Urban community home based elderly care service system: the dilemma between demand and supply in the city of Wuhan, China

Against a background of global ageing, the problem of ageing has become the basic national condition of China in the 21st century. China's ageing population presents the following characteristics: it is a large-scale, rapid process, an "ageing but not affluent society"; with an inclination to senility, and large regional differences. Wuhan City, in the Hubei Province, is a core city of central China. The basic characteristics of ageing in Wuhan are consistent with the national characteristics. China's rapid ageing coexists with a social background of not affluent population. As the ageing problem becomes gradually more serious, Community Home-based Elderly Care Services (CHECS) will also come under increasing pressure. With the availability of CHECS in China, as well as in Wuhan City, being restricted by scarce social resources and, therefore, unable to meet elderly's demand for services, the supply and demand for CHECS is seriously unbalanced. With the aim of solving this dilemma, the following research objectives have been defined in this thesis: the definition of CHECS and the reason for taking it as the basic supporting system for the elderly; the content of CHECS in Wuhan and the influencing factors of the elderly’s demand for CHECS; the review and analysis of elderly care policies in China and Wuhan City over the last 20 years, including the identification of current supply problems and influencing factors; a theoretical model of CHECS demand and supply is formed; and suggestions on improving the CHECS system in Wuhan are put forward. This thesis uses the Grounded Theory approach and qualitative research methods, including document analysis, participatory observation and in-depth interviews for data collection. Theoretical categorization of collected data was carried out with the coding method that allowed main categories to be extracted and the relationship between categories to be identified to form a substantive theoretical framework of the Demand and Supply of CHECS. In its analysis of the supply of CHECS, this thesis has thoroughly combed through the development context and content of China's elderly care policy in the past two decades, and identified two stages for China's elderly care policy: the normative development stage and the improving stage. Based on the influencing factors analyses, the CHECS demand and supply theoretical model was built. A further finding was that under the limited influence of government and limited resources, the supply of elderly home based care services by the community undergoes a dual problem of policy formulation and policy implementation, which arises from the defects present in the relationship between the different service provision actors.Sob o pano de fundo do envelhecimento global, o envelhecimento tornou-se um problema nacional básica da China no século XXI. O envelhecimento da população Chinesa caracteriza-se por ter sido um processo rápido e em larga escala, por resultar numa sociedade envelhecida, mas não afluente, uma tendência para a senilidade e pela existência de grandes diferenças regionais. A cidade de Wuhan situa-se na China central na província de Hubei. As características básicas do envelhecimento em Wuhan são consistentes com as características a nível nacional. O rápido envelhecimento da China coexiste com um contexto social de carência. À medida que o problema do envelhecimento se torna mais sério, os serviços comunitários de assistência domiciliária (CHECS) sentem uma pressão acrescida. Com os escassos recursos disponíveis quer na China, quer na cidade de Wuhan, é impossível responder à procura deste tipo de serviços, o que provoca um desequilíbrio sério entre a procura e a capacidade de oferta. Esta tese tem como principal objetivo resolver este problema, tendo sido definidos os seguintes subobjetivos: a definição de CHECS e a justificação para ser considerado como serviço básico de apoio à população idosa; o conteúdo deste tipo de serviço em Wuhan e os fatores que influenciam a sua procura pelos idosos; revisão e análise das políticas públicas de apoio aos idosos nos últimos 20 anos, na China e em Wuhan, incluindo a identificação dos atuais problemas e dos fatores que influenciam a oferta de serviços; desenha-se um modelo teórico para a procura e oferta de CHECS; e propõem-se sugestões para a melhoria do CHECS em Wuhan. Esta tese usa a metodologia da Grounded Theory e métodos de investigação qualitativos, incluindo a análise documental, a observação participativa e entrevistas em profundidade, para a recolha de informação. Dos dados recolhidos foram extraídas categorias teóricas com a ajuda do método de codificação, tendo sido também identificadas as relações entre categorias, bem como o quadro conceptual para a Procura e Oferta de CHECS. No âmbito da oferta de CHECS, esta tese examina em detalhe o desenvolvimento contextual e o conteúdo das políticas publicas chinesas de apoio aos idosos nas últimas duas décadas, tendo identificado dois estádios: o estádio de desenvolvimento normativo e o estádio de melhoria. Constrói-se um modelo teórico para a procura e oferta de CHECS com base nos fatores explicativos das duas variáveis. Perante a influência limitada do governo e a existência de recursos limitados, é possível concluir que a oferta de serviços comunitários de apoio domiciliário à população idosa de um duplo problema de formulação e implementação das políticas, derivado das deficiências presentes na relação entre os diferentes fornecedores de serviços

Large-scale educational telecommunications systems for the US: An analysis of educational needs and technological opportunities

The needs to be served, the subsectors in which the system might be used, the technology employed, and the prospects for future utilization of an educational telecommunications delivery system are described and analyzed. Educational subsectors are analyzed with emphasis on the current status and trends within each subsector. Issues which affect future development, and prospects for future use of media, technology, and large-scale electronic delivery within each subsector are included. Information on technology utilization is presented. Educational telecommunications services are identified and grouped into categories: public television and radio, instructional television, computer aided instruction, computer resource sharing, and information resource sharing. Technology based services, their current utilization, and factors which affect future development are stressed. The role of communications satellites in providing these services is discussed. Efforts to analyze and estimate future utilization of large-scale educational telecommunications are summarized. Factors which affect future utilization are identified. Conclusions are presented

The political economy of pensions : power, politics and social change : a comparative study of Canada, Britain and the United States

This thesis suggests that the pension systems in the advanced capitalist countries of Canada, Britain and the United States are on the verge of a crisis and that the problems associated with the marginalization and immiseration of the elderly, the universal and specific limitations of employer-based occupational pension plans and the underdevelopment of the state pension system are inherently and organically linked to the structure of private pension fund power. The impending pension crisis in these countries is explained by four converging structural considerations: first, the inadequate level of retirement income of the elderly; second, the increasing proportion of elderly in the population and the costs associated with an aging population; third, the general and particular limitations of the private pension system; fourth, under conditions of advanced capitalism, the corporate sector and state appropriating the occupational and state pension systems as a source of investment and social capital respectively to meet their finance requirements. The pension system now occupies a strategic position in advanced capitalist economies. The increasing economic power of pension funds is based on their role as financial intermediaries and institutional investors, with significant control over the economic surplus and reserve capital. The structure of pension fund power exhibits itself through formal and informal linkages to financial capital. The private pension system's investment and capital accumulation function has been transformed from a latent to a manifest function to supply the investment requirements of the economy and private sector. The private pension industry, characterized by a high degree of concentration and centralization of capital, increasingly facilitates the systemic fusion of the finance and industrial sectors of advanced capitalist economies. The symbiotic relationship between the corporate sector and private pension industry is identified as the primary economic and political obstacle to reforming and expanding the state pension system in the countries studied. It is concluded that the dynamic of the conflicting structural interests underlying the pension crisis may generate a heightened awareness of power and politics in capitalist countries by transcending the traditional limitations of economism and welfarism. The pension issue, both in the short and long-term, may generate increased social tension manifesting itself through intergenerational, sectoral, political and industrial relations conflict. This may result in increased politicization and progressive alternative economic strategies based on the pension system's investment and capital accumulation function. Public policy towards aging and pensions identifies personal problems and structural issues which may have significance in terms of power, politics, and social change in the future

Racial/Ethnic Variation in Perceptions of Medical Information Sources

Objectives: This report investigates the independent effect of race/ethnlcity on perceptions of the usefulness of 12 different sources of medical information, among a community-based sample. Methods: We analyzed data from a cross-sectional telephone survey of Latino, Black and White adults (n = 515) in Durham County in 2002. Subjects were asked to rate the usefulness of medical sources (doctors, nurses, pharmacy, health department), non-medical sources (minister/church, community center, friends/relatives, library) and media (internet, newspaper/magazine, radio, television). Logistic regression was used to determine the independent effect of race/ethnicity on ratings of information sources, adjusting for socioeconomic factors and health status factors. Results: Compared to Whites, Latinos and Blacks were more likely to perceive as useful the health department (OR= 3.7; 95% confidence interval [CI] = 1.4, 9.4 and OR= 2.0; CI = 1.1, 3.5) minister/churches (OR= 4.7; CI = 1.7, 12 and OR= 5.0; CI = 2.8, 9.1), community centers (OR= 6.4; CI = 2.4, 16.0 and OR= 3.2; CI = 1.8, 5.6), television (OR= 4.0; CI = 1.6, 10.0 and OR= 3.9; CI = 2.1, 7.2), and radio (OR= 4.5; CI = 1.9, 10 and OR= 3.2; CI = 1.8, 5.5). Latinos were less likely to report the pharmacy as a useful source (OR= .01; CI = .03, 0.27). Conclusions: There are substantial racial/ethnic differences in perceptions of certain medical information sources. Medical information designed for minority populations may be more effective if disseminated through particular sources.Master of Public Healt

The Use of digital games to enhance the physical exercise activity of the elderly : a case of Finland

According to the World Health Organization (WHO), population ageing is a global phenomenon, which brings both challenges and opportunities for society. The current longer expected lifespan can create opportunities for the elderly to contribute in many ways to their families and communities. However, it greatly depends on their quality of life, which is affected by many factors, including physical and functional health, social well-being, and cognitive abilities. The WHO (2012) states that physical health is one of the indicators for the elderly’s quality of life, and it declines with increasing age. Participation in regular physical exercises can help the elderly improve their physical and mental health, and this has been aided by the use of modern technologies to promote the elderly’s physical and functional health. Of these latest technologies, digital games have shown promise to improve and enhance the elderly’s physical activities through fun and engaging gameplay. The literature highlights that some commercial games in the market (e.g. Microsoft Kinect- Sports and Nintendo Wii Sports games) have the potential to improve the elderly’s physical health such as gait, balance, and fall prevention. However, researchers argue that these commercial games are not designed specifically for the elderly and their physical exercise activities. They state that most commercial games are not user-friendly for the elderly whose functional and physical abilities are limited due to their advanced years. The literature points out that more studies need to be undertaken to understand the usability and usefulness of digital games for physical exercise activities so that game designers can create elderly-friendly digital games in the future. In Finland, the government has been focusing on promoting healthy ageing and increasing home care services for the elderly. In recent years, Finnish researchers have used digital games to promote older Finns’ healthy and active ageing. The existing literature, whilst showing the potential of digital games for elderly Finns’ physical health, also acknowledges further research is needed particularly in the context of Finland. Thus, in this study, we aimed at investigating digital games to specifically assess their applications for older Finns’ physical activities, focusing on the quality of users’ experiences, and their reported ease of use and perceived usefulness. We used the mixed methods approach, which applies both qualitative and quantitative research methods. The study design included four stages: requirements gathering, analysis and design, prototyping, and evaluation. Firstly, we conducted pre-studies to elicit users’ requirements. This was followed by the analysis of the resulting data to identify trends and patterns, which fuelled ideas in the brainstorming game design and development phases. The final product was a digital game-based physical exercise called the Skiing Game. We then evaluated the Skiing Game in Finland with 21 elderly Finns (M=7, F=14, Average Age =76). By using questionnaires, observation, and interviews, we investigated user experiences, focusing on the game’s usability, and usefulness for enhancing the physical activity and wellbeing of the elderly. We also conducted a comparative test of the Skiing Game in Japan with 24 elderly Japanese participants (M=12, F=12, Average Age = 72) to further understand non-Finnish elderly users’ experiences. The findings from the usability study of the Skiing Game in Finland demonstrated that elderly Finns had a positive experience in the gameplay, and their motivation was noticeably high. It also confirmed that elderly Finns have a genuine interest in digital game-based exercises and strong intentions to play digital games as a form of physical exercise in the future. Although prior to the study most of them had negative views and misconceptions about digital games, after the gameplay their attitudes were decidedly positive. They acknowledged that whilst playing digital games could be an alternative way of exercising for them their use would primarily be when they don’t have access to their usual non-digital physical exercise. The Japanese usability of the Skiing Game showed that the elderly Japanese people also had positive user experiences in playing digital games, and also intend to use them in the future. Similarly, after playing the game they reported that their attitudes towards digital games become positive, and indicated playing digital games could be an alternative way of exercising. Although the comparison of the two studies suggests that the elderly Finns had relatively more positive experiences whilst playing the Skiing Game, compared to their Japanese counterparts, in general, both groups had a positive experience in the gameplay and showed interest in digital games as an alternative exercise. Based on the usability lessons learned from these two studies, recommendations for practitioners and designers regarding improvements in game design and development are made in this report. Implementing these modifications into future designs and further development of digital games for the elderly will improve their commercial viability and user uptake. The findings from this study can provide valuable insights, particularly for Finnish policymakers and healthcare practitioners who are keen to introduce digital games into the aged-care sector in Finland. The studies have also provided valuable insights into the optimal methods for introducing Finnish digital games to international markets, in particular, digital games tailored specifically for the physical exercise needs and motivations of the elderly. By taking into consideration the limitations of the study, we provide our future studies and further improvements of the game to be conducted

Physical environment of residential aged care facilities in northeast China

The increasing number of "empty nest elderly" has attracted much attention to the living environment of care facilities for, the elderly. For this reason, this research mainly studies and analyzes the living environments of elderly care facilities in China. With the increasing number of China’s aging and self care elderly people, the demand of residential aged care facilities (RACFs) is also growing in this country. This study compares elderly care facilities in China and UK, with focus on the merits of some RACFs in the United Kingdom. In addition, this study also selected 305 elderly people in a city, and summarized the elements that encouragement the elderly residents’ quality of life (QoL). Through the method of hierarchical coding associated with grounded theory, the relevant factors of the elderly resident’s QoL and the living environment are summarized. Yet, the RACFs are in short supply in China, and attention to this situation is insufficient. There are also problems regarding resource allocation. The system of elderly care facilities in UK is more rational organized with better caring facilities, which provides lessons for China. Drawing on the experience of the UK’s provision of aged care facilities helps to explore and develop facilities that meet the needs of China’s elderly care. Three main elements that have influence on the elderly’s QoL are: “What do they need; Why do they needed; and What choices are available for them” which can be approached through grounded theoretical research and analysis. The three factors play an central part in the QoL of the elderly and affect their choice behavior. In addition, the physical environment is one of the important influencing factors. The health of the elderly is poor, and any surrounding factors will affect the feeling of the elderly. Therefore, the elderly have higher requirements for RACFs. The physical environments of the RACFs were found to be highly correlated with the indoor environmental quality (IEQ) rating, which includes acoustic, lighting, and thermal environment, and indoor air quality (IAQ). The survey found that IEQ ratings are affected by seasonality, with rating of bedrooms higher than that of activity rooms. Among them, the satisfaction threshold related to sound is higher in summer than in winter, while the satisfaction threshold related to lighting is less affected by the season. The study of architectural composition, indoor building environment and residential satisfaction on the QoL of the elderly in the RACFs in the northeast China shows that IEQ and residential satisfaction RS as intermediary variables indirectly affect the effect of AC building component on QoL. Meanwhile, the influences of building types, seasonal distribution and RACFs scale on IEQ were analyzed in the 34 RACFs of northeast China. The results have shown that despite the reconstruction of RACFs and seasonal distribution, the satisfaction of the participants have changed, while the scale of RACFs has less influence on the satisfaction. Research into elderly residents’ rating of acoustic comfort in an activity hall in a residential aged care facility in Harbin, China, showed that the elderly had a low satisfaction with the acoustic environment of the activity hall. As the sound pressure level (SPL) raised, the elderly’s rating of their satisfaction with the acoustic environment declined. The elderly’s satisfaction and preference for music sounds were higher than other sound types, such as chatting or machine noises. The satisfaction towards music can also decline due to certain factors, but was slower than other sound types. Although the pension system has been established in China for a long time, improving the living environments of the elderly has not attracted attention, and the psychological factors of the elderly people are normally ignored due to the immature architectural understanding of the elderly. The devise of the living environment for the elderly people in China is not adequately sophisticated. The design of housing suitable for the elderly should attract social attention. In short, the investigation and analysis of this study have significance for the living environment of the elderly in China