Effect of the Use of Home and Community Care Services on the Multidimensional Health of Older Adults

Rural-urban differences in the association between home-based community care services satisfaction and mental health status among older adults in Zhejiang Province, China: a cross-sectional study

Objective

This study aims to examine the association between home-based community care services (HBCCS) and mental health in older adults and specifically analyzes rural-urban differences in the association.

Methods

This cross-sectional study enrolled 852 older adults from Zhejiang Province, China. The Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), University of California Los Angeles 3-item Loneliness Scale (UCLA-3), and the Mental Health (MH) component score of the 36-item Short Form (SF-36) were used to measure self-reported mental health status. Four categories of community care services were examined: daily, medical, social and recreational, and spiritual comfort. Satisfaction with community care services was assessed using self-reported measures. We used a multiple linear regression model.

Results

Satisfaction with daily care services, social and recreational services, and spiritual comfort services in rural older adults was significantly higher than in urban older adults (p = 0.016, p < 0.001, p < 0.001, respectively). Rural older adults reported lower scores on the PHQ-9, GAD-7, and UCLA-3 than urban older adults (p < 0.001, p = 0.003, p = 0.001, respectively) and had significantly higher scores on the SF-36 MH than urban older adults (p < 0.001). Among urban older adults, medical care services satisfaction was negatively related to the PHQ-9 and UCLA-3 scores (β = -0.296, p = 0.004; β = -0.447, p = 0.009, respectively). A lower UCLA-3 score was associated with higher levels of satisfaction with social and recreational services and with spiritual comfort services (β = -0.426, p = 0.010; β = -0.523, p = 0.002, respectively). A higher level of spiritual comfort services satisfaction was associated with a lower SF-36 MH score (β = 0.646, p < 0.001). Among rural older adults, medical care services satisfaction was negatively related to the GAD-7 score (β = -0.327, p = 0.028).

Conclusion

Home-based community care services satisfaction was positively associated with older adults' mental health status in Zhejiang Province. More attention should be paid to maintaining relevant satisfaction with HBCCS to ensure positive mental health among rural and urban older adults.

The Impact of Perceived Community Services for the Elderly on Self-Rated Health: An Analysis Utilizing a Mediated Latent Growth Model

Background

This study aims to investigate the relationship between older adults' perceived community services for the elderly (PCSE), life satisfaction (LS), and self-rated health (SRH).

Methods

Data from four rounds of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018 were used. A total of 2454 older adults were obtained. Unconditional Least Squares (ULS) was used to measure PCSE, LS, and SRH growth trajectories without covariates. Finally, a mediating latent growth model was constructed using Mplus 8.3 to examine the mediating role of LS in the relationship between PCSE and SRH after adjusting for some demographic characteristics.

Results

The results from the ULS method indicate that the intercepts and slopes for PCSE and LS are significantly negatively correlated (β 1 = -0.629, β 2 = -0.579, p < 0.001). Additionally, there is a significant positive correlation between the intercept and slope of health levels (β = 0.774, p < 0.001). Using a parallel growth model, significant regression coefficients were found between the intercept of PCSE and the intercepts of SRH and LS (β 1 = -0.335, β 2 = 0.378, p < 0.01). Similarly, the regression coefficients between the slope of PCSE and the slopes of SRH and LS were also significant (β 1 = -0.532, β 2 = 0.344, p < 0.01). Furthermore, the regression coefficient between the intercept of LS and the intercept of SRH was significant (β = 0.415, p < 0.001). The regression coefficient between the slope of LS and the slope of SRH was also found to be significant (β = 0.729, p < 0.001).

Conclusion

It is essential to ensure adequate supply and accessibility of community services for older adults. LS especially is, and should be a promising target for assessing the quality of life and utilization of PCSE supply.

Health Care Access and Cognitive Function in Older Adults: A Cross-Lagged Panel Longitudinal Analysis

Objective: The current longitudinal study examined how (1) cognitive measures, including episodic memory, executive function, and global cognition, predict later healthcare access and how (2) healthcare access predicts later cognition. Methods: Drawing a sample (n = 9920) from the Health and Retirement Study dataset, we created a cross-lagged panel model to examine the longitudinal association between cognitive measures and healthcare access from 2012 to 2018. Results: Results revealed that cognitive measures significantly predict later healthcare access, with effects increasing across waves. However, within sub-domains, memory was more predictive of later healthcare access over time compared to executive function. Discussions: Our study suggested an increased link between cognition and healthcare access during aging. Even outside of the context of AD, there are likely both policy-based and practical implications to ensure those experiencing cognitive decline continue to maintain access to care.

A Longitudinal Study on the Relationship Between Family Size and Instrumental Activities of Daily Living: The Masking Effect of Depressive Symptoms

PURPOSE

According to use and disuse theory, the decreasing size of families in China may have a considerable influence on older adults' health. However, research on the associations among family size, depression, and instrumental activities of daily living (IADL) in this population is limited. Thus, the current study examined the role of depression on the impact of family size on IADL and explored the differences between urban and rural areas.

METHOD

Mediation analyses were performed with data from 7,290 older adults aged ≥60 years from the Harmonized China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018, using stepwise regression and bootstrap methods.

RESULTS

Family size had a positive impact on IADL limitations of older adults (0.29, p < 0.01), and the masking effects of depressive symptoms had a partial effect of family size on older adults' IADL. However, these effects only exist in rural areas.

CONCLUSION

Providing emotional support through psychological counseling and guiding caregivers to provide moderate care support is crucial, particularly in rural areas, for alleviating depressive symptoms due to changes in family size and maintaining independent living skills among older adults. [Research in Gerontological Nursing, 17(4), 165-175.].

Community support, social isolation and older adults' life satisfaction: evidence from a national survey in China

OBJECTIVES

Despite the recognized importance of community social service and community built facility for enhancing older adults' life satisfaction, the mechanisms underlying their relationship have not been thoroughly examined. This study aims to complement the existing knowledge by investigating the mediating role of social disconnectedness and loneliness in the association between community support and life satisfaction among older adults.

METHODS

Using data from the 2018 China Longitudinal Aging Social Survey, the study analyzes responses from 9,874 Chinese older adults (mean age = 71.30 years, SD = 7.30). We conducted descriptive statistics and Pearson's correlation to explore the variables. This study also used Mplus 8.0 to conduct a path analysis model that evaluated both the direct and indirect effects of community social service and built facility on life satisfaction. Social disconnectedness and loneliness were included as mediating variables in this model.

RESULTS

The present study results show that both community social service and community built facility are positively associated with life satisfaction among older adults, and community social service is more imporatant for enhancing the life satisfaction. In addition, these associations are mediated by social disconnectedness and loneliness.

CONCLUSION

Our research suggests that strengthening community social service programs and improving the built environment can reduce social disconnectedness and loneliness among older adults, ultimately enhancing their life satisfaction. Specifically, policymakers can invest in targeted interventions to enhance social connectedness and reduce loneliness, with the goal of improving the overall well-being of older adults.

Use of home and community-based services and loneliness in older people with functional limitations: a cross-sectional study

BACKGROUND

Loneliness is one of the major health problems among older adults. Among this population, home and community-based services (HCBS) have become increasingly popular. Despite its health benefits, little is known about the relationship between HCBS use and loneliness in older people with functional limitations. We aim to explore the characteristics of loneliness among older people with functional limitations and examine the association between HCBS use and loneliness in China.

METHODS

We used a cross-sectional data from the 2018 China Health and Retirement Longitudinal Study, which includes a nationally representative sample of Chinese residents aged 65 and older with functional limitations. Logistic regression models were used to examine the associations between HCBS use and loneliness, and we further used propensity score matching to address potential sample selection bias.

RESULT

In China, 46% of older people with functional limitations felt lonely and only 22% of older people with functional limitations reported using HCBS in 2018. Compared with participants who did not receive HCBS, those who received HCBS were less likely to report loneliness (OR = 0.81, 95% CI = 0.63, 0.99, p = 0.048), and the results remained significant after addressing sample selection bias using propensity score matching.

CONCLUSION

Our results showed that loneliness was common among Chinese older people with functional limitations, and the proportion of HCBS use was low. There was robust evidence to support that among older people with functional limitations, HCBS use was associated with decreased loneliness. Further policies should promote the development of broader HCBS use for older people with functional limitations to reduce their loneliness.