Factors affecting community-dwelling older people's long-term care needs and utilization : a case study in Beijing, China

Abstract

Background: Along with the changes in economy and society, formal care has become an acceptable long-term care (LTC) mode. Older Chinese people are facing diverse choices of LTC.

Objectives: This study aims to describe older people’s LTC needs and utilization; figure out the influencing factors of LTC needs and utilization; develop a filial piety scale and explore the role of filial piety on LTC needs and utilization; find the relationship between LTC needs and utilization; test and improve the Andersen model.

Methods: Five hundred fifty six community-dwelling older people were interviewed by multi-stage sampling method in Beijing, China. First, factorial analyses were adopted to develop the Filial Piety Scale for Chinese Elders (FPSCE). Second, LTC needs and utilization was measured by LTC mode, service need patterns, and number of services used. Latent class analysis was adopted to explore the service need patterns. Third, factors (i.e. predisposing characteristics, enabling factors, need factors, cultural values, and barriers) affecting LTC needs or utilization were tested by multinomial logistic regressions or multiple linear regressions. The moderating effect on the relationship between cultural values and LTC needs, and the relationship between LTC needs and utilization were tested.

Results: For LTC mode, 83.1% preferred non-institutional care. Older people’s attitudes towards filial piety (p<0.01), instrumental activities of daily living (p<0.001), and number of diseases (p<0.05) were significant factors. For service need patterns, 10.1% had high needs for home- and community-based care (HCBC) services, 29.7% had medium needs, and 60.3% had low needs. Compared with high needs group, those living with at least two family members were more likely to have low needs (p<0.001) or medium needs (p<0.01) than those living alone or with one family member; those with more children (p<0.01) and less disease (p<0.05) were more likely to have low needs; when older people were living alone or with one family member, their attitude towards filial piety showed a significant effect on service need patterns. Compared with low needs group, those living with at least two family members were less likely to have medium needs (p<0.05) than those living alone or with one family member; those with more children (p<0.001) and less diseases (p<0.01) were less likely to have medium needs. For LTC utilization, older people with less LTC needs and less HCBC resources were less likely to use HCBC services. When older people were living in the community with more HCBC resources, their LTC needs showed a larger effect on LTC utilization.

Implications: This is one of the first attempts to explore the service need patterns in China. Greater recognition of the effects of living arrangement and HCBC resources should provide a strong stimulus for LTC policy development (i.e., encouraging family member to live with older people, enhancing the provision of HCBC services), and for service delivery and social work practice (i.e., establishing a comprehensive LTC evaluation system, enhancing the acceptance of HCBC). The FPSCE can serve as a valid measurement to help stakeholders to facilitate the development of family–friendly policies in ageing societies.