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