Research On Unmet Need And Its Influencing Factors Of Disabled Older Adults In China Under The Healthy Ageing

National strategy to deal with population ageing in a positive way emphases the importance to strengthen the older adults’ well-being and capability,to guarantee the equal opportunities for the older adults to participate in the social activities and enjoy the benefits of social development.With the declining family care and meager social care,how to satisfy the disabled older adults’ need effectively is the imperative task to achieve positive ageing and healthy ageing.However,the current status of unmet need of older adults is not consistent with the aim of healthy ageing.The way to interpret older adult’s need from the perspective of motivation,utility and resource,causes the one-dimensional need cognition,one-sided resource supply,as well as subjective evaluation method.This leads to the ignorance of unavoidable disability,dependency,and the social inequality caused by the lack of conversion capability in old age.The narrowness of these perspectives of older adults’ need interpretation leads to ageism and social exclusion of older adults.Therefore,it is important to rethink and reinterpret older adults’ need in a broader way for achieving healthy ageing.The aims of this study were: First,to reinterpret the need of disabled older adults from the perspective of capability and construct the theory model of disabled older adults’ need;Second,to evaluate the degree and main sources of breadth,depth,strength and inequality of unmet need of disabled older adults;Third,to analyze the influencing factors of the degree of breadth,depth,strength and inequality of unmet need of disabled older adults.The main research contents and conclusions were as followed.Firstly,based on the analysis of data collected from semi-structured interviews with disabled older adults living in nursing home and living in community by using the grounded theory,we found that,survival capability need consisted of daily care,health care,sense of safety,and sense of control.Specifically,daily care included basic daily care and instrumental daily care.Health care included physical health and the accessibility of medical service.Sense of safety included physical safety,economical safety,and care safety in the old age.Sense of control included ageing planning and financial management.Developmental capability need consisted of social integration,leisure activity,attachment,and mental health.Specifically,social integration included social participation and social adaptation.Attachment included family attachment,friend attachment,and community attachment.Secondly,based on literature review and the data from Chinese Longitudinal Healthy Longevity Survey,we constructed the evaluation index system of unmet need among Chinese disabled older adults.Then we explored the degree of breadth,depth,strength and inequality of unmet need of disabled older adults by using FGT index.We found that,disabled older adults faced with severe problem of unmet need,with much higher degree of unmet developmental capability need and lower degree of unmet survival capability need.Specifically,unmet control need which consisted of ageing planning and financial management made the biggest contribution to unmet survival capability need,and there was a huge unmet need gap.While potential daily care and financial support from children made a low contribution to the degree of breadth of unmet need and even a negative contribution to the degree of depth of unmet need.It meant that a small proportion of disabled older adults made an ageing planning for themselves or managed finance by themselves,while most of disabled older adults believed the possibility of the filial behaviors and prefer the daily care and financial support from their children.Leisure activity,economical activity participation and voluntary activity participation made the biggest contribution to the degree of unmet need,while family attachment,friend attachment and social adaptation made a small contribution to the unmet developmental need.It meant that disabled older adults who were concentrated on family activities received lots of support from family and friends,and had a good adaptation and positive attitude to current social policies.Thirdly,by using inequality index,we found that,compared to unmet survival capability need,unmet developmental capability need made a stronger contribution to the degree of inequality of unmet need.There was a severe inequality among some need indexes,and the main contributors of inequality among disabled older adults with unmet need,were different from the main contributors of inequality among all disabled older adults.Specially,for survival capability need,ageing planning and financial management made a stronger contribution to inequality of unmet needs among all the disabled older adults,while daily care,physical health status,financial safety,financial support from children in the future and daily care support from children in the future made a stronger contribution to inequality among the disabled older adults with unmet need.For developmental capability need,economical activity participation,voluntary activity participation,and leisure activity made a stronger contribution to inequality among all the disabled older adults,while attachment and mental health made a stronger contribution to inequality among older adults with unmet need.Forthly,based on the analysis of the influencing factors of the degree of breadth,depth and strength of unmet need by using regression,we found that,disability,living alone,and family scale,as risky factors,increased the risk and gap of unmet need,while pension and age-friendly community environment,as protective factors,decreased the risk and gap of unmet need.Based on the quantile regression and RIF regression analysis of influencing factors of unmet need,we found that,there was a cumulative advantage/disadvantage effect of the impact of influencing factors on unmet need.Specifically,the strengthening effect of disability,living alone and family scale on the higher degree of unmet need was significantly greater than that on the lower degree of unmet need,while the alleviating effect of pension and age-friendly environment on the unmet need at a higher degree was significantly less than that on the lower degree of unmet need.Fifthly,in order to improve need satisfaction among disabled older adults,First,it is imperative to satisfy the muti-dimensional needs and build older adults-friendly society,as well as to build adaptive pattern of development for disable older adults and rebuild a new filial culture in the modernized China.Second,strategies to develop the integrated medical care and social care should be carried out to achieve the healthy equality,and it is important to prompt the balanced development of public elder care services in urban and rural areas.Third,it is imperative for the government to take the leading role in building the overall elder care system,and promote the normalization of elder care service in the community.The capability of family care should be improved by developing family support policies,and the independence of social organization should be strengthened by providing more latitude and better policy motivation.