The effect of health status and living arrangements on long term care models among older Chinese: A cross-sectional study

<div><p>Background</p><p>Currently, there are many studies focusing on the influencing factors of the elderly people’s living arrangements or health status, but little is known about the relationship between living arrangements or health status and long-term care models for the old-age, especially the joint effects.</p><p>Objective</p><p>We aimed to assess the effects of health status and living arrangements on long-term care models (LTCM) among the elderly of Xiamen, China, especially their cumulative joint effects.</p><p>Methods</p><p>A total of 14,373 participants aged ≥ 60 years by multistage sampling in Xiamen of China were enrolled. Multinomial logistic regression was used to estimate the Odds ratios (ORs) regressing LTCM on health status and living arrangements using the Anderson model as theoretical framework.</p><p>Results</p><p>Totally, 14,292 valid questionnaires were obtained, of which 86.37% selected home care. With the increase of disability degree, older people are more likely to choose institutional care, compared to living alone (ORs = 1.75, 2.06, 4.00, 4.01 for the “relatively independent’, “mild disability’, “moderate disability’, and “total disability’, respectively, in comparison with “completely independent’). The elderly living with children and other family members preferred to choose home care. (ORs = 0.50, 0.39, 0.40, and 0.43 for the “living with children’, “living with spouse’, “living with children and spouse’, and “living with others’, respectively, in comparison with “alone’). Additionally, residence, number of children, education level, and feelings of loneliness were the determinants of the choice of social pension.</p><p>Conclusion</p><p>A multitude of older people are trended to choose home care in Xiamen of China. There was an interaction and joint effect between the degree of disability and the living arrangements on LTCM. Therefore, policymakers should pay close attention to care for those living alone, childless, and disabled elders to meet their care needs, especially in home care. In addition, the social construction of facilities for elders in rural areas should be strengthened.</p></div

The effect of health status and living arrangements on long term care models among older Chinese: A cross-sectional study - Fig 2

<p><b>Violin plots with jittering points (A) and Sector chart with proportion (B, C) of participants’ LTCM under age, living arrangements and ADL, and bubble plot (D) for interspersion of participants by living arrangements and ADL.</b> For LTCM, 1 = home care, 2 = community care, 3 = institution care. For living arrangements,1 = alone,2 = with spouse,3 = with children,4 = with spouse and children,5 = with others. For health status, 1 = totally independent, 2 = relatively independent, 3 = disability.</p

Odds ratios (95% confidence intervals) obtained from multivariable adjusted^a multinomial logistic models (Model Ⅱ).

<p>Odds ratios (95% confidence intervals) obtained from multivariable adjusted^a multinomial logistic models (Model Ⅱ).</p

The Anderson theoretical model of influencing factors on LTCM.

<p>The Anderson theoretical model of influencing factors on LTCM.</p

Basic characteristic of 14,292 participants according to the LTCM.

<p>Basic characteristic of 14,292 participants according to the LTCM.</p

Additional file 3: Figure S2. of Spatial analysis of gender variation in the prevalence of hypertension among the middle-aged and elderly population in Zhejiang Province, China

Posterior mean of RR adjusted for obese for Zhejiang Province in 2012. (a), (b) denotes posterior mean of RR adjusted for obese for Zhejiang Province in 2012, by gender. (DOCX 266 kb

Odds ratios (95% confidence intervals) obtained from multivariable adjusted^a multinomial logistic models regressing LTCM on health status and living arrangements, accounting for interactions of self-care level and living arrangements.

<p>(Model Ⅲ).</p

Multinomial logistic models of LTCM (ModelⅠ).

<p>Multinomial logistic models of LTCM (ModelⅠ).</p

Survey data of 13880 participants in Xiamen, China

Survey data of 13880 participants in Xiamen, Chin

Data_Sheet_1_Research on the optimization of financing scheme of long-term care insurance in China based on system dynamics simulation.docx

ObjectiveThe aging population in China highlights the significance of long-term care insurance (LTCI). This study provides policy suggestions for China to establish a sustainable LTCI financing mechanism by predicting the trend of funds balance and screening the appropriate financing scheme.MethodA system dynamics model (SDM) of LTCI funds was constructed by clarifying the current situation and its main influencing factors of revenue and expenditure of LTCI funds in China. Also, through literature research and expert consultation, we found the intervention goals and predicted the changing trend of LTCI fund balance from 2020 to 2050 under different intervention schemes.ResultsThe SDM of LTCI financing passes the dimensional consistency test, structural test, and historical test. Therefore, it can objectively reflect the structure and behavior of the financing system. It is found that the factors affecting the revenue and expenditure system of LTCI funds mainly include economic factors, demographic factors, and other factors. By adjusting three intervention indicators, namely, individual payment rate, reimbursement proportion, and severe disability rate, this study produces 45 financing combination schemes. By comparing the changing trend of LTCI fund balance under different intervention schemes, according to the screening principle, five better financing schemes are finally selected. These five financing schemes have no deficit and excessive balance in the forecast period, which is in line with the principle of sustainability. It can provide a reference for the selection of financing schemes in pilot areas.DiscussionThis study has optimized the policy of the LTCI financing mechanism, determined the suitable LTCI participants, financing channels and levels, and screened out the suitable LTCI financing policy optimization scheme for China. By appropriately increasing the individual payment rate, strengthening the disability intervention of the elderly, formulating scientific and objective disability evaluation standards, and finally establishing a dynamic financing adjustment mechanism of LTCI. This study can provide a basis for the scientific formulation of the LTCI financing mechanism in China and provide a reference for developing countries to establish a sustainable LTCI.</p