Care Services For Older Adults Research Articles

Older people’s challenges accessing health services in central Nepal: a qualitative study using the domain of access framework

BackgroundLow- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.MethodsThis qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.ResultsHypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.ConclusionsThis study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.

A scoping review of barriers to accessing aged care services for older adults from culturally and linguistically diverse communities in Australia

The ageing population of the culturally and linguistically diverse (CALD) population is increasing in Australia. This is because the number of early migrants in Australia is ageing, coupled with increasing family reunification. This scoping review aimed to describe the nature and extent of research on the barriers to aged care services for CALD older adults in Australia using Penchansky and Thomas’s Access to Care Framework of five A's dimensions: availability, accessibility, accommodation, affordability, and acceptability. Arksey and O’Malley’s five-step scoping review framework was adopted to search 6 databases from inception till August 2024. Title/abstract and full-text screening were conducted using predefined inclusion and exclusion criteria, with supplementary search of references from included articles to identify additional articles. Findings show that while all the five A's of access to care services were barriers for CALD older adults, accommodation and acceptability of services were the major areas of concern due to the lack of cultural sensitivity of such services in Australia. An additional barrier captured and termed as Awareness was noted in some of the included studies, highlighting the need to expand the five A's to 6 A’s. Researchers, practitioners, and policymakers on ageing could leverage these findings to improve cultural practice sensitivities when supporting these populations.

History of Incarceration and Dental Care Use Among Older Adults in the United States

IntroductionDental care is a critical component of healthy aging; however, emerging evidence suggests that having been previously incarcerated is a risk factor for not using dental care services. This study investigates the relationship between prior incarceration and dental care among older adults and assesses whether wealth and dental insurance explain this relationship. MethodsData are from the Health and Retirement Study, a nationally representative sample of community-dwelling older adults in the United States, collected in 2012 and 2014. Multivariable logistic regression is used to assess the relationship between a history of incarceration and dental care. Mediation analyses were conducted using the Karlson-Holm-Breen method of indirect effects in non-linear models. Statistical analyses were conducted from February to April 2024. ResultsAdjusting for potential confounding variables, a respondent's prior incarceration is associated with a 25% lower odds of dental care use (adjusted odds ratio [aOR] = .748, 95% CI = .624, .896). The relationship between incarceration and dental care use is fully mediated—over 90% is explained by—wealth and having dental care insurance. Prior incarceration decreased the likelihood of dental care only among non-Hispanic White respondents. ConclusionsThe findings offer new evidence that prior incarceration is a risk factor for lacking the ability to utilize dental care among older adults and suggest that broader consequences of incarceration for wealth accumulation and access to dental insurance underpin this relationship. These results suggest the urgent need to expand access to affordable dental care services for older adults with a history of incarceration.

Effectiveness of integrated care for older adults-based interventions on depressive symptoms: A systematic review and meta-analysis.

To pool existing studies to assess the overall effectiveness of integrated care for older adults (ICOPE)-based interventions in improving depressive symptoms in older adults. A systematic review and meta-analysis. Ten databases were systematically searched from inception to 15 July 2023 and the search was last updated on 2 September 2023. Standardized mean difference (SMD) was calculated using random effects models. RoB 2 and GRADEpro GDT were used to assess the methodological quality and confidence in the cumulative evidence. Funnel plots, egger's test and begg's test were used to analyse publication bias. Sensitivity, subgroup and meta-regression analyses were performed to explore potential sources of heterogeneity. The results of 18 studies showed ICOPE-based interventions had a significant effect on improving depressive symptoms (SMD = -.84; 95% CI, -1.20 to -.3647; p < .001; 18 RCTs, 5010 participants; very low-quality evidence). Subgroup analysis showed the intervention group was characterized by mean age (70-80 years old), intervention duration between 6 to 12 months, gender (female <50%), non-frail older adults, depressed older adults and mixed integration appeared to be more effective. Sensitivity analysis found the results to be robust. ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. Healthcare professionals are expected to use ICOPE as one of the interventions for depressive symptoms in older adults, and this ICOPE could provide more comprehensive care services for older adults to reduce depressive symptoms. ICOPE-based interventions may be a potentially effective alternative approach to reduce depressive symptoms in the older adults. ICOPE-based interventions had a significant effect on reducing depressive symptoms in the older adults. The intervention group characterized by mean age of older adults, intervention duration, gender ratio, health condition and integration types may influence the effect size. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No Patient or Public Contribution.

Enhancing the continuing willingness of Chinese college students to engage in volunteer services for older adults

BackgroundThe ageing population presents a substantial challenge to conventional care services for older adults in China. College students' voluntary service constitutes an integral component of youth volunteerism, and investigating their continuing willingness to engage in volunteer services to benefit older adults holds immense importance for fostering a stable and enduring framework for China's older adults' care team. MethodDrawing on the extended theory of reasoned action, this study establishes an analytical framework to examine the willingness of Chinese college students to engage in volunteer services for older adults. Using micro-survey data, we employ structural equation modelling and the bootstrap mediation effect test method to empirically investigate the influencing mechanism behind this willingness. Results(1) Attitude has the strongest influence on the continuing willingness of Chinese college students to engage in volunteer services for older adults, and plays a mediating role between subjective norms and continuing willingness to engage in volunteer services, which reveals the special role of attitude in the continuing engagement of Chinese college students in volunteer services for older adults. (2) Personality trait has a substantial positive impact on Chinese college students’ willingness to engage continuously in volunteer service for older adults, and subjective norms and attitudes have a chain mediating effect in this influence relationship. (3) The theoretical model constructed in this study is reasonable, reliable and robust. ConclusionThis study elucidates the potential relationship between attitude, subjective norms, personality traits and the willingness to engage in volunteer services, offering a novel perspective for understanding the continuing willingness of Chinese college students to engage in volunteer services for older adults. Furthermore, it highlights the value of incorporating the extended theory of reasoned action into the policy design of college students’ engagement in such services.

Nutritional Challenges in Nursing Homes: Pilot Study on Macronutrient Intake and Status of Vitamins D and B12.

Older adults living in nursing homes (NH) are considered a population group that could be at risk in terms of nutrition, even more so than their community-dwelling peers. Evidence on the nutritional status of NH residents is scarce, as they are commonly excluded from population-based dietary studies. This is also the case in Slovenia. In the presented pilot study, we assessed the intake of macronutrients as well as the intake and status of vitamin D and vitamin B12 on a sample of NH and NH daycare center users to explore the need for a larger representative study. The pilot study included 37 participants from three Slovenian NH (20 participants) and their daycare centers (17 participants). Daycare centers offer daytime care services for older adults, where users are also provided with major meals during their stay. Intakes of energy and nutrients were estimated by three 24 h dietary records. Fasting blood samples were collected for the assessment of vitamin D and vitamin B12 status. Over 90% of the participants had daily energy and protein intakes below recommendations (reference values: energy intake: males 2100 kcal and females 1700 kcal; protein intake > 1 g/kg body mass). The males' median daily intakes of vitamin D were 1.7 µg (1.5 µg females), and 2.3 µg for vitamin B12 (2.0 µg females). None of the participants had adequate vitamin D intake (>20 µg), and 92.3% males and 87.5% females had inadequate vitamin B12 intake (<4 µg). The prevalence of vitamin D deficiency (serum 25-OH-D conc. < 30 nmol/L) was 100% among NH residents and 53% among NH daycare center users. The prevalence of vitamin B12 deficiency was found in 20% of NH residents. The study results highlighted that certain nutrients might be critical in this population, especially among NH residents; however, a more thorough investigation with the inclusion of other important markers of nutritional status should be performed on a larger, representative sample to support the development and implementation of appropriate public health interventions.

Needs assessment in long-term care: expression of national principles for priority setting in service allocation

BackgroundLong-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on “ageing in place” and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults.MethodsThis qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis.ResultsThe allocators drew on all three principles for priority setting when assessing older adults’ long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators’ expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit).ConclusionsThe expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding “ageing in place”, active ageing, an investment ideology, and prioritising those who are “worse off”. Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults’ care needs. Additionally, difficulties in defining the severity of older adults’ complex needs lead to debates regarding “worse off” versus potentiality in future long-term care services allocation.Trial registrationNot applicable.

An undue emphasis on rural older adults in the Chief Medical Officer's annual report 2023?

The Chief Medical Officer's annual report 2023 presents an incomplete and skewed picture of the geography of older people in England. We show that there are higher absolute numbers of older people in urban areas in England and Wales, in contrast to key messages from the CMO report which suggest greater need in rural areas based on relative metrics. The absolute size of the urban–rural difference in the population of older people is projected to grow by 2043. Older adults in urban areas are much more likely to live in deprived areas than older adults in rural areas. The absolute number and prevalence of older adults in poorer health is also higher in urban areas, leading to greater healthcare needs. Policy-makers need to consider both absolute and relative demographic trends as well as making use of direct measures of health when planning how healthcare services for older adults are distributed geographically in England.

Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review.

Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking. In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries. We will follow the Arksey and O'Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms. This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024. This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries. DERR1-10.2196/49130.

Barriers and facilitators to the delivery of age-friendly health services in Primary Health Care centres in southwest, Nigeria: A qualitative study.

With the rapid growth of Nigeria's older population, it has become important to establish age-friendly healthcare systems that support care for older people. This study aimed to explore the barriers and facilitators to the delivery of age-friendly health services from the perspectives of primary healthcare managers in Lagos State, Nigeria. We conducted 13 key informant interviews including medical officers of health, principal officers of the (Primary Health Care) PHC Board and board members at the state level. Using a grounded theory approach, qualitative data analysis was initially done by rapid thematic analysis followed by constant comparative analysis using Dedoose software to create a codebook. Three teams of two coders each blind-coded the interviews, resolved coding discrepancies, and reviewed excerpts by code to extract themes. The main barriers to the delivery of age-friendly services included the lack of recognition of older adults as a priority population group; absence of PHC policies targeted to serve older adults specifically; limited training in care of older adults; lack of dedicated funding for care services for older adults and data disaggregated by age to drive decision-making. Key facilitators included an acknowledged mission of the PHCs to provide services for all ages; opportunities for the enhancement of older adult care; availability of a new building template that supports facility design which is more age-friendly; access to basic health care funds; and a positive attitude towards capacity building for existing workforce. While we identified a number of challenges, these offer opportunities to strengthen and prioritize services for older adults in PHCs and build on existing facilitators. Work is needed to identify and test interventions to overcome these challenges and improve the responsiveness of the PHC system to older adults through the delivery of age-friendly health services in PHCs in Lagos, Nigeria.

The Consequences of Unmet Needs for Assistance With Daily Life Activities Among Older Adults: A Systematic Review.

Many older adults are experiencing unmet needs for assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Such unmet needs might threaten their physical and psychosocial well-being. We conducted a systematic review to provide a comprehensive picture of the health consequences of unmet ADL/IADL needs among older adults. Twenty-eight published articles were included for qualitative synthesis. We found that unmet ADL/IADL needs were consistently associated with higher health care utilization (e.g., hospitalization, medical spending) and adverse psychosocial consequences (e.g., anxiety, depression), while the findings of falls and mortality remain inconsistent. More studies are needed to draw firm conclusions and to allow for quantitative synthesis. This review advocates for more coordinated and comprehensive long-term care services for older adults. Future studies should explore how the adverse health outcomes identified in this review can be prevented or improved by adequately meeting older adults' needs for assistance.

Study on Long-Term Care Service Awareness, Needs, and Usage Intention of Older Adult Male Homosexuals in Taiwan and Their Ideal Long-Term Care Service Model.

As the significance of long-term care services for older adults becomes more pronounced in Taiwan, especially considering the intensifying trend of an aging population, there remains a lack of comprehensive attention to the long-term care needs and experiences of older adult individuals within the LGBTQ+ community. The present study examines the long-term care service awareness, needs, and usage intention of older adult male homosexuals in Taiwan and assesses their ideal long-term care service model. This study of five older adult male homosexual subjects aged 66 to 73 years is intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects displayed high awareness of long-term care services, as they possessed actual experience of these services or had even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and reported problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to opt for home care services if they required long-term support. Due to their personal experiences, the subjects displayed negative awareness of long-term care services and expressed worry that long-term care service staff harbored poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects' sexual orientation or stereotypes related to it, and they were concerned above all about the "friendly attitude" of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, feeling that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against. Regarding ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, their situations, and care needs.

Does Maintaining High Accessibility to Medical Care Services Increase Psychological Well-Being of Chinese Older Adults?

Objective. The health benefits of medical care services for older adults have been well known. This study aims to identify trajectories of medical care accessibility and their impacts on Chinese older adults’ psychological well-being to enrich findings on health outcomes of medical care accessibility. Methods. This study included 2660 participants aged 65 years and older from the 2005–2018 Chinese Longitudinal Healthy Longevity Survey, and this paper used the latent class growth model to analyze the heterogeneous trajectories of medical care accessibility among Chinese older adults. Ordinary least squares (OLS) regression was also used to explore whether the trajectories of medical care accessibility impact the psychological well-being of Chinese older adults and its heterogeneity among different subgroups of older adults. Results. Three distinct trajectories of medical care accessibility “maintaining high accessibility” (n = 2230, 84.1%), “medium to high accessibility” (n = 222, 8.10%), and “high to low accessibility” (n = 208, 7.80%) were identified, respectively. Regression results show that older adults maintaining high accessibility to medical care reported well psychological well-being. This result was particularly evident among older adults in urban and eastern areas. Discussion. Our findings highlight the importance of maintaining high accessibility to medical care and reducing inequalities in the accessibility to medical care for increasing psychological well-being of Chinese older adults.

Luxury or normal goods? Evidence from the utilization of institutional care services for the disabled older adults in China.

Nursing care is essential for older adults with disabilities. Income plays a crucial role in determining the utilization of institutional care services. Pension benefit, as the main source of income for the older adults in China's cities and towns in their later years, is an important factor influencing the utilization of institutional care services. However, there have been no consistent findings on how pension benefits affect the utilization of institutional care services for the disabled older adults. This paper utilizes data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey. We select disabled older adults aged 65 and older, living in towns and cities, and use a probit regression model to investigate the impact of pension benefits on the utilization of institutional care services by urban disabled older adults empirically. The study shows that a 1% increase in pension benefits raises the probability that the urban disabled older adults use institutional care services by 0.03. It also finds that for low-income urban disabled older adults, the effect is statistically significantly positive at the 1% level; but for high-income urban disabled older adults, the effect is not statistically significant. The pension benefits significantly increase the probability for the disabled older adults who are male, financially dependent, and live in townships. In addition, the pension benefits significantly reduce the probability that children will provide care and pay for care services for their older parents. Institutional care service is a normal good for the urban disabled older adults, especially for low-income older adults. Therefore, higher pension benefit raises the probability of utilizing institutional care services for the urban older adults with disabilities, and this positive effect is especially pronounced for older adults who are male, financially dependent, and reside in townships. In addition, increase in the pension benefits for the disabled older adults in towns and cities reduces the burden on children by reducing the probability that children will provide care and pay for care services for the older adults.

Service Allocators' Experiences of Ethical Dilemmas and Strategies in Long-Term Care: A Qualitative Study.

The provision of long-term care services for older adults is characterised by increasing needs and scarce resources, leading to ethical dilemmas. This qualitative study explored the ethical dilemmas experienced by healthcare professionals when allocating long-term care services to older adults and the strategies used to handle ethical dilemmas. Data from semi-structured individual interviews, focus group interviews, and observations of service allocators assessing needs and assigning long-term care services to older adults were analysed using content analysis. The overarching theme was the struggle for safe and equitable service allocation. The identified dilemmas were: (i) Struggles with A Just Allocation of Services due to Limited Time and Trust, (ii) Pressure on Professional Values Concerning Safety and Dignity, and (iii) Difficulties in Prioritising One Group Over Another. The strategies to deal with ethical dilemmas were: (i) Assessing Needs Across the Entire Municipality, (ii) Ensuring Distance to Service Recipients, (iii) Working as a Team, and (iv) Interprofessional Decision-Making. Scarce resources, organisational limitations, and political expectations drive the ethical dilemmas in long-term care service allocation. An open public discussion regarding the acceptable minimum standard of long-term care is needed to reduce the ethical pressure on service allocators.

THE IMPACT OF HOME-BASED CARE SERVICES ON ADULT CHILDREN AS CAREGIVERS OF OLDER ADULTS IN CHINA

Abstract The family has always been the primary resource for elder care support in China, and adult children are the main caregivers of older parents. In the background of rapid development of home-based care services for older adults, this study aims to explore the impacts of the home-based care services on the adult children as caregivers for their older parents. Based on a national representative sample of aged 60 years or older (N=8674) from the China Longitudinal Aging Social Survey (CLASS) in 2018 and 2020, this study used propensity score matching difference-in-differences method to analyze the data. Firstly, we found that home-based care services for older adults could reduce the care burden of family caregivers by sharing part of the instrumental support effectively for the elderly. Secondly, this substitution effect is more significant among the families with more dependable and vulnerable older adults. Finally, the use of home-based care services appeared not to affect the intergenerational relationships between older parents and their adult children caregivers. Home-based care services may relieve the burden of family caregivers by providing instrumental care support for older adults. Therefore, it is very necessary to accelerate the implementation of an elder care programs in community to benefit the older and younger generations in Chinese family.

DIGITALIZATION OF HEALTH SERVICES FOR OLDER ADULTS: HEALTH INEQUALITIES AND THE COVID-19 PANDEMIC

Abstract There is a growing role for digital technologies in society, but concerns that older adults may be disadvantaged and excluded with the growth of use of these technologies. The COVID-19 pandemic led governments across the world to mandate lockdowns and social restrictions. This was accompanied by rapid implementation of many digitalized services, including to access health and social care. This paper reports on a project to advance our understanding of how health and social care services for older adults (65+) have been digitalized during the COVID-19 pandemic, and to learn what has worked well and what has not, with a specific lens on health inequalities. We report main findings from three workstreams: (i) a mapping review, to identify (a) the types of evidence available on the digitalization of health and social care services for older adults during the COVID-19 pandemic, and (b) the extent to which factors related to health inequalities have been considered in this evidence; (ii) quantitative analysis of health care records to examine the impact of digitalization on access to primary care for older people in England during the COVID-19 pandemic, with a focus on incidence rate of consultation types (face-to-face, telephone and video) examined against age, gender, ethnicity and socioeconomic status; (iii) qualitative work to explore the experiences of UK older adults of South Asian and Black African or Caribbean descent of using digital technologies to access primary care. We consider how digitalization of health and social care services relates to health inequalities for older people.

Leveraging Regulation and Legislation to Improve the Care of Older Adults Through Home- and Community-Based Services.

An increase in demand for health care services for older adults is being negatively impacted by lack of a sufficient nursing workforce with competence in home- and community-based services (HCBS). The current article examines the unique challenges and opportunities in caring for older adults in HCBS settings, outlines the core competencies nurses must possess to provide this care, and proposes strategies to leverage legislative and regulatory initiatives to incorporate these competencies into nursing education and practice. Examining the American Association of Colleges of Nursing's Essentials Competencies through the HCBS lens, it is an ideal time to create a roadmap for nurses in practice, policy, and education to shape the health care workforce to meet the needs of a diverse and vulnerable population: older adults who depend on home- and community-based care for maintaining or improving their health outcomes and overall quality of life. [Journal of Gerontological Nursing, 49(12), 11-16.].

The affordability of access to health care for older adults in China

This study evaluates the inequalities of affordability in health care delivery for older adults in China, and explores the variables significantly affecting the affordability. Using the data from China Health and Retirement Longitudinal Study (CHARLS) and adapting the Andersen behavioural model, this study uses structural equation models (SEMs) with regression imputations to explore the direct and indirect effects of these variables for 1,720 respondents, which are cross-validated by the results from binary logistic regression models applying multiple imputations. SEM results indicate that the associations of age, education, and hukou with cost ratios are statistically significant. Specifically, the results of the logistic regression model show that older adults aged 60 and above pay less out of pocket than younger adults on health care services; respondents with higher levels of education and more types of insurance pay less out of pocket; and respondents with agricultural hukou and higher premiums pay more out of pocket. Future targeted efforts of policymakers should continue to focus on strengthening the affordability of access to health care services for older adults both in rural and urban areas by increasing the accessibility to and improving the efficiency of the health care system.

Expenditure projections for community home-based care services for older adults with functional decline in China

IntroductionDifficulty in identifying the functional status of older adults creates an imbalance between the supply and demand for community home-based care. Using a multi-level functional classification system to guide care cost measurement may optimize care resources and meet diverse eldercare demands.MethodsThe Markov model was used to project the older population size in different functional decline (FD) statuses. The project cost and the man-hour costing method were combined to forecast the cost of community home-based care for older adults with FD.ResultsThe projected cost of eldercare increased from 1668.623 billion yuan in 2020 to 2836.754 billion yuan in 2035. By 2035, the total cost for community-based home care for those in pathological development of FD statuses such as “viability disorder,” “acute disease,” “somatic functional disorder,” and “sub-disorder” was projected to be 1094.591 billion, 433.855 billion, 1256.236 billion, and 52.072 billion yuan, respectively, which is 1.24, 1.58, 1.78, and 0.49 times higher than the results by the man-hour costing method. Family caregiving costs are about three times those of professional caregivers.ConclusionThe escalating cost of providing graded care for older adults, particularly by family caregivers, presenting a significant evidence for the need to optimize resource allocation and develop a robust human resources plan for community home-based care.