The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.
AndersenR. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36(1), 1. https://doi.org/10.2307/2137284
2.
AnkudaC. K.LevineD. A. (2016). Trends in caregiving assistance for home-dwelling, functionally impaired older adults in the United States, 1998-2012. JAMA, 316(2), 218. https://doi.org/10.1001/jama.2016.6824
3.
BasuR.SteinerA. C.StevensA. B. (2022). Long-term care market trend and patterns of caregiving in the U.S. Journal of Aging and Social Policy, 34(1), 20–37. https://doi.org/10.1080/08959420.2021.1926209
4.
BlomgrenJ.MartikainenP.MartelinT.KoskinenS. (2008). Determinants of home-based formal help in community-dwelling older people in Finland. European Journal of Ageing, 5(4), 335–347. https://doi.org/10.1007/s10433-008-0094-4
ChenY.-M.ThompsonE. A. (2010). Understanding factors that influence success of home- and community-based services in keeping older adults in community settings. Journal of Aging and Health, 22(3), 267–291. https://doi.org/10.1177/0898264309356593
8.
ChouR. J.-A. (2011). Filial piety by contract? The emergence, implementation, and implications of the “family support agreement” in China. The Gerontologist, 51(1), 3–16. https://doi.org/10.1093/geront/gnq059
9.
FavreaultM. M.GleckmanH.JohnsonR. W. (2015). Financing long-term services and supports: Options reflect trade-offs for older Americans and federal spending. Health Affairs, 34(12), 2181–2191. https://doi.org/10.1377/hlthaff.2015.1226
10.
FengZ.LiuC.GuanX.MorV. (2012). China’s rapidly aging population creates policy challenges in shaping A viable long-term care system. Health Affairs, 31(12), 2764–2773. https://doi.org/10.1377/hlthaff.2012.0535
11.
GlassA. P.GaoY.LuoJ. (2013). China: Facing a long-term care challenge on an unprecedented scale. Global Public Health, 8(6), 725–738. https://doi.org/10.1080/17441692.2013.782060
12.
HooymanN. R.KiyakH. A. (2017). Social gerontology. Pearson Education.
HuB. (2019). Projecting future demand for informal care among older people in China: The road towards a sustainable long-term care system. Health Economics, Policy and Law, 14(1), 61–81. https://doi.org/10.1017/S1744133118000221
15.
JacobsM. T.Broese van GroenouM. I.de BoerA. H.DeegD. J. H. (2014). Individual determinants of task division in older adults’ mixed care networks. Health and Social Care in the Community, 22(1), 57–66. https://doi.org/10.1111/hsc.12061
16.
KayeH. S.HarringtonC.LaPlanteM. P. (2010). Long-term care: Who gets it, who provides it, who pays, and how much?Health Affairs, 29(1), 11–21. https://doi.org/10.1377/hlthaff.2009.0535
17.
KempC. L.BallM. M.PerkinsM. M. (2013). Convoys of care: Theorizing intersections of formal and informal care. Journal of Aging Studies, 27(1), 15–29. https://doi.org/10.1016/j.jaging.2012.10.002
18.
KitchenerM.NgT.MillerN.HarringtonC. (2005). Medicaid home and community-based services: National program trends. Health Affairs, 24(1), 206–212. https://doi.org/10.1377/hlthaff.24.1.206
19.
KongD.LiM.WangJ.DavittJ. K.DongX. (2019). The relationship between depressive symptoms and health services utilization in U.S. Chinese older adults. The Gerontologist, 59(3), 447–455. https://doi.org/10.1093/geront/gny010
20.
LeeY.BarkenR.GonzalesE. (2020). Utilization of formal and informal home care: How do older Canadians’ experiences vary by care arrangements?Journal of Applied Gerontology, 39(2), 129–140. https://doi.org/10.1177/0733464817750274
21.
LiI.FannS.KuoH.-T. (2011). Predictors of the utilization of long-term care (LTC) services among residents in community-based LTC facilities in Taiwan. Archives of Gerontology and Geriatrics, 53(3), 303–308. https://doi.org/10.1016/j.archger.2010.11.009
22.
LinJ.-P.YiC.-C. (2013). A comparative analysis of intergenerational relations in East Asia. International Sociology, 28(3), 297–315. https://doi.org/10.1177/0268580913485261
23.
LitwinH.Attias-DonfutC. (2009). The inter-relationship between formal and informal care: A study in France and Israel. Ageing and Society, 29(1), 71–91. https://doi.org/10.1017/S0144686X08007666
24.
LuP.KongD.ShelleyM.DavittJ. K. (2022). Intersectional discrimination attributions and health outcomes among American older adults: A latent class analysis. The International Journal of Aging and Human Development, 95(3), 267–285. https://doi.org/10.1177/00914150211066560
25.
LuP.YangC.YaoJ.ShelleyM. (2020). Outpatient and inpatient service use by Chinese adults living in rural low-income households. Social Work in Public Health, 35(4), 223–233. https://doi.org/10.1080/19371918.2020.1774458
26.
LyonsK. S.ZaritS. H. (1999). Formal and informal support: The great divide. International Journal of Geriatric Psychiatry, 14(3), 183–192. https://doi.org/10.1002/(SICI)1099-1166
27.
NaylorM. D.KurtzmanE. T.MillerE. A.NadashP.FitzgeraldP. (2015). An assessment of state-led reform of long-term services and supports. Journal of Health Politics, Policy and Law, 40(3), 531–574. https://doi.org/10.1215/03616878-2888460
28.
Nguena NguefackH. L.PagéM. G.KatzJ.ChoinièreM.VanasseA.DoraisM.SambO. M.LacasseA. (2020). Trajectory modelling techniques useful to epidemiological research: A comparative narrative review of approaches. Clinical Epidemiology, 12, 1205–1222. https://doi.org/10.2147/CLEP.S265287.
29.
Nylund-GibsonK.ChoiA. Y. (2018). Ten frequently asked questions about latent class analysis. Translational Issues in Psychological Science, 4(4), 440–461. https://doi.org/10.1037/tps0000176
30.
ParaponarisA.DavinB.VergerP. (2012). Formal and informal care for disabled elderly living in the community: An appraisal of French care composition and costs. The European Journal of Health Economics, 13(3), 327–336. https://doi.org/10.1007/s10198-011-0305-3
31.
PhillipsD.GreenH.PetrosyanS.ShaoK.WilkensJ.LeeJ. (2021). Harmonized CHARLS documentation version D (2011-2018) (pp. 1–828). University of Southern California.
32.
RodriguezM. (2014). Use of informal and formal care among community dwelling dependent elderly in Spain. The European Journal of Public Health, 24(4), 668–673. https://doi.org/10.1093/eurpub/ckt088
33.
ScottJ. P.RobertoK. A. (1985). Use of informal and formal support networks by rural elderly poor. The Gerontologist, 25(6), 624–630. https://doi.org/10.1093/geront/25.6.624
34.
SkocpolT. (1996). Protecting soldiers and mothers: The political origins of social policy in the United States (1. Aufl., 4. Druck). Harvard University Press.
35.
Solé-AuróA.CrimminsE. M. (2014). Who cares? A comparison of informal and formal care provision in Spain, England and the USA. Ageing and Society, 34(3), 495–517. https://doi.org/10.1017/S0144686X12001134
36.
SolonG.HaiderS. J.WooldridgeJ. M. (2015). What are we weighting for?Journal of Human Resources, 50(2), 301–316. https://doi.org/10.3368/jhr.50.2.301
37.
SuanetB.Van GroenouM. B.Van TilburgT. (2012). Informal and formal home-care use among older adults in Europe: Can cross-national differences be explained by societal context and composition?Ageing and Society, 32(3), 491–515. https://doi.org/10.1017/S0144686X11000390
38.
ThomasK. S.ApplebaumR. (2015). Long-term services and supports (LTSS): A growing challenge for an aging America. Public Policy and Aging Report, 25(2), 56–62. https://doi.org/10.1093/ppar/prv003
39.
ThorpeJ. M.ThorpeC. T.KenneltyK. A.PandhiN. (2011). Patterns of perceived barriers to medical care in older adults: A latent class analysis. BMC Health Services Research, 11(1), 181. https://doi.org/10.1186/1472-6963-11-181
40.
VlachantoniA.ShawR. J.EvandrouM.FalkinghamJ. (2015). The determinants of receiving social care in later life in England. Ageing and Society, 35(2), 321–345. https://doi.org/10.1017/S0144686X1300072X
41.
WangJ.HuangY.ZhangY.WuF.WuB. (2022). Domestic helpers as frontline workers in home-based long-term care in China: Opportunities and challenges. Journal of Aging and Social Policy, 35(5), 1–20. https://doi.org/10.1080/08959420.2022.2120323.
42.
WellerB. E.BowenN. K.FaubertS. J. (2020). Latent class analysis: A guide to best practice. Journal of Black Psychology, 46(4), 287–311. https://doi.org/10.1177/0095798420930932
43.
WilkensJ.GreenH.PetrosyanS.ShaoK.RebellatoG.PhillipsD.LeeJ. (2022). Harmonized HRS documentation version C (1992-2019). University of Southern California.
WuB.CohenM. A.CongZ.KimK.PengC. (2021). Improving care for older adults in China: Development of long-term care policy and system. Research on Aging, 43(3–4), 123–126. https://doi.org/10.1177/0164027521990829
47.
XuQ.ChowJ. C. (2011). Exploring the community-based service delivery model: Elderly care in China. International Social Work, 54(3), 374–387. https://doi.org/10.1177/0020872810396260
48.
YangW.TanS. Y. (2021). Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China health and retirement longitudinal survey. Ageing and Society, 41(5), 980–999. https://doi.org/10.1017/S0144686X1900148X
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