Top

Published in:

Open Access 01-12-2024 | Research

Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?

Authors: Jingjing Luo, Dan Zhao, Tingting Gao, Jingjie Sun, Peilong Li, Xuehong Wang, Xueqing Wang, Shujun Chai, Jiayan Li, Chengchao Zhou

Published in: BMC Geriatrics | Issue 1/2024

Abstract

Background

This study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas.

Methods

The data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas.

Results

The prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001).

Conclusions

Our study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.

Available only for authorised users

United Nations. World Population prospects: 2022. New York: Population Division; 2022.CrossRef

Statistics NBo. China Statistical Yearbook 2019. Beijing: China Statistics Press; 2020.

Culica D, Rohrer J, Ward M, Hilsenrath P, Pomrehn P. Medical checkups: who does not get them? Am J Public Health. 2002;92(1):88–91. https://doi.org/10.2105/ajph.92.1.88.CrossRefPubMedPubMedCentral

Lai DWL, Kalyniak S. Use of annual physical examinations by aging Chinese canadians. J Aging Health. 2005;17(5):573–91. https://doi.org/10.1177/0898264305279778.CrossRefPubMed

Gao Y, Babazono A, Nishi T, Maeda T, Lkhagva D. Could investment in preventive health care services reduce health care costs among those insured with health insurance societies in Japan? Popul Health Manage. 2014;17(1):42–7. https://doi.org/10.1089/pop.2013.0007.CrossRef

Ljung R, Peterson S, Hallqvist J, Heimerson I, Diderichsen F. Socioeconomic differences in the burden of disease in Sweden. Bull World Health Organ. 2005;83(2):92–9.PubMedPubMedCentral

Haffty BG, Kornguth P, Fischer D, Beinfield M, McKhann C. Mammographically detected breast cancer. Results with conservative surgery and radiation therapy. Cancer. 1991;67(11):2801–4. https://doi.org/10.1002/1097-0142(19910601)67:11.CrossRefPubMed

Wei MY, Kabeto MU, Galecki AT, Langa KM. Physical functioning decline and mortality in older adults with multimorbidity: joint modeling of longitudinal and survival data. J Gerontol A Biol Sci Med Sci. 2019;74(2):226–32. https://doi.org/10.1093/gerona/gly038.CrossRefPubMed

Portegijs E, Rantakokko M, Viljanen A, Sipila S, Rantanen T. Identification of older people at risk of ADL disability using the life-space assessment: a longitudinal cohort study. J Am Med Dir Assoc. 2016;17(5):410–4. https://doi.org/10.1016/j.jamda.2015.12.010.CrossRefPubMed

10.

Anderson WL, Wiener JM, Khatutsky G, Armour BS. Obesity and people with disabilities: the implications for health care expenditures. Obesity. 2013;21(12):E798–E804. https://doi.org/10.1002/oby.20531.CrossRefPubMed

11.

World Report on Disability. 2011. Geneva: World Health Organization; 2011.

12.

Wong YC, Leung J. Long-term care in China: issues and prospects. J Gerontol Soc Work. 2012;55(7):570–86. https://doi.org/10.1080/01634372.2011.650319.CrossRefPubMed

13.

Hu B, Ma S. Receipt of informal care in the Chinese older population. Ageing Soc. 2018;38(4):766–93. https://doi.org/10.1017/s0144686x16001318.CrossRef

14.

Qi X. Filial obligation in contemporary China: evolution of the culture system. J Theory Soc Behav. 2015;45(1):141–61. https://doi.org/10.1111/jtsb.12052.CrossRef

15.

Feng Z, Liu C, Guan X, Mor V. China’s rapidly aging population creates policy challenges in shaping a viable long-term care system. Health Aff. 2012;31(12):2764–73. https://doi.org/10.1377/hlthaff.2012.0535.CrossRef

16.

Weaver FM, Weaver BA. Does availability of informal care within the household impact hospitalisation? Health Econ Policy Law. 2014;9(1):71–93. https://doi.org/10.1017/s1744133113000169.CrossRefPubMed

17.

Jeon B, Kwon S, Kim H. Health care utilization by people with disabilities: a longitudinal analysis of the Korea Welfare Panel Study (KoWePS). Disabil Health J. 2015;8(3):353–62. https://doi.org/10.1016/j.dhjo.2015.01.001.CrossRefPubMed

18.

Zhen Z, Feng Q, Gu D. The impacts of unmet needs for long-term care on mortality among older adults in China. J Disabil Policy Stud. 2015;25(4):243–51. https://doi.org/10.1177/1044207313486521.CrossRef

19.

Cho E, Lee N-J, Kim E-Y, Strumpf NE. The impact of informal caregivers on depressive symptoms among older adults receiving formal home health care. Geriatr Nurs. 2011;32(1):18–28. https://doi.org/10.1016/j.gerinurse.2010.08.012.CrossRefPubMed

20.

Chang W-C, Lan T-H, Ho W-C, Lan T-Y. Factors affecting the use of health examinations by the elderly in Taiwan. Arch Gerontol Geriatr. 2010;50(Suppl 1):11–S6. https://doi.org/10.1016/s0167-4943(10)70005-4.CrossRef

21.

Iezzoni LI, McCarthy EP, Davis RB, Siebens H. Mobility impairments and use of screening and preventive services. Am J Public Health. 2000;90(6):955–61. https://doi.org/10.2105/ajph.90.6.955.CrossRefPubMedPubMedCentral

22.

Okura M, Ogita M, Yamamoto M, Nakai T, Numata T, Arai H. Health checkup behavior and individual health beliefs in older adults. Geriatr Gerontol Int. 2018;18(2):338–51. https://doi.org/10.1111/ggi.13169.CrossRefPubMed

23.

Ko KD, Lee KY, Cho B, Park MS, Son KY, Ha JH, et al. Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean National Health and Nutrition Examination Survey. Arch. Phys Med Rehabil. 2011;92(8):1230–7. https://doi.org/10.1016/j.apmr.2011.03.004.CrossRef

24.

Kwak M, Kim B, Lee H, Zhang J. Does gender matter in the receipt of Informal care among community-dwelling older adults? Evidence from a cross-national comparative study across the United States, South Korea, and China. J Gerontol B Psychol Sci Soc Sci. 2021;76:64–S75. https://doi.org/10.1093/geronb/gbaa018.CrossRef

25.

Dunlop DD, Hughes SL, Manheim LM. Disability in activities of daily living: patterns of change and a hierarchy of disability. Am J Public Health. 1997;87(3):378–83. https://doi.org/10.2105/ajph.87.3.378.CrossRefPubMedPubMedCentral

26.

Yang L, Sun L, Wen L, Zhang H, Li C, Hanson K, et al. Financing strategies to improve essential public health equalization and its effects in China. Int J Equity Health. 2016;15:194. https://doi.org/10.1186/s12939-016-0482-x.CrossRefPubMedPubMedCentral

27.

Liu M, Wang JH, Yang SS, Yao Y, Wang SS, He Y. Evaluation of activities of daily living and related factors in community elderly people in urban and rural areas of Beijing. Chin J Epidemiol. 2018;39(03). https://doi.org/10.3760/cma.j.issn.0254-6450.2018.03.004.

28.

Cai F. Is there a ‘middle-income’ trap? Theories, experiences and relevance to China. China & World Economy. 2012;20(1):49–61. https://doi.org/10.1111/j.1749-124X.2012.01272.x.CrossRef

29.

Ge D, Chu J, Zhou C, Qian Y, Zhang L, Sun L. Rural-urban difference in the use of annual physical examination among seniors in Shandong, China: a cross-sectional study. Int J Equity Health. 2017;16(1):86. https://doi.org/10.1186/s12939-017-0585-z.CrossRefPubMedPubMedCentral

30.

Stensland J, Akamigbo A, Glass D, Zabinski D. Rural and urban Medicare beneficiaries use remarkably similar amounts of health care services. Health Aff. 2013;32(11):2040–6. https://doi.org/10.1377/hlthaff.2013.0693.CrossRef

31.

Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet. 2012;379(9818):805–14. https://doi.org/10.1016/s0140-6736(12)60278-5.CrossRefPubMed

32.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged:the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185(12):914–9. https://doi.org/10.1001/jama.1963.03060120024016.CrossRefPubMed

33.

Zhao D, Li J, Gao T, et al. Do older adults with multimorbidity prefer institutional care than those without multimorbidity? The role of functional limitation. BMC Geriatr. 2022;22(1):126. https://doi.org/10.1186/s12877-022-02812-2.CrossRefPubMedPubMedCentral

34.

Chen J, Fang M, Xiao C. Activities of daily living and depressive symptoms in the Chinese elderly. Chin Gen Pract. 2020;23(22):2852–55.

35.

Zhou BF. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults - study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002;15(1):83–96.PubMed

36.

Jones GC, Beatty PW. Disparities in preventive service use among working-age adults with mobility limitations. Res Social Sci Disabil. 2002.

37.

Huang W, He B, Wang YH, Ma WJ, Zhou J. Disability severity and home-based care quality in older adults: the mediating effects of social support and caregiver competence. J Nurs Res. 2020;28(6). https://doi.org/10.1097/jnr.0000000000000405.

38.

Dejong G, Palsbo SE, Beatty PW, Jones GC, Knoll T, Neri MT. The organization and financing of health services for persons with disabilities. Milbank Q. 2002;80(2):261–301. https://doi.org/10.1111/1468-0009.t01-1-00004.CrossRefPubMedPubMedCentral

39.

Peters CL, Hooker K, Zvonkovic AM. Older parents’ perceptions of ambivalence in relationships with their children. Fam Relat. 2006;55(5):539–. https://doi.org/10.1111/j.1741-3729.2006.00424.x. 51.CrossRef

40.

Denton M, Prus S, Walters V. Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health. Soc Sci Med. 2004;58(12):2585–600. https://doi.org/10.1016/j.socscimed.2003.09.008.CrossRefPubMed

41.

Orel NA, Ford RA, Brock C. Women’s financial planning for retirement: the impact of disruptive life. J Women Aging. 2004;16(3–4):39–53. https://doi.org/10.1300/J074v16n03_04.CrossRefPubMed

42.

Chen X, Giles J, Wang Y, Zhao Y. Gender patterns of eldercare in China. Fem Econ. 2018;24(2):54–76. https://doi.org/10.1080/13545701.2018.1438639.CrossRefPubMedPubMedCentral

43.

Glauber R. Gender differences in spousal care across the later life course. Res Aging. 2017;39(8):934–59. https://doi.org/10.1177/0164027516644503.CrossRefPubMed

44.

Bracke P, Christiaens W, Wauterickx N. The pivotal role of women in informal care. J Fam Issues. 2008;29(10):1348–78. https://doi.org/10.1177/0192513x08316115.CrossRef

45.

Ji Y. Asian families at the crossroads: a meeting of east, west, tradition, modernity, and gender. J Marriage Fam. 2015;77(5):1031–38.CrossRef

46.

Gu H, Kou Y, You H, Xu X, Yang N, Liu J, et al. Measurement and decomposition of income-related inequality in self-rated health among the elderly in China. Int J Equity Health. 2019;18. https://doi.org/10.1186/s12939-019-0909-2.

47.

Cheung C-K, Kwan AY-H. The erosion of filial piety by modernisation in Chinese cities. Ageing Soc. 2009;29(2):179–98. https://doi.org/10.1017/S0144686X08007836.CrossRef

48.

Graham C, Zhou S, Zhang J. Happiness and health in China: the paradox of progress. World Dev. 2017;96:231–44. https://doi.org/10.1016/j.worlddev.2017.03.009.CrossRef

Title: Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?
Authors: Jingjing Luo
Dan Zhao
Tingting Gao
Jingjie Sun
Peilong Li
Xuehong Wang
Xueqing Wang
Shujun Chai
Jiayan Li
Chengchao Zhou
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Geriatrics / Issue 1/2024
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-024-04673-3

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Sleep duration, sleep efficiency, and amyloid β among cognitively healthy later-life adults: a systematic review and meta-analysis

Lifestyle patterns, nutritional, and metabolic syndrome determinants in a sample of the older Iranian population

Understanding health service utilisation patterns for care home residents during the COVID-19 pandemic using routinely collected healthcare data

“Just pee in the diaper” - a constructivist grounded theory study of moral distress enabling neglect in nursing homes

Association of cooking oil and incident of frailty in older adults: a cohort study

The willingness and influencing factors to choose institutional elder care among rural elderly: an empirical analysis based on the survey data of Shandong Province

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials