Unmet Needs Of Activities Of Daily Living Among Disabled Elderly People Living In Nursing Homes And Families And The Differences Between Them

Background: By the end of 2016,more than 240 million people were over 60,more than 150 million people were over 65,occupying about 17.3% and 11.4% of the total population of China,respectively.With the acceleration of aging,the number of disabled elderly people in China has also increased year by year.By the end of 2010,China had more than 33.00 million disabled elderly people.But the number had already increased to 40.63 million by the end of 2015.Disability refers to the fact that due to the serious defects in the structure and function of the body and obvious problems in physical or mental health,one or more Activities of Daily Living(ADL)cannot be completed independently.The ADL can be further divided into Basic Activities of Daily Living(BADL)and Instrumental Activities of Daily Living(IADL).Using questionnaires to assess the ADL level of the elderly is the easiest and most effective way to determine whether they are disabled and their disability levels.Although the disabled elderly tries to remain independent in ADL,some may need some assistance from others.The failure to get sufficient assistance creates the situation of unmet need.Available studies indicate that unmet ADL need among disabled elderly people leads to adverse consequences including higher risk of hospitalization,hospital readmission,emergency department admission and death.Therefore,it is extremely necessary to meet the ADL needs of disabled elderly people as much as possible.Objectives: 1 To identify the prevalence and risk factors of unmet needs of Activities of Daily Living(ADL)among disabled elderly people in nursing homes and families.2 To compare the differences of unmet ADL needs between disabled elderly people living in nursing homes and families.Methods: A total of 258 disabled elderly people from 11 nursing homes and 303 disabled elderly people from 15 communities in Nanjing were recruited.Barthel Index(BI)and Functional Activities Questionnaire(FAQ)were first used to screen disabled elderly people from nursing homes and families.Disabled elderly people were then investigated in terms of their unmet ADL needs,using an unmet needs assessment form,which had been adapted from BI and FAQ.Risk factors of unmet ADL needs were assessed through using general information questionnaire,Zarit Burden Interview(ZBI)and Family Caregiver Task Inventory(FCTI).At last,propensity score matching was used to balance the general information of disabled elderly people living in nursing homes and families,differences of unmet ADL need between them were explored.Results: 1 There are 96.12% of disabled elderly people in nursing homes report at least one unmet ADL need.The mean quantity of unmet ADL needs is 5.21(SD=3.26).There are 93.07% of disabled elderly people in families report at least one unmet ADL need.The mean quantity of unmet ADL needs is 4.98(SD=3.17).2 The prevalence of unmet ADL needs ranges from 13.95% to 76.47% in nursing homes.The prevalence of unmet ADL needs ranges from 4.62% to 77.18% in families.Unmet ADL needs with high percentage in nursing homes and families are the same ones: ambulating(71.70% VS 60.07%),using stairs(59.41% VS 73.13%),using vehicles(69.05% VS 77.18%),working on a hobby(76.47% VS 72.15%)and social interation(62.64% VS 62.55%).3 Logistics regression analysis shows that risk factors of unmet ADL need among disabled elderly people in nursing homes pertain to degree of disability in Basic Activities of Daily Living(BADL)(OR=0.948,p=0.002),education levels(OR=0.737,p=0.002),monthly expenses in medicine and nursing(OR=0.557,p=0.001),duration of disability(OR=1.344,p=0.032),of the disabled elderly people,age(OR=1.090,p=0.005)and monthly income(OR=0.247,p<0.001)of caregivers.The risk factors of unmet ADL need among disabled elderly people in families pertain to degree of disability in Instrumental Activities of Daily Living(IADL)(OR=1.093,p<0.001)of disabled elderly people,relationship with caregivers(OR=1.262,p=0.005)and monthly income(OR=0.691,p=0.010)of caregivers.4 The total quantity of unmet ADL needs(t=2.485,p=0.014)and the quantity of unmet IADL needs(t=3.408,p=0.001)for disabled elderly people in families are less than those for disabled elderly people in nursing homes.The differences are mainly in dressing(c2=4.975,p=0.026),toileting(c2=5.543,p=0.019),ambulating(c2=5.105,p=0.024),financial management(c2=26.054,p<0.001),doing housework(c2=10.630,p=0.001)and cooking(c2=11.911,p=0.001).Conclusions: 1 The condition of unmet ADL needs among disabled elderly people in nursing homes and families is severe.Disabled elderly people in nursing homes and families all had a high percentage of unmet needs for long distance off bed activities and spiritual aspects.2 The condition of unmet ADL needs among disabled elderly in nursing homes gets worse with worse disability status in BADL,lower education level and monthly expense in medicine and nursing,longer duration of disability.Employing younger caregivers and providing them with higher salary will be conductive to improve the condition of unmet ADL needs.3 The condition of unmet ADL needs among disabled elderly in families gets worse with worse disability status in IADL and less monthly income of caregivers.Caregivers who have more alienated relationship with the elderly will be conductive to improve the condition of unmet ADL needs.4 The number of unmet ADL needs among disabled elderly in families is closely related to the cargiving burden and ability of caregivers.5 When the disabled elderly people have the similar general information,living in families is superior to living in nursing homes in satisfying ADL needs.Nursing homes should take more useful actions to improve their services.