Why do older adults living alone in cities cease seeking assistance? A qualitative study in China

Need for community-based medical-nursing combined services among urban empty nesters in China and its influencing factors: a cross-sectional study

OBJECTIVE

We aimed to investigate the need and influencing factors for community-based medical-nursing combined services among urban empty nesters in China based on ecological system theory.

METHODS

A cross-sectional survey was conducted in Wuhan and Nanyang city. 289 empty nesters participated in the survey. This study employed a self - administered questionnaire, which had been tested for reliability and validity, to conduct the survey. Descriptive analysis, univariate analysis, and multiple stepwise linear regression were used for data analysis.

RESULTS

Chinese empty-nest elderly had the highest need for health management and safety services. Age, monthly income, number of chronic diseases, marital status, walking time to the community health service center, frequency of choosing community health service center for primary medical treatment, differences in the health insurance type, and the understanding of medical-nursing combined model policies, could predict urban empty nesters' needs.

CONCLUSION

The findings of this study assist elderly care service providers in closely matching the needs of empty-nest elderly when delivering medical-nursing combined services. In community elderly care, special attention should be given to specific types of elders, like the very old, the chronically ill, and those with mobility impairments. A comprehensive assessment of the needs of empty-nested elders for community-based home healthcare services should be carried out. Moreover, a community social and recreational platform should be established to facilitate interactions among the empty-nest elders.

The relationship between widowhood and depressive symptoms among Chinese older adults: Does living alone make a difference?

The experience of widowhood and that of living alone are significant life events that are strongly associated with depressive symptoms in older adults. Nevertheless, few studies have examined the relationship between widowhood, living alone, and depressive symptoms among Chinese older adults, particularly with regard to the duration of widowhood. This study included 4,644 older adults aged 65 and above from the 2015, 2018, and 2020 China Health and Retirement Longitudinal Study (CHARLS). Linear regression models were used to examine the relationship between widowhood, living alone, and depressive symptoms. Unlike previous studies, our findings indicate that living alone instead played a buffering effect on the relationship between widowhood and depression among urban older adults, especially for short-term and long-term widowhood. However, this result did not appear in the rural sample. Our study highlights the significance of considering the role of living alone in the relationship between widowhood and depressive symptoms in older adults, as well as the need to distinguish between residence and duration of widowhood.

Need for and Acceptance of Digital Health Interventions for Self-Management Among Older Adults Living Alone: A Mixed-Methods Approach

PURPOSE

Although digital solutions could mitigate the challenges faced by older adults living alone (OALA), only a few studies investigated the need for and acceptance of digital health interventions for self-management (DHISMs) among this demographic. Thus, we aim to explore this need and acceptance, along with the contextual factors, among OALA.

METHODS

A mixed-methods research approach was adopted. We conducted 1) a quantitative survey (n = 191) to investigate the need for and acceptance of DHISMs using a numeric rating scale and 2) a qualitative study (n = 24) based on focus group interviews to explore contextual factors related to the quantitative results. Qualitative data were analyzed using thematic analysis.

RESULTS

In the quantitative study, the mean scores for the need for and acceptance of DHISMs were 6.41 and 6.53 out of 10, respectively. Emergency response systems had the highest need and acceptance scores, whereas digital interventions for behavioral change (medication adherence, sleep, stress, and diet management) had relatively lower scores. The qualitative analysis revealed two themes and five subthemes: the need for inclusive support for independent living (environmental safety and diverse self-management challenges with limited support) and multidimensional factors related to DHISM acceptance (personal, technological, and relational barriers and facilitators).

CONCLUSIONS

In the future, the unique and multidimensional factors influencing the need for and acceptance of DHISMs among OALA should be carefully considered to support their self-management and independent living. Blended care, which involves integrating age-friendly technology with personalized human interaction, is pivotal for increasing DHISM acceptance in this population.

Chinese American Pain Experience Project (CAPE): Perceptions, Expectations, and Attitudes on Pain Management among Chinese American Postoperative Patients

INTRODUCTION

Chinese Americans are one of the fastest growing racial and ethnic groups and represent the largest subgroup of the Asian American population in the US and in New York City (NYC) where they number 573,528 in 2021. Despite their numbers, current pain perceptions, expectations, and attitudes of Chinese Americans remains poorly understood, especially as related to postoperative pain.

OBJECTIVE

A better understanding of pain experience among Chinese American patients is needed to inform strategies on improving pain management satisfaction.

METHODS

A total of 27 Chinese American postoperative patients from a NYC health system were recruited for face-to-face surveys and interviews with a trained bilingual and bicultural Community Health Worker. Questions from the Survey on Disparities in Quality of Healthcare and Kleinman's Explanatory Model of Illness were integrated into the survey and topic guide. Topics of discussion included satisfaction with healthcare and pain management during hospital stay and health beliefs and practices.

RESULTS

More than half of participants experienced language challenges that made it difficult to communicate with healthcare staff. In general, high levels of satisfaction with pain management were reported; however, participants reported feeling less comfortable asking healthcare teams questions. Common themes across interviews included: (1) pain was an expected outcome of the procedure and was thus perceived as tolerable; (2) the wish to not be a burden to others; (3) concerns about side effects of pain medications; and (4) a cultural and language mismatch between healthcare teams and patients on words being used to elicit pain and discomfort.

CONCLUSION

Our project findings can inform pain management strategies and tools to serve the Chinese American patient population.

Help-seeking preference in obtaining social support for older adults in depopulated areas

OBJECTIVE

To clarify the circumstances of help-seeking preference among older adults in depopulated areas and the relationship between help-seeking preference and social support.

METHODS

This was a cross-sectional study that included a sample of 271 men and women aged 65-79 years living in Japan. A questionnaire survey was conducted to assess help-seeking preference, social cohesion (community trust, norms of reciprocity and community attachment), socialising (interaction with neighbors and social network) and social support. Multiple regression analysis was performed with items that were found to be significantly associated with social support in the univariate analysis. Then, we examined the significance of the change in the coefficient of determination between a model that included help-seeking preference as an independent variable and a model that did not.

RESULTS

Social support was related to help-seeking preference, living arrangements, economic status, norms of reciprocity and social networks. There was a significant difference in the coefficient of determination between the models with and without help-seeking preference.

CONCLUSIONS

For older adults in depopulated areas to obtain social support, it is important to build trusting relationships with others and shows a willingness to seek and accept help.

Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors

Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.

Demographics moderated the association of symptom burden with falls and fall-related outcomes

OBJECTIVES

To examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults.

METHODS

We used 2011-2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors.

RESULTS

The majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.20, 95% CI: 1.18-1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20-1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes.

CONCLUSIONS

Symptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.

Preference for care models among older people living with HIV: cross-sectional study

BACKGROUND

The number of people living with HIV (PWH) aged 50 and above is increasing. The question of care among older PWH (aged ≥ 50 years) is an increasing concern. Understanding the care preference of older people can better provide care services for them. The purpose of this study was to investigate the care preference (home-based care, self-care, institutional care, community-based care, and mutual-aid care) among older PWH and identify the factors affecting their care preference.

METHODS

A cross-sectional survey was conducted among older PWH (aged ≥ 50 years) about care preference from May to November 2021. We enrolled 319 participants using convenience sampling. We designed a questionnaire to assess the care preference of older PWH. The Chi-square test and Fisher's exact test were used to conduct univariate analysis of care preference. Multinomial logistic regression was used to identify factors influencing care preference.

RESULTS

Most older PWH (72.7%) preferred home-based care, and few (15.7%) preferred self-care. Fewer older PWH preferred community-based care (5.3%), institutional care (5.0%) and mutual-aid care (1.3%). Multivariate analysis showed that older PWH with a house, spouse and more children were more inclined to choose home-based care (p < .05). Older PWH living alone, having higher monthly income and higher HIV stigma preferred to choose self-care (p < .05).

CONCLUSION

Home-based care was the most preferred model of older PWH, and self-care ranked second. The number of those who preferred institutional care, community-based care and mutual-aid care were few. Nation and government should take measures to allocate care resources for older adults reasonably to better meet the care needs of older PWH. It is important to strengthen social security, reduce internalized HIV stigma, improve social support, and explore diversified care models for improving the quality of life of older PWH.

Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces

BACKGROUND

Migrant and left-behind families are vulnerable in health services utilization, but little is known about their disparities in immunization of non-National Immunization Program (NIP) vaccines. This study aims to evaluate the immunization coverage, knowledge, satisfaction, and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China.

METHODS

A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China. A total of 1648 caregivers of children aged 1-6 years were interviewed face-to-face by a pre-designed online questionnaire, and their families were grouped into four types: local urban, migrant, non-left-behind, and left-behind. Non-NIP vaccines included Hemophilus influenza b (Hib) vaccine, varicella vaccine, rotavirus vaccine, enterovirus 71 vaccine (EV71) and 13-valent pneumonia vaccine (PCV13). Log-binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the difference on immunization coverage of children, and knowledge and satisfaction of caregivers among families. The network models were conducted to explore the interplay of immunization coverage, knowledge, and satisfaction. Logistic regression models with odds ratios (ORs) and 95% CIs were used to estimate the associated factors of non-NIP vaccination.

RESULTS

The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest, followed by migrant, non-left-behind and left-behind families. Compared with local urban children, the PRs (95% CIs) for getting all vaccinated were 0.65 (0.52-0.81), 0.29 (0.22-0.37) and 0.14 (0.09-0.21) among migrant children, non-left-behind children and left-behind children, respectively. The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule. Non-NIP vaccination was associated with characteristics of both children and caregivers, including age of children (> 2 years-OR: 1.69, 95% CI: 1.07-2.68 for local urban children; 2.67, 1.39-5.13 for migrant children; 3.09, 1.23-7.76 for non-left-behind children); and below caregivers' characteristics: family role (parents: 0.37, 0.14-0.99 for non-left-behind children), age (≤ 35 years: 7.27, 1.39-37.94 for non-left-behind children), sex (female: 0.49, 0.30-0.81 for local urban children; 0.31, 0.15-0.62 for non-left-behind children), physical health (more than average: 1.58, 1.07-2.35 for local urban children) and non-NIP vaccines knowledge (good: 0.45, 0.30-0.68 for local urban children; 7.54, 2.64-21.50 for left-behind children).

CONCLUSIONS

There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts. Non-NIP vaccination promotion strategies, including education on caregivers, and optimization of the immunization information system, should be delivered particularly among left-behind and migrant families.

Understanding the life experiences of elderly in social isolation from the social systems perspective: using Hong Kong as an illustrating example

Aim

The elderly in social isolation often referred to as older people who experience social alienation with little social support from their family, peers, and community suffer from a poor quality of life and well-being. Since their life experiences are affected by a range of factors from different levels, this study seeks to investigate their current life situations and experiences from a social systems perspective.

Methods

A qualitative study was conducted to enrich the understanding of their current life situations and experiences and to generate corresponding practice implications. In this study, there were 13 elderly participants in social isolation, which were users of a social service agency in Hong Kong. They took part in a semi-structured individual interview, sharing their life stories about their daily lives, social relationships, and sense of well-being. Qualitative results were analyzed based on these dimensions.

Results

Results showed that the elderly participants in social isolation had a low level of social support and participation in social activities. Their life experiences and situations were affected by multiple levels of factors that were interrelated.

Conclusion

The results support the application of the social systems perspective in investigating the living conditions of the elderly in social isolation. The corresponding practice implications were also discussed.

The impact of internet use on health status among older adults in China: The mediating role of social support

Background

With the popularization of the Internet, the use of the Internet is becoming more and more important in the daily life of older adults. However, previous research mainly focuses on Internet use and health in general, and the mechanism of this effect remains to be studied. To bridge this gap, this study aims to explore the mediational effects of social support between Internet use and health among older adults in China.

Methods

The data used in this article are from the 2021 Chinese General Social Survey (CGSS). Social support is divided into two aspects and four dimensions: informal social support (relatives support, friends support, neighbors support) and formal social support (social insurance). This article uses the nested multivariate OLS regression models to analyze the impact of Internet use on health. Furthermore, Finally, SPSS macro PROCESS is applied to test their mediation effects.

Results

Informal social support positively influenced the health status among older adults, while formal social support did not. Among the three types of informal social support, relatives support and friends support significantly affected health status among Chinese older adults. Regarding social support differences between urban and rural areas, it was found that relatives support is a positively significant factor for rural older adults, while friends support is significant for urban older adults.

Conclusions

Since Internet use has many ways of impacting health status, social support only plays a partial mediating role in this study. It recommends that the government should take compelling measures to encourage and promote the use of the Internet among older adults and obtain various social support to improve their health status.