Individual Factors Influencing the Use of Home- and Community-Based Care Services by Disabled Elderly Individuals in Urban Areas: Evidence from Beijing, China
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data
2.2. Analytic Framework
2.3. Measures
2.3.1. Dependent Variables
2.3.2. Independent Variables
2.4. Analysis
3. Results
3.1. Descriptive and Bivariate Analyses
3.2. Predisposing, Enabling, and Need Factors for the Two Types of Service Use
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Wang, Y.; Sun, Y. A study on the benefit groups and development trend of home care service in China: An empirical study based on three-wave CLASS data. J. Fujian Prov. Comm. Party Sch. CPC 2021, 110–119. [Google Scholar] [CrossRef]
- Gong, J.; Wang, G.; Wang, Y.; Chen, X.; Chen, Y.; Meng, Q.; Yang, P.; Yao, Y.; Zhao, Y. Nowcasting and forecasting the care needs of the older population in China: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS). Lancet Public Health 2022, 7, e1005–e1013. [Google Scholar] [CrossRef]
- Liu, E.; Zhang, Q. Analysis of the caregiving trend and caregiving effect of children caring for the disabled elderly. Econ. Perspect. 2018, 92–105. Available online: https://kns.cnki.net/kcms2/article/abstract?v=4d8R2eTuy_ktMIfLKC3pjC0g0ZepA2MU-_hFveCkG6t2MQQiHIbJPPXyEXyYEHoFA5rI9V_ek8FIKdD-C4Ds2cJx7HK1nebf5EWmNGqZugDReEYpDfYuAmeRRtI6I8vWmSGsLFoWDQc-R9622R2Bg7vXLpLv4tieFNwnCkT_NTbJ_BXWAYws0Y_yFLjwGoLtbwfp0yxLYWU=&uniplatform=NZKPT&language=CHS (accessed on 1 January 2025).
- Chen, N.; Deng, M.; Wang, C. Research on the main body of home-based care service providers for disabled elderly in China. Med. Soc. 2020, 33, 46–49+77. [Google Scholar]
- Liu, C.; Eom, K.; Matchar, D.B.; Chong, W.F.; Chan, A.W. Community-based long-term care services: If we build it, will they come? J. Aging Health 2016, 28, 307–323. [Google Scholar] [CrossRef]
- Miller, B.; McFall, S. The effect of caregiver’s burden on change in frail older persons’ use of formal helpers. J. Health Soc. Behav. 1991, 32, 165–179. [Google Scholar] [CrossRef]
- Zhang, J.; Yang, A.; Yue, N.; Lin, S.; Zhang, R. Caregiving burden and demands for respite services among family caregivers of disabled elderly. J. Nurs. Sci. 2022, 37, 89–92. [Google Scholar]
- Zeng, Q.; He, Z.; Zeng, Y. Study on the preference patterns of home-based care services for the older adults and its influencing factors. Northwest Popul. J. 2023, 44, 58–69. [Google Scholar]
- Lee, Y.; Penning, M. The determinants of informal, formal, and mixed in-home care in the Canadian context. J. Aging Health 2019, 31, 1692–1714. [Google Scholar] [CrossRef] [PubMed]
- Andersen, R.; Newman, J.F. Societal and individual determinants of medical care utilization in the United States. Milbank Meml. Fund Q. Health Soc. 1973, 51, 95–124. [Google Scholar] [CrossRef]
- Peng, X.; Song, L.; Huang, J. Determinants of long-term care services among disabled older adults in China: A quantitatitive study based on Andersen behavioral model. Popul. Res. 2017, 41, 46–59. [Google Scholar]
- Bass, D.M.; Noelker, L.S. The influence of family caregivers on elder’s use of in-home services: An expanded conceptual framework. J. Health Soc. Behav. 1987, 28, 184–196. [Google Scholar] [CrossRef] [PubMed]
- Bookwala, J.; Zdaniuk, B.; Burton, L.; Lind, B.; Jackson, S.; Schulz, R. Concurrent and long-term predictors of older adults’ use of community-based long-term care services: The caregiver health effects study. J. Aging Health 2004, 16, 88–115. [Google Scholar] [CrossRef]
- Chen, Z.; Wu, S. Factors affecting caregivers willingness to use long-term care services. J. Popul. Stud. 2006, 32, 83–121. [Google Scholar]
- Weaver, R.H.; Roberto, K.A. Location matters: Disparities in the likelihood of receiving services in late life. Int. J. Aging Hum. Dev. 2021, 93, 653–672. [Google Scholar] [CrossRef]
- Hu, Y.; Li, G.; Zhong, X.; Ye, X.; Qiu, H. Using status and influencing factors of home-based care services for older adults in Putian Fujian Province. Northwest Popul. J. 2019, 40, 101–113. [Google Scholar]
- Lehning, A.J.; Kim, M.H.; Dunkle, R.E. Facilitators of home and community-based service use by urban African American elders. J. Aging Health 2013, 25, 439–458. [Google Scholar] [CrossRef] [PubMed]
- Stoddart, H.; Whitley, E.; Harvey, I.; Sharp, D. What determines the use of home care services by elderly people? Health Soc. Care Community 2002, 10, 348–360. [Google Scholar] [CrossRef]
- He, X.; Liang, Y. Service utilization and policy optimization of the home care services for the urban older adults: A latent class analysis based on potential category. J. Shanghai Adm. Inst. 2023, 24, 97–111. [Google Scholar]
- Chen, L.; Wen, W. Complement or substitution: Family care and community home-based care services. Chin. J. Health Policy 2021, 14, 35–42. [Google Scholar]
- Henning-Smith, C.; Lahr, M.; Casey, M. A national examination of caregiver use of and preferences for support services: Does rurality matter? J. Aging Health 2019, 31, 1652–1670. [Google Scholar] [CrossRef]
- Du, P.; Wang, Y. Determinants of utilization of social care service for older persons in China. Popul. Res. 2017, 41, 26–37. [Google Scholar]
- Gao, X.; Tang, Y. Association Between Community Elderly Care Services and the Physical and Emotional Burden of Family Caregivers of Older Adults: Evidence from Beijing, China. Int. J. Aging Hum. Dev. 2024, 99, 247–262. [Google Scholar] [CrossRef] [PubMed]
- Kumamoto, K.; Arai, Y.; Zarit, S.H. Use of home care services effectively reduces feelings of burden among family caregivers of disabled elderly in Japan: Preliminary results. Int. J. Geriatr. Psychiatry 2006, 21, 163–170. [Google Scholar] [CrossRef] [PubMed]
- Lee, Y.; Choi, W.; Park, M.S. Respite service use among dementia and nondementia caregivers: Findings from the National Caregiving in the US 2015 Survey. J. Appl. Gerontol. 2022, 41, 1557–1567. [Google Scholar] [CrossRef]
- Xia, H.; Wang, Y. Research on the income structure and income inequality of older adults. Soc. Sci. Beijing 2021, 109–118. [Google Scholar]
- Huang, Z.; Zhao, J. How to enjoy equal old age: Pension and urban-rural income gap of older adults. Popul. Econ. 2022, 74–86. Available online: https://link.cnki.net/urlid/11.1115.f.20211216.1122.003 (accessed on 1 January 2025).
- Li, K.; Tang, D.; Liu, X.; Xu, Y. Review of the application of Barthel Index and modified Barthel Index in mainland China. Chin. J. Rehabil. Med. 2009, 24, 737–740. [Google Scholar]
- Brodaty, H.; Thomson, C.; Thompson, C.; Fine, M. Why caregivers of people with dementia and memory loss don’t use services. Int. J. Geriatr. Psychiatry 2005, 20, 537–546. [Google Scholar] [CrossRef]
- Wang, Y. How education promotes older adults’ service utilization of social elder care: Based on the evidence of Beijing. Lanzhou Acad. J. 2018, 187–198. Available online: https://kns.cnki.net/kcms2/article/abstract?v=4d8R2eTuy_n4bnYD7odjo6eW-z3yabGkpaZzv7tEGYERnJiHuNzvATo1YYNRvuZOnOrdbXwyhWpM2ZRxalLsagAm2Nwi7YN5c-7G3fcGIv03if6CRGNaCakUX6rzRBp6gWVwCNw3gP5U9SGd49D3rPDuekNRZFuC2a72CBIzhxbwdgs60xTLckfPPT1eMLOT0PTBXS0Dveo=&uniplatform=NZKPT&language=CHS (accessed on 1 January 2025).
- Ying, T.; Tang, J.; Wang, K.; Lü, J. Study on the consumption decision-making model of commercial senior services from the perspective of family power relationship. J. Zhejiang Univ. (Humanit. Soc. Sci.) 2020, 50, 47–60. [Google Scholar]
- Keith, P.M.; Wacker, R.; Collins, S.M. Family influence on caregiver resistance, efficacy, and use of services in family elder care. J. Gerontol. Soc. Work 2009, 52, 377–400. [Google Scholar] [CrossRef]
- Xia, C. A role engagement model of elder care. Chin. J. Sociol. 2007, 114–141+208. [Google Scholar] [CrossRef]
- Wang, L.; Joseph, W.S. Types of family care for older persons and family relationships in caregiving: A field study of family care for older persons. Sociol. Stud. 2000, 27–41. [Google Scholar] [CrossRef]
- The People’s Government of Beijing Municipality. Available online: https://www.beijing.gov.cn/zhengce/zhengcefagui/qtwj/201110/t20111015_567088.html (accessed on 1 January 2025).
- Leocadie, M.-C.; Roy, M.-H.; Rothan-Tondeur, M. Barriers and enablers in the use of respite interventions by caregivers of people with dementia: An integrative review. Arch. Public Health 2018, 76, 72. [Google Scholar] [CrossRef]
- Chang, C.-H.; Ming, Y.; Chang, T.-H.; Yen, Y.-Y.; Lan, S.-J. The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors. Int. J. Environ. Res. Public Health 2020, 17, 6009. [Google Scholar] [CrossRef]
- Gao, X.; Tang, Y. Caregiving burden profile of the family caregivers of Beijing disabled elderly: Patterns and influencing factors. Popul. Dev. 2024, 30, 110–119. [Google Scholar]
- Cheung, C.-K.; Kwan, A.Y.-H.; Ng, S.H. Impacts of filial piety on preference for kinship versus public care. J. Community Psychol. 2006, 34, 617–634. [Google Scholar] [CrossRef]
- Hong, S.-I.; Hasche, L.; Lee, M.J. Service use barriers differentiating caregivers’ service use patterns. Ageing Soc. 2011, 31, 1307–1329. [Google Scholar] [CrossRef]
Variables | Category | % | Meal Service | Respite Care |
---|---|---|---|---|
Sum | 7.02 | 3.88 | ||
Age | 80~89 | 79.47 | 7.05 | 3.74 |
≥90 | 20.53 | 6.92 | 4.39 | |
X2 | 0.15 | 6.31 * | ||
Gender | Female | 57.92 | 6.97 | 3.80 |
Male | 42.08 | 7.10 | 3.99 | |
X2 | 0.20 | 0.81 | ||
Marital status | Unmarried | 54.57 | 6.36 | 3.94 |
Married | 45.43 | 7.82 | 3.80 | |
X2 | 27.44 *** | 0.42 | ||
Education | Illiterate/primary school | 53.00 | 6.28 | 4.25 |
Middle school | 18.41 | 7.44 | 3.82 | |
High school | 12.94 | 7.46 | 2.74 | |
University or higher | 15.64 | 8.69 | 3.63 | |
X2 | 40.87 *** | 23.05 *** | ||
Income level | Low | 24.55 | 6.68 | 3.08 |
Middle | 66.88 | 7.18 | 4.07 | |
High | 8.57 | 6.76 | 4.65 | |
X2 | 2.74 | 21.39 *** | ||
Disability | Mild | 69.74 | 7.57 | 4.13 |
Moderate | 13.95 | 6.74 | 3.78 | |
Severe | 16.31 | 4.92 | 2.89 | |
X2 | 49.49 *** | 18.70 *** | ||
Self-rated health | Good | 10.73 | 5.84 | 2.05 |
Fair | 53.31 | 7.68 | 4.56 | |
Poor | 35.96 | 6.41 | 3.40 | |
X2 | 26.98 *** | 63.46 *** |
Variables | Category | % | Meal Service | Respite Care |
---|---|---|---|---|
Age | <50 | 10.64 | 7.90 | 2.92 |
50~59 | 42.10 | 6.63 | 3.70 | |
60~69 | 28.50 | 6.40 | 4.09 | |
≥70 | 18.76 | 8.35 | 4.50 | |
X2 | 30.65 *** | 17.93 *** | ||
Gender | Female | 49.40 | 7.14 | 3.66 |
Male | 50.60 | 6.91 | 4.09 | |
X2 | 0.70 | 4.33 * | ||
Marital status | Unmarried | 6.85 | 6.88 | 3.46 |
Married | 93.15 | 7.03 | 3.91 | |
X2 | 0.08 | 1.15 | ||
Education | Illiterate/primary school | 7.54 | 8.78 | 5.28 |
Middle school | 21.39 | 6.49 | 4.04 | |
High school | 39.88 | 6.37 | 3.55 | |
University or higher | 31.20 | 7.81 | 3.84 | |
X2 | 34.40 *** | 18.04 *** | ||
Employment | Not working | 68.96 | 6.19 | 3.66 |
Working | 31.04 | 8.88 | 4.37 | |
X2 | 80.76 *** | 9.94 ** | ||
Caregiving Hours per day | 0~4 | 17.39 | 3.69 | 3.45 |
5~8 | 37.69 | 10.00 | 5.03 | |
Over 8 | 44.92 | 5.82 | 3.08 | |
X2 | 309.50 *** | 74.86 *** | ||
Duration of caregiving (years) | 0~5 | 27.77 | 5.36 | 3.80 |
6~10 | 28.38 | 6.08 | 3.57 | |
11~15 | 15.11 | 7.03 | 3.91 | |
Over 15 | 28.74 | 9.57 | 4.24 | |
X2 | 150.99 *** | 6.09 | ||
Relationship with care recipient | Spouse | 17.22 | 8.48 | 4.39 |
Children a | 78.49 | 6.66 | 3.75 | |
Other relatives | 4.29 | 7.79 | 4.23 | |
X2 | 25.90 *** | 5.86 | ||
Self-rated health | Good | 52.66 | 5.70 | 2.77 |
Fair | 42.78 | 8.58 | 5.00 | |
Poor | 4.55 | 7.78 | 6.17 | |
X2 | 103.56 *** | 130.38 *** | ||
Caregiving burden | No | 41.84 | 7.65 | 6.14 |
Yes | 58.16 | 6.57 | 2.25 | |
X2 | 14.72 *** | 337.10 *** |
Predictor Variables | LR Model (OR) | SE Model (β) | |
---|---|---|---|
Service Use | Burden | ||
Meal assistance service use | —— | —— | −0.250 |
Predisposing | |||
Age of elderly (80~89) | |||
≥90 | 1.143 * | 0.007 | −0.008 |
Sex of elderly (female) | 0.851 ** | −0.010 ** | —— |
Marital status of the elderly (unmarried) | 1.091 | 0.006 | —— |
Education of elderly (illiterate/primary school) | —— | ||
Middle school | 1.195 ** | 0.009 * | −0.012 |
High school | 1.296 *** | 0.011 | −0.036 *** |
University or higher | 1.464 *** | 0.025 *** | −0.006 |
Age of caregiver (<50) | |||
50~59 | 1.031 | 0.002 | −0.014 |
60~69 | 1.213 * | 0.006 | −0.044 *** |
≥70 | 1.280 | 0.002 | −0.040 * |
Sex of caregiver (female) | 0.859 ** | −0.012 ** | −0.020 *** |
Marital status of caregiver (unmarried) | 0.963 | −0.008 | −0.043 *** |
Education of caregiver (illiterate/primary school) | —— | ||
Middle school | 0.802 * | −0.014 * | —— |
High school | 0.804 * | −0.014 * | —— |
University or higher | 0.904 | −0.008 | —— |
Employment of caregiver (not working) | 1.762 *** | 0.036 *** | —— |
Caregiver caregiving hours per day (0~4) | |||
5~8 | 2.971 *** | 0.097 *** | 0.226 *** |
Over 8 | 1.699 *** | 0.065 * | 0.260 *** |
Years of caregiving (0~5) | |||
6~10 | 1.035 | 0.008 | 0.041 *** |
11~15 | 1.197 * | 0.019 * | 0.061 *** |
Over 15 | 1.578 *** | 0.034 *** | 0.031 *** |
Relationship (spouses) | —— | ||
Children | 1.173 | —— | −0.007 |
Other relatives | 1.322 | —— | −0.066 ** |
Enable | |||
Income level of elderly (low) | |||
Middle | 1.079 | 0.001 | −0.019 ** |
High | 1.118 | −0.009 | −0.075 *** |
Need | |||
Disability of elderly (mild) | |||
Moderate | 0.946 | 0.015 | 0.125 *** |
Severe | 0.766 *** | 0.009 | 0.153 *** |
Self-rated health of elderly (good) | |||
Fair | 1.206 * | 0.033 | 0.142 *** |
Poor | 1.249 * | 0.048 | 0.235 *** |
Self-rated health of caregiver (good) | |||
Fair | 1.468 *** | 0.036 ** | 0.092 *** |
Poor | 1.471 *** | 0.046 * | 0.165 *** |
Burden of caregiver (no) | 0.773 *** | −0.165 | —— |
Predictor Variables | LR Model (OR) | SE Model (β) | |
---|---|---|---|
Service Use | Burden | ||
Respite care service use | —— | —— | −0.344 |
Predisposing | |||
Age of elderly (80~89) | |||
≥90 | 1.166 * | 0.005 | −0.008 |
Sex of elderly (female) | 1.041 | 0.001 | —— |
Marital status of the elderly (unmarried) | 0.915 | −0.003 | —— |
Education of elderly (illiterate/primary school) | —— | ||
Middle school | 0.797 ** | −0.011 ** | −0.018 * |
High school | 0.508 *** | −0.028 *** | −0.047 *** |
University or higher | 0.746 ** | −0.013 ** | −0.016 * |
Age of caregiver (<50) | |||
50~59 | 1.499 ** | 0.011 ** | −0.010 |
60~69 | 1.824 *** | 0.013 * | −0.038 *** |
≥ 70 | 2.364 *** | 0.021 *** | −0.030 |
Sex of caregiver (female) | 0.983 | −0.003 | −0.018 *** |
Marital status of caregiver (unmarried) | 0.924 | −0.008 | −0.043 *** |
Education of caregiver (illiterate/primary school) | —— | ||
Middle school | 0.875 | −0.005 | —— |
High school | 0.835 | −0.008 | —— |
University or higher | 1.060 | −0.001 | —— |
Employment of caregiver (not working) | 1.624 *** | 0.016 *** | —— |
Caregiver caregiving hours per day (0~4) | |||
5~8 | 1.837 *** | 0.055 ** | 0.217 *** |
Over 8 | 1.193 | 0.044 | 0.255 *** |
Years of caregiving (0~5) | |||
6~10 | 1.001 | 0.005 | 0.040 *** |
11~15 | 1.216 * | 0.015 * | 0.060 *** |
Over 15 | 1.402 *** | 0.014 *** | 0.026 ** |
Relationship (spouses) | —— | ||
Children | 1.040 | —— | −0.005 |
Other relatives | 1.295 | —— | −0.063 ** |
Enable | |||
Income level of elderly (low) | |||
Middle | 1.345 *** | 0.008 * | −0.016 * |
High | 1.492 ** | 0.006 | −0.069 *** |
Need | |||
Disability of elderly (mild) | |||
Moderate | 1.208 * | 0.021 | 0.126 *** |
Severe | 1.107 | 0.024 | 0.156 *** |
Self-rated health of elderly (good) | |||
Fair | 2.100 *** | 0.042 ** | 0.145 *** |
Poor | 1.663 *** | 0.046 * | 0.234 *** |
Self-rated health of caregiver (good) | |||
Fair | 1.835 *** | 0.034 *** | 0.093 *** |
Poor | 2.993 *** | 0.065 *** | 0.173 *** |
Burden of caregiver (no) | 0.298 *** | −0.177 | —— |
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Gao, X.; Tang, Y. Individual Factors Influencing the Use of Home- and Community-Based Care Services by Disabled Elderly Individuals in Urban Areas: Evidence from Beijing, China. Sustainability 2025, 17, 676. https://doi.org/10.3390/su17020676
Gao X, Tang Y. Individual Factors Influencing the Use of Home- and Community-Based Care Services by Disabled Elderly Individuals in Urban Areas: Evidence from Beijing, China. Sustainability. 2025; 17(2):676. https://doi.org/10.3390/su17020676
Chicago/Turabian StyleGao, Xiuwen, and Yong Tang. 2025. "Individual Factors Influencing the Use of Home- and Community-Based Care Services by Disabled Elderly Individuals in Urban Areas: Evidence from Beijing, China" Sustainability 17, no. 2: 676. https://doi.org/10.3390/su17020676
APA StyleGao, X., & Tang, Y. (2025). Individual Factors Influencing the Use of Home- and Community-Based Care Services by Disabled Elderly Individuals in Urban Areas: Evidence from Beijing, China. Sustainability, 17(2), 676. https://doi.org/10.3390/su17020676