adults in China is unclear. Consequently, this study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults.

METHODS

This study included 7,787 older adults (≥ 60 years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, "What kind of HCBSs were being utilized in their community?". Data were analyzed using binary logistic regression models and generalized hierarchical linear models (GHLM).

RESULTS

Of the 7,787 participants, 20.0% (n = 1,556) reported that they utilized HCBSs, and 36.7% (n = 2,859) were evaluated that they had depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.180, 95% CI: 1.035-1.346, p < 0.05). Additionally, the depressive symptoms were significantly associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health (SRH), smoking, and provincial Gross Domestic Product (GDP) per capita.

CONCLUSIONS

This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is of utmost significance for the government to provide targeted HCBSs at the community level to address the unmet care needs of older adults, which can reduce the occurrence of negative emotions, consequently contributing to less severe depressive symptoms.

Level of humanistic care ability and its influencing factors among nursing aides in long-term care facilities

OBJECTIVE

To determine the level and influencing factors of the humanistic care ability (HCA) in nursing aides, thus providing a baseline for its improvement.

METHODS

This study investigated 302 nursing aides in six long-term care facilities (LTCFs) in Suzhou between December 2021 and June 2022 by convenience sampling. A descriptive questionnaire and the Caring Ability Inventory were applied in this study.

RESULTS

The HCA was at a low level, and its influencing factors were education level, marital status, personality, reason for employment, and the degree of perceived care from colleagues (p<0.05).

CONCLUSIONS

Nursing aides' HCA needs to be strengthened urgently. Nursing aides with poor education, widowed, single, and an introversion type of personality should receive more attention. Additionally, creating a warm atmosphere among colleagues and cultivating the nursing aides' motivation for eldercare will help improve their HCA.

The impact of older adult care policy mixes on the construction of senior centers

The problem of an aging population is becoming increasingly serious, and the establishment of senior centers helps to promote the physical health and mental health of the older adult, a key factor in achieving the high-quality development of the old-age security industry. The government has issued a number of policies to promote the establishment and development of senior centers. However, more and more older adult care policy mixes have gradually shown the phenomenon of poor policy connection, confusing standards, and even mutually exclusive content, resulting in many problems in the construction of policy-driven senior centers. Therefore, based on the overall perspective of the older adult care policy mix, this paper uses the GMM method to explore the impact of the comprehensiveness, balance, and consistency of older adult care policy tool portfolios issued by Chinese government agencies on the construction of senior centers in China. The empirical analysis results show that a comprehensive and consistent policy mix can promote the establishment of senior centers, while the balance of the policy mix will inhibit the establishment of senior centers. This paper analyzes the impact of older adult care policy on the construction of senior centers from the perspective of the policy mix, which helps to clarify the different policy effects produced by different policy mix characteristics and provides feasible policy suggestions for the government to formulate more reasonable and effective policies.

Rural-urban disparities in the unmet need for home visiting services among oldest-old in China: Changes over time and decomposition analysis

PURPOSE

This study aims to assess trends in rural-urban disparities in the prevalence of unmet community-based home visiting services need and their contributing factors from 2005 to 2018 among oldest-old in China.

METHODS

The Chinese Longitudinal Healthy Longevity Survey data of oldest-old collected with a targeted random-sampling approach from half of counties/cities from 23 provinces across China was used. Unmet need was measured as the differences between healthcare services expected and available. We used Cochran-Armitage tests to test linear trends in prevalence of unmet need. Average marginal differences were estimated to measure magnitude of rural-urban disparities in prevalence of unmet need. Changes in rural-urban disparities were decomposed using Blinder-Oaxaca Decomposition technique to logit models. All analysis was performed by Stata 15.0.

RESULTS

From 2005-2018, decreased trends in prevalence of unmet need were observed (overall: 62.4% to 48.6%; rural: 65.9% to 47.3%; urban: 57.5% to 49.8%) (all p_trend < 0.001). In 2017/2018, urban oldest-old reported greater prevalence of unmet need (average marginal difference, 95% CI: 3.7% [0.4%-7.1%]); affluent oldest-old reported less unmet need than their peers. Oldest-old from Central and Western China reported greater prevalence of unmet need than their Eastern peers. Increases in income (percentages of explained change, overall: 21.3%; rural: 16.9%, urban: 36.9%) mainly contributed to decreased trends in prevalence of unmet need.

CONCLUSIONS

Oldest-old with socioeconomic disadvantages or living in Central and Western China reported greater prevalence of unmet need. Policy efforts are warranted to ensure equitable access to home visiting services among those oldest-old.

Public long-term care insurance and consumption of elderly households: Evidence from China

This study investigates the impact of long-term care insurance (LTCI) on the non-health consumption of elderly households. By exploiting a quasi-experiment on the public LTCI pilot program in China, we identify the effect of LTCI using a triple-difference approach. Using longitudinal data from the China Health and Retirement Longitudinal Study, we find that LTCI has led to an increase in the non-health consumption of elderly households by 15.7%, mostly observed in households having no older members with need for long-term care (LTC). Further evidence suggests that the effects are stronger for households with higher expected LTC risks, less wealth or family insurance, and covered by more generous schemes. Finally, LTCI increases the expectation of using formal LTC when disabled and subjective longevity expectations for older adults having no need for LTC. Overall, these findings offer empirical support for the role of LTCI in mitigating precautionary savings against LTC risks.

Trends in the availability of community-based home visiting services for oldest-old in China, 2005-2018

OBJECTIVES

This study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China.

DESIGN

Repeated, cross-sectional study.

SETTING

This study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey.

PARTICIPANTS

A final analytical sample of 38 032 oldest-old individuals.

PRIMARY OUTCOME MEASURES

Availability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics.

RESULTS

Of 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018.

CONCLUSIONS

Despite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.

Trends in the availability of community-based psychological counselling services for oldest-old in China, 2005 to 2018

BACKGROUND

Community-based psychological counselling services (CPCS) is crucial for the oldest-old who often faces challenges or are reluctant to seek care at the healthcare settings. This study aims to examine trends in availability of CPCS over time and rural-urban disparities in service availability among nationwide oldest-old in China.

METHODS

Multiple cross-sectional data were derived from the 2005-2018 Chinese Longitudinal Health Longevity Survey. Service availability was reported by each oldest-old participant or their next-of-kins as having CPCS in one's neighborhood. We used Cochran-Armitage tests to estimate service availability trends and applied sample-weighted logistic regression models to examine its rural-urban disparities.

RESULTS

Of 38,032 oldest-old, CPCS availability decreased from 6.7 % in 2005 to 4.8 % in 2008/2009, followed by continual increases to 13.6 % in 2017/2018. In 2017/2018, rural oldest-old's neighborhoods had no greater service availability. Oldest-old residing in the Central (6.7 %), Western (13.4 %) and Northeast China (8.1 %) were less likely to report having services locally than their Eastern counterparts (17.8 %). Oldest-old having any disability or living in the nursing homes reported having greater service availability than those without disability or living at home.

LIMITATION

Service availability might have disrupted during the COVID-19 pandemic.

CONCLUSIONS

Despite the increasing service availability, as of 2017/2018, only 13.6 % oldest-old in China had reported CPCS availability. It raises concerns on the disproportionate access to and continuity of mental health care, especially for those living the Central, Western China and those living at home. Policy efforts are needed to incentivize service expansion and eliminate disparities in the service availability.

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

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.

The Role of Contextual Factors in Shaping Urban Older Adults' Intention of Institutional Care in China: A Mixed-Methods Study

BACKGROUND

This mixed-methods study explores older people's intention of institutional care and its contributing contextual factors, and the meaning given to their intention by older adults in the transitioning Chinese society.

METHODS

Guided by the extended Anderson model and frameworks of the ecological theory of aging, survey data collected from 1937 Chinese older adults were used. Transcripts from six focus group interviews were analyzed to incorporate the voices of the participants.

RESULTS

Community environment and services, health services, financial services, and regional service organizations were related to the institutional care intention of older people. The qualitative analysis showed that the reported conflicting feelings about institutional care was driven by the lack of supporting resources and age-friendly environment. The findings of this study suggested that the reported intention of Chinese older adults for institutional care may not be an ideal choice but a compromise or, in some cases, a forced choice.

CONCLUSIONS

Rather than treating the stated institutional intention as a simple expression of older Chinese people's likes or desires, the intention of institutional care should be understood within a framework that fully considers the influence of psycho-social factors and contextual organizations.

"It's your Liangxin that tells you what to do": Interpreting workplace-induced emotions in a Chinese nursing home

How Direct Care Workers (DCWs) interpret their work and perform care activities undeniably impacts the well-being of institutionalized older adults. Despite the emotionally charged nature of paid care work, little is known about how Chinese DCWs talk about their work and construct meaning within China's unique social context of a burgeoning institutional care market and changing cultural expectations for long-term care. This study qualitatively explored Chinese DCWs' emotion work as they navigate among institutional pressures and low social recognition in an urban government-sponsored nursing home in central China. Results revealed that DCWs used Liangxin (the good heart/mind) - a ubiquitous Chinese moral notion emphasizing the unity of feeling, thought, and action - as an interpretive framework, including its four dimensions (ceyin, xiue, cirang, and shifei), to inform care practice, manage emotions, and find dignity within what can be personally demeaning and socially devalued work. Our study delineated the processes through which DCWs sympathized with the pain and struggles of the older adults in their care (ceyin xin), shamed unjust attitudes and behaviors embedded in institutional care (xiue xin), delivered family-like relational care (cirang xin), and formed and reinforced principles of good (versus bad) care (shifei xin). We also revealed the nuanced role that the cultural value of xiao (filial piety), working in tandem with liangxin, both shaped the emotional terrain of the institutional care setting and impacted how DCWs engaged in emotion work. While recognizing the effect of liangxin for incentivizing DCWs to provide relational care and renegotiate their role status, we were also alerted to the risks of overburdening and exploiting DCWs who relied solely on their liangxin to meet complex care needs.

Evolutionary Game Analysis of Behavior Strategies of Multiple Stakeholders in an Elderly Care Service System

As the aging of Chinese society continues to deepen, it is particularly important for the development of the national elderly care service industry to further strengthen the government's supervision of private pension institutions and improve their management awareness of standardized operations. The strategic behaviors among the participants of senior care service regulation have not been well studied yet. In the process of senior care service regulation, there is a certain game association among three stakeholders, namely, government departments, private pension institutions, and the elderly. This paper firstly constructs an evolutionary game model including the above three subjects and analyzes the evolutionary path of strategic behaviors of each subject and the evolutionary stabilization strategy of the system. On this basis, the feasibility of the evolutionary stabilization strategy of the system is further verified through simulation experiments, and the effects of different initial conditions and key parameters on the evolutionary process and results are discussed. The research results show that (1) There are four ESSs in the pension service supervision system, and revenue is the decisive factor that affects the evolution of the stakeholders' strategy. (2) The final evolution result of the system is not necessarily related to the initial strategy value of each agent, but the size of the initial strategy value will affect the rate of each agent's evolution to a stable state. (3) The increase in the success rate of government regulation, subsidy coefficient and punishment coefficient, or the reduction in the cost of regulation and the fixed subsidy for the elderly can effectively promote the standardized operation of private pension institutions, but the large additional benefits will lead to their tendency to operate in violation of regulations. The research results can provide reference and a basis for government departments to formulate the regulation policy for elderly care institutions.

The impact of home and community care services pilot program on healthy aging: A difference-in-difference with propensity score matching analysis from China

BACKGROUND

Home and community care service (HACCS) is an important policy response worldwide to the growing and unmet care needs of the aging population. In China, the government also started to implement a HACCS pilot program in 2016. This study aims to evaluate the association of HACCS utilization with healthy aging in Chinese older adults.

METHODS

This study followed a quasi-experimental design and derived data from the nationwide China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. We employed the propensity score matching with difference-in-difference approach (PSM-DID) to examine the association between HACCS and healthy aging indicators.

RESULTS

A total of 8345 older adults were incorporated for a final sample. The results indicated that HACCS utilization was associated with significantly reduced functional limitations (β for BADL=-0.124, β for IADL=-0.210; P<0.01) and depression (β=-0.386, P<0.05) as well as improved cognitive function (β=0.609, P<0.001), life satisfaction (β=0.083, P<0.01) and social participation (β=0.105, P<0.01) in older people, although its association with reduced disability was non-significant (β=-0.005, P = 0.676). The heterogeneous tests further found that rural older adults and older adults aged<80 were more likely than their counterparts to benefit from the HACCS utilization in specific healthy aging indicators such as cognitive function.

CONCLUSIONS

The implementation of the HACCS program benefited a range of healthy aging domains among older adults in China. Policymakers are encouraged to further expand the program implementation and also continue to improve the services list and care quality of HACCS.

Elderly people's preferences for healthcare facilities in Shanghai: gender features and influencing factor analysis

BACKGROUND

China has one of the fastest paces of the growing aging population, High-level policymakers have recently recognized the aging population presents significant challenges to the Chinese healthcare system. In this context, the healthcare-seeking behaviors of the elderly population have become an essential field of study. It is necessary to understand their access to health services and to improve their quality of life, as well as to help policymakers to formulate healthcare policy. The study empirically investigates the factors influencing the elderly population's healthcare-seeking behaviors in Shanghai, China, especially in choosing the quality of healthcare facilities to visit.

METHODS

We designed a cross-sectional study. The data of this study were derived from the "Shanghai elderly medical demand characteristics questionnaire" in the middle of November to early December 2017. A total of 625 individuals were included in the final sample. Logistic regression was adopted to investigate the differences in healthcare-seeking behaviors between elderly people when suffer from mild illness, severe illness and follow-up treatment. Next, the differences in gender were also discussed.

RESULTS

Factors affecting the healthcare-seeking behaviors of the elderly differ in mild illness and severe illness situations. For mild illness, demographic factors (gender and age) and socioeconomic factors (income and employment) play an important role in elderly healthcare choices. Female and older elderlies are more likely to choose local, lower-quality facilities, whereas those with high income and private employment are more likely to choose higher-quality facilities. For severe illness, socioeconomic factors (income and employment) are important. Furthermore, individuals with basic medical insurance are more likely to choose lower-quality facilities.

CONCLUSION

This study has shown that the affordability of public health services should be addressed. Medical policy support may be an important way to reduce the gap in access to medical services. We should pay attention to the gender differences in the elderly's choice of medical treatment behavior, consider the differences in the needs of male and female elderly. our findings are only for elderly Chinese participants in the greater Shanghai area.

Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China

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.

Physical disability, low self-esteem, and suicidal ideation among Chinese nursing home residents: the moderating role of resilience

OBJECTIVES

This study aimed to investigate the mediating role of self-esteem in the relationship between physical disability and suicidal ideation, and whether the mediation effect was moderated by resilience among nursing home residents.

METHODS

Participants were 538 nursing home residents recruited from 37 nursing homes in Jinan, China (mean age = 78.13 years, SD = 8.72). The Lawton and Brody Activities of Daily Living Scale, Rosenberg Self-Esteem Scale, 10-item version of the Connor-Davidson Resilience Scale, and Beck Suicidal Ideation Inventory-Chinese Version were used. Mediation and moderated mediation analyses were performed using Models 4 and 15 of the PROCESS macro for SPSS.

RESULTS

The prevalence of suicidal ideation among the nursing home residents was 14.90%. The mediation analysis showed that self-esteem partially mediated the association between physical disability and suicidal ideation. Resilience was a protective factor for suicidal ideation and moderated the relationship between physical disability and suicidal ideation, and between self-esteem and suicidal ideation.

CONCLUSION

Both physical disability and lower self-esteem are important in understanding the development of suicidal ideation among nursing home residents. Improving resilience may be crucial for suicide prevention.

Different impact on health outcomes of long-term care insurance between urban and rural older residents in China

Long-term care insurance (LTCI) is garnering attention internationally and is being considered a public policy in a growing number of countries. Previous research has focused on the effects of LTCI in developed countries, ignoring the health outcomes of developing countries, especially in rural regions. Therefore, this study investigates whether different impact on health outcomes is present in the effects of LTCI between urban and rural residents in China. We employed a quasi-experimental design with data from the China Health and Retirement Longitudinal Survey. The specific implementation time of each pilot city was sorted according to the LTCI policy texts, dividing these pilot cities into the treatment group and control group. Finally, difference-in-differences analyses were utilized to evaluate the health effects of LTCI between urban and rural residents, and the health effect in urban areas was further tested. The implementation of LTCI has effectively enhanced the self-rating health (SRH) of the entire group of residents; however, this effect may only be significant for the urban group. In particular, LTCI can increase the SRH of urban residents by 0.377 units compared to the urban residents without LTCI (P < 0.01). The result of the placebo effect test further verifies that LTCI could improve the health of residents to some extent. In China, LTCI may have triggered different impacts on health outcomes between urban and rural residents, and may not improve the SRH of rural residents and only prove efficacious for urban residents. Government and policy-makers should give more attention to the rural group as it needs long-term care the most.

Impact of community care services on the health of older adults: evidence from China

Introduction

The rapid growth in the population of older adults has put tremendous pressure on medical and social services in countries including China. Community care services are a feasible solution for promoting healthy aging in developing countries. This study investigated the association between community care services and the health of older adults in China.

Method

Using nationally representative survey data from China, consisting of four waves conducted in 2005, 2008, 2011, and 2014, a balanced panel dataset was constructed using a sample of 4,700 older adults (33.1% aged 80 years or older, 51.0% residing in rural areas, and 48.8% women). We employed linear regression models with time-fixed effects and instrumental variable approaches to estimate the effect of community care services on the health of older adults, as well as the differences in these effects across subgroups.

Results

The results showed that community care services lead to a significant improvement in both the objective and subjective health and wellbeing of older adults. Among the various service offerings, spiritual recreation services led to a significant increase in both objective and subjective health scores, while medical care services significantly improved wellbeing. This suggests a varied effect of subdivided service types. Further evidence suggests that spiritual recreation services have a significant health-enhancing effect on multiple groups of older adults, and the effect of medical care services is more effective for those living in rural areas, women, and those who are older than 80 years (all p < 0.05).

Discussion

Few studies have examined the impact of community care services on the health of older adults in developing countries. The findings present important implications for improving the health status of older adults and provide suggestions for establishing a socialized aged care system in China.

Validating the Well-Being of Older People (WOOP) Instrument in China

Generic health-related quality of life (HRQoL) measures have been used for estimating utility value, which is then used for calculating quality-adjusted life years (QALYs). HRQoL measures may not capture many of the relevant and important non-health aspects of quality of life. The well-being of older people (WOOP) instrument was first developed in the Netherlands. This study aimed to validate this new instrument among older people in China. WOOP was first translated into simplified Chinese (for use in Mainland China) by two experienced translators. From July to August 2022, a cross-sectional study was conducted on a convenience sample of 500 older people in Southwestern China. Older people who provided consent reported their demographic information and completed the simplified Chinese version of the WOOP instrument using a pencil and paper. The feasibility of WOOP was determined by the percentage of missing responses. Then, using the data without any missing responses, we examined the item response distributions, pairwise Spearman correlations, underlying factors, and known-group validity of WOOP. Among the nine items of WOOP, three had more than 10% missing responses. The response distributions of the nine items were overall good without signs of ceiling and floor effects. The correlations among the WOOP items were low. A two-factor exploratory factor analysis model suggested that the WOOP items can be categorized into either internal or external well-being items. Good known-group validity results were found. Some WOOP items may not be easily understood by a small proportion of rural residents. However, other results have suggested WOOP to be a valid instrument for measuring the well-being of the elderly in China. The availability of WOOP enables the measurement of well-being-related utility.

Comparison of research hotspots and trends in long-term care for the elderly between China and Australia: a bibliometric analysis†

Objective: To explore the current status and development of long-term care (LTC) research in terms of publications in China and Australia, to identify the major contributing authors and institutions, and to compare the research hotspots and trends between China and Australia in order to encourage informed collaborations and work in future.

Methods: We collected bibliometric data on the LTC of the elderly in China and Australia from 2009 to 2020 using Chinese National Knowledge Infrastructure (CNKI) and Web of Science (WOS). CiteSpace software was used to analyze co-authorships, co-institutions, and co-keywords.

Results: A total of 826 articles in Chinese and 393 in English were included for analysis. The total number of publications showed an upward trend in both countries. The top 10 productive researchers and institutions in China and Australia were identified, and their collaboration network was revealed. Then, the knowledge maps of cooccurring keywords, respectively, showed the hotspots of “LTC insurance, disabled elderly, combination of medical and health care, nursing home” and “nursing home, dementia, quality of life, intervention” in China and Australia. Strong citation burst keywords illustrated the emerging trends of “combination of medical and health care, healthy aging” in China and “polypharmacy, prevention” in Australia.

Conclusions: This article provided an insight into LTC of the elderly in China and Australia, and research in this field is developing rapidly and is being increasingly valued. The findings will be useful for future researchers to facilitate collaboration, identify new topics, and support urgently needed research of LTC in China.

Urban living and chronic diseases in the presence of economic growth: Evidence from a long-term study in southeastern China

High-speed urban development has brought about an increase in per capita income in low- and middle-income countries (LMICs) as well as the high prevalence rate of chronic diseases. Based on a study of chronic diseases from 2011 to 2021 in southeastern China, we used multivariate adjusted logistic regression method to analyze the effect of urban living on the incidence of typical chronic diseases and the trend of such effect with the improvement of public healthcare system. We adopted potential mediating risk factors of urban lifestyles including body mass index (BMI), frequency of dining out, sedentary time, and psychological distress in the adjusted estimation. Baseline results indicate a positive relationship between living in urban areas and the prevalence of type 2 diabetes, hyperlipidemia, and hypertension. Regarding the mediating factors, psychological distress had the highest positive coefficient (Cr) on type 2 diabetes, hyperlipidemia, and hypertension (Cr: 0.4881-0.7084), followed by BMI (Cr: 0.1042-0.1617) and frequency of dining out (Cr: 0.0311-0.0478), and finally, sedentary time (Cr: 0.0103-0.0147). However, regression results on the follow-up survey reveal that trend in the impact of living in urban areas on chronic disease diminished as the level of the healthcare system improved. Additionally, urban living was more positively correlated with the incidence of metabolic disease than with the incidence of cardiovascular disease and cancer. Our findings provide empirical evidence that future urban health planning in LMICs should pay sustained attention to upgrading the level of public health infrastructure covering urban residents as well as rural-to-urban migrants, constructing a long-term dynamic system of chronic disease prevention and control, and regularly monitoring the mental health problems of residents in order to interrupt the process of urban chronic disease prevalence in an early stage.

The path to healthy ageing in China: a Peking University-Lancet Commission

Around the world, populations are ageing at a faster pace than in the past and this demographic transition will have impacts on all aspects of societies. In May 2020, the UN General Assembly declared 2021–2030 the Decade of Healthy Ageing, highlighting the importance for policymakers across the world to focus policy on improving the lives of older people, both today and in the future. While rapid population ageing poses challenges, China’s rapid economic growth over the last forty years has created space for policy to assist older persons and families in their efforts to improve health and well-being at older ages. As China is home to 1/5 of the world’s older people, China is often held up as an example for other middle-income countries. This Commission Report aims to help readers to understand the process of healthy ageing in China as a means of drawing lessons from the China experience. In addition, with the purpose of informing the ongoing policy dialogue within China, the Commission Report highlights the policy challenges on the horizon and draws lessons from international experience.

Secular trends of morbidity and mortality of prostate, bladder, and kidney cancers in China, 1990 to 2019 and their predictions to 2030

Background

Prostate, bladder and kidney cancers are common age-related genitourinary cancers. China's population is aging at an increasing rate, so predicting the morbidity and mortality of prostate, bladder, and kidney cancer in China is of great significance to provide epidemiological evidence for forward planning and implementation of national health policies.

Methods

Numbers of incidences and deaths by cancer (prostate, bladder and kidney), sex (male and female) and age groups from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) Study. We applied Bayesian age-period-cohort models to predict incidences and deaths to 2030. We also calculated Age-standardized incidence rate (ASIR) and mortality rate (ASMR), their trends were quantified by estimated average percentage change (EAPC) and 95% confidence interval (CI).

Results

Predictions suggest that by 2030, there will be 315,310 prostate cancer cases, 192,390 bladder cancer cases and 126,980 kidney cancer cases. The ASIRs will increase to 25.54/100,000 for prostate cancer (EAPC: 2.88, 95% CI, 2.84, 2.93), 7.54/100,000 for bladder cancer (EAPC: 2.58, 95% CI, 2.54, 2.61) and 5.63/100,000 for kidney cancer (EAPC: 4.78, 95% CI, 4.54, 5.02). Number of deaths in 2030 will be 81,540, 61,220, and 41,940, respectively. Different ASMR changes are observed, the ASMR for prostate cancer will drop to 7.69/100,000 (EAPC: -0.29, 95% CI, -0.31, -0.27), the ASMR for bladder cancer will stabilize at 2.49/100,000 (EAPC: 0.00, 95% CI, -0.02, 0.03), the ASMR of kidney cancer will increase to 1.84/100,000 (EAPC: 3.45, 95% CI, 3.22, 3.67). From 1990 to 2030, higher numbers of cases and rates are reported among males and in the 60 plus age group, both ASIR and ASMR of bladder and kidney cancers presents progressively widening differences between both males and females and between the < 60 and the ≥ 60 age groups.

Conclusion

Morbidity and mortality of the three genitourinary cancers are predicted to increase further over the next decade. It highlights the need for timely development and implementation of optimal health policies to curb the epidemic trends.

Experiences and expectations of receiving volunteer services among home-based elderly in Chinese urban areas: A qualitative study

BACKGROUND

The various complex needs for assistance among home-based older adults have increased dramatically. Thus, it would be advantageous to recruit volunteers with medical knowledge and a better understanding to support and assist the elderly living in urban communities.

AIM

This study aimed to explore the experiences and expectations of receiving volunteer services among the home-based elderly in Chinese urban areas. DESIGN, SETTING AND PARTICIPANTS: A descriptive qualitative study was conducted following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. This study was performed in two communities in Wuhan, Hubei Province. A purposive sampling method, which includes criterion and maximum variation sampling, was used to identify and select a diverse range of participants. Semistructured face-to-face interviews with 20 older adults (aged 62-90 years old) were performed. The conventional content analysis method was used for thematic analysis.

RESULTS

Three categories with associated subcategories were identified: experiences of receiving volunteer services including negative and positive experiences; specific needs for volunteer services involving physiological, psychosocial, health-related behaviours and environmental domains; characteristics of expected volunteer services including availability, formats, recipients, providers and service strategies.

CONCLUSIONS

The volunteer services provided to the home-based elderly were found to be unsatisfactory, and lacking relevance and effectiveness. Due to a lack of family support or difficulty in meeting some high-level needs, the home-based elderly expressed a strong demand for volunteer services involving physiological, psychosocial, health-related behaviours and environmental domains. This finding can provide a basis for developing training plans beneficial to volunteers. Furthermore, the present research clarifies the criteria for selecting volunteers and the necessity of supervising and managing volunteers. Improving the effectiveness and accessibility of urban-community volunteer service may reduce the burden on care institutions and home caregivers while enhancing the quality of life and well-being of the elderly.

PATIENT OR PUBLIC CONTRIBUTION

Developing research questions, study design, management and conduct and interpretation of evidence.

Perceived availability of home- and community-based services and self-reported depression among Chinese older adults: A cross-sectional study

Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression.

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

Background

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

Methods

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

Results

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

Conclusions

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