Search

Background: Currently, there are many studies focusing on the influencing factors of the elderly people’s living arrangements or health status, but little is known about the relationship between living arrangements or health status and long-term care models for the old-age, especially the joint effects. Objective: We aimed to assess the effects of health status and living arrangements on long-term care models (LTCM) among the elderly of Xiamen, China, especially their cumulative joint effects. Methods: A total of 14,373 participants aged ≥ 60 years by multistage sampling in Xiamen of China were enrolled. Multinomial logistic regression was used to estimate the Odds ratios (ORs) regressing LTCM on health status and living arrangements using the Anderson model as theoretical framework. Results: Totally, 14,292 valid questionnaires were obtained, of which 86.37% selected home care. With the increase of disability degree, older people are more likely to choose institutional care, compared to living alone (ORs = 1.75, 2.06, 4.00, 4.01 for the “relatively independent’, “mild disability’, “moderate disability’, and “total disability’, respectively, in comparison with “completely independent’). The elderly living with children and other family members preferred to choose home care. (ORs = 0.50, 0.39, 0.40, and 0.43 for the “living with children’, “living with spouse’, “living with children and spouse’, and “living with others’, respectively, in comparison with “alone’). Additionally, residence, number of children, education level, and feelings of loneliness were the determinants of the choice of social pension. Conclusion: A multitude of older people are trended to choose home care in Xiamen of China. There was an interaction and joint effect between the degree of disability and the living arrangements on LTCM. Therefore, policymakers should pay close attention to care for those living alone, childless, and disabled elders to meet their care needs, especially in home care. In addition, the social construction of facilities for elders in rural areas should be strengthened. [ABSTRACT FROM AUTHOR]

• Healthy ageing is a process of developing or maintaining the functional capability. • Find out linear and non-linear effects of clean air policy on functional capacity. • Long-term exposure PM 2.5 was applied as a proxy of clean air policy. • The subpopulations possibly modify the effects of air pollution. • Different influencing mechanism of air pollutant on outdoor and indoor activities. Since there is limited knowledge about health effects of the clean air policy (CAP, i.e., a series of emission-control actions) on continuum functional capacity (CFC) among the older adults on a large representative data, our research was to fill this gap. We used a continuous variable of airborne fine particulate matter (PM 2.5) particles as a proxy for the CAP to evaluate the linear and non-linear effect of PM 2.5 exposure on CFC of older adults, under the quasi-experimental framework of the temporal contrast between 2011 (before the CAP) and 2015 (after the CAP). Multiple environmental factors were considered and spline function was utilized to fit the spatial autocorrelations. A competing risk model was constructed to qualify the impact of PM 2.5 on multidimensional disability. After adjusting for potential confounders, a J-shaped association was found between PM 2.5 concentration increase on CFC, with a threshold 2μg/m3. We also demonstrated that a 10-µg/m3 increase in PM 2.5 concentration was related to a 14.0% (95% CI :0.00, 19.00%) increment risk in the functional decline. Similarly, the competing risk model presented a hazard ratio of multidimensional disability ranging from 1.707(0.928-4.141) at 40μg/m3 concentration of PM 2.5 to 4.384 (1.970-9.755) over 80μg/m3. Stratified analyses showed that married men less than 80 years old in rural areas are more likely to be affected by PM 2.5 exposure, where the influencing mechanism of air pollutant to outdoor and indoor activities might be the potential cause. Implementing CAP might improve CFC, prevent the occurrence of disability, and update the air policy. [ABSTRACT FROM AUTHOR]