Undermet Needs for Assistance in Personal Activities of Daily Living Among Community-Dwelling Oldest Old in China From 2005 to 2008

Abstract

Based on the 2005 and 2008 Chinese Longitudinal Healthy Longevity Survey, this study examined the prevalence of undermet needs for assistance in personal activities of daily living (ADL) and its associated risk factors among the oldest old aged 80+. Multilevel multinomial logistic modeling was used to analyze the risk factors and changes of undermet needs over time. The results show that the prevalence of slightly undermet needs decreased in urban China from 2005 to 2008. However, the prevalence of undermet needs remained high; 50% or more for both rural and urban residents. Compared to 2005, the likelihood of having slightly undermet needs in 2008 significantly decreased by 28% among rural residents and 22% among urban residents. The common risk factors of undermet needs among rural and urban residents included financial dependence, living alone, having unwilling caregivers, more ADL disabilities, and having poor self-rated health.

Keywords

undermet ADL needs change Chinese oldest multilevel model

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References

Allen

S. M.

Mor

(1997). The prevalence and consequences of unmet need: Contrasts between older and younger. Medical Care, 35, 1132–1148.

Allin

Grignon

Le Grand

(2010). Subjective unmet need and utilization of health care services in Canada: What are the equity implications? Social Science & Medicine, 70, 465–472.

Bai

(2008). Migrant workers in China: A general survey. Social Sciences in China, 29, 85–103.

Biao

(2007). How far are the left-behind left behind? A preliminary study in rural China. Population, Space and Place, 13, 179–191.

Casado

B. L.

Van Vulpen

K. S.

Davis

S. L.

(2011). Unmet needs for home and community-based services among frail older Americans and their caregivers. Journal of Aging and Health, 23, 529–553.

China National Committee on Ageing. (2011). Basic information on the elderly in 2011. Retrieved from http://www.cncaprc.gov.cn/res/w/2012_3/file/v21ah7it00m9.pdf

Chen

Hou

(2002). Unmet needs for health care. Health Reports, 13, 23–34.

Colman

Symoens

Bracke

(2012). Professional health care use and subjective unmet need for social or emotional problems: A cross-sectional survey of the married and divorced population of Flanders. BMC Health Services Research, 12, 420.

Cordingley

Hughes

Challis

(2001). Unmet need and older people: Towards a synthesis of user and provider views. York, England: Joseph Rowntree Foundation.

10.

DePalma

Covinsky

K. E.

Craig

B. A.

Stallard

Thomas

Sands

L. P.

(2012). Hospital readmission among older adults who return home with unmet need for ADL disability. The Gerontologist, 53, 454–461.

11.

Desai

M. M.

Lentzner

H. R.

Weeks

J. D.

(2001). Unmet need for personal assistance with activities of daily living among older adults. The Gerontologist, 41, 82–88.

12.

Ding

Gui

(2004). The impact of village children leaving home to work on the elders who stay behind. Renkou Yanjiu, 11, 44–52.

13.

Dubuc

Dubois

M.-F.

Raîche

Gueye

N’D. R.

Hébert

(2011). Meeting the home-care needs of disabled older persons living in the community: Does integrated services delivery make a difference? BMC Geriatrics, 11, 67.

14.

Dunlop

D. D.

Manheim

L. M.

Song

Chang

R. W.

(2002). Gender and ethnic/racial disparities in health care utilization among older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57, S221–S233.

15.

Feng

Zhen

Duncan

P. W.

Purser

J. L.

(2013). Trends in ADL and IADL disability in community-dwelling older adults in Shanghai, China, 1998-2008. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 68, 476–485.

16.

Feng

Liu

Guan

Mor

(2012). China’s rapidly aging population creates policy challenges in shaping a viable long-term care system. Health Affairs, 31, 2764–2773.

17.

Giacalone

J. A.

(2011). Long-term care as a threat to China’s economic growth. China-USA Business Review, 10, 65–72.

18.

Gibson

M. J.

Verma

S. K.

(2006). Just getting by: Unmet need for personal assistance services among persons 50 or older with disabilities. Washington, DC: AARP Public Policy Institute.

19.

Giles

Wang

Zhao

(2010). Can China’s rural elderly count on support from adult children? Implications of rural-to-urban migration. Journal of Population Ageing, 3, 183–204.

20.

Glass

A. P.

Gao

Luo

(2013). China: Facing a long-term care challenge on an unprecedented scale. Global Public Health, 8, 725–738.

21.

Goldstein

R. B.

Olfson

Martens

E. G.

Wolk

S. I.

(2006). Subjective Unmet need for mental health services in depressed children grown up. Administration and Policy in Mental Health, 33, 666–673.

22.

Grilli

Rampichini

(2007). A multilevel multinomial logit model for the analysis of graduates’ skills. Statistical Methods and Applications, 16, 381–393.

23.

(2007). General data quality assessment for the 2005 CLHLS wave. The CLHLS Technical Report 2007-No.1. Durham, NC: Duke University.

24.

Dupre

M. E.

Liu

(2007). Characteristics of the institutionalized and community-residing oldest-old in China. Social Science & Medicine, 64, 871–883.

25.

Dupre

M. E.

Warner

D. F.

Zeng

(2009). Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002. Social Science & Medicine, 68, 2170–2179.

26.

Vlosky

D. A.

(2008). Long-term care needs and related issues in China. In Garner

J. B.

Christiansen

T. C.

(Eds.), Social sciences in health care and medicine (pp. 52–84). New York, NY: Nova Science.

27.

Zeng

(2004). Data assessment of the Chinese Longitudinal Healthy Longevity Survey. In Zeng

Xiao

Zhang

(Eds.), Determinants of healthy longevity of the oldest-old in China (pp. 3–22). Beijing, China: Peking University Press.

28.

Guo

(2013). Parental status and late-life well-being in rural China: The benefits of having multiple children. Aging and Mental Health, 18, 19–29. doi:10.1080/13607863.2013.799117

29.

Henry

A. D.

Long-Bellil

Zhang

Himmelstein

(2011). Unmet need for disability-related health care services and employment status among adults with disabilities in the Massachusetts medicaid program. Disability and Health Journal, 4, 209–218.

30.

X.-Y.

Cheng

Peng

X.-D.

Zhang

X.-M.

Huang

C.-Q.

(2012). Living arrangements and risk for late life depression: A meta-analysis of published literature. International Journal of Psychiatry in Medicine, 43, 19–34.

31.

Katz

S. J.

Kabeto

Langa

K. M.

(2000). Gender disparities in the receipt of home care for elderly people with disability in the United States. Journal of the American Medical Association, 284, 3022–3027.

32.

Kemper

Weaver

Short

P. F.

Shea

Kang

(2008). Meeting the need for personal care among the elderly: Does medicaid home care spending matter?. Health Services Research, 43, 344–362.

33.

Kennedy

(2001). Unmet and undermet need for activities of daily living and instrumental activities of daily living assistance among adults with disabilities: Estimates from the 1994 and 1995 disability follow-back surveys. Medical Care, 39, 1305–1312.

34.

Komisar

H. L.

Feder

Kasper

J. D.

(2005). Unmet long-term care needs: An analysis of medicare-medicaid dual eligibles. Inquiry, 42, 171–182.

35.

LaPlante

M. P.

Kaye

H. S.

Kang

Harrington

(2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59, S98–S108.

36.

Leung

J. C. B.

(1997). Family support for the elderly in China. Journal of Aging & Social Policy, 9, 87–101.

37.

Liang

(2011). Migration and development in rural China. Modern China Studies, 18, 73–100.

38.

Lin

Chen

(2011). Urbanization and urban-rural inequality in China: A new perspective from the government’s development strategy. Frontiers of Economics in China, 6, 1–21.

39.

Liu

Zhang

Kwon

C.-S.

Quan

(2007). Rural and urban disparity in health services utilization in China. Medical Care, 45, 767–774.

40.

Liu

Y.-H.

Chang

H.-J.

Huang

C.-C.

(2012). The Unmet Activities of Daily Living (ADL) needs of dependent elders and their related factors: An approach from both an individual and area-level perspective. International Journal of Gerontology, 6, 163–168.

41.

Luo

Zhang

Jin

Wang

(2009). Inequality of access to health care among the urban elderly in northwestern China. Health Policy, 93, 111–117.

42.

Manton

K. G.

(1989). Epidemiological, demographic, and social correlates of disability among the elderly. Milbank Memorial Fund Quarterly/Health & Society Supplement on Disability, 67, 13–58.

43.

Middelboe

Mackeprang

Hansson

Werdelin

Karlsson

Bjarnason

… Sorgaard

K. W.

(2001). The Nordic study on schizophrenic patients living in the community. Subjective needs and perceived help. European Psychiatry, 16, 207–214.

44.

Ministry of Civil Affairs of the People’s Republic of China. (2006). Suggestions on accelerating the development of old-age service industry. Retrieved from http://fss.mca.gov.cn/article/lnrfl/zcfg/200903/20090310028507.shtml

45.

Ministry of Civil Affairs of the People’s Republic of China. (2012). 2011 Annual statistical report of the People’s Republic of China on the development of social services. Retrieved February from http://cws.mca.gov.cn/article/tjbg/201210/20121000362598.shtml

46.

Mitra

Bogen

Long-Bellil

L. M.

Heaphy

(2011). Unmet needs for home and community-based services among persons with disabilities in Massachusetts. Disability and Health Journal, 4, 219–228.

47.

Momtaz

Y. A.

Hamid

T. A.

Ibrahim

(2012). Unmet needs among disabled elderly Malaysians. Social Science & Medicine, 75, 859–863.

48.

Morrow-Howell

Proctor

Rozario

(2001). How much is enough? Perspectives of care recipients and professionals on the sufficiency of in-home care. The Gerontologist, 41, 723–732.

49.

Newcomer

Kang

LaPlante

Kaye

(2005). Living quarters and unmet need for personal care assistance among adults with disabilities. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60, S205–S213.

50.

op Reimer

W. J.

Scholte de Haan

R. J.

Rijnders

P. T.

Limburg

van den Bos

G. A.

(1999). Unmet care demands as perceived by stroke patients: Deficits in health care? Quality in Health Care, 8, 30–35.

51.

Quail

J. M.

Addona

Wolfson

Podoba

J. E.

Lévesque

L. Y.

Dupuis

(2007). Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over. European Journal of Ageing, 4, 45–55.

52.

Quail

J. M.

Wolfson

Lippman

(2011). Unmet need for assistance to perform activities of daily living and psychological distress in community-dwelling elderly women. Canadian Journal on Aging/La Revue Canadienne du Vieillissement, 30, 591–602.

53.

Qualité

Tillé

(2008). Variance estimation of changes in repeated surveys and its application to the Swiss survey of value added. Survey Methodology, 34, 173–181.

54.

Royston

(2005). Multiple imputation of missing values: Update. Stata Journal, 5, 527–536.

55.

The Center for the Study of Aging and Human Development. (2013). Technical reports of the Chinese Longitudinal Healthy Longevity Survey. Retrieved November from http://centerforaging.duke.edu/documentation/technical-reports

56.

Vitali

(2010). Regional differences in young Spaniards’ living arrangement decisions: A multilevel approach. Advances in Life Course Research, 15, 97–108.

57.

Wan

Kolanowski

(2008). Caring for aging Chinese: Lessons learned from the United States. Journal of Transcultural Nursing, 19, 114–120.

58.

Wang

(2006). China’s urban and rural old age security system: Challenges and options. China & World Economy, 14, 102–116.

59.

Wang

Chen

Pan

Jing

Liu

(2013). Associations and impact factors between living arrangements and functional disability among older Chinese adults. PLoS One, 8, e53879.

60.

Wang

Xie

Fisher

J. H.

(2009). Multilevel models: Applications using SAS. Beijing, China: Higher Education Press.

61.

Williams

Lyons

Rowland

(1997). Unmet long-term care needs of elderly people in the community: A review of the literature. Home Health Care Services Quarterly, 16, 93–119.

62.

Carter

M. W.

Goins

R. T.

Cheng

(2005). Emerging services for community-based long-term care in urban China. Journal of Aging & Social Policy, 17, 37–60.

63.

Mao

Z.-F.

Zhong

(2009). Long-term care arrangements in rural China: Review of recent developments. Journal of the American Medical Directors Association, 10, 472–477.

64.

Chow

J. C.

(2011). Exploring the community-based service delivery model: Elderly care in China. International Social Work, 54, 374–387.

65.

Zeng

Vaupel

J. W.

(2002). Functional capacity and self-evaluation of health and life of the oldest old in China. Journal of Social Issues, 58, 733–748.

66.

Zhang

(2006). Long-term care for the aged: Critical issues and challenges to China’s sustainable development. World Review of Entrepreneurship, Management and Sustainable Development, 2, 126–143.

67.

Zhang

Goza

F. W.

(2006). Who will care for the elderly in China? A review of the problems caused by China’s one-child policy and their potential solutions. Journal of Aging Studies, 20, 151–164.

68.

Zhen

Feng

(2013). The impacts of unmet needs for long-term care on mortality among older adults in China. Journal of Disability Policy Studies.Advance online publication. doi: 10.1177/1044207313486521.

69.

Zhu

C. W.

Livote

E. E.

Ross

J. S.

Penrod

J. D.

(2010). A random effects multinomial logit analysis of using medicare and VA healthcare among veterans with dementia. Home Health Care Services Quarterly, 29, 91–104.