A total of 2217 respondents were included in our study. Table 1 describes the sample. 53.3% were aged over 85, 63.9% were female, 50.7% lived in urban areas, 69.5% were engaged in farming, and 57.7% had never attended school.
In terms of enabling resources, 92.6% of the elderly were widowed. 63.9% of the elderly had more than 3 children. 70.7% reported that their economic status were similar to that of their neighbors. 48.8% of older adult’s income source were family members. 49.1% of the elderly reported that their primary caregiver were their son when they got sick.
In addition, 32.0% of participants were limited in ADL by health problems. A majority of the sample reported good or fair health status. However, almost 70% had at least one chronic illness. On the psychological level, 45.9% of the sample felt lonely and isolated.
Anticipated future living arrangements
Table 2 depicts the anticipated future living arrangements of older adults. Among the 2217 respondents, the combined percentage of older adults who wanted to live alone was 75.4%. However, there were some differences in the patterns of living alone, which was mainly reflected in the distance to their children’s home. In both urban and rural areas, almost half of older adult respondents preferred to continue living alone in the future over any other living arrangement, but hoped their children live nearby. Around one fifth of respondents reported that they would prefer to live alone regardless of the residential distance from their children. Co-residing with children was preferred by 17.2% respondents. Very few people (less than 3%) reported that they would prefer to live in institution, such as older adult centers and homes. The chi-square test showed significant differences of anticipated living arrangements in older adults in age, sex, years of schooling, number of children, economic status, income source, primary cagariver, loneliness, self-rated health and ADL (p<0.05).
Anticipation and availability of HCBS
Table 3 presents the demand and supply of HCBS. Among all types of services, the category of health care services, such as home visits and health education were in most demand, accounting for 81.73% and 73.63% of respondents, respectively. Other services were also in high demand with over 60% of respondents reporting a need for all services. Compared with demands, we found that the supply of services was highly inadequate, particularly in services of personal daily care, psychological consulting, and daily shopping.
The disparity between demand and supply of HCBS in urban and rural areas were analyzed and compared (Table 3). On the demand side, all of the services were higher in urban than in rural areas, except for home visits. There was a significant difference between urban and rural areas for home visits demands (p<0.05). In terms of supply, we found that supply of all services in urban areas were higher than that of rural areas, except for home visits. There was a significant difference between urban and rural areas for home visits, social and recreation activities, health education, and neighboring relations services (p<0.05).
Factors influencing anticipated living arrangements
Table 4 summarizes the factors influencing anticipated living arrangements. Using “living alone regardless of residential distance from children” as reference group, we discovered that predisposing variables of age and sex, enabling variables of number of children, primary caregiver, income source and need variables of loneliness, ADL all affected the anticipated living arrangements of older adults.
Results showed that older adults who were younger, male, childless and not limited in ADL have higher probability to choose “living alone regardless of residential distance from children” rather than “living alone and children living nearby” (OR=0.73, 0.81,0.18, 0.67, p<0.05). Those who reported their primary caregiver was their son or other family members will take more concern about the residential distance from children and hope their children live nearby (OR=3.13, 2.84, p<0.05). As for the willingness of co-residence with children, we found that respondents who were older, had more children, higher sense of loneliness and ADL limitation were more willing to live with their children rather than live alone (OR=0.56, 0.28, 0.54, 0.63, p<0.05), and income source was family members will also increase the likelihood of co-residence with children (OR=1.87, p<0.05). Moreover, the odd ratios reaveled childless (OR=5.19, p<0.05) and higher sense of loneliness (OR=0.37, p<0.05) will significant increase the likelihood to live in institution among older adults who were living alone.
Factors influencing anticipated HCBS
As shown in Table 5, the odds ratios revealed that predisposing variables, including age, residence, and occupation, enabling resources, including income source, economic status, and availability of services, and need characteristics, including loneliness and chronic diseases had an impact on the HCBS needs of older adults.
In terms of predisposing variables, those who were younger were more likely to have demand for anticipated needs for social and recreation activities, legal aids, health education, and neighboring relations services. Urban-dwelling people tended to show needs for psychological consulting, health education, and neighboring relations services. Farmers were more in need of home visits service compared to non-farmers. For enabling variables, those who reported poor self-rated economic status and income source was family members were more likely to have various demands for HCBS compared to counterparts. Older adults who had access to personal daily care and home visits services were tend to show demands for HCBS. In the aspect of need variables, older adults with chronic diseases were more tend to have demands for personal daily care, home visits, psychological consulting and heralth education services. Furthermore, those who had higher sense of loneliness were more likely have demands for all kinds of services.