Rural-urban disparities in unmet long-term care needs and the demand for community care services among elderly people in China

DOI: https://doi.org/10.21203/rs.2.15656/v1

Abstract

Background: Estimates of unmet needs, as an indicator of future needs for long-term care (LTC) services, have become increasingly crucial policy concerns. This study aimed to examine the urban-rural differences in unmet needs and the demand for community care service among community-dwelling elderly people in China.

Methods: The data come from the 2014 Chinese Longitudinal Health Longevity Survey (CLHLS). A total of 1587 community residents aged 65+ with disabilities in the activities of daily living (ADLs) were included in this study. Based on the Andersen theoretical model, binary logistic regression was used to estimate the correlates of unmet needs in LTC. A chi-square test was used to examine the differences in expected needs for community-based LTC services between urban and rural areas.

Results: Over half (55.07%) of the participants reported their needs were unmet. Poor economic status and reluctant caregivers seriously affected elderly unmet needs. Among urban older adults, those who were male and lonely reported more unmet needs. Among rural ones, those with severe ADL disability and poor self-rated health reported more unmet needs. In addition, access to medication and home visit services were negatively associated with unmet needs. Living with children (69.12%) was viewed as the most desirable living arrangement among older adults, while living in a LTC facility seemed to be more accepted for rural residents with unmet needs than for other elderly respondents. Residents showed a high demand for community LTC care services, with 82.55% of them expecting to need home visits and 74.29% to healthcare education. Specifically, rural residents had greater expected needs for every community care service than their urban counterparts. However, only 4.66% to 36.42% of the respondents reported that all eight types of services were available, which was far below the demand for these services.

Conclusion: The risk of having unmet LTC needs is largely determined by elderly people’s economic status and caregivers’ willingness to provide care for both rural and urban elderly residents. More attention should be paid to psychological consulting services in urban areas, as well as personal care, home visits, psychological consulting and healthcare education services in rural areas.

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Tables

Table 1. Sample distribution                                           

Variables

Urban (n=821)(%)

 

Rural (n=766)(%)

Sum (n=1587)

(%)

Unmet needs (n=425)

Met needs (n=396)

 

Unmet needs (n=449)

Met needs (n=317)

Predisposing factors:

 

 

 

 

 

 

 

Age, mean±SD*

 

92.00±9.66

92.56±9.47

 

93.64±9.66

92.89±9.42

92.78±9.58

Gender

Male

40.94 

34.60 

 

33.41 

33.12 

35.66 

 

Female

59.06 

65.40 

 

66.59 

66.88 

64.34 

Ethnicity

Han

93.88 

95.45 

 

94.21 

97.16 

95.02 

 

Non-Han

 6.12 

 4.55 

 

 5.79 

 2.84 

 4.98 

Years of education***

0

62.35 

62.12 

 

78.17 

76.97 

69.69 

 

1-6

26.82 

27.02 

 

19.82 

18.61 

23.25 

 

7+

10.82 

10.86 

 

 2.00 

 4.42 

 7.06 

Occupation before 60***

Farmer

52.00 

50.76 

 

81.51 

81.70 

65.97 

 

Non-farmer

48.00 

49.24 

 

18.49 

18.30 

34.03 

Exercise***

Yes

16.24 

22.22 

 

 4.45 

12.93 

13.74 

 

No

83.76 

77.78 

 

95.55 

87.07 

86.26 

Social activity

Yes

 5.88 

 5.56 

 

 2.90 

 6.31 

 5.04 

 

No

94.12 

94.44 

 

97.10 

93.69 

94.96 

Enabling resources:

 

 

 

 

 

 

 

Financial independence

Yes

 1.41 

 0.76 

 

 0.89 

 1.26 

 1.07 

 

No

98.59 

99.24 

 

99.11 

98.74 

98.93 

Economic status***

Good

14.82 

27.53 

 

 7.57 

17.35 

16.45 

 

Fair

65.88 

63.38 

 

72.61 

74.45 

68.87 

 

Bad

19.29 

 9.09 

 

19.82 

 8.20 

14.68 

Medication availability*

Yes

94.12 

95.71 

 

88.20 

98.42 

93.70 

 

No

 5.88 

 4.29 

 

11.80 

 1.58 

 6.30 

Currently married*

Yes

27.53 

26.01 

 

20.71 

22.40 

24.20 

 

No

72.47 

73.99 

 

79.29 

77.60 

75.80 

Living alone**

Yes

 8.71 

 8.84 

 

14.03 

12.93 

11.09 

 

No

91.29 

91.16 

 

85.97 

87.07 

88.91 

Caregiver

Spouse

16.47 

14.90 

 

13.59 

14.20 

14.81 

 

Son and daughter-in-law

48.94 

48.74 

 

58.57 

56.15 

53.06 

 

Daughter and son-in-law

17.18 

22.22 

 

15.81 

17.03 

18.02 

 

Others

17.41 

14.14 

 

12.03 

12.62 

14.11 

Caregiver willingness

Yes

88.24 

98.99 

 

89.09 

97.48 

93.01 

 

No

11.76 

 1.01 

 

10.91 

 2.52 

6.99 

Cost**

0

34.35 

38.89 

 

37.42 

37.54 

36.99 

 

1-300

32.94 

36.87 

 

42.76 

44.16 

38.94 

 

301+

32.71 

24.24 

 

19.82 

18.30 

24.07 

Personal care*

Yes

6.35 

 4.80 

 

 2.45 

 4.73 

 4.54 

 

No

93.65 

95.20 

 

97.55 

95.27 

95.46 

Home visit***

Yes

32.94 

31.57 

 

33.85 

52.68 

36.80 

 

No

67.06 

68.43 

 

66.15 

47.32 

63.20 

Need factors:

 

 

 

 

 

 

 

Severe ADL disability

Yes

51.29 

42.42 

 

58.80 

40.38 

49.02 

 

No

48.71 

57.58 

 

41.20 

59.62 

50.98 

Cognitive impairment***

Yes

52.24 

51.26 

 

64.81 

54.89 

56.08 

 

No

47.76 

48.74 

 

35.19 

45.11 

43.92 

Self-rated health*

Good

46.82 

65.40 

 

38.75 

67.19 

53.25 

 

Fair

26.59 

16.16 

 

28.73 

15.77 

22.43 

 

Bad

26.59 

18.43 

 

32.52 

17.03 

24.32 

Self-rated satisfaction

Good

18.59 

34.85 

 

20.27 

34.07 

26.21 

 

Fair

34.79

29.90

 

30.14

34.60

31.76 

 

Bad

46.96

36.08

 

50.47

30.48

42.03 

Loneliness***

Yes

38.44

22.94

 

43.69

37.78

34.85 

 

No

61.56

77.06

 

56.31

62.22

65.15 

Depression*

Yes

22.14

15.46

 

17.06

12.70

17.83 

 

No

77.86

84.54

 

82.94

87.30

82.17 

Note: Differences between groups were tested by a chi-square test or t-test as appropriate.

Significance levels: * p < 0.05, ** p <0.01, *** p < 0.001.


 

Table 2. Odds ratios of unmet needs by residence (binary logistic regression)

Independent variables

Urban

Rural

Age

0.99(0.97,1.01)

0.99(0.97,1.02)

Gender (ref. Female)

1.55(1.06,2.28)*

1.25(0.82,1.90)

Ethnicity (ref. Non-Han)

0.84(0.43,1.66)

1.08(0.46,2.55)

Years of education (years) (ref. 0)

 

 

 1-6

0.79(0.52,1.19)

1.19(0.73,1.94)

 >6

0.93(0.53,1.62)

0.56(0.20,1.55)

Farmer (ref. No)

0.96(0.70,1.33)

0.89(0.58,1.37)

Exercise (ref. No)

0.87(0.58,1.32)

0.55(0.29,1.02)

Involvement in social activities (ref. No)

1.25(0.63,2.48)

0.91(0.41,2.03)

Financial independence (ref. No)

1.38(0.28,6.85)

0.64(0.13,3.25)

Economic status

1.56(1.23,1.98)***

1.76(1.28,2.43)***

Medication availability (ref. No)

1.40(0.67,2.93)

0.25(0.09,0.67)**

Currently married (ref. No)

0.89(0.55,1.44)

0.91(0.51,1.63)

Living alone (ref. No)

0.92(0.54,1.56)

1.06(0.65,1.74)

Caregiver (ref. Spouse)

 

 

Son and daughter-in-law

0.94(0.53,1.67)

1.33(0.68,2.60)

Daughter and son-in-law

0.83(0.45,1.53)

1.12(0.54,2.36)

Others

1.19(0.62,2.27)

1.08(0.51,2.30)

Caregiver willingness (ref. No)

0.12(0.04,0.33)***

0.25(0.11,0.58)**

Cost (yuan) (ref. 0)

 

 

1-300

1.01(0.70,1.44)

0.87(0.60,1.26)

>300

1.32(0.90,1.95)

0.99(0.63,1.57)

Personal care (ref. No)

1.43(0.74,2.76)

0.58(0.24,1.40)

Home visit (ref. No)

1.11(0.80,1.54)

0.50(0.36,0.70)***

Severe ADL disability (ref. No)

0.98(0.69,1.38)

1.73(1.21,2.47)**

Cognitive impairment (ref. No)

0.90(0.65,1.25)

1.24(0.86,1.79)

Self-rated health

1.11(0.94,1.32)

1.40(1.16,1.70)***

Self-rated life satisfaction

1.14(0.94,1.39)

0.92(0.74,1.14)

Loneliness (ref. No)

1.58(1.13,2.21)**

1.29(0.92,1.81)

Depression (ref. No)

1.15(0.78,1.71)

1.26(0.78,2.03)

Significance levels: * p < 0.05, ** p <0.01, *** p < 0.001.


 

Table 3. Long-term care (LTC) service needs and plans by place of residence and needs

Variables

Total

(N=1587)

Urban (n=821)(%)

 

Rural (n=766)(%)

Unmet needs

(n=425)

Met needs

(n=396)

P-value# 

 

Unmet needs

(n=425)

Met needs

(n=396)

P-value#

Anticipated living arrangement

 

 

 

0.353

 

 

 

0.614

Living alone regardless of residential distance from children

 6.93

 9.18

 7.32

 

 5.57

 5.36

 

Living alone (or with a spouse) and children living nearby

23.13

21.88

21.21

 

24.05

25.87

 

Coresidence with children

69.12

68.00

70.71

 

69.27

68.45

 

LTC facility

 0.82

 0.94

 0.76

 

 1.11

 0.32

 

Anticipated community-based service needs (yes)

 

 

 

 

 

 

 

 

Personal care***

60.62

58.59

54.29

0.215 

 

70.60

57.10

<0.001

Home visits***

82.55

79.06

75.51

0.224 

 

86.86

89.91

0.199

Psychological consulting***

64.90

61.18

60.86

0.926 

 

73.05

63.41

0.005

Daily shopping***

54.88

50.82

50.51

0.927 

 

61.92

55.84

0.092

Social and recreation activities**

59.48

54.82

56.82

0.565 

 

64.81

61.51

0.351

Legal aid**

58.03

53.88

55.30

0.683 

 

63.92

58.68

0.141

Healthcare education**

74.29

71.53

70.96

0.857 

 

77.28

77.92

0.836

Neighborhood-relation***

58.48

54.35

54.04

0.928 

 

65.03

60.25

0.177

Note: *Indicates the differences between urban and rural areas by chi-square tests, and indicates the differences between people with unmet needs and those with met needs in urban and rural areas by chi-square tests.

Significance levels: * p < 0.05, ** p <0.01, *** p < 0.001.

 

 

 

Table 4. Availability of community services by place of residence and needs

Variables

Total

(N=1587)

Urban (n=821)(%)

 

Rural (n=766)(%)

Unmet needs

(n=425)

Met needs

(n=396)

P-value#

 

Unmet needs

(n=425)

Met needs

(n=396)

P-value#

Available community care services (yes)

 

 

 

 

 

 

 

 

Personal care

4.66

 6.35

 4.80

0.333

 

 2.90

 4.73

0.182

Home visits***

36.42

32.71

31.06

0.613

 

33.41

52.37

<0.001

Psychological consulting*

 7.81

 9.41

9.34

0.973

 

 4.45

 8.52

0.021

Daily shopping***

10.52

 8.47

7.83

0.737

 

14.92

10.41

0.068

Social and recreation activities

17.52

16.94

16.41

0.840

 

20.49

15.46

0.077

Legal aid

12.85

15.06

12.12

0.220

 

12.03

11.99

0.987

Healthcare education

38.06

37.41

38.13

0.832

 

32.74

46.37

<0.001

Neighborhood-relation

23.00

24.24

22.47

0.552

 

23.61

21.14

0.420

Note: *Indicates the differences between urban and rural groups by chi-square tests, and # indicates the differences between people with unmet needs and those with met needs in urban and rural areas by chi-square tests.

Significance levels: * p < 0.05, ** p <0.01, *** p < 0.001.