Comparison of research hotspots and trends in long-term care for the elderly between China and Australia: a bibliometric analysis^†

Bibliometrics and visualization methods were employed for this analytical study.

A literature search from China (Chinese) and Australia (English) was conducted on 25 November 2020. Chinese data were retrieved from Chinese National Knowledge Infrastructure (CNKI) using the following searching strategy: subject = (long-term care Or long-term support Or long-term service Or LTC) And (aged Or elderly Or old); Language: Chinese; Publication year: from 2010 to 2020; Publication type: journal articles, while the English literature data were collected from Web of Science (WOS) Core Collection using the following retrieval strategy: TS=(“long-term care” OR “long-term support” OR “long-term service” OR “long-term aged care” OR “LTC”) AND TS=(“aged” OR “elderly” OR “old” OR “older” OR “geriatric”); Language: (English);Document type: (Article); Countries/Regions: (AUSTRALIA);Timespan: 2010-2020.

Then, two bilingual authors independently screened the literature against the inclusion criteria: (1) published journal articles on LTC for the elderly and (2) articles published from 2010 to 2020. We excluded the following articles: (1) reviews, letters, news reports, and bibliometric analyses; (2) articles unrelated to the topic; (3) duplicated publications; and (4) articles without author, keyword, or abstract.

We conducted a bibliometric analysis, which is a statistical analysis, to evaluate and quantify the literature; this method is widely applied in different fields to identify core researchers, institutions, journals, and countries, as well as the geographic distributions and international collaborations. CiteSpace software (5.5 R2) was used to perform visualization analysis of the data. Knowledge maps of authorship, institution, and keyword were generated. The parameters of software were set as follows: time slicing (2010–2020), years per slice (1), term source (all selection), node type (institution, keywords, and author), selection criteria (top 30), thresholding (2, 2, 20), and pruning (pathfinder).

In total, we retrieved 826 Chinese articles and 393 English articles for analysis. Both China and Australia showed an upward trend in the total number of publications from 2010 to 2020, with some fluctuations (Figure 1).

Figure 1.

The top 10 authors with the highest number of publications in LTC research from China and Australia are listed in Table 1. The inclusion of two authors in the same article was treated as one cooperation, and the knowledge maps of the co-authorship network are shown in Figures 2A,B. From Figure 2A, we can notice some productive authors intended to cooperate with others to create a research group or had close cooperative relationship with each other, for example, Yuhuan Wang, Weiwei Hou, and Fangchao Huang of Shihezi University built a relatively stable collaboration network. In Figure 2B, there were already some collaboration networks in place, and authors had extensive cooperation with each other, for example, Tanya Davison worked closely with David Mellor, Gery Karantzas, and David Kissane.

Figure 2.

Table 2 presents the top 10 institutions in terms of publications from China and Australia. Institutions include universities and organizations conducting research. The inclusion of two institutions in the same article was considered as one cooperation. Figures 3A,B shows the knowledge maps of co-institution in China and Australia. In China, Fudan University had cooperation with other institutions in Shanghai, such as Shanghai Jiao Tong University, while Central South University and Yangzhou University had research partnership. Otherwise, there was a weak cooperation between the institutions. Figure 3B displays more frequent and closer cooperative relationships, and almost all the institutions had some degree of collaboration with others; for example, the research partners of Monash University have included Deakin University, the University of South Australia, and the Swinburne University of Technology. Some research organizations from Australia and other countries have built international networks. For instance, Stockholm University in Sweden is a partner of the University of Tasmania, Austin Health in the Australian state of Victoria, and Hornsby Ku-ring-gai Hospital in the Australian state of New South Wales.

Figure 3.

Analysis of keyword cooccurrence reflects hot topics in a research field. Figures 4A,B illustrates the analysis of keywords. According to the frequency, Table 3 shows the top 10 keywords in both Chinese and English data, from which we could see keywords with the highest frequency in China including “LTC insurance, aging, disabled elderly, combination of medical and health care, nursing home”. In the Australian studies, the most frequent keywords included “nursing home, dementia, quality of life, intervention”. Burst keywords are the keywords that were cited frequently over time. Burst keywords identify the emerging trends, and the strongest bursts indicate frontier topics in a research area. Figure 5 illustrates the top keywords with the strongest citation bursts between 2010 and 2020 in Chinese and Australian LTC publications.

Figure 4.

Figure 5.

Findings from this study will support other researchers to identify potential collaborators for future research. Table 1 and Figure 2A list some highly productive authors in China, such as Weidong Dai from Zhejiang University of Finance and Economics, which is one of the most productive institutions in this area from China. His research focused on LTC insurance²⁰ that was suggested by the WHO for China to address the issue of providing care to the disabled and elderly people.²¹ Other analysis of the results showed that the collaboration network in China between different institutions seemed to be limited. This situation demonstrates that domestic and international cooperation is needed to form the influential research team of LTC in China.

In Australia, the research network of LTC for the elderly was relatively more closely knit (Figures 2B and 3B). Indeed, there was frequent and close cooperation between researchers of different organizations associated with almost every productive author and institution. In addition, compared with China, Australian LTC research collaboration is more international. This may be because of the similar research and health care systems, cultures, family structures, and economic levels between developed countries.

Demographic changes in China led to a large increase in the number of people in need of LTC.²² As a developing country, China is experiencing acute challenges in providing the elderly with LTC services.¹⁰ However, due to longer life expectancy and low fertility rates in Australia, there is also an increase in the number of older Australians, some of whom will need support by aged care.²³ The public aged-care system is already under strain, and aged-care demands are expected to put additional pressure on Australian governments equivalent to about 6% of national Gross Domestic Product (GDP) by 2060.²⁴ Therefore, when China and Australia face the same challenge, communication and collaboration between researchers and organizations may promote an effective problem-solving mechanism and improve aged-care service provision. Aged-care reforms in Australia and China are evolving. Although residential and community aged care are more developed in Australia than in China, each country can potentially learn from the other through improved research collaboration.

The hotspot of “LTC insurance” indicated that some Chinese researchers have a strong interest in public subsidization of LTC to improve the care of older adults in the health care system. Chinese policymakers share this interest and aim to establish an LTC insurance policy framework in 2020.²⁰ The other hot keywords of “nursing home” and “disabled elderly” then showed the research concerns on service facilities and clients. Here, we must note that the combination of medical and health care was the biggest hit in recent years in China, was also the strongest burst keywords. Combination of medical and health care is the Chinese government’s plan for policy reform of aged care. The purpose is to combine medical and aged-care resources and to encourage the cooperation between medical institutions and aged-care homes.²⁵ This is similar to the concept of integrated care and is an emerging model of LTC in China.²⁶ Another strong burst word in recent 3 years, as shown in Figure 5A, was healthy aging. They would continue to be the research trends in the coming years.

Compared with the research hotspots in China, Australian researchers were more interested in care of elderly living with dementia. This reflects a focus in Australian aged-care practice on large numbers of older adults in residential care who live with dementia. By contrast, although China has the largest population of people with the diagnosis of dementia in the world, limited research is being conducted in this area. This may reflect the pattern of inadequate diagnosis and management for dementia in China, which are common.²⁷ Most Chinese living with dementia receive care at home, rather than in a residential care facility.²⁸ In future, Chinese policymakers should plan to attach importance to the prevention, treatment, and care of people with dementia. The research results of dementia care in Australia and elsewhere may be useful for Chinese researchers.

Other hotspots of LTC in Australia included research on workforce and on interventions or management to improve the quality of care in residential aged care. This reflects the focus in Australian LTC facilities, which are required to achieve accreditation to secure government funding by demonstrating their capacity to meet quality aged-care standards as informed by research evidence.²⁹

In Australian studies, two of the most recent keywords with the strongest citation bursts were polypharmacy and prevention, illustrating that they are the future research trends. Polypharmacy, including overuse of medications and more than five medications concurrently, is most common in the elderly because older people often live with several chronic conditions.³⁰ According to a study published by Page et al.,³¹ almost one million older Australians are affected by polypharmacy, and the number is increasing with the population aging. Reducing polypharmacy was highlighted by the WHO in its third global patient safety challenge to halve the global burden of medication-related harm.³² Thus, future research into polypharmacy and quality use of medicines is an important research trend in improving quality and safety for older adults globally.