Ageing in rural China: impacts of increasing diversity in family and community resources

Unveiling the Evolution of Eldercare Facilities in Rural China: Tracing the Trajectory from Eldercare Support Pattern and Service to Facilities for the Aging Population

The phenomenon of population aging in rural China presents a compelling societal challenge, necessitating a growing demand for both the quantity and quality of facilities supporting the needs of older people. However, a lack of comprehensive understanding concerning the underlying mechanisms that drive the emergence of these facilities, coupled with the distinctive historical backdrop and social development stage of the nation, engenders complexities in achieving sustainable rural eldercare services. This paper endeavors to comprehensively elucidate diverse eldercare facility types in rural China, delineating their intrinsic characteristics and prerequisites for construction. Additionally, the research delves into the political and economic contexts and advancements in healthcare and eldercare services, culminating in the formulation of an integrated framework that interconnects eldercare support patterns with the political landscape and public service provisions. The implications derived from this nuanced framework provide insightful reflections on significant historical transitions, intricacies faced by rural eldercare facilities, and strategic pathways for fostering future eldercare service delivery systems and allied facilities. The paper's findings furnish insights for bolstering the well-being of the aging population in rural China and lay a substantive foundation for addressing the evolving requisites of eldercare within this distinctive context.

Overage labor, intergenerational financial support, and depression among older rural residents: evidence from China

Background

Depression is a major factor affecting the happiness of older rural residents. With the increasing aging of the Chinese population, overage labor is becoming more prevalent in rural areas of China. This study aimed to assess whether, and if so, how, overage labor affects depression status in older rural residents.

Methods

Using data from the China Health and Retirement Longitudinal Study, this study explored the association between overage labor and depression among older rural residents by using ordinary least squares and moderated mediation models.

Results

The results show that overage labor significantly reduced levels of depression in older rural residents. This result remained robust after using propensity score matching and double machine learning. Furthermore, the improvement of older rural residents' depression via overage labor is mainly achieved through work income, but this mediating effect is negatively moderated by intergenerational financial support. This implies that in traditional Chinese rural society, intergenerational financial support from children plays an important role in reducing depression among older rural residents.

Conclusion

Our findings have potential policy implications for China and other developing countries in terms of addressing issues related to aging and depression in older adults.

Ageing and familial support: a three-generation portrait from urban China

Research on ageing in China has been preoccupied with the unsolved question of whether traditional filial piety is eroded or sustained by societal modernisation. This article engages with the ongoing debate on modernisation and family change, but seeks to go beyond the prevailing dichotomous conclusion. Rather than focusing on one intergenerational relationship between ageing parents and their adult children – a common formula in the existing literature – this article draws upon 120 life-history interviews, involving both genders and three generations in three cities, and examines how old-age support practices have shifted across three generations, as well as between sons and daughters across time. The findings indicate that while there has been a decline in everyday financial and instrumental support by adult children for their parents across all three generations, crisis-induced intergenerational solidarity has remained intact. As the market economy has matured, differences in ageing experience have widened between working-class and affluent families. The article also reveals that care for bilateral parents has characterised the behaviour of the three urban generations. The complex shifts and continuities are the outcome of a combination of state policies, evolving filial norms, gender and demographic forces, as well as reflecting the broader structural consequences of China's shift to a market economy. By systematically comparing old-age practices by generation and gender in both Mao and post-Mao eras, the article makes a major empirical contribution to the study of ageing in urban China. From a theoretical perspective, it contributes to the global debate on modernisation and ageing by emphasising the uneven processes in which social change interacts with family life within a single country, when viewed through generational and gender prisms. In so doing, it highlights the ways in which old-age support trajectories are firmly grounded in local history and cultural, economic and demographic forces.

Measuring demand and supply of community care services for older people healthy ageing in rural Zhejiang Province

BACKGROUND

A consequence of demographic trends and economic prosperous is the increasing diversity in needs for care services. However, the traditional family support for older people has been largely supplanted by the wider provision of community care services. This study aims to investigate the current status of demand and supply in community care services across different villages of Zhejiang province and assess service effectiveness for healthy ageing.

METHODS

A questionnaire survey was carried out towards 207 rural villages across 9 cities in Zhejiang province. One hundred eighty-six valid responses were received, representing a response rate of around 89.9%. Descriptive statistics were employed to identify older villagers' care needs and available community services. Comparative analysis examined the balance between the demand and supply of community care services. Correlation analysis were applied to determine key factors that impacted the supply of social services in rural communities.

RESULTS

The research found that rural older residents normally lived with their children or spouse with limited literacy and income. On average the categories of community care services is substantially small in comparison with the increasingly diverse demands of older people in rural areas. There was an obvious mismatch between service demand and service supply in rural communities, which often caused the waste of public resources. Moving forward, the uppermost priority is given to infrastructure construction service and daily life service, while little attention is paid to mental health service and specialized nursing service.

CONCLUSION

There needs to be an improvement in the socio-economic capacity of rural communities and in the diversity of social care services. Policies and strategies are also needed to encourage private sectors' involvement in providing care services for rural older people. Local government should have a clear vision of the potential demands for community care services, practical guidelines will be useful in guaranteeing better service quality.

Exploring Daily Activity Patterns on the Typical Day of Older Adults for Supporting Aging-in-Place in China's Rural Environment

Severe aging in rural China is prompting communities to promote support for older people to age in place. The study of the daily life of older adults in rural areas is conducive to understanding their real life and demands, as well as the way they interact with their environment, to develop feasible strategies. In this study, 171 older adults over 60 years old in two different types of villages in Northern Zhejiang Province were investigated and analyzed in terms of the temporal and spatial features of daily activities, as well as their relationship with population attributes, personal competence, and subjective demands. The results show that: (1) significant association can be seen between working hours and the demand for health services, housework hours and gender and age, as well as leisure hours and ADL and the demand for recreational services. (2) The older adults appear to have inter-group homogeneity in some aspects: basic living activities, leisure hours, the gender difference in housework hours, and recreational preference, while they have higher average paid work hours and fewer leisure alternatives than their urban counterparts. Their definitions of paid work, housework, and leisure activities are vague. (3) The definition of home by the older adults in rural places sometimes seems to go beyond the scope of their own house, and the extensive definition of home may change their recognitions of some activities. They also inclined to assign meaning to a place through frequent use rather than through external definitions. (4) The weak consciousness on buying services and deteriorated financial situation hinders the older adults in rural communities from expressing their real demands. Unspoken demands include economic security, recreational choices, and assistance in housework. The results will help to provide references for the improvement of eldercare services and the community environment.

An Analysis of the Impact of Forest Policy on Rural Areas of Chile

The relationship between the forest sector and the well-being of people that depend on it for their economic livelihoods in rural areas is of strong interest in forest policy. In this sense, Chile has developed a forest policy that has had positive impacts, particularly on economic and productive aspects, but also negative impacts, such as the reduction of natural forest area, biodiversity, and provision of ecosystem services, as well as the increase in social conflicts and land abandonment. However, there are few studies that have evaluated the impacts of forest policy on rural population and development of the territory. Therefore, the objective of this research is to evaluate the impacts of Chilean forest policy on rural communities, particularly in terms of demographic variables and indicators of community well-being. The study area corresponds to the Bio Bio and Ñuble Regions (Chile), and the analysis includes productive, demographic, socioeconomic, and educational characteristics of population. The results show that the forestry policy implemented was able to generate a significant increase in the proportion of forest area. However, when this increase is mainly of the type of exotic forest plantations, it is associated with a demographic and socio-economic detriment of the population in some counties of the study area.

Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City

Background

Community-based care services refers to the professional services provided at home to the elderly with formally assessed demands. The growth of the elderly population has increased the demand for these services, and this issue is even worse in the affordable housing community (AHC) of China. Understanding of elderly’s demands for different types of community-based care services and its determinations would enable the implementation of appropriate incentive schemes to promote utilization of community-based care services in the AHCs of China.

Methods

Guided by previous studies, a conceptual framework was developed. Then, a questionnaire was designed and a community based survey was conducted from May 10–20, 2018 in Daishan AHC of Nanjing City, China. Four hundred eight participants from 25,650 elderly people were selected by systematic random sampling technique. Binary logistic regression was applied to the data about the elderly’ primary demands for community-based care services in the AHC, to quantify the elderly’s demands and explore related individual-level factors.

Results

The finding indicates that more than 50% of respondents had the demand for an elderly care hotline, building health archives, on-call nursing and doctor visits, medical lectures, regular medical examinations and sporting fitness. The binary logistic regression models revealed that the primary demands of the elderly for community-based care services were influenced by distinct factors.

Conclusions

Our findings help clarify different types of community-based care services and provide fresh information about the demand for community-based care among the elderly in AHCs. Several policy implications are discussed to enhance the efficiency of community-based care service provision.

Urban–rural disparities in cardiovascular disease risks among middle-aged and older Chinese: two decades of urbanisation

China has been undergoing dramatic socio-economic and demographic changes in the last few decades. The rapid growth of the ageing population will pose tremendous challenges to its public health and social welfare system. This study aims to examine how urbanisation has impacted cardiovascular disease (CVD) risks among middle-aged and older Chinese in two decades, from 1991 to 2011. Data were drawn from a nationwide longitudinal data-set of the China Health and Nutrition Survey (CHNS) (sweeps 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011). Participants aged ⩾45 years old were included. A dynamic urbanisation index was created for each community (village or neighbourhood) based on community-level data that can reveal the heterogeneity within and across places and capture dimensions of social, economic and physical characteristics of urban living over time and space. Multi-level modelling analyses (level 1: occasions; level 2: individuals; level 3: households; level 4: communities) were performed on outcomes of CVD risks such as body mass index, waist circumference, and systolic and diastolic blood pressure. The results show upward trends in all CVD risks for both genders over 20 years of urbanisation after adjustment for socio-economic and demographic confounders. Urbanisation in China is associated with absolute increases in CVD risks over time among its middle-aged and older people, despite its contribution to relative reduction of the rural–urban gap over time. This is particularly true for women from the least urbanised areas. It is relevant to inform policy-making processes to target the most vulnerable groups of older people in China during its rapid urbanisation process. There is a possibility for policy intervention to reduce inequality during the process of China's planned urbanisation.

The need for community care among older people in China

The social care system of China has come under close scrutiny from policy makers due to the rapid ageing of China's population. Unfortunately, there is very little Chinese research evidence that might be used to plan future service developments. This article is a contribution to filling that gap and it provides essential new information on the expressed demand among older people in China for various community care services. The data are from the 2008 wave of the Chinese Longitudinal Healthy Longevity Survey. According to the characteristics of the dependent variables, we used Binary Logistic Regression Analysis to analyse the need for community care among older people in China. The results show considerable need for such care, but China is still a developing country and there are insufficient resources to fund a Western-style social care system (even if that was desirable). Thus, it is argued that the development of social care in China should emphasise community-based care, in partnership with families, with institutional care as a last resort. In addition, it is argued that China (and other countries) should introduce measures to prevent the demand for social care.

Alignment or struggle? Exploring socio-demographic correlates of individual modernity in Chinese older people

It is noteworthy that while modernisation, together with population ageing, has happened in Western countries for a rather long period of time, China must confront the challenges of an ageing population before it really becomes an advanced industrial society. Facing rapid societal changes, citizens may react differently to this process. By conducting questionnaire surveys with 445 elders in Wuhan, China, this study examines Chinese older adults' individual modernity modes and reveals its socio-demographic correlates. The results show that facing rapid changes in societal modernisation, participants have reacted differently to this process, with 23.8 per cent of Chinese older participants using an accommodation mode, 27.0 per cent using a resistance mode, 13.3 per cent using a withdrawal mode and 36.2 per cent using a coping mode. In addition, socio-demographic factors such as urban–rural residence, age, gender, socio-economic status, living arrangement and daily activities have been identified as significant correlates of Chinese older participants' individual modernity modes. It is further suggested that governments at all levels should allow for options and opportunities for older people to align themselves in the modernisation process by removing the barriers that may hinder their integration and empowerment efforts. While it is important to respect older adults' different responses in the face of modernisation, their participation in societies should be encouraged and respected by the wider society in the context of modernisation.

Exploratory analysis of health-related quality of life among the empty-nest elderly in rural China: an empirical study in three economically developed cities in eastern China

BACKGROUND

Along with rapid economic development, the aging process in China is gradually accelerating. The living conditions of empty-nest rural elderly are worrisome. As a more vulnerable group, empty-nest elderly are facing more urgent health problems. This study explores the health-related quality of life (HRQOL) of empty-nest elderly in rural China and aims to arouse more social concern for their HRQOL.

METHODS

Research subjects were empty-nest rural elderly from three cities: Nanjing, Suzhou, and Wenzhou (ages ≥ 60, n = 967). This study used the five-dimensional European quality of health scale (EQ-5D) and the 12-item Short Form Health Survey (SF-12) to measure the HRQOL of the respondents. Spearman correlation coefficient, stereotype logistic regression, ordered probit regression and multinomial logistic regression, and Structural equation model (SEM) methods are employed to study the relationship.

RESULTS

(1) The Spearman correlation coefficient shows that the correlations of similar domains between the SF-12 and the EQ-5D scales are relatively strong. (2) Men's scores are higher than that of women's in general health (GH) and anxiety/depression (AD) models. (3) The scores of physical component summary (PCS), physical functioning (PF), mental health (MH), and usual activities (UA) decline with age. (4) Apart from PCS, vitality (VT), and role-emotional (RE) as dependent variables, the education passes all the significance tests. The higher the education is, the higher the scores of physical or psychological health are. (5) The scores of PCS and bodily pain (BP) of empty-nest elderly are divorced or higher in other marital status. (6) In SEM analysis, the effect of basic information of empty-nest elderly on SF-12 scale is more significant.

CONCLUSIONS

First, the frequency histograms of EQ-5D show that the scores of empty-nest elderly in rural China are generally low. Second, in all SF-12 items, the HRQOL is low. Third, men's scores are higher than that of women's. The elderly with higher education reported higher scores than those with lower education. Fourth, the effect of socio-demographic variables of the rural Chinese empty-nest elderly on SF-12 scores is more significant, whereas the effect on EQ-5D scores is less significant.

Older people's exclusion from healthcare services in Nepal: an analysis of the political economy of development aid, domestic policy and research

The objective of this review was to contribute to the discussion on older people's access to healthcare in developing countries. Relevant research findings, survey reports, policy papers and planning documents were critically reviewed, placing a particular focus on their relevance in understanding issues of access, equity and justice. A number of factors are identified for their roles on the issue; that is, place of residence, economic factors/poverty, cultural stigma, situation and impact of research, and the prevalent policy framework in health and the approach of development assistance adopted by donor communities. In order to make healthcare facilities equitable for older people, the identified factors need to be addressed at different levels - at local policy work, in the allocation of funding for health service research and in designing overseas development work.

Disability among elderly rural villagers: report of a survey from Gonoshasthaya Kendra, Bangladesh

BACKGROUND

The study was set up to identify the extent and nature of difficulty with activities of daily living (disabilities) among elderly village residents of Bangladesh, to describe help currently given and to identify possible interventions. It was carried out at Gonoshasthaya Kendra (GK), a community development organization responsible for the health care of 600 villages with a population of some 1.5 million.

METHODS

A survey card was designed and piloted using 12 questions on disability, elaborated from the Washington Group Disability questions, together with a checklist of health problems. A survey was carried out in 2010 in 535 villages under the care of GK since 2005, with village paramedics interviewing residents believed to be age 60 years or older. Respondents were matched where possible to data from the 2005 GK household census, giving data on education, occupation, socioeconomic group and smoking habit.

RESULTS

Survey cards were completed for 43417 residents of which 17346 were matched to residents recorded in the GK census as born ≤ 1945. The proportion reporting 'much difficulty' on one or more functional capacities increased steadily with age, reaching 55% (1796/3620) among those ≥ 85 years. Difficulties most frequently reported were lifting and carrying, vision and going outside the home. At all ages women were more likely to report 'much difficulty' than men (OR = 1.43 (1.35 to 1.48)), with widows and the illiterate at greater risk. Health problems, particularly hemiplegia, resting tremor, urinary incontinence and depression were strongly related to the 12 disabilities assessed. Help came almost entirely from family members; of 11211 villagers with 'much difficult' on at least one functional capacity, only 15 reported getting help outside the family.

CONCLUSIONS

Disabled elderly residents were dependent on the family for help but, with family cohesiveness under threat from migration to the city, there is a pressing need for the development and critical evaluation of community-based interventions designed specifically for the elderly in poor rural societies. New approaches to training and practice will be needed to integrate such disability management into primary care.

Validation of Self-Image of Aging Scale for Chinese Elders

Researchers are increasingly interested in the “image of aging” concept. Models on the image of aging abound, but few have rigorously tested measures that are culturally sensitive and domain-specific. This study first translates Levy et al.‘s (2004) Image of Aging Scale into the Chinese language and revises it into the Chinese Version of the Self-Image of Aging Scale (SIAS-C). Based on the results of a survey of 445 elderly people in Wuhan-China, it then reports the factorial structure of SIAS-C and some of its psychometric properties. Confirmatory factor analysis (CFA) supports a conceptually meaningful five-factor model, as suggested in an exploratory factor analysis (EFA). The 14-item SIAS-C vindicates an acceptable level of internal consistency and test-retest reliability. Its criteria-referenced validity is demonstrated by its correlation with several criteria in expected directions. In conclusion, the SIAS-C is a psychometrically sound instrument which is recommended for use among Chinese older people.

Urbanisation and health in China

China has seen the largest human migration in history, and the country's rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.

Access to residential care in Beijing, China: making the decision to relocate to a residential care facility

The demand for residential care by older people is increasing in Beijing as a result of dramatic demographic and socio-economic transformations. Little is known about the way older people access residential care in the context of Beijing. In this research, qualitative data collected from 46 in-depth semi-structured interviews with residential care facility (RCF) managers, older residents, and their family members in six RCFs in Beijing were transcribed and analysed using the constant comparative method. The findings included the following themes: access to residential care as geographical access, information access, economic access, socio-cultural access, and the socio-managerial environment. Geographical access is influenced by location, distance, and the micro-physical environment and amenities of RCFs. Information access refers to the capability to acquire related information on available resources. Economic access is the financial affordability for the resources. Socio-cultural access is affected by individual attitudes and aggregative cultural values on ageing and care of older people. Additionally, the social-managerial environment such as reputations of RCFs, quality of services, and management mechanisms are also important to the decision-making process. All these factors influence older people and their family members’ decision-making process of which RCF to choose. The research provides a multi-perspective analysis of access to residential care and suggestions on improving the accessibility of residential care for older people in Beijing.

Caring for grandchildren and intergenerational support in rural China: a gendered extended family perspective

This investigation examines how support from adult children is affected by their parents' involvement in grandchild care. Instead of focusing on dyadic interactions, we adopt a gendered extended family perspective to examine how financial and emotional support from children was influenced when their siblings received help with child care from their elder parents. The data were from a two-wave (2001, 2003) longitudinal study of 4,791 parent–child dyads with 1,162 parents, aged 60 and older, living in rural areas of Anhui Province, China. Random effects regression showed that emotional support from both sons and daughters was strengthened when parents provided more child care for their other adult children; in addition, daughters were more emotionally responsive than sons under this situation. Concerning dyadic parent–child relationships, daughter and sons increased their financial support, and sons increased their emotional support when they themselves received help with child care from parents. We suggest taking a gendered extended family perspective when studying intergenerational relationships in rural China.

Meal and residence rotation of elderly parents in contemporary rural northern China

This study examines the shared caregiving responsibilities of adult children in the form of long-existing practice of meal and residence rotation of elderly parents in rural China in the post-reform era. Based on the analysis of qualitative data collected in two northern Chinese villages in 2007, the study goes beyond the usual focus on inter-generational relations and a discussion of living arrangements at a particular point in time, and it stresses the role of intra-generational relations in mediating inter-generational relations and shaping arrangements for care of the elderly. The study demonstrates that adult sons as well as daughters-in-law play important roles in negotiating elderly care arrangements. It argues that the new economic restructuring reshapes both inter- and intra-generational relations, with members of the younger generation actively negotiating among themselves and with their elderly parents to fulfill their perceived cultural roles in elderly care.

Long-term care arrangements in rural China: review of recent developments

Developing long-term care systems for the elderly has become an increasingly urgent policy issue in China, especially in rural areas. This article provides an overview of the current status of long-term care development in rural China and discussion on the future development of institutional care and its policy implications. Formal long-term care systems are emerging but remain in the preliminary stages of development. Several policy considerations and practical implications deserve further attention: increases in regional and national government funding, integration of long-term care with the acute health care system, and creating more multilevel and multifunctional LTC facilities with a well-trained and skilled workforce.

Intergenerational support of Chinese rural elders with migrant children: do sons' or daughters' migrations make a difference?

This article investigates how the out-migration of adult children affects monetary, instrumental, and emotional support of Chinese rural elders over a 5-year interval, and whether the gender of migrant children makes a difference in such relationships. With a sample of 1,006 older parents (60+) in rural Anhui province, the result of hierarchical regression analyses showed that support from adult children was mainly needs based. Declining income of older parents related to increased monetary support. Experiencing widowhood and difficulties with instrumental activities of daily living was associated with higher probability of receiving instrumental support. Beyond expanding parental needs, only the out-migration of sons led to more monetary and emotional support among elders over time. Implications for policy, social work practice, and future research are discussed.

Intergenerational transfers and living arrangements of older people in rural China: consequences for psychological well-being

OBJECTIVE

The migration of working-age adults from rural to urban China has altered traditional patterns of living arrangements and intergenerational support among elderly persons who remain in rural regions. This investigation examined how household composition and support exchanges with adult children influenced the psychological well-being of older parents in rural China.

METHODS

Data derived from a 2001 survey of 1,561 parents aged 60 and older living in rural Anhui Province, China. We used multiple regression in order to estimate the effects of multigenerational living arrangements and intergenerational transfers of financial, instrumental, and emotional support on depression and life satisfaction in older parents.

RESULT

Older parents living in three-generation households or with grandchildren in skipped-generation households had better psychological well-being than those living in single-generation households. Receiving greater remittances from adult children increased well-being and explained why living with grandchildren was beneficial. Stronger emotional cohesion with children also improved well-being.

DISCUSSION

These results suggest that traditional family arrangements are beneficial in rural Chinese society as they represent the fulfillment of a cultural ideal. We discuss implications in the context of the corporate Chinese family, characterized by mutual aid and interdependence across generations, and its adaptation to social change.

Best practices in care management for Asian American elders: the case of Alzheimer's disease

This article addresses practice concerns and special issues for professionals doing case management for older Asian Americans using Alzheimer's disease as the case example. Highlighted are cross-cultural issues in assessment for depression in this population, as well as caregiving and community service utilization issues. The research is based on the author's own work and the literature, as well as results from a population-based study of caregivers of the elderly in California.