Study On The Status And Related Factors Of Family Care For Homebound Disabled Older Adults In China

BackgroundWith the aging of the global population,the demand for long-term care services has increased exponentially.Family care is the most extensive choice for the older adults in China.Many studies have shown that family support can delay disability and reduce long-term caring costs.However,the sustainability of family care becomes less common as family planning policies and national economic levels change.Different from western countries,the Confucian culture of China and the long-term care model based on family care make us need to consider how to encourage the family to improve the supply and quality of family care and strengthen the basic role of home care while exploring formal long-term care.However,there were few studies on the influencing factors of family care supply and quality.The relevant research has not answered the care quality,social support and improvement strategies of long-term care from family members in China.ObjectiveThis study studied the status quo of family care for disabled people aged 65 or above in China,analyzed the factors that affect the status quo of family care,and explored the improvement strategies of family care for homebound disabled older adults in China.MethodsBased on previous studies of relevant international policies and literature,we used Beijing University’s "2018 Chinese Longitudinal Healthy Longevity Survey "(CLHLS)to study the status quo,influencing factors and improvement strategies of family care for the disabled older adults.The inclusion criteria of the sample included:living at home,having family care,mild disability or above,65 years of age or above.Samples that did not meet any of the inclusion criteria were excluded,and the final sample size to meet the requirements was 1750.The main outcome variables included five dimensions of family care status:the category of daily living care personnel,the source of emotional support,the time of family care,the performance evaluation of family carers,the satisfaction degree of family care needs.The main independent variables included personal factors,family factors and social factors of the disabled older adults.The main statistical analysis included:descriptive analysis and differential analysis of the general data characteristics and the status of family care for the disabled at home;using binary logistic regression and multivariate logistic regression analysis to explore the influencing factors of family care status from individual factors,family factors and social factors.ResultsOf the 1,750 subjects in this study,68.7 percent were women,71.6 percent never attended school.The older adults with moderate or severe disability accounted for 53.6 percent of all the disabled older adults.Only 17.1 percent of the older adults had better socioeconomic conditions than others in the same region.46.0 percent of disabled older adults persons had pensions.The study found that older adults’ daily living care and emotional support mainly supported by their children or spouse.90.1 percent of the older adults had a good evaluation of the performance of family caregivers,and 50.5%of the older adults believed that the current family care can fully meet their needs.The difference between daily living care,emotional support,family care time and the satisfaction degree of family care needs of the disabled older adults living in cities and towns were statistically significant.There were significant differences in daily living care(P=0.001),emotional support(P<0.001),family care time(P<0.001),the performance evaluation of family caregivers(P<0.001)and the satisfaction degree of family care needs(P<0.001)among the older adults with mild disability and the older adults with severe disability.There were significant differences in the performance of family carers(P<0.001)and the satisfaction degree of family care needs(P<0.001)among the disabled older adults with good social and the disabled older adults with bad economic conditions.Multiple Logistic regression analysis showed,the category of daily living care personnel for disabled older adults was related to sex,age.The source of emotional support for disabled older adults was related to sex,socioeconomic conditions,and area of residence.The time of family care for the disabled older adults was related to sex,age,disability grade,and area of residence.Male(OR=1.58,P=0.033),living in cities(OR=1.91,P=0.001)disabled older adults were more likely to receive longer family care time.79 years or under(OR=0.43,P=0.030),mild disability(OR=0.17,P<0.001),moderate disability(OR=0.45,P<0.001)disabled older adults were more likely to receive shorter family care time.Binary Logistic regression analysis showed,the performance evaluation of family carers was related to the degree of disability,social security,socioeconomic conditions,and family care time.The satisfaction degree of family care needs of the disabled older adults were related to the degree of disability,socioeconomic conditions,living areas,and the performance of caregivers.Severe disability(OR=2.23,P<0.001),with poor socioeconomic conditions(OR=5.02,P<0.001)disabled older adults tended to have poor performance evaluation of family caregivers.With social security(OR=0.60,P=0.008),receiving 72 hours or more family care(OR=0.49,P=0.002)disabled older adults tended to have good performance evaluation of family caregivers.Moderate disability(OR=1.77,P<0.001),severe disability(OR=2.59,P<0.001),with average socioeconomic conditions(OR=2.80,P<0.001),with poor socioeconomic conditions(OR=4.81,P<0.001),residing in rural areas(OR=1.53,P=0.010),with poor performance evaluation of caregivers(OR=4.37,P<0.001)disabled older adults tended to think that their care needs were not fully met.Conclusions and recommendationsConclusion:This study found that the daily living care of older adults mainly relied on their children and their spouses.Most of the older adults gave a good performance evaluation to the family carers,and thought that the current family care service could meet their needs.The personal,family and social factors of the disabled older adults had significant influence on the status quo of family care.Suggestions:Actively constructing social policies for family care support,such as providing paid care leave,care subsidy,care public facilities and other diverse and flexible policy support for family carers.Formulating long-term care policy based on supporting family,and exploring long-term care insurance to support family carers.Strengthening the construction of public care facilities and financial investment in township areas to reduce the gap between urban and rural areas in social security,employment environment and living resources.Strengthening the professional training of family carers.Enhancing the community’s auxiliary ability to family care.