| BackgroundWith the acceleration of the population aging process and the increase in the prevalence of chronic diseases,the number of elderly patients with chronic diseases continues to increase.Elderly people live longer with disease,which can cause the expenditures of pension and medicine increase.The pension pressure is more severe,and the pressure of family and society is also increased.Elderly patients with chronic diseases have higher requirements for care and medical services due to illness.But it is difficult to meet the requirements for them only by the traditional family care.With the development of the economy and society and the changes in family structure,the elderly and their families have more choices for the elderly care.They can choose various elderly care models such as home care,community care,and institutional care according to their own circumstances.Therefore,it has important practical significance to study the preference for old-age support and determinants among the elderly patients with chronic diseases,which can help us respond to aging actively and promote elderly care services.ObjectiveThe purpose of the research is to understand the distribution of choices of elderly care models for the elderly with chronic diseases,and explore the determinants of elderly care preference based on Andersen behavior model.To compare the differences and determinants of elderly care preference for elderly people with or without chronic diseases and elderly people with different numbers of chronic diseases,so as to further understand the common and the unique determinants of the choice of elderly care for the elderly with and without chronic diseases.Then we can focus on the preference for old-age support of the elderly with chronic diseases,and put forward policy recommendations for the further rational allocation of elderly care resources and the construction of diversified old-age service system.MethodsThis study was based on the data of Shandong Province in the sixth national health service sampling survey.The sampling method used multi-stage stratified cluster random sampling.The survey covered 17 cities in the province,with a total of 20 counties(cities,districts),100 towns(sub-districts),and 200 villages(residential committees).12,938 households were selected for investigation in the whole province.A total of 8,903 people living in Shandong Province who have been registered for 6 months and aged 60 years and above were selected as the research subjects.After excluding dementia and vacancy values,8,583 people were finally included,of which 4,761 were elderly people with chronic diseases.The data were analyzed by Stata 14.0 for statistical analysis.Descriptive statistics were used to analyze the basic characteristics and the preference for old-age support of the elderly with chronic diseases in Shandong Province.Based on Andersen behavior model,a multiple logistic regression model was constructed to analyze the influence of predisposing characteristics,enabling resources and demand factors on preference for old-age support.ResultsAmong the 8,583 subjects in this survey,the prevalence of chronic diseases was 55.5%.The chronic diseases were mostly hypertension,diabetes,cardiovascular and cerebrovascular diseases and intervertebral disc diseases.Among the 4761 elderly with chronic diseases,most of them are females,60-69 years old,elementary school education,unemployed,living in rural areas,married,and not living alone.Most of the elderly have their children and relatives as the main caregivens and the shortest medical treatment distance is less than 1km.Most of them have good self-assessed health,normal activities of daily living(ADL),and do not feel anxious or depressed.The proportions of the elderly with chronic diseases who choose home care,community care,and institution care were 84.6%,7.4%,and 8.0%,respectively.Among the 3822 elderly with chronic diseases,these three proportions were 86.4%,6.2%,and 7.4%,respectively.Chi-square test results showed that gender,age,education level,employment status,marital status,annual household income,shortest medical distance,main caregiver,regional distribution and ADL were statistically significantly associated with preference for old-age support(P<0.05).The Andersen behavior model showed that age,education level,employment status and place of residence among the predisposing characteristics,annual household income,main caregivers and regional distribution among the enabling factors,and self-rated health and ADL among the demand factors have a significant impact on whether the elderly choose home care or socialized care.The elderly with chronic diseases who were older(P<0.01),with low education level(P<0.01),unemployed(P<0.05),living in the city(P<0.01),and the middle annual household income(P<0.01),got care from children and relatives(P<0.05),in central and western regions(P<0.001),with good self-rated health(P<0.05),and with impaired ADL(P<0.05)were more inclined to choose home care.It was found that the enabling factors had the greatest impact on the preference for old-age support for the elderly with chronic diseases by comparing the fit of the model.A further comparison of the factors influencing the preference for old-age support for the elderly with different numbers of chronic diseases found that for the elderly without chronic diseases,the factors included age,education level,employment status,residence,regional distribution,self-rated health and mental health.For the elderly suffering from a chronic disease,the factors that affect their preference for old-age support included age,education level,employment status,living style,shortest medical distance,and regional distribution.For the elderly suffering from multiple chronic diseases,factors affecting their preference for old-age support for the elderly included age,education level,annual household income,self-rated health and ADL.Conclusions and RecommendationsConclusion:This study found that home care was the first choice for the elderly with chronic diseases in Shandong Province,and the proportion of elderly who choose home care was much higher than that of socialized care.Age,education level,employment status,place of residence,annual household income,main caregivers,regional distribution,self-rated health and ADL can all affect the preference for old-age support of the elderly with chronic diseases.Specifically,the elderly who were much older,with lower education level,unemployed,living in the city,with middle household income,mainly cared by children and relatives,with good self-rated health,and with impaired ADL were more inclined to choose home care.Among the three types of factors in the Andersen behavior model,enabling characteristics had the greatest impact on the preference for old-age support of the elderly with chronic diseases.Among them,living style,shortest medical distance,family annual income and ADL were the unique factors affecting the preference for old-age support for the elderly with chronic diseases.Recommendations:Strengthen health education for the elderly to help the development of home care;improve the quality of home care services based on the actual needs of the elderly;pay attention to the elderly needs of people with chronic diseases,and further promote the development of integrated health care;improve the old-age security system and accelerate the advancement of long-term care insurance;promote smart old-age care,and strengthen the construction of talent team. |
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