Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China.

Fen Li,Hansheng Ding,Chunyan Xie,Xinye Fang,Yitong Yang,Changying Wang,Chunlin Jin,Jiechun Gao,Jerson Laks

doi:10.1371/journal.pone.0176548

Abstract

The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.

Highlights

The majority of the elderly adults (81.59%) chose informal care in 2014, among which 60.85% was provided by a spouse and 33.82% by children
The odds of formal care use increased with Activities of Daily Living (ADL) scores
With regard to chronic diseases, suffering from stroke, advanced tumor, lower limb fracture, and dementia led to much higher odds of formal care use

Summary

Introduction

In 2015, the number of the household residents aged 60 and above reached 4.36 million in Shanghai and the average life expectancy of the total household population was 82.75 years. Determinants of formal care use and expenses among elderly http://www.wsjsw.gov.cn/wsj/index.html), and the “Fourth Round of Shanghai Three-year Action Plan on Public Health: Research on Building the Integrated System of Health Care and Nursing Care in Shanghai” Wsjsw.gov.cn/wsj/index.html).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Determinants of formal care use and expenses among elderly http://www.wsjsw.gov.cn/wsj/index.html), and the “Fourth Round of Shanghai Three-year Action Plan on Public Health: Research on Building the Integrated System of Health Care and Nursing Care in Shanghai” (HSD, No GWIV-37, URL http://www. wsjsw.gov.cn/wsj/index.html).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

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Discussion

Conclusion