Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment

Li, Chaofan; Zhou, Rui; Yao, Nengliang; Cornwell, Thomas; Wang, Shuangshuang

doi:10.1016/j.jamda.2020.02.010

Cited by 34 publications

(31 citation statements)

References 34 publications

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“…Several possible explanations for this finding are as follows. First, older adults with both multimorbidity and functional limitations would use much health care services, which may make them impoverished by illness and unable to afford the cost of an eldercare institution [ 17 ]. The social health insurance covered more than 95% of the Chinese population in 2013, and the average reimbursement rate was approximately 50%–70%.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, gerontology research concerning chronic conditions has shifted from single disease type to multimorbidity that was defined as the co-occurrence of at least two chronic diseases [ 14 – 16 ]. It was estimated that 46% of older adults in China are suffering from multimorbidity [ 17 ]. Compared with older adults with a single disease, those with multimorbidity are considered to have poorer quality of life, more health service utilization and higher risk of mortality, imposing a heavy economic burden on healthcare system [ 14 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Zhao

Gao

et al. 2022

BMC Geriatr

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zhao

Gao

et al. 2022

BMC Geriatr

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“…We also found three subscales—cognition, mobility and ADL—to have some predictive ability of mortality, which is consistent with previous studies ( 39 , 40 ). Studies showed that some domains of healthy aging, such as physical functional impairment ( 41 , 42 ), mobility limitations and cognitive deficits ( 43 ), and disability ( 44 ), are risk factors for utilization of healthcare, but no study has examined the association of healthy aging and healthcare utilization. In the current study, we also found that the general HAS and some subscales (mobility, ADL, and psychology) were negatively associated with healthcare utilization.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Multidimensional Population-Based Healthy Aging Scale: Results From the China Health and Retirement Longitudinal Study

Gao

Chen

et al. 2022

Front. Med.

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BackgroundThe World Health Organization proposed a multidimensional concept of healthy aging in 2015; there was limited evidence about how the concept was constructed and measured. The current study aims to develop a health aging scale (HAS) following the WHO framework and validate it using data from the China Health and Retirement Longitudinal Study (CHARLS).MethodsA total of 13,233 adults aged ≥ 45 years old from the CHARLS included in current study. Based on the WHO framework, 37 self-reported indicators were used to determine healthy aging. Exploratory factor analysis and second-order and bi-factor modeling, as well as psychometric coefficients, were used to examine the structure of healthy aging. To assess concurrent validity of the HAS, regression analyses were used to examine the associations of HAS and its subscales with sociodemographic characteristics, health conditions, healthcare utilization and life satisfaction in Wave 1. The predictive validity of HAS and subscales was assessed by their associations with mortality in Wave 2 follow-up using Cox regressions.ResultsThe general HAS and its five subscales were generated according to bi-factor modeling [CFI = 0.949; TLI = 0.942; SRMSR = 0.030; and RMSEA = 0.033 (95% CI, 0.032–0.034)] and psychometric coefficients (ω = 0.903; ωH = 0.692; ECV = 0.459). The general HAS presented solid evidence of concurrent validity with various sociodemographic characteristics, health conditions, healthcare utilization and life satisfaction; and predictive validity with mortality.ConclusionsThe population-based multidimensional healthy aging scale and its subscales can be used to monitor the trajectories of general healthy aging and its subdomains to support the development of healthy aging policies and interventions.

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“…The likelihoods of hospital admissions were 50% higher and outpatient visits were 20% higher among homebound older adults than among non-homebound older adults [ 5 ]. Homebound adults have many unmet medical needs; meanwhile, they face significant challenges in accessing hospital-based care [ 6 ]. High healthcare costs and transportation difficulties were the most frequently reported barriers to healthcare access for homebound older adults [ 5 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of home health care experiences among Chinese homebound adults

et al. 2021

Self Cite

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Background Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China. Methods This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi’s method was used to generate qualitative codes and identify themes. Results The evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly. Conclusions Findings from this study suggested that the HHC model benefited Chinese older adults—primarily homebound adults—in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.

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Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment

Cited by 34 publications

References 34 publications

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

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

Development and Validation of a Multidimensional Population-Based Healthy Aging Scale: Results From the China Health and Retirement Longitudinal Study

A qualitative study of home health care experiences among Chinese homebound adults

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