A study on the health service demands and influence factors among elderly people based on a community survey in Western China†

This study used random sampling to investigate elderly people in a community in Western China. The sample size was determined to be 330–400. To ensure the generalization of the study, the population of elderly seniors (80 years old) should account for at least 10%. Inclusion criteria were as follows: (1) ≥60 years old; (2) taking care at home; (3) communicating without barrier after hearing and visual correction; and (4) volunteered to participate in this study after consent. Exclusion criteria were as follows: (1) diagnosed with mental issues; (2) undergoing addiction; (3) impairment in memory and cognitive function; (4) experiencing hearing and language communication disabilities; and (5) unwilling to participate.

The database was established using the double-entry method, and statistical processing was conducted using SPSS 17.0. (IBM Corporation, Armonk, New York, United States) χ² test and single-factor variance analysis were used to compare the degree of demand between groups. Logistic regression was used to analyze multiple factors.

The healthcare needs survey was categorized into six aspects. The results were presented as the mean and standard deviation. A1–A10 addressed physiological and psychological health needs, B1–B3 addressed the demand for daily life care, C1–C7 addressed the safety requirements, D1–D7 addressed needs for health education, E1–E5 addressed the rehabilitation training and guidance needs, and F1–F5 addressed the demand for respect and self-development. The demand level was assessed using the 3-level scoring method: not require = 0 point, unclear = 1 point, and required = 2 points. The score for elderly home care needs was 42.95 ± 1.34, and the top 3 needs in the 6 aspects were safety needs (1.61 ± 0.45 points), health education needs (1.54 ± 0.57 points), respect and self-development (1.13 ± 0.64 points); the lowest demand was rehabilitation training and guidance (0.53 ± 0.66 points). The demand rate and satisfaction rate of stay-at-home healthcare for the elderly are shown in Table 1.

According to the results of this questionnaire, the average score of nursing needs for the elderly residing at home was 42.95. Using this score as the baseline, those lower than the baseline were classified as the low-demand group, with a total of 173 people (47.30%); those higher than the baseline were classified as the high-demand group, with a total of 193 people (52.70%).

The demand for “safety” of the elderly was the highest among the 6 aspects, indicating that the elderly have a certain level of risk awareness toward the external environment safety. According to the report, falls ranked as the primary cause of injury among Chinese elderly aged ≥65 years.⁶ It was closely related to the underlying physiological causes such as functional degeneration and delayed reaction. Eternal environmental risks, such as unsafe furniture arrangement and floor water stains, would also be considered. Hence, guiding the elderly to control these risk factors could effectively reduce safety risks in the home environment. In this study, we found that the satisfaction rate of “community emergency call system” was the lowest. This suggested that the community was still in the first stage of providing this service, indicating a great gap compared with developed countries. Establishing an emergency call system positively improved the rescue success rate of pre-hospital emergency services, especially for “empty-nesters” and disabled seniors. We suggested that actively promoting the emergency call system could provide safety assurances for the elderly. Meanwhile, it could also demonstrate social welfare and accelerate the development of internet-based elderly services.

The demand for “health education” was ranked second in the survey, reflecting participants’ strong desire for health education. This aspect should be given serious consideration as well. The “model of healthy beliefs” states that people will only adopt healthy behaviors if they recognize the seriousness of the disease and its impact on society and family.⁷ Among the surveyed elderly individuals, 12.60% reported smoking habits; 10.90% reported alcohol consumption; 10.70% reported a lack of exercise; and 19.40% reported incidents of medication misuse, including missed medication, selfadjusting medication dosage, and self-prescribing medication. These unhealthy behaviors not only increase the risk of developing chronic diseases but also may lead to adverse consequences such as delayed treatment and impact the prognosis. This study highlighted the necessity and urgency of carrying out health education in Western China.

The demand for “respect and self-development” was ranked at the third place. With the gradual improvement of living standards in China, elderly individuals also paid more attention to their psychological needs. During our case investigation, we encountered a disabled elderly participant who experienced hemiplegia, salivation, and urinary and fecal incontinence after the onset of cerebral infarction. The main home care tasks fell on his aged spouse, who experienced heavy physical and mental exhaustion due to the high-intensity caregiving work. Since it was so hard to promptly clean the bodily excrement and maintain a fine appearance, he felt very awkward and embarrassed when relatives and friends came to visit. This case prompted us to pay more attention to the self-esteem needs of elderly individuals with disabilities and chronic diseases. Another noteworthy phenomenon was that only 20.22% of the elderly participants in this survey needed hospice service and palliative care. However, we found that participants in good health conditions were more unwilling to discuss hospice topics. This tendency may be related to the taboo and fear of “death” in Chinese traditional culture. In Western China, due to the low universalization of palliative care, the avoidance of discussing the topic of death became a psychological weakness for most elderly individuals.⁸ Therefore, we thought the findings of this survey did not truly reflect the actual demand. Furthermore, another investigation reveals that the family members hoped their loved patients could pass away without suffering as their lives came to an end. Nevertheless, the hospital and community cannot currently provide hospice services due to the limited medical resources and timely hospitalization. In fact, according to the previous study, <5% of elderly care institutions in China were able to provide palliative care.⁹ Therefore, community and home hospice services were highly recommended in the elderly population, which demonstrated the reverence and respect for life.

The western region of China was a multiethnic area where people from various minority groups had different cultural practices. Their home-based care also presented distinctive ethnic characteristics and habits. In this study, we found that the Mien (also known as Yao people) elderly received a higher degree of family support. This may be related to Mien’s tradition that women shared equal rights as men in terms of inheriting family property. Therefore, both men and women in the family had equal responsibility and obligation to the elderly. The equality of family ethics relationship provided a strong support for home-based caring. However, due to the small sample size of ethnic minorities, the reliability of the conclusion needed to be further demonstrated.

This study showed that the nursing needs of males were higher than females, which may be related to their stereotypical “social gender.”¹⁰ The difference between “social gender” and “physiology gender” was formed in the acquired sociocultural constraints. The concept of “The man goes out to work while the woman looks after the house” within the Chinese traditional social division often expected women to take on more responsibilities for household carings than male. To a certain extent, this led to a relative weakening of the self-care ability of the male elderlies, which was consistent with the findings of Li et al.¹¹ Therefore, improving the self-care ability of male elderlies had a certain significance.

The higher home-based nursing demand positively correlated with the lower monthly income, aligning with the expectation of the life cycle hypothesis, which suggested that the elderly’s consumption was governed by the total income received by the family over its entire life. It could be predicted that relying solely on the income or savings of the elderly to purchase health services would bring huge financial and mental pressure to them. This would lead to a high expectation of the public health services provided by the government. This was consistent with the studies in developing countries.¹² Elderlies covered by Urban Resident Basic Medical Insurance and New Rural Cooperative Medical Insurance had higher nursing demand than those covered by Urban Employee Basic Medical Insurance, which is because they had to pay more on their health insurance deductible. This led to a greater financial burden and inability to afford medical services, which affected the accessibility and equity of health services for the elderly. Therefore, we suggested that improving the medical insurance system and increasing the investment in medical care were necessary to meet the needs of the elderly.

The higher nursing demand among the elderly who lack exercise may be related to their susceptibility to health problems such as obesity and hyperlipidemia. Since they have already gotten used to their lifestyle, even if they understand the importance of exercise in maintaining health, it is still hard for them to persist in exercising. Therefore, health service support was required in a greater extent. On the contrary, elderly individuals with regular exercise had better physical function, less health problems, and a stronger ability to maintain their health. Therefore, we suggested strengthening the community elderly care environment, organizing community sports activities, and improving the physical fitness of the elderly, enabling them to “Aging in place” safely, independently, and comfortably in the community and their own homes.

Self-care ability was closely related to the patient’s health. The elderly with poor self-care ability often need to rely on family or professional external support to meet their daily life and medical service requirements. The study also suggested that, with the decline in their selfcare ability, there was a need for changes and adjustments in their personal role, family function, and social support system to meet their multifaced nursing needs. Although we believed that self-care ability and chronic diseases had a certain correlation, but single-factor analysis revealed that the difference in whether participants suffered from chronic diseases between high- and low-demand groups was not significant. Thus, it was not the main factor influencing the nursing needs in this research. However, there was still controversy regarding this question.^13–15 Our study suggested that the reasons for the controversy may be: (1) The participants under investigation had good control and had coexisted with the chronic diseases for a long-term status. The diseases were adjusted adaptively so that impacts on physiological functions and self-care ability were not significant. This was consistent with the Lidgren’s¹⁶ findings. (2) It required a larger sample size to show the trend of statistical changes more accurately. (3) Since this questionnaire was based on subjective preferences and personal choices, the results may be biased by the participants’ inconsistent perceptions of the definition of nursing needs. The results of this study regarding the above factor remain to be further studied and demonstrated.

The survey showed that 65.80% of the elderly participants chose home-based care, which was much higher than community care (12.60%) and institutional care (21.60%). It was obvious that elderlies had a high level of acceptance of home-based care. This might be related to the Chinese tradition that most of the aged people preferred to spend the rest of their lives with their children and families. Although the willingness to care at home had a high level of uniformity but the nursing demands were inconsistent. The elderlies who chose community-based and institution-based care may had more health demands than those who chose to live in the home. The family was limited to meet the diverse needs of nursing, but the community and facilities had the advantage of providing specialized health services that meet the expectations of elderlies with more nursing needs. Therefore, we believed that building a comprehensive home-care system focused on the nursing needs at home was the best way to support the aged people’s interest and willingness. It could also strengthen the weakened family caregiving resulting from the 4-2-1 pyramid-shaped family structure accompanied by China’s one-child policy.