Investigating Predictors Of The Elders’ Willingness To Enroll In Nursing Homes In Shanghai

Objectives:The aggravating trend of aging population in China has brought serious contradiction between supply and demand of the elderly care services so that the nursing home care services can’t play its due role.It is urgent to know the elders’willingness to enroll in nursing homes and its influencing factors in Shanghai.The results may contribute to guiding private capital into the elderly care service industry and lay a solid base for the prosperous development of the nursing homes.Methods:Based on the study of relevant literature,the situation of institutional elderly care in Shanghai is learnt and the questionnaire is made up of the possible factors.In 2016,people aged over 60 years old and above were interviewed in six community health service centers in Shanghai.The survey was conducted by the investigators in order to know the social demographic information of the elderly as well as the factors on individual level,interpersonal level,social level and institutional health care centers level.All data were input into Epidata3.0 database.SPSS22.0 software and AMOS21.0 software wwere used to analyze the results.χ~2 test and binary logistic regression were used to analyze the influencing factors of elders’willingness to enroll in nursing homes in Shanghai.The structural equation model(SEM)was also used to further study the psychological pathway.Results:A total of 660 questionnaires were distributed,and 641 valid questionnaires were received back,with an effective returning rate of 97.86%.The average age of enrolled elder was(70.18±7.56)years old,of which 45.9%was willing to enroll in the nursing home.Univariate logistic analysis showed that age,number of chronic diseases,poor self-care ability,subjective social support,perceived barrier,value-added services,attitude and subjective norms were closely related to willingness of using nursing home.Multivariate analysis found that subjective social support(OR_m=1.04,95%CI=1.01-1.09),shame(OR_m=0.79,95%CI=0.64-0.97),the adaptability(OR_m=0.63,95%CI=0.52),value-added services(OR_m=1.61,95%CI=1.29-2.00),attitude(OR_m=1.77,95%CI=1.57-2.00)and subjective norms(OR_m=1.46,95%CI=1.27-1.69)remained significant.The model we developed agreed well with the theory and had a good fit to the data(χ~2/df=2.913,Comparative Fit Index=0.950,Root Mean Square Error of Approximation=0.055).The willingness of the elderly to enroll in nursing homes was predicted by attitude(β=0.29,P<0.001)and subjective norms(β=0.24,P<0.001).Attitude was predicted by loneliness(β=0.14,P<0.001),adaptability(β=-0.62,P<0.001)and shame(β=-0.58,P<0.001).Subjective norms were predicted by life satisfaction(β=-0.23,P<0.001)and shame(β=-0.77,P<0.001).Simultaneously,loneliness and life satisfaction(β=-0.30,P<0.001),adaptability and shame(β=0.37,P<0.001)were correlated.Conclusions:The overall proportion of the elders who are willing to enroll in nursing homes was significantly higher than 3%set by the government.The related departments and nursing homes should solve the specific problems the elders faced,by strengthening the publicity,providing more services and improving the quality of services,so as to balance the overall contradictions of supply and demand as well as to achieve the goal of"healthy aging".