Understanding the Unmet Needs among Community-Dwelling Disabled Older People from a Linkage Perspective

Abstract

One of the challenges in response to population aging is to meet needs for elderly care among older people especially for those who want to age in their homes or communities. However, disabled older people have more challenges due to their restricted mobility to access care resources than non-disabled ones. We propose a new framework based on the changing relationship between older people and their environment, in which resource linkage in elderly care utilization is emphasized. We conducted a survey with 139 participants (i.e., older people age 60 years or over with different level of disabilities) in three types of neighborhoods in Beijing, China. By conducting a decision tree analysis under the Person-Environment Link (P-E Link) model, we (1) characterized unmet needs for elderly care (activities of daily living (ADL) and instrumental activities of daily living (IADL) assistance) among community-dwelling disabled older people; (2) found disabled older people had more unmet needs for both ADL and IADL assistance because of a lack in linkages to care resources than non-disabled ones; and (3) characterized the linkages to care resources for better supporting disabled older people to age in place, including family support, social connection, and spatial environment. Our findings help improve the Anderson behavioral model by characterizing enabling environments, which highlights that not only the availability of enabling resources but also linkages to these enabling resources play an important role in meeting needs for care among disabled older people. Our findings can also inform improvements in policy design that are targeted to reduce elderly care inequalities.

Community Support for Persons with Disabilities in Low- and Middle-Income Countries: A Scoping Review

“…Topics covered in this literature included barriers to participation [ 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], unmet needs for assistance [ 7 , 8 , 9 , 20 , 21 , 22 , 23 , 24 ], human support and peer support [ 25 , 26 , 27 , 28 ], and documentation of specific programmes [ 26 , 29 , 30 , 31 ].…”

“…For instance, Andrade and Andrade [ 7 ] showed that older persons with disabilities have a high proportion of unmet needs, both in the basic activities of daily life (such as bathing, dressing, walking, using the toilet, feeding, and moving in and out of bed), as well as the instrumental activities of daily life (such as managing finances, using transportation, shopping, and taking medication). In papers from Thailand [ 21 ] and China [ 22 , 23 , 24 ], specific unmet needs are highlighted: Access to available and continuous rehabilitation services local to where persons with disabilities live; State welfare or other financial support; Information for parents of children with disabilities about disability and how to provide care and opportunities for their child; Support for childcare among parents of children with disabilities; Social support and other social resources; Support for activities required for inclusion in society (e.g., communicating, doing housework, working outside, making friends); and Support to pursue employment opportunities in line with personal preferences. …”

“…For instance, Andrade and Andrade [7] showed that older persons with disabilities have a high proportion of unmet needs, both in the basic activities of daily life (such as bathing, dressing, walking, using the toilet, feeding, and moving in and out of bed), as well as the instrumental activities of daily life (such as managing finances, using transportation, shopping, and taking medication). In papers from Thailand [21] and China [22][23][24], specific unmet needs are highlighted: A study from China, reported by Wu et al [22], characterised unmet needs for elderly care-ADL and IADL-in a sample of community-dwelling older persons with disabilities, and provided a useful amount of detail for understanding how unmet needs influence persons with disabilities' daily lives. Importantly, the study found that older persons with disabilities had a higher number of unmet needs with regard to both ADL and IADL assistance, largely due to a lack of linkages to care resources when compared to older persons without disabilities.…”

What does community‐embedded care mean to aging‐in‐place in China? A relational approach

“…Taken together, the following factors are important in the analysis of AIP in China: a community-centric setting (versus a home-centric setting); a state-led role in care provision (versus a grassroots-led role); and AIP as a family/societyoriented decision (versus as an individual right and choice). Research has revealed characteristics of AIP in China, including the presence of different community-based models of care supporting AIP (e.g., Leung and Wong 2002;Wu et al 2005;Xu and Chow 2011); preferences to and needs for community care and support of older people with different socio-economic characteristics (e.g., Liu et al 2015;Lum et al 2016;Cheng et al 2018); and significant variations in communities and their residents' AIP experiences (e.g., Gao et al 2012;Yu and Rosenberg 2017;Wu et al 2021). However, relatively under-researched is how community works as a mediator of forces at various scales to produce new care spaces within which lived experiences of AIP are shaped, whether in western or non-western contexts (Gao et al 2015;Skinner et al 2015).…”

How Does the Care of the Disabled Elderly Affect the Caregiver’s Subjective Well-being?evidence From China Time Use Survey

“…With the increasing number of disabled elderly and their caregivers, the impact of disabled care activities on caregivers has received widespread attention 4,5 . In developing countries, the proportion of elderly people who choose to live at home is always higher [6][7][8] . Therefore, once the elderly have physical problems and need to be taken care, family members will assume the main tasks of support and care 9,10 .…”