Study On The Health And Health Care Model Of "Empty Nest" Elders In A Mountainous Rural Area

Life and housing condition improved, family structure miniaturized, and a lot of yong man studing and working outside, the number of empty nest elders in our country is increasing. The empty nest elders, as the weak population in the progress of social changing, their physical and mental health was not optimistic. According the survey of the health and health care utilization between the empty nest and not empty nest elders in the rural area of a mountainous county, to estimate the equity of health and health care utilization of the empty nest elders, and to furtherly analyze the factors influencing the health care utilization of the empty nest elders. Investigating the current conditions of the Township Hospitals in the area, to find their deficiencies in serving the the empty nest elders. Using western contries' practice in home health care for reference, to further discuss the function of home health care in serving the empty nest elders, and to build the home health care modle serving the empty nest elders in the area. The study will be benefit to improve the rural empty nest elders' health, increase their health care utilization. It will also provide reference for the home health care system building in the rural area of the whole country.A set of questionnaires, including general information questionnaire, Social Support Rate Scale, self report health and health care utilization questionnaire, 6-Item Short-Form Health Survey, UCLA Loneliness Scale, Geriatric Depression Scale, Life satisfaction Index Z and activities of daily living questionnaire, were sent to a randomized sample of 550 empty nest elders and 630 not empty nest elders in Yuan'an County, Hubei Provence. We investigated their social, demographic and economic characters, insurance status, health related behaviors, self report health, chronic health conditions, quality of life, loneliness, depression, two-week visits and one-year hospital admissions, unmet health care needs and the reasons, self-care ability, ability of daily life and life satisfaction, et al.. Compared with the not empty nest elders, the empty nest elders showed lower income, worse relationships with children, less social support, lower insurance coverage, higher prevalence of smoking consumption, worse self report health, higher prevalence of chronic diseases, lower physical and mental scores from SF-36, higher loneliness and depression level, lower two-week visit rate, higher health care need unmet rate and lower life satisfaction. There were quite a proportion of empty nest elders without self-care ability and ability of daily life. Among the empty nest old persons with unmet health care, the barriers fell into four groups: access, social attitudes, services, and cost. Questionaire investigation and interview were carried out among the people knowing the inside story in six Township Hospitals of Yuan'an County, Hubei Provence. The general information, including the classification, gender and education constitution ratio of all persons, daily outpatient and inpatient visits in the recent five years, section office setting and service, was investigated. The results showed that the human resource sizes in the six Township Hospitals were not equal; the total human resource was higher than the countrywide mean level in 2003; the gender constitution ratio of the health care staff was balanced; majority of the health care staff had lower education; the specialty structure of health technical staff was relatively rational; there was no doctors and nurses mastering geratology; and there was no health hotline, so patients can not contact with doctors by phone; the Township Hospitals seldomely provided home services; there was no psychology consulting and rehabilitation services; the daily outpatient and inpatient visits from 2002 to 2006 were decreacing year by year. Unless there was reform, and advantage and character of theirselves was emphasized in the Township Hospitals, it will not benefit the health of the empty nest elders and its own development.Using workshop and conceptual modeling methods, it was built that the goal model in care of empty nest elders, health care problem model of the Township Hospitals and home health care model for elders. The results showed that, the goal in care of empty nest elders, realizing their health and active aging, will come true through total, continuous, no grey-zone comprehensive services which increase the empty nest elders' independency; the problems in care of the empty nest elders of the Township Hospitals were categorised into three main themes: attitudes among staff, processes of care and resources for care; home health care model for elders mainly included four microsystem domains: self-management support, decision support, delivery system design and clinical information system; the services included primary health care service and social service, which were provided in the patients' home; at the same time, to improve the quality of health care, it was essential to fully utilize the resources and policies in the town and attach importance to the productive interactions between practice team and patients.The results suggested that compared with the not empty nest elders, the empty nest elders were unequal in health and health care utilization; the inaccessibility to health care was one of the barriers; compared with Township Hospitals, home health care can do better in improving the empty nest elders' accessibility to health care, increasing their independent living ability and improving their quality of life.