Search

Background: Forecasting the intensity, source, and cost of informal care for older adults in China is essential to establish and enhance policy support systems for informal care within the context of East Asian traditional culture that emphasizes filial piety. This study aims to analyze the current situation and influencing factors for the informal care needs and predict the trends of informal care needs for older adults in China from 2020 to 2040. Methods: Using the CHARLS database from 2015 to 2018, this study first combined a two-part model and a multinomial logit to analyze the influencing factors for the informal care needs of urban-rural older adults in China. Secondly, a multi-state Markov model was constructed to forecast the number of urban-rural older populations in each health state from 2020 to 2040. Finally, based on a microsimulation model, this study predicted the trends of informal care intensity, source, and cost for older adults in urban and rural areas from 2020 to 2040. Results: In 2040, the size of the disabled older population in China will expand further. In rural areas, the total number of disabled people in 2040 (39.77 million) is 1.50 times higher than that in 2020; In urban areas, the total number of disabled people in 2040 (56.01 million) is 2.51 times higher than that in 2020. Compared with 2020, older adults population with mild, moderate and severe disability in 2040 would increase by 87.60%, 101.70%, and 115.08%, respectively. In 2040, the number of older adults receiving low-, medium-, and high-intensity care in China will be 38.60 million, 22.89 million, and 41.69 million, respectively, and older people will still rely on informal care provided by spouses and children (from spouses only: 39.26 million, from children only: 36.74 million, from spouses and children only: 16.79 million, other: 10.39 million). The total cost of informal care in 2040 will be 1,086.65 billion yuan, 2.22 times that of 2020 (490.31 billion yuan), which grows faster than the economic growth rate. Conclusion: From 2020 to 2040, the informal care needs of older people in rural areas will increase first and then decrease due to the demographic structure and rapid urbanization. In contrast, the informal care needs of older people in urban areas will continuously increase from 2020 to 2040, with the growth rate gradually slowing down. This study provides an evidence-based rationale for scientifically measuring the economic value of informal care and reasonably allocating care resources. [ABSTRACT FROM AUTHOR]

Background: With the increasing global aging population, how to allocate older people care resources reasonably has become an increasingly urgent international issue. China, as the largest developing country, has made many efforts to actively respond to the challenges of an aging population. However, there are still problems with uneven allocation of older people care resources and low efficiency of allocation. Therefore, this study evaluates the regional differences and dynamic evolution of the equity and efficiency of older people care resource allocation in China from 2009 to 2020, and explores ways to change the current situation. Methods: The data used in this study were derived from the "China Statistical Yearbook" and the "China Civil Affairs Statistical Yearbook" for the period of 2010–2021. Firstly, the equity of older people care resource allocation was measured using the Gini coefficient, the Theil index, the Older People Care Resource Density Index, and the Older People Care Resource Agglomeration Degree. Secondly, the dynamic Slack-Based Measure data envelopment analysis method was adopted to evaluate efficiency. Lastly, the Z-score is used to normalize the equity index and perform classification matching with the efficiency value. Spatial autocorrelation analysis and hotspot analysis were conducted using GIS technology to examine the dynamic evolution process of older people care resource allocation equity and efficiency, as well as their spatial distribution patterns and coordination across provinces from 2009 to 2020. Results: The equity analysis showed that the spatial distribution of various types of older people care resources was uneven, and the differences were mainly due to internal differences within each region, with the largest equity differences observed in western provinces. Currently, older people care resources are mainly concentrated in eastern regions, while the total amount of older people care resources in western regions and some central regions is relatively small, which cannot meet the older people care needs of residents. The efficiency analysis results showed that the efficiency of older people care resource allocation has been improving over the past 12 years, and in 2020, 77.42% of provinces were located on the efficiency frontier with an average efficiency value of 0.9396. Finally, the coordination analysis results showed that there were significant spatiotemporal differences in the equity and efficiency of older people care resources allocation. Conclusion: With the development of society and economy, the total amount and service capacity of older people care resources in China have greatly improved. However, there are still significant spatiotemporal differences in the equity and efficiency of older people care resource allocation. The development of older people care services in central and eastern provinces is unbalanced, and there is a polarization trend in terms of equity and efficiency of older people care resource allocation. Most provinces in western regions face the dual dilemma of inadequate older people care resources and low utilization efficiency. It is recommended that policymakers comprehensively consider population and geographic factors in different provinces, establish relevant allocation standards according to local conditions, improve the redistribution system, and focus on increasing the total amount of older people care resources in underdeveloped provinces while promoting resource flow. [ABSTRACT FROM AUTHOR]

Introduction: Difficulty 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. Methods: The 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. Results: The 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. Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Introduction: Broad issues relating to filial piety and ethical dilemmas of families and care practitioners in residential care were discussed as part of an international networking project. It is meaningful to explore the different roles and responsibilities of participants in residential care in the context of China's filial piety. Older residents and their children are part of this caring process, which might be significantly different from that in Western countries. However, only a little amount of research related to this topic has been conducted. Objective: This study aimed to identify and describe the roles and responsibilities of a nursing professional, manager, older person, and her children, as well as other mutual contacts in residential care, based on the context of Chinese filial piety culture. Methods: The study was conducted as a case study. The product of the analysis, themes, or categories that describe the phenomenon, content analysis method was applied. After a consultation with a group of experts on research on older adults, a specific nursing home was selected in Xiamen City, China. This case study emphasized the roles and responsibilities of a nursing professional, manager, the older resident, and her children as they related to the care of older adult. The data, which consisted of interviews with four participants, were collected using a semi-structured interview method. Inductive content analysis was applied to analyze data. Ethical considerations: Permission to conduct the interviews received ethical approval from the participating organization based on national standards. The elements of voluntary participation, anonymity, and confidentiality on the part of the respondent were explained. Findings: The analysis resulted in four participants, with some variation of roles and responsibilities, describing staffing level and competence and their behavior for reducing the accident of the older adult, and the children of older adult influencing the quality of taking care of the older adult, based on the filial piety. The nursing home residents were described as becoming increasingly complex with a subsequent demand for increased spiritual support. There was variation in roles and responsibilities among four participants, but their contributions adjusting was an overall focus. Manager plays a considerable role in the future development of the institution, as a resource allocator, and decision-maker. Nursing professional is the main personnel serving as a link among staffs. The older adult herself adjust mentally and actively with the aging process, and some of them can be able to burden in taking care of her grandchildren or can be rehired and still have a distinct role in society. Children are required to fulfill their obligations to their parents, which involves supports of care, spiritual and economy. Several factors such as managers and nursing professional competence and their cooperation, various aspects of supports from their children based on the filial piety, and adequate communication and self-adjusting of the older adult, were recognized as factors affecting the process of taking care of the older adult. Discussion: New information was produced to serve as theoretical guidelines in managing nursing homes, the training of nursing staff, preservation of the filial piety culture, and encouraging self-care among older people in the new era. Conclusion: A variety of roles and responsibilities for a nursing professional, manager, MrsWang and her children was identified in the older adult care process. Several factors to manager's and nursing professional's experience of the resource situation and competence level, and also adequate communication and self-adjusting of the older adult were suggested to affect the effect of taking care of the older adult. The older adults were perceived as more complex with more physical and mental problems but inadequate care from family members forcing the older adult from home care to a nursing home. A nursing home seems to have a higher nursing competence and be well-suited for the needs of the older adult, on the other hand, filial piety and self-care are also needed to play an important role in taking care of the older adult. [ABSTRACT FROM AUTHOR]