TYPOLOGIES OF SOURCE OF CARE AMONG OLDER ADULTS: A COMPARATIVE STUDY OF CHINA AND THE UNITED STATES

Abstract

Abstract Background We investigated typologies of source of care for older adults in China and the United States and applied Anderson Health Behavior model to examine associated significant determinants. Methods Cross-sectional data from 2014 Health and Retirement Study and 2013 China Health and Retirement Longitudinal Study were used. We included older respondents aged 65+ who had at least one limitation in activities of daily living (ADL) and instrumental ADL (IADL) (NChina=2,482, NUS=3,152). Respondents reported whether they received assistance with ADLs and IADLs from spouse, child/grandchild, relatives, other, and formal helpers, respectively. We employed latent class analysis to characterize the typologies of sources of care and multinomial logistic regression to examine the significant determinants of identified typologies. Results Four classes were identified in China: class 1 (59.91%) minimal care with IADL assistance from child/grandchild; class 2 (8.66%) child/grandchild-based care; class 3 (27.96%) spouse-based care; and class 4 (3.46%) spouse/child/grandchild-based care. Five classes were identified in the US: class 1 (51.97%) minimal care overall with limited spousal support; class 2 (20.88%) child/grandchild-based care; class 3 (8.44%) spouse-based care; class 4 (13.20%) formal care plus child/grandchild support; and class 5 (6.31%) various sources. In both countries, ADL and IADL were significant determinants. Conclusion In the US, sources of care were more diverse and included formal assistance. In contrast, older Chinese relied largely on their spouses and children/grandchildren for support. In both countries, physical circumstances are significant determinants. Policy efforts on supporting family-based care and expanding formal care are needed in both countries, particularly China.