Factors Associated with Intended Utilization of Home-Based Long-Term Care among Older Adults in China: The Moderating Effect of Community Support.

Abstract

Guided by Andersen's behavioral model, the objectives of this study were to (1) examine the associations between individual factors and the intended utilization of home-based long-term care (LTC) services among older adults in China and (2) explore the influence of community support, if any, on these associations. Using a multi-stage random sampling approach, we recruited 1,064 older adults in Chengdu, China. Hierarchical regression was employed to investigate the direct effects of individual predictors and community support on the intended use of home-based LTC services. The moderating effect of community support was examined using the Hayes Process. Two predisposing (i.e., being old and unmarried), four enabling (i.e., living alone, having fewer children, and receiving less family and peer support), and six need factors (i.e., having more chronic illnesses; decreased performance in instrumental activities of daily living; higher levels of depression, anxiety, loneliness; and a lower self-image of aging), and low community support were significantly associated with increased intended utilization of home-based LTC. In addition, community support moderated the effects of family support (B = -.20, p < .001), peer support (B = -.20, p < .001), self-image of aging (B = -.39, p < .001), depression (B = -.34, p < .001), and loneliness (B = -.48, p < .001) on the intended utilization of home-based LTC services. Policymakers and practitioners should consider delivering tailored services for older adults and involve the community in the context of enhancing home-based LTC services.