Study on the measurement of coupling and coordinated development level between China's internet and elderly care services and its influencing factors.

BACKGROUND: With the intensification of China's aging population, the demand for elderly care services has become increasingly prominent. At the same time, rapid development of internet technology provides more convenience and possibilities for the elderly. However, the coordinated development between the internet and elderly care services still faces challenges. This study aims to measure the level of coupling and coordinated development between the internet and elderly care services in China, and analyze the influencing factors, in order to provide reference for promoting elderly care services. METHODS: In this paper, the entropy method and coupling coordination degree model were used to measure the coupling coordination development index of the internet and elderly care services in China from 2012 to 2021. In addition, considering that the coordinated development between the two is affected by many factors, the Tobit model was used to analyze the main factors affecting the integration of the internet and elderly care services. RESULTS: (1) The coupling and coordination of the Internet and senior care services is in its infancy, but the coupling and coordination of the two is on the rise, and there is still a lot of room for development in the future. (2) In terms of time scale, the coupling coordination development level between the internet and elderly care services in China has gone through three stages of "disorder recession-transition coordination-coordinated development". (3) In terms of influencing factors, government management ability has a more positive impact on the development of the integration of the Internet and senior care services, financial support, scientific and technological investment and the level of innovation play a mild pulling role, while the level of informatization to a certain extent restricts the level of integration of the Internet and senior care services. CONCLUSION: In order to promote the coordinated development of China's Internet and senior care services, it is necessary to comprehensively understand the current situation and development space of China's Internet and senior care services coupling coordination degree, accurately grasp the dynamic trend of China's Internet and senior care services coupling and coordinated development, promote the stage of leapfrogging, and fully consider the influencing factors, so as to realize the optimal allocation of policies and resources. These measures will help to promote a more coordinated and sustainable development of the internet and elderly care services in China.

The impact of using community home-based elderly care services on older adults' self-reported health: fresh evidence from China.

Background: The rapid population aging in China, characterized by a higher prevalence of illnesses, earlier onset of diseases, and longer durations of living with ailments, substantially engenders challenges within the domain of older adults' healthcare. Community home-based elderly care services (CHECS) are a feasible solution to solve the problem of older adults' care and protect older adults' health. The aim of this study is to investigate the relationship, heterogeneity effects and influential mechanisms between older adults' use of CHECS and their self- reported health. Methods: The study employs the Instrumental Variable technique and empirically investigates the relationship, heterogeneity effects and influential mechanisms between older adults using CHECS and their self-reported health using data from the China Longitudinal Aging Social Survey from 2018. Results: The findings indicate, firstly, that using CHECS considerably improves older adults' self-reported health. Secondly, the heterogeneity test reveals that the effect is more pronounced for older adults who are under the age of 80, have functional disabilities, are free of chronic diseases, have never attended school, reside in lower-income households, are single, rarely interact with their children, and live in central urban or city/county regions. Thirdly, the mechanism test reveals that the "social network effect" and "family care effect" are the key influence channels of using CHECS. Conclusion: An empirical foundation for the policy reform of community home-based care for seniors is provided by this study with the limitations to discuss the other socioeconomic aspects such as government health expenditure and discuss the specific services aspects such as health care. The findings carry substantial implications for improving the health of older individuals and provide suggestions for establishing a socialized aged care system in China.

Home/Community-Based Medical and Elderly Care Services Utilization in China: A Cross-Sectional Study from the Middle-Aged and Elderly Population.

Few studies have analyzed the acceptance of home/community-based medical and elderly care services in China. Therefore, we conducted a cross-sectional study to describe the acceptance of five services among people aged ≥ 45 years in the China mainland, and their influencing factors. The data were obtained from the database China Health and Retirement Longitudinal Study 2018. For each service, a binary logistics regression was adopted. A total of 9719 people were included, of whom 20.12% received services. The numbers of recipients (acceptance rates) of the five services, namely, comprehensive aged care services, regular physical examinations, onsite visits, health management, and entertainment, were 107 (1.10%), 1640 (16.87%), 323 (3.32%), 156 (1.61%), and 245 (2.52%), respectively. About 4% of people had received two or more services. The elderly aged 65-74 and those who were satisfied with the local medical services had higher acceptance of services. Urban hukou having health insurance, two or more chronic diseases, provincial economic welfare, and social welfare were positively associated with the acceptance of regular physical examination services. It is suggested that the government should gradually improve satisfaction with local medical services, and pay more attention to the needs of elderly people aged 65-74 for all kinds of home/community-based medical and elderly care services.

Spatio-temporal Analysis of Demand for Elderly Care Services and Its Key Influencing Factors in Chinese Cities: A Web Search Engine Approach.

The demand for elderly care services (DECS) in Chinese Cities is one of the most concerned issues. The aim of this study was to understand the spatial and temporal evolution and external factors of DECS in Chinese cities and support the formulation of elderly care policies. We collected Baidu Index data for 287 prefecture-level and above cities and 31 provinces in China from January 1, 2012 to December 31, 2020. The Thiel Index was employed to describe the differences of DECS at different regional levels, and multiple linear regression was used to explore the external factors affecting DECS by calculating the variance inflation factor (VIF) to identify multicollinearity. The DECS of Chinese cities increased from 0.48 million in 2012 to 0.96 million in 2020, and the Thiel Index decreased from 0.5237 in 2012 to 0.2211 in 2020. Per capital GDP, number of primary beds, proportion of population aged 65 and over, number of primary care visits, and proportion of illiterate population over the age of 15 have significant influences on DECS (P < .05). DECS was on the rise in Chinese cities, with significant regional differences. At the provincial level, regional differences were influenced by level of economic development, primary care provision, aging population, educational attainment, and health status. It is suggested to pay more attention to DECS in small and medium-sized cities or regions, to strengthen primary care, and to improve the health literacy and health status of the elderly population.

Community home elderly care services, multidimensional health and social participation of chronically ill elderly-Empirical analysis based on propensity score matching and multiple mediation analysis.

Introduction: In recent years, China's aging process has deepened rapidly, the disease spectrum of the population has undergone major changes, the proportion and scale of elderly patients with chronic diseases are growing rapidly, and the multidimensional health problems of the chronically ill elderly are prominent, seriously affecting the participation of the chronically ill elderly in family, community, and social development. In response, China has implemented the "active response to population aging strategy," accelerated the development of community home elderly care services, and encouraged the chronically ill elderly to continue to play a role through social participation. So how does the community-based home-based medical care service affect the social participation of the chronically ill elderly? Is an important subject. Methods: Based on the 2018 China Longitudinal Aging Social Survey and the propensity score matching method to measure the impact of community home elderly care services on the four types of social participation of chronically ill elderly, including economic participation, family participation, voluntary participation, and political participation, and group differences, and uses the multiple mediation analysis method to explore the mechanism and effect of community home elderly care services on the four types of social participation of chronically ill elderly. Results: (1) Community home elderly care services have an asymmetric impact on the social participation of the chronically ill elderly, and have generally promoted the level of social participation of the chronically ill elderly. (2) Community home elderly care services change the social participation arrangements of the chronically ill elderly by driving and inhibiting effects, so that it has a tendency to reduce economic participation and increase voluntary participation and political participation as a whole. This feature shows group differences among the chronically ill elderly of different ages, education levels, living arrangements and community types. (3) Community home elderly care services have an asymmetric impact on various social participation of the chronically ill elderly through the multidimensional health mediation mechanism. Conclusion: (1) With the continuous deepening of the interweaving between the growth of chronic diseases and the aging of the population in China, the development of a positive aging society must attach great importance to the important role of social participation for the chronically ill elderly. (2) Strengthen the development of physical, psychological, and social adaptation and other health abilities of the chronically ill elderly, shape their awareness of social participation, and give the chronically ill elderly a reasonable social role orientation. (3) Through policy incentives, promote the realization of fairness, justice, adequacy, and sustainability of community home elderly care services. (4) Pay special attention to the penetration, integration, and application of digital technology into the field of community home elderly care services to effectively protect the health of chronically ill elderly, ensure that the elderly with different chronic diseases participate in social activities of high quality, enjoy a high-quality happy life, and promote the high-quality development of the aging society.

Evolutionary Game Analysis of Behavior Strategies of Multiple Stakeholders in an Elderly Care Service System.

As the aging of Chinese society continues to deepen, it is particularly important for the development of the national elderly care service industry to further strengthen the government's supervision of private pension institutions and improve their management awareness of standardized operations. The strategic behaviors among the participants of senior care service regulation have not been well studied yet. In the process of senior care service regulation, there is a certain game association among three stakeholders, namely, government departments, private pension institutions, and the elderly. This paper firstly constructs an evolutionary game model including the above three subjects and analyzes the evolutionary path of strategic behaviors of each subject and the evolutionary stabilization strategy of the system. On this basis, the feasibility of the evolutionary stabilization strategy of the system is further verified through simulation experiments, and the effects of different initial conditions and key parameters on the evolutionary process and results are discussed. The research results show that (1) There are four ESSs in the pension service supervision system, and revenue is the decisive factor that affects the evolution of the stakeholders' strategy. (2) The final evolution result of the system is not necessarily related to the initial strategy value of each agent, but the size of the initial strategy value will affect the rate of each agent's evolution to a stable state. (3) The increase in the success rate of government regulation, subsidy coefficient and punishment coefficient, or the reduction in the cost of regulation and the fixed subsidy for the elderly can effectively promote the standardized operation of private pension institutions, but the large additional benefits will lead to their tendency to operate in violation of regulations. The research results can provide reference and a basis for government departments to formulate the regulation policy for elderly care institutions.

Research on the Existing Problems and Countermeasures of Home-based Elderly Care Services in China / 中国医学伦理学

At present, China’s response to the aging population situation is unprecedentedly urgent, and the construction and planning of the pension system face great challenges. Home-based elderly care services stand out in institutional-based elderly care and family-based elderly care due to their unique advantages in meeting the individual needs of the elderly. By sorting out the main types, policy lines, and supply and demand status of home-based elderly care service, this paper indicated that there are five aspects of problems in home-based elderly care service, including weak professional talent team construction, relatively insufficient capital investment, weak supply-demand matching, imperfect operating mechanism, and imperfect supporting facilities. It was proposed that in the future home-based elderly care services should strive to strengthen the construction of professional talent teams, widen financing channels, fully play the leading role of the government, perfect the operational mechanism and the construction of supporting facilities of home-based elderly care services, so as to provide reference for the optimization of the home-based elderly care service system in China.

Factors related to the social network of core members of elderly care service social organizations: a cross-sectional study.

BACKGROUND: The social network of the core members of elderly care service social organizations could affect the performance of the organization, while studies concerning its related factors are limited. We aimed to explore factors that are associated with the social network of core members from elderly care service social organizations and provide references and suggestions for improving elderly care services. METHODS: This cross-sectional study employed a multi-stage stratified sampling method, and collected data concerning social network, demographic information and occupation. Univariate analysis and binary logistic regression were used to analyze factors that could affect the social network of the core members. RESULTS: Our results demonstrated that there is low social network of core members of elderly care social organizations. Out of the total membership, men (AOR = 1.708; 95%CI: 1.034-2.823), those with senior high school education (AOR = 1.923; 95%CI: 1.053-3.511), those with a college degree and above (AOR = 3.010; 95%CI: 1.591-5.692) and those that receive awards related to elderly care services (AOR = 2.260; 95%CI: 1.285-3.976) were associated with higher social network scores. CONCLUSIONS: Our data successfully characterized the social status of core members of elderly care organizations. Therefore, health care professionals and policy makers in social organizations should use this knowledge in the care and service provision to the elderly; and implement actions that would promote networking in social organizations.

An Evaluation Index System of Basic Elderly Care Services Based on the Perspective of Accessibility.

Population aging has become more and more severe in many countries. As a result, the demand for basic elderly care services has risen. The establishment of an evaluation index system for basic elderly care services can provide guidelines for governments to improve the quality of such services. Based on the "5A" theoretical analysis framework of Penchansky and Thomas, this paper introduces the concept of "accessibility" into evaluation. The "accessibility" model of services, through a literature review, field research, and three rounds of expert correspondence, consists of three first-level indicators, including the accessibility of home-based community elderly care services, the accessibility of institutional elderly care services, and the accessibility of administrative services. The evaluation index system of 15 s-level indicators and 70 third-level indicators, using AHP to determine the weight value of each indicator, provides a quantitative basis for the quality evaluation and improvement of basic elderly care services. Based on our quantitative results, policy recommendations are put forward: strengthen the support for the human and financial resources of community home-based elderly care services; improve the affordability of basic elderly care services; increase the types and numbers of institutional elderly care service projects; improve the availability and adaptability of institutional elderly care services; improve the accessibility of administrative services so that elderly care service institutions and elderly care administrative agencies can establish an effective communication and feedback mechanism.

Optimal Subsidy Support for the Provision of Elderly Care Services in China Based on the Evolutionary Game Analysis.

Public-private partnership is a type of cooperation that has been widely employed to alleviate contradictions between supply and demand in the elderly care industry in China. Based on evolutionary game theory, this paper mainly analyzes the effects of static subsidy and dynamic subsidy to private sectors and consumers on the evolution of the decision process for private investors, consumers, and government in the three-dimension system. The simulation results show that without active supervision, a higher subsidy to private sectors will not promote the provision of high-quality services when the cost saving is large. Furthermore, there exists a threshold value of the difference between the two types of subsidies such that elderly people will be encouraged to choose institutional care if the value exceeds the threshold. We also find that dynamic subsidy policy works more efficiently in promoting the provision of home-based care services.

The Expected Demand for Elderly Care Services and Anticipated Living Arrangements Among the Oldest Old in China Based on the Andersen Model.

Objective: The first aim of this study was to explore expected demands of the oldest old and their determinants for different types of elderly care services. The second aim was to investigate preferred choices of living arrangements among the oldest old and the influencing factors. Methods: Data of 4,738 participants aged ≥80 years were extracted from the Chinese Longitudinal Health Longevity Survey carried out in 2014. Using the Andersen model as the analysis framework, a multiple logistic regression analysis was performed to analyze the relationship between the expected elderly care services and living arrangements and other influencing factors. The odds ratios were calculated to indicate the relationship between the influencing factors and the dependent variables. Results: From the descriptive analysis results, we found that the oldest old showed high anticipated needs for home visits (83.5%) and health education (76.4%). Further, there existed a huge imbalance between the supply and demand of care services for the aged. Living with children is still the most important way of providing for the oldest old. The regression results showed that the expected demands for elderly care services and anticipated living arrangements among the oldest old in China are influenced by age, residence, housing property rights, economic status, loneliness, and activities of daily living (ADLs). The oldest old who are older without housing property rights, childless, and have restricted ADLs were more frequently observed to live in long-term care institutions. Conclusions: There is an inequality of the supply and expected demand for elderly care services, and living with children is still a preferred choice of the Chinese oldest old. Our findings indicate that when planning how to promote elderly care services among the oldest old, it is important to consider their expectations, especially for the subgroup that is relatively disadvantaged. Related policies should be developed to offer incentives to family caregivers when they live with the oldest old.

Strategic Analysis of Participants in the Provision of Elderly Care Services-An Evolutionary Game Perspective.

Population aging poses challenges to the immature elderly care service system in many countries. The strategic behaviors of different participants in the provision of elderly care services in a long-term and dynamic situation have not been well studied. In this paper, an evolutionary game model is developed to analyze the strategic behaviors of two types of participants-the government sectors and the private sectors in provision of elderly care services. Firstly, eight scenarios are analyzed, and the evolutionary process and stable strategies are identified. Then, the behavioral strategies of the two types of participants under demand disturbance and dynamic subsidy strategy are analyzed. Simulation experiments are conducted to explore the influence of different initial conditions and parameter changes on the evolutionary process and results. The obtained observations are not only conducive to a systematic understanding of the long-term dynamic provision of elderly care services but also to the policymaking of the government.

Reducing the quality risk of elderly care services in government procurement from market-oriented private providers through ex ante policy design: lessons from the principal-agent theory analysis.

BACKGROUND: Government procurement of elderly care services from market-oriented private providers has become an important way to respond to the growing demands of elderly care. However, the government cannot accurately identify the actual quality efforts of these providers, and the government pursues social benefits while the providers pursue economic interests. The existence of asymmetric information and goal divergence increases the quality risk of services. From the perspective of maximizing the government's net benefits, this study aimed to analyze how to reduce the quality risk through ex ante policy design. METHODS: On the basis of the principal-agent theory, this study defined the asymmetric information of market-oriented private providers' efforts on quality as a random variable, and constructed the theoretical model in the case of asymmetric information to compare with the one in the reference case of complete information, in both of which the government is the principal and market-oriented private providers are the agents. And the models also introduced several parameters to describe key factors that affect the contract results, including the physical health of the elderly, the spillover benefits to the government and market-oriented private providers, and the market risks. RESULTS: The optimal results of the models in the two cases were obtained respectively, and the validity of the theoretical models was verified in a numerical example. Taking the case of complete information as the basic frame of reference, the difference of the optimal results in both cases showed the extent of negative impacts of asymmetric information, and highlighted the role of ex ante policy design in minimizing asymmetric information and reducing its negative impacts. Some ex ante policies that can improve the supervision of market-oriented private providers and their quality efforts, as well as have positive effects on key factors, were also recommended. CONCLUSIONS: The government should attach importance to ex ante policy design to reduce the quality risk of elderly care services supplied by market-oriented private providers in government procurement. Our study provides main framework and critical directions for ex ante policy design, which is conducive to the realization of real and sustained quality improvement.

Impacts of robot implementation on care personnel and clients in elderly-care institutions.

BACKGROUND: Digital technologies, including robots, are being increasingly used in elderly care. Their impact on users carries implications for successfully integrating technological innovations into care. This study aims to identify the impacts of care-robot implementation on elderly-care service stakeholders. METHODS: Impacts of care-robot implementation on users - care personnel and elderly clients - are identified from the data collected during a 10-week field study of the implementation process of the care robot 'Zora' in municipal elderly care services in Finland. The data were obtained from semi-participatory observation (27 sessions) of the robot engaging in rehabilitation efforts in two care homes and a geriatric rehabilitation hospital, and focus-group interviews conducted with 40 care workers and clients. RESULTS: Robot use in elderly care is associated with multiple types of impacts with positive, negative, and neutral dimensions. These include impacts on interaction and activity for clients, and impacts on the work atmosphere, meaningfulness of work content, and professional development for care personnel. Impacts on personnel were related to the need for orientation, problems of time usage, and overall attitudes toward novelty and renewing of care service. The robot's presence stimulated the clients into exercising and interacting. The care workers perceived the clients' well-being both as a motivation to learn how to use robots as well as a justification for negative views. CONCLUSIONS: Care-robots like Zora have the potential for multi-faceted rehabilitative functions and can become part of care service with careful systemic planning with a specific focus on orientation. Many of the identified impacts were related to how the robot fits into the service processes. Distinguishing between positive, negative, or neutral dimensions of different impacts is important.