Obstacles to access to community care in urban senior-only households: a qualitative study

Abstract

Background The increased number of older adults living alone has created a substantial care need. However, the utilization rate of services and facilities to meet these needs are surprisingly low. Many of older adults experience difficulties accessing these services, although it remains unclear how these obstacles impede access to services. This study explored the obstacles and difficulties experienced by urban older adults in seeking community care. Methods A phenomenological study was carried out and participatory observation and in-depth interviews were employed to investigate the process of seeking care of older adults in urban communities. A total of 18 urban community-dwelling older adults aged 75 years and over were included. Data collected were analysed by content analysis. Results We identified the pathways by which senior-only households sought community care and encountered obstacles. (1) lack of community care information: older adults did not know where and how to get services, even though the care institutions scattered throughout the community; (2) limited mobility: older adults often suffered from various chronic diseases, which physically hindered their access to care resources; (3) complex process of achieving care: the functional fragmentation and geographical dispersion of care institutions made the care-seeking process challenging and confusing for older adults; (4) incomprehension of needs expression: limited interaction time and communication barriers between staff of institutions and the older adults were the final obstacle. Only by surmounting these obstacles one by one can older adults access the care resources effectively. Conclusions When older adults in the community initiated calls for help, they encountered several obstacles. Their physiological and social disadvantages limited their ability to seek care physically. Lack of integration and clear guidance in the process of providing community care exacerbated these difficulties. Reform of care services should focus on the visibility and accessibility of services for older adults.

Factors Associated with Poor Self-Rated Health among Older Women Living Alone

“…Poor SRH was also 6.20 times higher in older women with restrictions in daily functions than those without restrictions in daily functions. A study reported that more restrictions on daily activities were associated with poor SRH in older people in Korea, which is partially supported by the results of this study [ 15 ]. In a study that analyzed the functional impairment of older people living alone based on the 2017 National Survey of Older Koreans [ 4 ], it was reported that restrictions in daily functioning that interfered with the independent performance of the ADL negatively affected the SRH of older women living alone.…”

“…Choi and Lee [ 19 ] reported that the level of education strongly affected the health of older people: the lower the education level, such as elementary school graduation or below, the higher the inequality in SRH. The higher the education level, the more social resources are accessible and utilized, such as health information and medical service use networks; thus, a more positive self-assessment of older people’s health was reported in participants with a high level of education [ 15 ]. Conversely, poor SRH was reported among participants with a low level of education who lack support systems, such as family members, as they experience difficulty in acquiring and internalizing health information.…”

“…Therefore, it is necessary to develop a walking program that is tailored to suit the needs and characteristics of the vulnerable older group, especially as the frequency of walking for exercise purposes was low among older people with low levels of education. In addition, the need for health education to motivate residents to practice walking on their own and induce changes in residents’ awareness of the issue of walking has been emphasized [ 15 ]. Considering that older women living alone tend to have lower levels of education than older men and that older women are usually financially disadvantaged, walking for exercise is a suitable and convenient health-promoting activity for older women because it is inexpensive and requires less time and physical strength than other forms of exercise.…”

Why do older adults living alone in cities cease seeking assistance? A qualitative study in China

“…Although older people are the main consumers of healthcare services, stereotypes, prejudice, discrimination, and structural obstacles such as inconvenient transportation, shortage of geriatric specialists, and the spread of digital healthcare make it difficult for older people to access relevant resources [19,20]. Our research team conducted a qualitative study to reconstructed the paths and obstacles encountered by older adults in seeking community care services, and found multiple barriers, which were lack of community care information, limited mobility, complex process of achieving care, and incomprehension of needs expression, deterred the access of care resources for older adults effectively [21]. The quality of community care services may need to be improved, as service providers tend to provide care in the most convenient way, which may not be suitable for older adults [22].…”

Experiences and expectations of receiving volunteer services among home‐based elderly in Chinese urban areas: A qualitative study

“…These fragmented experiences do not allow for a comprehensive and in‐depth understanding of the need for volunteer services among the home‐based elderly. Furthermore, compared to rural areas, elderly people living in cities have a more difficult life and can easily become disconnected from society 31 . As a result, it is necessary to investigate the experience and expectations of urban home‐based older adults receiving volunteer service to point out the direction for volunteers to provide assistance services tailored to their needs.…”