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

Zhang, Liang; Shi, Kewei; Wang, Chengzhong; Li, Zhong

doi:10.1016/j.archger.2022.104919

Cited by 3 publications

(4 citation statements)

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“…Open access of older adults with disabilities, the increasing travelling burdens to get to and from clinician practice locations, pervasive polypharmacy and high-risk medications 13 and the individuals' preferences for home health vs hospital care 12 have sparked the increasing need for home visiting services. 14 Home visiting services, which usually include preventivepromotive care, medications, long-term maintenance care, hospice care and rehabilitative services provided in the patients' home, offer an opportunity to reach patients with healthcare needs, those lacking transportation or those with limited mobility. 15 Home visiting services have been proven effective in reducing the occurrence of medication errors, avoiding hospitalisation or institutionalisation and reducing costs in older adults.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“… 12 The growing population of older adults with disabilities, the increasing travelling burdens to get to and from clinician practice locations, pervasive polypharmacy and high-risk medications 13 and the individuals’ preferences for home health vs hospital care 12 have sparked the increasing need for home visiting services. 14 …”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, many older adults prefer staying at home or in their community rather than relocating to institutions, such as assisted living and nursing homes, despite their increasing healthcare needs 12. The growing population of older adults with disabilities, the increasing travelling burdens to get to and from clinician practice locations, pervasive polypharmacy and high-risk medications13 and the individuals’ preferences for home health vs hospital care12 have sparked the increasing need for home visiting services 14…”

Section: Introductionmentioning

confidence: 99%

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

Xuan

Gao

et al. 2023

BMJ Open

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ObjectivesThis 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.DesignRepeated, cross-sectional study.SettingThis study derived nationally representative data from the 2005–2018 Chinese Longitudinal Health Longevity Survey.ParticipantsA final analytical sample of 38 032 oldest-old individuals.Primary outcome measuresAvailability 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.ResultsOf 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.ConclusionsDespite 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.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Xuan

Gao

et al. 2023

BMJ Open

Self Cite

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“…In addition, due to the urban rural dual social security system in China, older rural residents received lower pension support ( 38 ). Moreover, there are urban–rural disparities in CBLTCS ( 39 ). Furthermore, with the accelerated process of urbanization, massive younger populations have traveled to cities to earn income ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China

Sun

De-sheng

2023

Front. Public Health

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ObjectiveThe 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.MethodsWe 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).ResultsThis 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.ConclusionThis 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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Temporal dynamics of unmet long-term care needs in China: an age period cohort analysis

Zhang

2024

Ageing and Society

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Rapid demographic changes and heavy reliance on informal care pose significant challenges to meeting long-term care (LTC) needs in China. Understanding changes in unmet LTC needs across different times and places can inform future LTC system planning and care resource allocation, identifying emerging care needs and services gaps in different regions. Drawing on data from 6,030 urban and 5,070 rural residents in the Chinese Longitudinal Health Longevity Survey 2005–2017/18, this study investigates variations in unmet LTC needs across different age groups, periods and birth cohorts among Chinese older adults and their place-based rural–urban differences. We applied the age-period-cohort interaction model to disentangle the three temporal processes, and found that, overall, rural older adults experienced higher risk of unmet LTC needs and had larger variation in age effects, yet the age, period and cohort effects on unmet needs among rural older people differed from their urban counterparts. Although ‘younger’ older adults (aged below 85) had fewer care needs than older adults, they had a higher risk of experiencing unmet needs. The risk of having unmet needs did not change significantly over the 12 years, though unmet LTC needs were more pronounced among more-recent cohorts than previous generations, especially in urban areas. The findings contribute to the social gerontology debate regarding changing patterns in unmet LTC needs, and provide crucial policy insights, underscoring the necessity of targeted interventions to address ‘younger’ older adults’ care needs and increased investmed in the formal LTC system to tackle the escalating care gap.

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

Cited by 3 publications

References 40 publications

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

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

Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China

Temporal dynamics of unmet long-term care needs in China: an age period cohort analysis

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