The expectations and influencing factors to choose institutional elder care for older person in the context of future disability: an empirical analysis in China based on Anderson's health behavior model.

backgroundSince entering an aging society, the trend of population aging in China has become increasingly intense. As the average life expectancy continues to rise, the number of older people who lack the ability to take care of themselves is also increasing. The growing number of disabled older people and the extension of their survival time after becoming disabled will increase the demand for elderly care services, especially specialized institutional care services. The purpose of this paper is to study the expectations of older people regarding future institutional care services in the event of incapacity and the factors that influence these expectations, in order to provide a basis for the development of elderly care organizations. METHODOLOGY: Based on Anderson's health behavior model, an analytical framework was constructed for the expectations of the older people to choose nursing services from elderly care institutions in the situation of future disability. Using survey data from 1134 older people who live in communities of 15 cities of 12 provinces, China. The respondents were selected using stratified and random sampling methods. First, the cities in the country were divided into four regions based on their geographical locations. Then, 2-4 cities were selected from each region, 1-2 districts within each selected city, and some communities were randomly chosen within each district. In the selected communities, a list of older person aged 60 years and over was obtained through community registration information, and a certain number of these older person were randomly selected as survey participants. The survey was mainly conducted in the form of face-to-face questionnaires, and the online survey method was used only in distant cities, such as the Xinjiang Uygur Autonomous Region. After getting the data, descriptive statistics, correlation analysis and binary logistic regression methods were used to analyze the expectation of the older people to choose nursing services from elderly care institutions in the situation of future disability and its influencing factors.

resultOnly 38.3% of the respondents expressed willingness for institutional elder care in the context of future disability. The variables of age, education, number of children, income, health status, self-care level,whether the community provides elderly care services and health services have a significant positive impact on the willingness of the older people to receive institutional elder care in the situation of future disability. The results of the Model 1 showed that older individuals those without a spouse, and those with higher education levels were more willing to consider moving into a nursing home if they became disabled in the future. The results of Model 2 show that older person with fewer children, not living with their children, higher income, and lower access to community pension services are more likely to choose pension service institutions if they become disabled in the future. The results of Model 3 show that the poorer the health status of the older person, such as those suffering from severe or chronic diseases, the more willing they are to consider moving into a pension institution if they become disabled in the future. Additionally, older person with lower self-care abilities are also more likely to consider moving into a pension institution under the same circumstances.

conclusionAffected by a variety of factors, the older person's low acceptance of institutional care remains consistent even when future disability is considered. This situation provides the background and ideas for China's current research on promoting social care services. For example, the nursing institutions should consider factors such as the age, education leveland income of the older person when designing elderly care services. The government can lower the threshold for the older person to stay in nursing homes by providing subsidies, tax relief and other incentives. Besides, when promoting the development of socialized elderly care services, emphasis should be placed on integrating medical and care services in elderly care institutions and developing inclusive community home care services. At the same time, the government should strengthen publicity and education efforts to popularize scientific knowledge about elderly care to the public.