Background
Population aging has become a significant global challenge due to increasing life expectancy and decreasing fertility rates [1]. By 2050, 20% of the world’s population is predicted to be over 65 years old, with 80% of them living in low- and middle-income countries [2]. As the world’s largest low- and middle-income country, China has 13.5% of its population over 65 years old [3]. The number of older adults in China is projected to peak at 487 million in 2053 and continue to grow [4]. Advanced age is accompanied by impaired ability to carry out activities of daily living (ADLs) due to structural and functional deterioration [5]. A recent study in China showed that the prevalence of impairment in ADLs in older adults ranged from 18.8 to 24.1%, physical performance from 28.8 to 44.2%, and cognitive impairment from 38.7 to 52.8% [6].
Population aging, coupled with impaired ADLs, has contributed to enormous demand for long-term care (LTC) [7]. LTC is defined by the WHO [8] as “the activities undertaken by others to ensure that people with or at risk of a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms, and human dignity.” In China, the demand for LTC services is rising rapidly, with up to 51.53% of older adults in need of LTC [9]. However, LTC services in China are insufficient, leading to a huge imbalance between the supply and demand of LTC services [10]. According to the international standard of one caregiver for three older adults with disabilities, about 10 million caregivers are needed in China. However, only 1 million caregivers provide LTC for older adults, accounting for only 10% of the demand [11]. Most of them are unlicensed informal caregivers, and only 60,000 are formal caregivers with professional qualification certificates for eldercare [11]. Therefore, developing and improving the LTC service network has become a health policy priority, which requires a full understanding and accurate assessment of LTC service demand for older adults.
Anzeige
Although the assessment of LTC service needs has attracted increasing research attention in recent years, most studies are focused on the epidemiological descriptions of LTC needs without considering the cost and time of service implementation [9, 12‐14]. Accurate cost measurement in healthcare is essential for resource allocation and priority setting to ensure the calculation, validation, and comparison of the impact of process improvements, especially in resource-limited countries [15, 16]. Yet, healthcare organizations around the world are constantly faced with the challenge of developing a standard for cost calculations [16]. Recently, time-driven activity-based costing (TDABC) has emerged as an effective cost-accounting tool to estimate unit costs in response to the widespread cost crisis in healthcare [15, 17]. TDABC is a process-based micro-costing methodology developed by Kaplan and Anderson [18, 19]. It employs a patient perspective by identifying the resources mapped onto each step of the patient’s care trajectory to facilitate the improvement of the healthcare system [15]. It assesses operational costs using a time equation to allocate resource costs directly to products [18, 19]. TDABC requires only two key parameters: the unit cost of supplying capacity and the time required to perform activities in service delivery [18, 19]. Compared to traditional activity-based costing, TDABC has the advantages of accurately assessing costs, optimizing internal processes, and simplifying implementation [16].
Ever since its initial development, TDABC has been widely applied to various healthcare areas around the world to facilitate cost processes and inform payment reimbursement systems [15, 16, 20]. Da Silva Etges [20] conducted a literature review on the application and effectiveness of TDABC in surgical inpatient management. They identified 26 studies using TDABC in surgical procedures (mainly orthopedic surgeries) and found consistent evidence supporting the value-based contributions of TDABC for increasing cost accuracy in real-world settings [20]. Keel [16] conducted another systematic review to explore the application of TDABC in health care more broadly using content analyses. Among the 25 articles they identified, 21 were conducted in the US and Europe, and 22 were conducted in hospital settings [16]. The findings suggest that TDABC is efficient and simple to use, overcoming the inherent complexity of cost accounting in hospital settings [16]. It provides an accurate and detailed capture of the cost of care and facilitates operational improvement by reducing waiting times, resource waste, redundant human resources, and non-value-adding steps [16].
Despite the well-demonstrated advantages of TDABC in health care, most of the empirical evidence is based on studies conducted in hospital settings from Western countries with well-developed healthcare systems [16, 20]. To our knowledge, no study has used TDABC to assess the LTC service needs of older adults in less developed countries, such as China. As a developing country with a rapidly aging population, China faces even more severe challenges in the LTC system [21]. It is predicted that the total health expenditure of the Chinese government will triple by 2060 if no effective cost-containment measures are taken [22]. Therefore, a complete understanding of older adults’ LTC service needs in China is crucial to inform feasible and cost-effective solutions to address the LTC challenges. To ensure an accurate evaluation of older adults’ LTC service needs, a culturally adaptive and psychometrically sound assessment tool is needed. In response to such needs, our research team has developed a quantitative index system of the medical and nursing services needs of older adults (QISMNSNE) based on the framework of TDABC [23].
The QISMNSNE was developed based on an extensive literature review, a group discussion, and two rounds of expert consultation [23]. The LTC needs were determined according to the primary surviving needs (existence) in Alderfer’s [24] Existence, Relation, Growth (ERG) theory, which is also consistent with Maslow’s [25] Hierarchy of Needs theory. According to these theories, survival needs are the most primitive and basic needs of human beings and a prerequisite for other higher-level needs [24, 25]. Survival needs are also fundamental to the older adults in LTC facilities, and services that meet residents’ physiological and safety needs constitute key indicators of LTC service quality [26]. The QISMNSNE includes a total of 105 indicators covering various LTC service areas provided by different personnel and measures the service time needed from each provider [23]. Although the QISMNSNE has shown good reliability and validity during its initial development and validation, it has not been widely used in the assessment of the LTC needs of older adults in China.
Anzeige
To fill the research gap, we conducted the current study to comprehensively investigate the LTC service needs of older adults for survival using the QISMNSNE based on TDABC. Specifically, we assessed the service time required from caregivers, nurses, and doctors to satisfy the survival needs of older adults. Additionally, we explored factors associated with the total service time needed for LTC of older adults. Our findings will offer deeper insights into the needs, demands, and costs of LTC services in China, which will help inform the future planning and financing of LTC resources.
Methods
Study design
A cross-sectional study was conducted from June 2021 to December 2022 among older adults aged ≥ 65 years living in Changsha City, Hunan Province, China. In order to get a representative sample, we employed a multistage cluster-sampling method to recruit subjects. In the first stage, we randomly selected three areas out of 6 districts (Yuhua District, Tianxin District, Furong District, Yuelu District, Kaifu District, Wangcheng District), 1 county (Changsha County), and 2 cities (Liuyang City and Ningxiang City) from Changsha City. In the second stage, we randomly selected one nursing home and one street/township/village from each area as our final sampling unit. In the third stage, we randomly selected 240 older adults from each sampling unit. If the sampling unit had < 240 older adults, we continued selecting new sampling units until the sample size was reached. Details on participant recruitment and selection are demonstrated in Fig. 1.
Participants
Eligible participants were older adults currently living in Changsha City during the study period who satisfied the following inclusion criteria: (1) Aged ≥ 65 years; (2) have lived in Changsha City for over one year, (3) have lived in nursing homes or communities continuously for over one month. We excluded participants who (1) refused to participate in the survey, (2) withdrew in the middle of the survey, (3) could not be contacted, or (4) had been hospitalized in a specialized/general hospital within one month of the survey completion.
The sample size was calculated based on the indicator of LTC service demand, which was assessed using the quantitative index system of the medical and nursing services needs of older adults (QISMNSNE). The QISMNSNE has 105 three-level indicators, and the sample size should be 10 to 20 times the number of indicators [27]. Considering an attrition rate of 20%, we further expanded our sample size to 1260 to 2520.
In this study, 1440 older adults were selected, which satisfied the sample size requirement. We excluded 170 participants due to hospitalization within one month (n = 53), loss of contact (n = 39), study refusal (n = 42), and study withdrawal (n = 36), leading to a final sample of 1270 participants who provided valid questionnaires, with an effective response rate of 88.2%.
Procedures
The study was approved by the Ethics Committee of Xiangya Hospital of Central South University (No.202105083). The research team comprised 12 licensed nurses who received unified training on research conduction and data collection. The research team approached the eligible participants and their primary caregivers and explained the study’s purpose, procedure, benefits, and risks in detail. All participants were informed that they could withdraw from the study at any time during the survey period, which would not affect them in any respect. After providing written informed consent, the participants were invited to complete a questionnaire survey based on face-to-face interviews with our research team. The research team also obtained written informed consent from the managers of the nursing homes or communities where the participants lived. If the participant could not communicate effectively, the primary caregiver would provide the information, which was further reviewed and agreed upon by both the participant and the primary caregiver. The research team also reviewed the participants’ medical and nursing records, if available.
Measures
Socio-demographic information
A researcher-developed questionnaire was used to collect participants’ socio-demographic characteristics, including sex, age, place of residence, marital status, education, type of health insurance, primary source of income, and income.
LTC service needs
Older adults’ LTC service needs were assessed using the QISMNSNE developed by our team [23]. The QISMNSNE was developed based on Alderfer’s [24] Existence, Relation, Growth (ERG) theory and Maslow’s [25] Hierarchy of Needs theory, focusing on the survival needs of older adults. Therefore, the QISMNSNE assesses exclusively the needs of long-term care rather than medical service needs [23]. It includes 4 first-level indicators, 17 s-level indicators, and 105 third-level indicators [23]. Each indicator clearly identifies the provider of the service, such as a doctor, a caregiver, or a nurse [23]. Each item is quantified by measuring working hours and care needs with the corresponding weight according to the framework of TDABC [23].
The QISMNSNE assesses older adults’ needs of human resources for LTC services by calculating the service time required from caregivers, nurses, and doctors and the total service time in 24 h. The service content includes four dimensions: life-sustaining, environmental-sustaining, health-sustaining, and health-promotion services. The total service time is the sum of the product of the service time and the weight of the salary. The weight of salary is the ratio of the salary of caregivers, nurses, and doctors, which is calculated based on the actual wages of caregivers, nurses, and doctors in each region according to three indicators: the difficulty of the service, the degree of contribution, and the degree of risk. These indicators are determined by referring to the calculation of labor costs for medical services in public hospitals in China [28] and the Resource Utilization Groups (RUGs) Version III casemix classification system for payment systems in the U.S [29]. We also take into account the regional differences in economic development, similar to the national LTC expenditure calculation system in Japan, which determined eight regional levels and assigned extra rates to these regions based on the labor costs of local government employees in each regional level [30]. In this study, we adopted 1:1.06:1.44 as the weight of salary for caregivers, nurses, and doctors [31]. The QISMNSNE demonstrated good reliability and validity in a previous study, with Cronbach’s alpha coefficient of 0.73, split-half reliability of 0.74, content validity of 0.93, and corrected validity of 0.78 [23]. In the current study, the QISMNSNE also showed good internal consistency with a Cronbach’s α of 0.895.
Comorbidity of geriatric syndromes
Comorbidity of geriatric syndromes(CGS) [32] was used to determine the presence of 11 geriatric syndromes: falls, delirium, chronic pain, geriatric Parkinson’s syndrome, syncope, polypharmacy, dementia, insomnia, urinary incontinence, and stress injury. The presence of each syndrome is coded as 1 point, while absence is coded as 0 point. The total CGS score ranges from 0 to 11, with higher scores indicating more geriatric syndromes. The CGS score was further categorized into low (0 ~ 2), middle (3 ~ 4), and high levels (≥ 5) of geriatric syndromes.
Disability
Participants’ degree of disability was assessed using the Standardized Geriatric Ability Assessment Scale (SGAAS), which is highly recommended by the Medical Affairs Bureau of the National Health and Health Commission for assessing the degree of disability in older adults [32]. The SGAAS includes three subscales: Activities of Daily Living (ADLs), Mental Status and Social Involvement (MSSI), and Sensory and Communication (SC), each described below. The SGAAS demonstrated good internal consistency in the current study, with a Cronbach’s α of 0.978.
ADLs The ADLs assess the older adults’ daily living abilities in 15 aspects, including turning over in bed, bed-to-chair transferring, flat walking, non-walking movement, activity endurance, walking up and down stairs, eating, wearing/taking off clothes, wearing/taking off pants, bathing, using a toilet, controlling bowel function, controlling bladder function, and medication use. The total score of ADLs ranges from 0 to 60, with a higher score indicating more restrictions in ADLs, which is further categorized into Normal (0), mild impairment (1 ~ 20), moderate impairment (21 ~ 40), and severe impairment (≥ 40) of ADLs.
Anzeige
MSSI The MSSI evaluates the following 8 aspects of mental and social functioning: temporal orientation, spatial orientation, personal orientation, memory, aggression, depressive symptoms, obsessive-compulsive behavior, and financial management. The total score of MSSI ranges from 0 to 40, with a higher score indicating poorer mental and social functioning, which is further categorized into Normal (0), mild impairment (1 ~ 8), moderate impairment (9 ~ 24), and severe impairment (≥ 25) levels of mental and social functioning.
SC The SC evaluates older adults’ sensory and communication functions in the following four aspects: consciousness, vision, hearing, and communication. The total score ranges from 0 to 12, with a higher score indicating poorer sensory and communication functions, which is further categorized into Normal (0), mild impairment (1 ~ 4), moderate impairment (5 ~ 8), and severe impairment (≥ 9) levels of sensory and communication function.
Statistical analyses
Statistical analysis was performed using SPSS 23.0. Continuous variables were described using means and standard deviations, and categorical variables were presented using frequencies and percentages. Descriptive statistics were analyzed using medians and quartiles because of the skewed nature of the outcome variables. The Mann-Whitney U test and the Kruskal-Wallis H test were used to compare non-parametric data distribution between groups because the collected data did not strictly follow a multivariate normal distribution. Multi-factorial analysis was performed using a generalized linear model to examine the effect of multi-factorial interactions on the total service time. A two-sided P-value < 0.05 was considered statistically significant.
Results
Sample characteristics
Table 1 shows the socio-demographic characteristics and disability status of the participants. The participants had an average age of 76.41 ± 8.31 years, and 56.3% were males. Most were married (60.2%), had provincial/municipal medical insurance (64.3%), and had pensions as their primary sources of income (60.4%). About half lived in the community (50.1%) and had primary and below education (50.2%). Most participants (82.8%) suffered from 0 ~ 2 geriatric syndromes, and their average scores of ADLs, MSSI, and SC were 20.12 ± 22.87, 9.87 ± 8.80, and 2.27 ± 2.35, respectively.
Anzeige
LTC service needs
Table 2 shows the participants’ needs for human resources for LTC services. The median required service time from caregivers, nurses, and doctors were 53.34 min/d (range: 0.00 ~ 250.33 min/d), 3.66 min/d (range: 0.00 ~ 95.23 min/d), 0.33 min/d (range: 0.00 ~ 38.76 min/d), respectively, and the total service time was 92.32 min/d (range: 0.00 ~ 371.12 min/d). The participants required the highest service time from caregivers and the lowest service time from doctors.
Factors associated with LTC service needs
Univariable Analysis
Table 3 shows the comparison results of the total service time of LTC by various socio-demographic characteristics and disability status. The total service time of LTC differed significantly by age, marital status, dwelling place, education, type of medical insurance, primary source of economy, income, ADL, MSSI, SC, and CGS (P < 0.05 for all).
Multivariable Analysis
Multivariate analysis was conducted using a generalized linear model with the dependent variable being the total service time, and the independent variables were 11 variables with P < 0.05 in the univariable analysis. As shown in Table 4, after controlling for all other factors, the following five factors remained significantly associated with the total service time: aged 75–84 years (β = 7.023, P = 0.000), residence (β = 53.42, P<0.001), monthly income above 5000 yuan (β = 12.04, P = 0.009), having 3 ~ 4 kinds of geriatric comorbidity (β = 13.981, P<0.001), ADLs (β = 12.579-109.211, P<0.001), MSSI above 8 (β = 28.204–39.814, P<0.001), and SC (β = 4.66-26.379, P ≤ 0.0284).
Discussion
Summary of the Findings
To the best of our knowledge, this study was the first to explore the demand for human resources for LTC to meet the survival needs of older adults in China through TDABC. In this study, 1,270 older adults completed the questionnaire, and the results showed that older adults required the most service time from caregivers and the least service time from doctors. In addition, age 75–84 years, residence place, income over 5000 per month, ADLs, MSSI (9 ~ 40), SC, and having 3 ~ 4 kinds of comorbidity of geriatric were significantly associated with total service time for LTC. Our findings provide preliminary insights into Chinese older adults’ needs for LTC services and their associations with socio-demographic characteristics and health status.
LTC service needs
Our study showed that older adults required the highest service time from caregivers, which was consistent with the findings of Dijuan Meng et al. [33] in comparing older adults’ service required from caregivers, nurses, and doctors. Our findings indicate an urgent need for caregivers to provide LTC services for older adults. Based on Markov modeling, the required number of caregivers for China’s aging population in 2025 is projected to be 5.6 million at the lowest and 11.5 million at the highest [34]. However, there is a severe shortage of LTC caregivers for older adults in China, and the existing caregiver system is characterized by low education of staff, low staff structure, and high staff mobility [35]. The insufficient supply of human resources for senior LTC services suggests an urgent need to establish a team of caregivers with solid professionalism, excellent comprehensive quality, and enough numbers. Furthermore, it is recommended that more efforts be directed toward improving the working environment of senior care institutions and caregivers’ salaries to recruit and retain more caregiver workforce [36]. Understanding the demands of service users and rational staffing is essential to ensure the healthy and sustainable development of senior care services [37].
Factors associated with total LTC service time
This study quantified older adults’ needs for LTC through the total service time, which was significantly associated with the following factors: aged 75–84 years, living in a nursing home, income over 5000 per month, ADLs having an impairment, MSSI having a moderate and above impairment, SC having an impairment, and having 3 ~ 4 kinds of geriatric comorbidity. These findings were congruent with Sun et al.‘s study [38] showing that older adults in the age group of > 75 years had more cognitive and daily living impairment. Therefore, they were dependent on the support of others to overcome the barriers faced in community settings and thus had more LTC service needs.
Anzeige
Our study also revealed that place of residence was associated with the total LTC service time, with nursing home residents requiring more service time than older adults living in the community. In developed countries, the monthly healthcare expenditures for LTC services from support facilities are $3,000 higher than from home or community-based services [39]. China faces increasing family miniaturization, weakened family functions, and discrete family relationships, and the lack of care provided by children or spouses has led to an increasing demand for senior care services provided by society [40]. However, most studies show that older adults with disabilities tend to be reluctant to receive care from institutions, preferring to be cared for in a friendly environment such as the home of an informal caregiver or the community [41, 42]. Besides, the cost of home and community care is lower than that of LTC services in institutions [39]. In developing countries with less developed economies and shortages of geriatric caregivers, it is recommended that the continuity of community-based care services be promoted through internal and external motivational incentives [43]. Some practical measures include providing support and training to families, their unpaid caregivers, and community-based service providers [44] and optimizing day services and short-term residential services in senior care facilities [45], which are helpful in achieving the goal of maintaining the healthy and sustainable development of LTC services.
Consistent with the literature, our study showed that higher levels of disability, including having more geriatric syndromes, higher impairment of ADLs, SC, and MSSI, were associated with higher total service time for LTC. Wang et al.‘s study [46] showed that impaired ADL abilities were significantly associated with poor mental status, social participation, and sensory and communication skills, leading to higher LTC service needs. Wu et al.‘s study [47] demonstrated that older age, stroke, dementia, and impaired ADL were associated with greater LTC demands. Chen et al. [12] reported that older adults with multimorbidity required more time for informal care, such as care from family members. Kato et al. [48] also revealed that multi-morbid older adults had more LTC demands. In addition, Zhang et al.’s study [6] showed that although old age remains the most important predictor of ADL and MSSI dysfunction, they may improve due to improved medical and social care. When socioeconomic development meets the population’s most basic needs, ADL and MSSI can improve even without significant improvements in objective physical and cognitive functioning in old age [6].
In summary, as older adults age, they have more comorbid geriatric syndromes and experience deterioration in their ADLs and MSSI, leading to higher needs for LTC services. Our findings provide important implications for rationalizing the allocation of LTC resources for the older population. On the one hand, older adults’ needs for LTC services can be assessed according to age, comorbid geriatric syndromes, and self-care ability. Targeted interventions, such as improving older adults’ health status, nutrition, disease management skills, social networks, and communication skills, can be used to slow the functional decline and the need for LTC services [49]. Exploring the factors associated with older adults’ LTC service needs can help rationally allocate LTC resources for this population and ultimately provide a basis for improving the LTC system for older adults.
Limitations
Several limitations should be acknowledged. First, our sample, though very large, was recruited solely from Changsha City and may not represent older adults in other parts of China. Future studies should consider conducting a national survey for a more representative sample. Second, the cross-sectional study design precludes any causal inference between older adults’ LTC service needs and associated factors, including socio-demographic characteristics and health status. Future longitudinal study designs are needed to establish robust predictors that influence older adults’ LTC service needs. Third, the total service time of LTC in this study was measured based on a certain period, which did not consider its dynamic change over time. Future studies should include multiple time points in the assessment of service time to acquire the dynamic changes. Fourth, all data were collected based on self-reported questionnaires, which may be subject to recall bias and social desirability bias. Future studies should consider combining other objective assessment tools to enhance data reliability. Fifth, the questionnaire was assessed by professionals trained in questionnaire assessment and with a medical background, which limited the dissemination of the questionnaire. Future studies should optimize the questionnaire in order to expand its use by those who are caregivers, family members, or older adults themselves.
Conclusion
Our study shows that older adults have the highest service needs from caregivers and lowest needs from doctors, which can provide a scientific basis for LTC service staffing in low- and middle-income countries. In addition, their LTC needs are associated with age, residence, geriatric syndromes, ADL, and MSSI. Our findings offer deeper insights into the needs of LTC services for older adults in China and provide essential guidance for future planning and financing of LTC resources to ensure the healthy and sustainable development of the LTC system.
Fig. 1
Flow chart of participants selection in Changsha, Hunan, China
×
![]()
Table 1
Socio-demographic data and disability status of the older adults (N = 1270)
Characteristics | Croup | N | % |
|---|---|---|---|
Sex | Male | 715 | 56.3 |
Female | 555 | 43.7 | |
Age | 65–74 | 600 | 47.2 |
75～84 | 405 | 31.9 | |
85～103 | 265 | 20.9 | |
Residence | Community | 636 | 50.1 |
Nursing home | 634 | 49.9 | |
Marital status | Single/divorced/widowed | 505 | 39.8 |
Married | 765 | 60.2 | |
Education | Primary and below | 637 | 50.2 |
Middle/High | 520 | 40.9 | |
University or above | 113 | 8.9 | |
Type of medical insurance | New rural cooperative medical Insurance | 442 | 34.8 |
Provincial/Municipal medical insurance | 816 | 64.3 | |
Other | 12 | 0.9 | |
The primary source of income | Pension | 767 | 60.4 |
Government subsidy | 347 | 27.3 | |
Child subsidy | 148 | 11.7 | |
Other | 8 | 0.6 | |
Monthly income(yuan) | > 1000 | 414 | 32.6 |
1000～2500 | 342 | 26.9 | |
2500～5000 | 420 | 33.1 | |
5000～ | 94 | 7.4 | |
Comorbidity of geriatric syndromes (CGS) | 0～2 | 1052 | 82.8 |
3～4 | 212 | 16.7 | |
5～ | 6 | 0.5 | |
Activity of daily living (ADL) | Normal (0) | 419 | 33.0 |
Mild impairment (1～20) | 353 | 27.8 | |
Moderate impairment (21～40) | 185 | 14.6 | |
Severe impairment (41～60) | 313 | 24.6 | |
Mental status and social involvement (MSSI) | Normal (0) | 95 | 7.5 |
Mild impairment (1～8) | 599 | 47.2 | |
Moderate impairment (9～24) | 440 | 34.6 | |
Severe impairment (25～40) | 136 | 10.7 | |
Sensory and communication(SC) | Normal (0) | 330 | 26.0 |
Mild impairment (1～4) | 709 | 55.8 | |
Moderate impairment (5～8) | 218 | 17.2 | |
Severe impairment (9～12) | 13 | 1.0 |
Table 2
Comparison of service time required from caregivers, nurses, and doctors
Service times | Min (min/d) | Max (min/d) | Median (min/d) | Mean(min/d) | P25, P75 (min/d) | Rank |
|---|---|---|---|---|---|---|
The service time of the caregiver | 0.00 | 250.33 | 53.34 | 71.86 | 0.00, 136.77 | 1 |
The service time of the nurse | 0.00 | 95.25 | 3.66 | 9.15 | 0.58, 13.95 | 2 |
The service time of the doctor | 0.00 | 38.76 | 0.33 | 7.47 | 0.00, 11.98 | 3 |
The total service time | 0.00 | 371.12 | 83.31 | 92.32 | 0.61, 169.50 |
Table 3
Comparison of the total service time by sample characteristics (N = 1270)
Variables | Croup | TST (P25, P75) min/d | Z/H | P |
|---|---|---|---|---|
Gender | Female | 84.44(1.09, 169.29) | -1.01 | 0.31 |
Male | 78.74(0.61, 170.41) | |||
Age | 65～74 | 1.09(0.16, 92.18) | 283.48 | 0.00 |
75～84 | 128.30(6.44, 197.74) | |||
85～103 | 148.48(103.56, 204.49) | |||
Dwelling place | Community | 0.61(0.16, 6.26) | -29.34 | 0.00 |
Nursing home | 168.06(122.55, 217.76) | |||
Marital status | Single/divorced/widowed | 119.35(14.27, 179.11) | -7.98 | 0.00 |
Married | 7.87(0.61, 156.61) | |||
Educational | Primary and below | 16.10(0.61, 145.82) | 54.12 | 0.00 |
Middle/High | 105.63(0.84, 182.83) | |||
University or above | 146.44(88.98, 209.99) | |||
Type of medical insurance | New rural cooperative medical Insurance | 1.33(0.29, 83.32) | 167.68 | 0.00 |
Provincial/Municipal medical insurance | 124.10(4.62, 196.58) | |||
Other | 2.85(0.64, 91.92) | |||
The primary source of income | Pension | 116.72(1.09, 190.41) | 131.14 | 0.00 |
Government subsidy | 1.23(0.16, 70.29) | |||
Child subsidy | 122.05(8.14, 172.51) | |||
Other | 13.61(0.16, 153.16) | |||
Monthly income(Yuan) | < 1000 | 2.72(0.30, 124.27) | 150.88 | 0.00 |
1000～2500 | 15.45(0.61, 149.21) | |||
2500～5000 | 137.67(5.60, 213.73) | |||
5000～ | 142.81(90.36, 207.58) | |||
Comorbidity of geriatric syndromes (CGS) | 0～2 | 15.45(0.61, 137.25) | 303.54 | 0.00 |
3～4 | 212.49(160.43, 255.18) | |||
5～ | 175.21(144.26, 215.78) | |||
Activity of daily living (ADL) | 0 | 0.61(0.16, 1.09) | 1027.60 | 0.00 |
1～20 | 30.09(1.78, 104.20) | |||
21～40 | 148.75(130.47, 165.83) | |||
40～60 | 218.86(186.80, 248.33) | |||
Mental status and social involvement (MSSI) | 0 | 0.61(0.16, 7.24) | 875.66 | 0.00 |
1 ~ 8 | 87.23(1.09, 149.44) | |||
9 ~ 24 | 223.17(179.41, 255.44) | |||
25 ~ 40 | 213.66(188.05, 278.26) | |||
Sensory and communication (SC) | 0 | 0.27(0.16, 1.09) | 550.26 | 0.00 |
1 ~ 4 | 1.09(0.27, 16.95) | |||
5 ~ 8 | 157.42(120.11, 204.76) | |||
9 ~ 12 | 240.15(193.93, 266.91) |
Table 4
Generalized Linear Model (GLM) analysis of the factors associated with the total service time
Variables | Estimate(β) | Std.Error | 95% CI of β | Wald χ2 | P | |
|---|---|---|---|---|---|---|
Age | 65～74 | 0a | ||||
75～84 | 7.023 | 1.956 | 3.189–10.857 | 12.891 | 0.000 | |
85～103 | 4.562 | 2.434 | -0.209-9.333 | 3.512 | 0.061 | |
Dwelling place | 53.42 | 2.911 | 47.715–59.125 | 336.78 | <0.001 | |
Marital status | 0.534 | 1.71 | -2.818-3.886 | 0.098 | 0.755 | |
Educational | Primary and below | |||||
Middle/High | 3.334 | 1.823 | -0.239-6.908 | 3.345 | 0.068 | |
University or above | 0.933 | 3.203 | -5.345-7.211 | 0.085 | 0.771 | |
Type of medical insurance | New rural cooperative medical Insurance | 0a | ||||
Provincial/Municipal medical insurance | 4.272 | 3.029 | -1.665-10.208 | 1.989 | 0.159 | |
Other | 6.414 | 8.241 | -9.737-22.566 | 0.606 | 0.437 | |
The primary source of income | Pension | 0a | ||||
Government subsidy | -2.665 | 3.575 | -9.672-4.342 | 0.556 | 0.456 | |
Child subsidy | 2.259 | 3.476 | -4.553-9.071 | 0.422 | 0.516 | |
Other | -1.03 | 10.421 | -21.455-19.395 | 0.01 | 0.921 | |
Monthly income(Yuan) | < 1000 | 0a | ||||
1000～2500 | -1.457 | 3.242 | -7.812-4.898 | 0.202 | 0.653 | |
2500～5000 | 4.055 | 3.576 | -2.954-11.065 | 1.286 | 0.257 | |
5000～ | 12.04 | 4.566 | 3.091–20.988 | 6.954 | 0.009 | |
Comorbidity of geriatric syndromes (CGS) | 0～2 | 0a | ||||
3～4 | 13.981 | 2.523 | 9.036–18.926 | 30.708 | <0.001 | |
5～ | 1.707 | 11.494 | -20.822-24.235 | 0.022 | 0.882 | |
Activity of daily living (ADL) | 0 | 0a | ||||
1～20 | 12.579 | 2.389 | 7.897–17.262 | 27.725 | <0.001 | |
21～40 | 66.133 | 3.571 | 59.134–73.133 | 342.928 | <0.001 | |
40～60 | 109.211 | 3.985 | 101.4-117.022 | 751.037 | <0.001 | |
Mental status and social involvement (MSSI) | 0 | 0a | ||||
1 ~ 8 | 5.886 | 3.162 | -0.312-12.084 | 3.464 | 0.063 | |
9 ~ 24 | 28.204 | 4.266 | 19.843–36.566 | 43.706 | <0.001 | |
25 ~ 40 | 39.814 | 5.378 | 29.273–50.354 | 54.809 | <0.001 | |
Sensory and communication (SC) | 0 | 0a | ||||
1 ~ 4 | 4.66 | 2.124 | 0.498–8.823 | 4.816 | 0.028 | |
5 ~ 8 | 26.379 | 3.564 | 19.393–33.364 | 54.778 | <0.001 | |
9 ~ 12 | 26.063 | 8.364 | 9.669–42.457 | 9.709 | 0.002 | |
Acknowledgements
We extend our gratitude to the participating nursing homes and communities and their administrators.
Declarations
Ethical approval and consent
All methods were conducted by the ethical principles stated in the Declaration of Helsinki. The research was approved by the Institutional Review Board of Xiangya Hospital of Central South University (202105083). Permission was also obtained from the study sites. Informed consent was obtained from all participants involved in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
