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Objective:To explore the mediating effect of meaning in life between family care and subjective well-being of family caregivers of community disabled elderly, and provide reference for improving caregivers' mental health.Methods:From August 2019 to August 2020, A total of 526 family caregivers of disabled elderly from several communities in Guangzhou were household surveyed by general information questionnaire, family APGRA index, Chinese meaning in life questionnaire and general well-being schedule.SPSS 22.0 software was used for descriptive analysis, correlation analysis and mediating effect analysis.AMOS 22.0 software was used for structural equation model construction, and Bootstrap method was used for mediation effect test.Results:The score of subjective well-being, family care, meaning in life of family caregivers of disabled elderly were (69.41±19.17), (6.42±2.56), (42.96±7.61), respectively.The family care was positively correlated with meaning in life and subjective well-being ( r=0.275, 0.289, both P<0.01) and a positive correlation was found between meaning in life and subjective well-being ( r=0.345, P<0.01). Meaning in life had a partial mediating effect between family care and subjective well-being.The mediating effect value was 4.304, accounting for 30.6% of the total effect value. Conclusion:The family care can directly or indirectly affect caregivers' subjective well-being through meaning in life.
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The psychological health problems of the disabled elderly in China are closely related to physical diseases. Through combing the opening of psychological care services in the pilot cities of long-term care insurance in China, it is revealed that the current pilot cities do not pay much attention to psychological nursing services, the evaluation of psychological nursing needs is absent, and the implementation regulations of psychological nursing services are not perfect. Pilot cities should strengthen psychological care services for the disabled elderly; develop an evaluation system compatible with psychological care services; improve and implement psychological care services; developing information systems that match the needs of psychological care services to ensure the linkage of data in the transition between long-term care and medical needs; and the clients and service providers should cooperate to jointly promote the sustainable development of long-term care insurance psychological care services.
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Objective:To develop a questionnaire for voluntary care of the disabled elderly based on the theory of planned behavior, and test its reliability and validity.Methods:With the theory of planned behavior as the theoretical framework, a questionnaire entry pool was formed on the basis of extensive reading of domestic and foreign literatures and semi-structured interviews, and the questionnaire items were screened by Delphi method. From July to August 2020, 350 nursing staff from 10 hospitals in Suzhou were selected by convenience sampling method, and the reliability and validity of the questionnaire were tested, and the formal questionnaire was finally formed.Results:Totally 350 questionnaires were distributed in this study, and 330 copies of effective questionnaires were recovered, with an effective recovery rate of 94.29%. This questionnaire included a total of 26 items in 4 dimensions, including attitude, subjective norms, perceived behavioral control and behavioral intention. Cronbach′s α coefficient was 0.977, split-half reliability was 0.906, test-retest reliability was 0.84, the content validity index (CVI) of total questionnaire was 0.97, item-level CVI value was 0.88 to 1.00. Four exploratory factors were extracted, and cumulative contribution rate was 80.03%.Conclusions:The questionnaire has good reliability and validity, which can well explain and predict the willingness of nursing staff to volunteer for the disabled elderly, and can also provide incentive basis for policy makers and managers.
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Objective:To analyze the focuses and shortcomings of the long-term care policy for disabled elderlies in China, for references to optimize such policies.Methods:The data came from the policy documents on long-term care for disabled elderlies published on respective official websites of various ministries and commissions from January 1, 2013 to April 20, 2022. Text quantitative analysis was used to extract policy clauses, and three types of policy tools(including 13 types of sub-tools) were used to analyze these provisions.Results:132 clauses were extracted from a total of 34 policy documents, of which the number of clauses of supply, demand and environmental policy tools were 28(21.21%), 25(18.94%) and 79(59.85%) respectively. There were few clauses on scientific and technological information support(5) and capital investment(3) in the supply-type policy tools; In terms of demand-based policy tools, there were only a few clauses for government purchase(5), pilot projects(3) and service outsourcing(2); In terms of environmental policy tools, there were only a few clauses for standard design(9) and supervision and management(7).Conclusions:The long-term care policy structure of the disabled elderly in China was not balanced, the supply-based policy tools had less scientific and technological information support, the demand-based policy tools were short and single, and the environment-based policy tools were widely used but lack of standard design. Relevant policy-making departments should further improve the accuracy of policy targets, optimize the internal structure of policy tools, pay attention to the application of scientific and technological information policies and clarify the relevant standards of care services.
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Objective:To investigate the status and influencing factors of quality of life among disabled elderly whose home care services were paid by the long-term care insurance in Guangzhou, in order to provide a scientific evidence for improving their quality of life and improving the long term care insurance system.Methods:A convenience sample of 161 disabled elderly whose home care services were paid by the long-term care insurance were recruited and investigated. A cross-sectional survey was conducted by general information questionnaire, World Health Organization Quality of Life Brief Scale, Barthel Index, Self-rating Depression Scale, Self-rating Anxiety Scale and World Health Organization Happiness Index Scale.Results:The score of the quality of life among disabled elderly was 41.17±7.79. And the score of its four dimensions in descending order: environment, social relationships, psychological and physical with (11.38 ± 2.71), (10.36 ± 3.16), (9.86 ± 2.08), (9.56 ± 1.89) points. The multiple linear regression analysis found that frequencies of outdoor activities per week, frequencies of hospitalization in the past year, subjective well-being, depression and anxiety influenced the quality of life of the disabled elderly( P<0.05). Conclusions:The quality of life of disabled elderly is not optimistic. Nurses in home care institutions should formulate personalized nursing intervention based on influencing factors to improve the quality of life of disabled elderly, while providing a basis for optimizing long-term care insurance policies.
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Objective@#To develop the outcome evaluation index system for home care service of disabled elderly based on the long-term care insurance in Guangzhou.@*Methods@#Delphi method was used to develop the outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou. The Analytic Hierarchy Process was used to determine the weights of all indexes.@*Results@#After two rounds of expert consultation, questionnaire response rates were 86.67%, 100%; expert authority coefficients were 0.843, 0.858; coefficients of variation ranged from 0.07 to 0.23 and 0.00 to 0.14; coordination coefficients ranged from 0.221 to 0.355 and 0.379 to 0.433 (P<0.01). The final index system consisted of 5 first-level indicators, 17 second-level indicators, and 59 third-level indicators. The analytic hierarchy process was used to determine the weights of all indexes, and the consistency test (CR<0.1) was performed.@*Conclusions@#The outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou was scientific and reliable, the weights of all indexes were reasonable, which could provide reference for the designated service institution on evaluation and improvement of the effect of home care service of long-term care insurance for disabled elderly.
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Objective: To explore the influencing factors of the long-term care insurance demand in Jiangsu province and provide reference for the establishment and improvement of a perfect long-term care insurance system in China. Methods:Factor analysis,multiple regression analysis and logistic regression analysis were applied for analy-zing the survey data collected from Jiangsu province. Results: (1) From the perspective of subjective attitude fac-tors,nursing expenses,family ability to pay,insurance concepts, nursing needs and chronic disease awareness and long-term care insurance demand are positively correlated,and the impact was significant;(2) From the perspective of demographic factors, residents with a high level of education are more willing to buy long-term care insurance. Conclusions: The Chinese government should take full account of the influencing factors of long-term care insurance demand,improve the income of urban and rural residents,increase promotional activities,and encourage nursing in-stitutions to develop at different levels,and build a government-led long-term care service system.
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objective To develop long-term care demand assessment indicators for the disabled elderly in nursing home.Methods The assessment indicators were formulated based on literature review,semi-structured interviews and expert meeting.Then,Delphi technique was used to identify the indicators through two rounds of consultation among 23 experts.Results The response rates of two rounds consultation were 74.19％ and 95.65％,and the authority coefficients of experts were 0.850 and 0.905.The coordination coefficients of two levels of indicators in the second round were 0.600 and 0.269,respectively (P＜0.001).The long-term care demand assessment indicators for the disabled elderly in nursing homes consisted of 5 first-level indicators and 40 seeond-level indicators.Conclusion The longterm care demand assessment indicators for the disabled elderly in nursing home is reliable and scientific,which can provide references for further developing long-term care contents for the elderly in the nursing home and standardizing quality of long-term care.
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Objective To explore the influencing factors of disabled elderly caregivers' resilience,and to provide evidence for further intervention studies.Method Totally 221 caregivers in several communities were investigated with self-design general questionnaire,Activity of Daily Living Scale (ADL),ConnerDavidson Resilience Scale(CD-RISC) Chinese version,Simplified Coping Style Questionnaire(SCSQ),General Self-Efficacy Scale(GSES) and Perceived Social Support Scale (PSSS).Results The caregivers' resilience score was 59.99 ± 15.86,at a medium level and lower compared with normal population (t =-5.07,P＜0.01).It was positively correlated with the positive coping(r=0.468,P＜0.01),general self-efficacy (r=0.546,P＜0.01)and perceived (r=0.372,P＜0.01).Multiple stepwise regression analysis showed the positive coping,self-efficacy and social support of caregivers were influencing factors of caregivers' resilience (P＜0.01).Conclusion Disabled elderly caregivers' resilience is lower than the general population,and implementation of the intervention should be taken according to different resilience levels at clinical practice.
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Objective To assess the effect of family doctor team care on morbidity of disabled elderly in home care.Methods Eighty six disabled elderly patients with home care in Shanghai Xujiahui community were enrolled from February 2014 to January 2015.The patients were randomly divided into intervention group and control group with 43 cases in each.In intervention group,the family doctor team provided long-term,comprehensive and integrated care,and in control group the conventional home care was provided.The rates of morbidity and readmission to hospital were documented during the 3,6 and 12 monthfollow-up,and compared between two groups.Results The incidence rates of bedsore,pneumonia and deep vein thrombosis in intervention group was significantly lower than those in control group [after 6 months:4.9％ (2/41) vs.28.9％(11/38),x2 =8.311;2.4％ (1/41) vs.21.1％ (8/38),x2 =6.769;2.4％ (1/41) vs.15.8％ (6/38),x2 =4.353,respectively;after 12 months:2.4％ (1/41) vs.42.1％ (16/38),x2 =18.374;4.9％ (2/41)vs.28.9％ (11/38),x2 =8.311;7.3％ (3/41)vs.28.9％ (11/38),x2 =6.328,respectively;all P ＜0.05].The number of cases with bedsore healing(6/7 vs.0,x2 =18.555)and pneumonia recovery[5/6 vs.4.3％ (1/23),x2 =18.092] was significantly more and that with pneumonia deterioration (0 vs.52.2％ (12/23),x2 =5.340)was significantly less in intervention group than those in control group (all P ＜ 0.05).More cases with deep vein thrombosis improved(1/3 vs.0,x2 =3.949) and less cases with deep vein thrombosis deteriorated(0 vs.8/11,x2 =5.091) in intervention group than those in control group (P ＜ 0.05).And both the readmission rate for home care patients [2.4％ (1/41) vs.36.8％ (14/38),x2 =15.175] and for patients with complications [1/12 vs.43.8％ (14/38),x2 =4.872] was much lower in intervention group than that in control group (both P ＜ 0.05).Conclusion The family doctor team care can reduce the risk of complications and readmission to hospital,and also can improve the quality of life of home care disabled elderly,as well as reduce the burden of family and society.
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Objective:To study the current status and needs of Community Care for disabled elderly in Beijing and put forward the suggestions for improving the elderly Community Care system. Methods:Descriptive statistical a-nalysis, Chi-square test and Multivariate logistic analysis were adopted to analyze the situation of Community Care for Disabled elderly using data from the community survey of elderly population in Beijing. Results:The status of health is not optimistic for Disabled elderly, there are high demands for the community health services and welfare facilities for elderly and the needs for services provided by part-time home care, day care and volunteers are high, but those services and facilities provided by communities were found to be inadequate. Conclusion:China has a large popula-tion base of Disabled elderly and its number grows fast, but community care supply is in shortage and cannot meet the needs of those people. It is therefore urgent to improve community health services and community care system.
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Objective To survey the social support status and demands for family caregivers of the disabled elderly.Methods A cross-sectional survey based on convenience sampling was conducted among 779 disabled elderly and their family caregivers from May to June 2013 in five communities of Beijing Dongcheng District.Barthel index was used to measure the degree of functional impairment of the elderly.Self-rating Depression Scales (SDS) was used to evaluate depression symptoms of caregivers.Social Support Rating Scale (SSRS) and social support demand questionnaire were used to measure the social support status and social support demands of caregivers,respectively.Multiple linear regression analysis was used to analyze the influence factors of social support.Results Total 779 caregivers were identified and 744 caregivers completed the questionnaires with a valid response rate of 95.5％.Among 744 family caregivers the social support levels were low with an average SSRS score of 31.16 ± 6.86.There were significant differences in SSRS scores among caregivers of disabled elderly with different characteristics (age,married status and the Barthel index score) (all P ＜ 0.05);and there were significant differences in SSRS scores among caregivers with different characteristics (age,educational level,married status,current employment,relationship with patients,caregiving time daily,subjective care burden,living with patients,number of caregivers and depression status) (all P ＜ 0.05).Multiple linear regression analysis showed that the Barthel index score of the disabled elderly,the relationship with the elderly,depression status of the caregivers and the subjective care burden were correlated with the social support level of family caregivers (all P ＜0.05);the standard regression coefficients of above significant factors were 0.098,0.190,0.134 and 0.155,respectively.The social support demands of family caregivers were various;the average score was 2.44 ± 0.64,the top three demands were provision of care subsidy for the disabled elderly (average score was 2.95 ± 0.93),provision of care allowance for family caregivers (average score was 2.90 ± 0.93) and the guidance of safe medication (average score was 2.83 ± 0.83).Conclusions Family caregivers for the disabled elderly obtain low level social support in the surveyed area.Since the earegivers have various social support demands,the social support and assistance for them should be specific,effective and comprehensive.
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Objective To investigate the status of self-care ability and cognition among disabled elderly,and to analyze the relationship between self-care ability and cognition,then analyze their influencing factors.Methods A total of 813 disabled elderly accepted long-term care at community or facility were recruited by stratified sampling method and investigated by socio-demographic questionnaire,activities of daily living and short portable mental status questionnaire.Results The total scores of self-care ability of the long-term care disabled was 32.01±11.59,and the total points of cognition was 3.77±3.24.Disabled elderly with severe disorders of self-care ability had a higher obstacle rate in every cognition ability than those with mild disabilities (P＜0.001).There were differences in orientation and memory function with different persistent disabled time (x2 =11.875,14.758,P＜0.01).Disabled elderly with cognition obstacles have a higher obstacle rate in every self-care aspect than those with normal cognition (P＜0.01).The multiple regression analysis showed that the educational level (β=-0.067),arital status (β=-0.071),disabled persistence time (β=0.121),orientation ability (β=0.403),the amount of cognition obstacles (β=0.443) were the influence factors of Basic Activities of Daily Living(BADL) among disabled elderly ; and disabled persistence time (β=0.116),orientation ability (β=0.417),recalled ability (β=0.275),memorial ability (β=0.189),calculative ability (β=0.257),the amount of cognition obstacles (β=0.358) were the important factors influence Instrumental Activities of Daily Living(IADL).Conclusion The self-care ability and cognition of the long-term care elderly were declining sharply,and influencing each other.It is advisable to offer them direct long-term care service combined with the laws and characteristics of cognition and self-care ability.
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The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on conditions of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.