Do older adults with multimorbidity prefer institutional care than those without multimorbidity? The role of functional limitation

Abstract

Background Population ageing and social transformation present tremendous challenges to the informal support system of older adults, which engendered institutional care in China. This study aimed to examine the association between multimorbidity and institutional care willingness, and investigate whether there is an interaction effects between multimorbidity and functional limitations on institutional care willingness among Chinese older adults. Methods Data were obtained from the sixth National Health Service Survey of Shandong province, China. The sample included 8583 older adults (age ≥ 60 years; 51.7% women), 44.8% without chronic diseases, 34.8% and 20.4% with one chronic condition and multimorbidity, respectively. Multivariable logistic regression models and marginal effects analysis were used to the interaction effects analysis. Results A total of 666 (7.8%) participants had institutional care willingness in Shandong, China. Participants with multimorbidity were more likely to have institutional care willingness than their peers without chronic condition (OR = 1.25, 95% CI = 1.06, 1.55) after adjusted for confounders. Marginal effect analysis showed that under the condition that other variables remain unchanged, the probability of them with multimorbidity choosing institutional care for older adults with functional limitations was 6.9% lower than those without multimorbidity (95% CI = -0.128, -0.010, P = 0.023). The interaction effect between chronic health conditions and functional limitation for older adults to choose institutional care was statistically significant, and the average interaction effect was 4.83% (Z = -2.70, $${S}_{\overline{x} }$$ S x ¯ = 0.0189, P < 0.05). Conclusions This relationship between multimorbidity and institutional care willingness varied by functional limitations. To better meet the care needs among older adults with multimorbidity and functional limitations, more resources and incentives should be provided to encourage the building-up of eldercare institutions. The governments should also establish long-term care system and to provide better home-based care for older adults, as older adults who prefer home care remain the majority.

The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?

“…As a nationally representative survey, NHSS has been conducted every five years since 1993 to understand the basic health status of the population and the situation of health care utilization [ 32 ]. More details about the interview have been published in previous studies [ 33 – 35 ]. The survey used a multistage cluster sampling method to select 100 townships of which 20 counties were randomly chosen within 137 counties of Shandong Province.…”

Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?

“…If the answer to any of the items was “with difficulty and need help” or “unable to complete”, they were categorized as older adults with ADL limitations. Finally, ADL limitations were coded as a binomial variable (“yes” or “no”) [ 33 ]. The option of “yes” indicated an ADL limitation and “no” manifested no ADL dysfunction.…”

“…(1) Sociodemographic variables: age (65–74 years or 75 years and above), gender (male or female), marital status [single (unmarried, divorced, widowed), married]. (2) Economic status variables: the highest education level (illiteracy, primary school, junior school, middle school or above), region (urban, rural), and household income [ 33 ] (four types based on percentile, Q1, Q2, Q3 and Q4, from poorest to richest). (3) Health status variables: chronic health conditions [no chronic condition, one chronic condition, multimorbidity (at least two chronic diseases coexist)], and self-rated health (range: 0-100), body mass index [underweight (< 18.5), normal (18.5–24.0), overweight (24.0–28.0), obesity (≥ 28.0)] [ 35 ].…”

Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study

“…In the context of filial piety and Confucian familism, older Chinese adults prefer home care provided by their adult children and adult children should visit their parents in person at least once per month to provide the care needed. 31 32 Therefore, the frequency of face-to-face meetings between older adults and adult children is a more accurate indicator of left-behind status. In some cases, older adults with adult children living in the same communities can also be left behind if their adult children rarely visit and support them.…”