Factors Associated with the Utilization of Home and Community-Based Services (HCBS) Among Older Adults: A Systematic Review of the Last Decade.

Home and community-based services (HCBS) for older adults have been promoted worldwide to address the growing problems of aging. This systematic review included 59 studies published from 2013 to 2023 to explore factors influencing the utilization of HCBS among older adults. The review identified 15 common factors grouped into four levels of influence: individual, inter-relationship, community, and social contextual levels. The findings suggest that HCBS utilization is a dynamic process influenced by multiple factors at different levels. Gerontological social work should incorporate ecological thinking to improve practice and strengthen caregiver-recipient relationships.

Factors Associated with Intended Utilization of Home-Based Long-Term Care among Older Adults in China: The Moderating Effect of Community Support.

OBJECTIVES: Guided by Andersen's behavioral model, the objectives of this study were to (1) examine the associations between individual factors and the intended utilization of home-based long-term care (LTC) services among older adults in China and (2) explore the influence of community support, if any, on these associations. METHODS: Using a multi-stage random sampling approach, we recruited 1,064 older adults in Chengdu, China. Hierarchical regression was employed to investigate the direct effects of individual predictors and community support on the intended use of home-based LTC services. The moderating effect of community support was examined using the Hayes Process. RESULTS: Two predisposing (i.e., being old and unmarried), four enabling (i.e., living alone, having fewer children, and receiving less family and peer support), and six need factors (i.e., having more chronic illnesses; decreased performance in instrumental activities of daily living; higher levels of depression, anxiety, loneliness; and a lower self-image of aging), and low community support were significantly associated with increased intended utilization of home-based LTC. In addition, community support moderated the effects of family support (B = -.20, p < .001), peer support (B = -.20, p < .001), self-image of aging (B = -.39, p < .001), depression (B = -.34, p < .001), and loneliness (B = -.48, p < .001) on the intended utilization of home-based LTC services. DISCUSSION: Policymakers and practitioners should consider delivering tailored services for older adults and involve the community in the context of enhancing home-based LTC services.

Validation of the Perceived Community Support Questionnaire for Older Chinese.

BACKGROUND AND OBJECTIVES: Community support has a profound positive impact on older people's health and plays a crucial role in facilitating aging in place. This impact is particularly significant in the Chinese context, where community support can alleviate the pressure on traditional family caregiving. This study translated, adapted, and validated the perceived community support questionnaire (PCSQ) for use with older Chinese. RESEARCH DESIGN AND METHODS: Data for this validation study were collected from a cross-sectional survey of 1,064 Chinese aged 65 years and above. Following the cultural adaptation of the PCSQ-14, confirmatory factor analysis (CFA) was conducted to examine its factor structure. Criterion validity, convergent and discriminant validity, internal consistency reliability, and test-retest reliability of the scale were also assessed. RESULTS: Based on the CFA results, the adapted PCSQ-14 was found to have a 3-factor solution for community integration, community participation, and community organizations. The criterion-related validity was supported by its significant correlation with depression. Convergent and discriminant validity were established, with the internal consistency of the scale being 0.90. The test-retest reliability intraclass correlation coefficient for the scale was 0.78. DISCUSSION AND IMPLICATIONS: The adapted version of the PCSQ-14 demonstrated promising psychometric properties in assessing perceived community support in older Chinese. The adapted PCSQ-14 could assist researchers in determining older Chinese adults' perceptions of community support, and could also assist practitioners and policymakers in developing targeted services for older people and allocating resources more effectively.

Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model.

In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults' intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults' intended use of long-term care and contribute to the delivery of appropriate care services by public policy.