The role of psychosocial factors in long-term care utilization among elderly Chinese

Abstract

AIMS: This study aims to examine the role of psychosocial factors associated with the choices of community-based long-term care services for elderly Chinese people in Hong Kong. METHOD: The survey method was adopted using multi-stage sampling. A standardized questionnaire was designed based on Anderson’s Health Behavioral Model. A total of 435 elderly people were interviewed successfully. Among them, about 37% were male; close to 45% did not have formal education, and about 56% were not married. 23% were cared for by spouses; about half were cared for by children. RESULTS: The study tested the expanded Anderson model empirically on its enhanced power to explain long-term care utilization by including psychosocial factors. As hypothesized, psychosocial factors contributed the largest explained variance (changedR2 = 0.1663) to the differentiated utilization of long-term care services, followed by needs characteristics (changedR2 = 0.1590) and enabling characteristics (changedR2 = 0.1028). On top of needs factors (i.e. level of impairment in daily living and cognitive functioning), and enabling factors (i.e. financial considerations), older adults who chose to stay in the community were more likely to have positive attitudes towards community-based services, higher levels of family solidarity (i.e. the availability of caregivers in the same household and the primary caregivers being economically inactive), and preferences for staying in the community. CONCLUSION: To achieve ‘Aging in place’ in a Chinese context such as Hong Kong, psychosocial factors in regards to attitude, family solidarity, and service preference need to be taken into consideration in program planning and policy development.