Background As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have been increasingly important in China. However, the association between HCBSs utilization and depressive symptoms in older adults in China is unclear. Consequently, this study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults. Methods This study included 7,787 older adults (≥ 60 years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, “What kind of HCBSs were being utilized in their community?”. Data were analyzed using binary logistic regression models and generalized hierarchical linear models (GHLM). Results Of the 7,787 participants, 20.0% (n = 1,556) reported that they utilized HCBSs, and 36.7% (n = 2,859) were evaluated that they had depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.180, 95% CI: 1.035–1.346, p < 0.05). Additionally, the depressive symptoms were significantly associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health (SRH), smoking, and provincial Gross Domestic Product (GDP) per capita. Conclusions This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is of utmost significance for the government to provide targeted HCBSs at the community level to address the unmet care needs of older adults, which can reduce the occurrence of negative emotions, consequently contributing to less severe depressive symptoms.
Background Studies have shown a close association between home and community-based healthcare service (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This research was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults. Methods Data were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Results HCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents. Conclusion The results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization negatively associated with IADL among single but not married respondents. The government should focus on older rural adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.
Background Studies have shown a close association between home and community-based healthcare services (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This study was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults. Methods Data were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes’ PROCESS macro (Model 7). Results HCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents. Conclusion The results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.
Background As the phenomenon of ageing continues to intensify, home and community-based services (HCBSs) have become of increasing importance in China. However, few studies have assessed the impact of HCBSs utilization on depressive symptoms among older adults. This study aimed to examine the association between HCBSs utilization and depressive symptoms in Chinese older adults. Methods This study included 7,787 older adults (≥ 60years old) who were recruited within the framework of the 2018 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). HCBSs utilization was assessed via the question, “What kind of HCBSs were being utilized in their community?”. Data were analyzed using generalized hierarchical linear models. Results Of the 7,787 participants, 20.1% (n = 1,567) reported they utilized HCBSs, and 36.7% (n = 2,859) were currently with depressive symptoms. After adjusting for individual- and province-level covariates, the HCBSs utilization was found to be associated with depressive symptoms (OR = 1.189, 95% CI:1.043–1.356, p < 0.01) among older adults. Additionally, the depressive symptoms were associated with gender, residence, educational level, marital status, number of chronic diseases, self-rated health, smoking, and provincial GDP per captia. Conclusions This study found HCBSs utilization might be a protective factor against depressive symptoms in Chinese older adults. It is important that the government provides targeted HCBSs at the community level to address the unmet care needs of older adults to reduce the occurrence of negative emotions and consequently the depressive symptoms.
Background: China has the highest number of older adults with disabilities worldwide. Home and community-based services (HCBSs) are optimal ways to deal with disability problems. Studies have shown urban-rural disparities in the supply and demand of HCBSs in China and that disability levels are significantly associated with HCBSs utilization. However, what’s inconspicuous is whether there are urban-rural disparities in HCBSs utilization and whether HCBSs utilization and levels of disabilities are associated. This study is designed to analyze urban-rural disparities both in HCBSs utilization and in the relationship between HCBSs utilization and levels of disabilities among Chinese older adults with disabilities. Methods: In applying the Andersen behavioral model, bivariate analysis and multivariate regression models were employed using data from 843 older adults with disabilities from the 2018 China Longitudinal Aging Social Survey. Results: Urban older adults with disabilities used HCBSs over twice as often as their rural counterparts. Furthermore, older adults with moderate disabilities living in urban areas used HCBSs more than twice as often as older adults with mild disabilities, while older adults with severe disabilities residing in urban areas used HCBSs approximately three times more often than older adults with mild disabilities. However, regarding rural older adults with disabilities, the levels of disabilities were unrelated to HCBSs utilization. Conclusion: Disability levels among Chinese older adults with disabilities were significantly correlated with HCBSs utilization throughout the country and in urban areas, but not in rural areas. The underlying reason for these disparities is the low utilization of HCBSs in rural areas among older adults with disabilities. The government should combine the supply-side and demand-side perspectives to fundamentally address urban-rural disparities in using HCBSs among Chinese older adults with disabilities.
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