Navigating care in rural areas: Strategies employed by older adults with continuing care needs and their impact on social exclusion

ABSTRACTRecent economic development and socio-cultural changes have made it increasingly difficult for Chinese families to provide eldercare. Consequently, institutional care has been strongly promoted to meet older adults' long-term care needs. Although it has been estimated that China needs more beds to meet such needs, unfilled beds have been reported nationwide. One reason for the low occupancy may be a lack of willingness among older adults to live in long-term care institutions. Based on a national survey of 20,255 older adults, this study examined the extent of willingness among older Chinese to live in eldercare institutions, and it was found that in urban and rural areas, only 20 and 17 per cent of older adults, respectively, were willing to do so. Using an integrated theoretical model and logistic regression analyses, this study shows that gender, perceived family harmony, perceived filial piety, socio-cultural beliefs and practices about raising children and eldercare, knowledge and opinion about eldercare institutions, and self-assessed economic status were associated with willingness to live in eldercare institutions for both urban and rural older adults, while other predictors of willingness had different effects. The paper concludes with a discussion of the substantive, theoretical and policy implications for long-term care in China.

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A MULTI-SITE PROGRAM TO PROVIDE GERIATRICS TELECONSULTATION TO OLDER RURAL VETERANS (GRECC CONNECT)

Innovation in Aging ◽

10.1093/geroni/igz038.2264 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S608-S608

Author(s):

William Hung ◽

Steven Barczi ◽

cathleen Colon-Emeric ◽

Michelle Rossi ◽

Stuti Dang ◽

...

Keyword(s):

Older Adults ◽

Rural Areas ◽

Care Needs ◽

Adult Care ◽

Research Education ◽

Team Care ◽

Geriatric Consultation ◽

Need Support ◽

Rural Clinics ◽

Geriatric Research

Abstract Older Veterans living in rural areas often do not have access to geriatrics team care; rural frontline providers and teams may need support to address the needs of older adults with complex chronic conditions. GRECC Connect aims to link up geriatric teams at Geriatric Research, Education and Clinical Centers (GRECCs) and rural clinics to provide geriatric consultation remotely through clinical video telehealth (CVT) and other means. GRECC Connect is established in twelve GRECCs across the country with links to rural clinics in their catchment area; consultations led to identification and meeting of care needs of older adults with complex conditions, improving medication use and reducing older adults’ need for travel to long distances for consultation. In this presentation, we review the experience of establishing connections with rural clinics, impact on older adult care and adaptations needed to address local needs and contexts.

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Spreading Telehealth for Older Adults in Rural Areas Through Network of Geriatric Interprofessional Teams

Innovation in Aging ◽

10.1093/geroni/igaa057.2885 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 796-796

Author(s):

Steven Barczi ◽

Megan Gately ◽

Lauren Welch ◽

Kathryn Nearing ◽

Stephen Thielke ◽

...

Keyword(s):

Older Adults ◽

Rural Areas ◽

Urban Areas ◽

Care Needs ◽

Community Based ◽

Team Care ◽

Geriatric Consultation ◽

Complex Care Needs ◽

Nursing Professionals ◽

Community Based Services

Abstract Older adults living in rural areas have limited access to geriatrics interprofessional team care. In the Veteran healthcare system, geriatric teams such as geriatricians, nursing professionals, social workers, pharmacists and psychologists, located in urban areas link up with rural clinics to provide geriatric consultation remotely through clinical video telehealth and other means in the project GRECC Connect. Since its inception in 2014, the service has now grown to 16 geriatric teams offering consultation to over 100 clinic sites serving older rural Veterans. GRECC Connect delivered over 2,000 consultations in 2019, meeting complex care needs by identifying and linking geriatric services and management to patients with geriatric syndromes. The network of established geriatric teams, local champions and a shared Electronic Health Record facilitated the spread, while ongoing effort to build and maintain relationships between consultants and local rural provider teams and other community based services are important for ongoing success.

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Digital ageing in Europe: a comparative analysis of Italian, Finnish and Swedish national policies on eHealth

Ageing and Society ◽

10.1017/s0144686x21000945 ◽

2021 ◽

pp. 1-22

Author(s):

Heli Valokivi ◽

Simone Carlo ◽

Elin Kvist ◽

Marjo Outila

Keyword(s):

Older Adults ◽

Rural Areas ◽

Urban Areas ◽

Care Needs ◽

High Expectations ◽

Policy Debates ◽

High Age ◽

Demographic Challenge ◽

Digital Landscape

Abstract Ageing Europeans are today healthier than previous generations and often manage to live independently up to a high age. The proportion of people 80 years of age and older has increased significantly, and with high age the risk of multi-illness and dementia increases. Strong urbanisation processes have changed the demographic structure in rural areas, and young women and men have migrated towards the urban areas to study and work, while older persons have remained behind. This demographic challenge of increasing numbers of persons older than 80 years with care needs living in remote rural areas has become a major European social problem. In tackling this dilemma, many European countries have high expectations for eHealth, digitalisation and welfare technology. In this comparative study of policy debates in Italy, Finland and Sweden, we analyse how – between 2009 and 2019 – the issues of eHealth have been articulated in national and regional policies of the three countries with deep differences in terms of digitalisation and health systems, but with similar ageing populations. We identify in the documents three core topics – the role of technology, the rural issue and responsibility for care. These topics are treated in the documents with differences and similarities between the three countries. Beyond the differences and similarities, the documents reveal both a certain techno-enthusiasm about the role of eHealth in the life of the older adults as well as a limited understanding of the complexity (relationally as well as spatially) of the digital landscape of caring for older adults.

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Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China

BMC Health Services Research ◽

10.1186/s12913-021-06908-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Changle Li ◽

Zhuo Chen ◽

M. Mahmud Khan

Keyword(s):

Older Adults ◽

Primary Care ◽

Health System ◽

Rural Areas ◽

Urban Areas ◽

Chinese Patients ◽

Care Needs ◽

Healthcare Facilities ◽

Primary Health ◽

Care Facilities

Abstract Background With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. Methods Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. Results Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. Conclusions The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.

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PLANNING FOR AGING IN PLACE IN RURAL AREAS: PERCEPTIONS AND NEEDS OF OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.945 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S252-S252

Author(s):

Raven H Weaver ◽

Cory Bolkan

Keyword(s):

Older Adults ◽

Rural Communities ◽

Rural Areas ◽

Chronic Conditions ◽

Family Care ◽

Computer Assisted ◽

Service Access ◽

Community Resources ◽

Care Needs ◽

Age In Place

Abstract Most individuals prefer to live independently in their homes, but will need support to age-in-place safely. Rural-dwelling individuals historically have worse health, limited income, and restricted access to adequate services/supports compared to their urban counterparts. Community-based aging services organizations (i.e., Area Agency on Aging; AAA) offer in-home health, social support, and information/referral to community resources that support older adults in both urban and rural communities. A representative sample of adults aged 60+ (N=253, mean age=74) were surveyed via computer-assisted-telephone interviews about their health status, needs, and service utilization. Over half (54%) lived in rural counties, which was significantly associated with receiving insufficient health care services (X2=9.227, p=.002). Insufficient service access was also associated with experiencing a fall (X2=7.315, p=.007). While 53% reported having chronic conditions, most individuals still reported good health and their top reported needs included: yard work, interior/exterior house repairs, and housework. Content analysis of open-ended survey responses regarding future care needs revealed participants anticipate help from family/friends or neighbors; reliance on physicians for referrals; and expect insurance to cover their needs. Participants had varying awareness levels of available community resources and identified concerns about adequacy of services (e.g., mental health; transportation) and health insurance barriers (e.g., reimbursement; vision/dental coverage). Preparing for future needs and anticipating changing functional capacity is critical, especially among rural-dwelling older adults with chronic conditions. To improve ability for adults with diverse needs to age-in-place, preventive services/supports that span the continuum of care needs and that complement informal family care are necessary.

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Ageing in a changing place: a qualitative study of neighbourhood exclusion

Ageing and Society ◽

10.1017/s0144686x1900045x ◽

2019 ◽

Vol 40 (10) ◽

pp. 2238-2256 ◽

Cited By ~ 3

Author(s):

Lena Dahlberg

Keyword(s):

Older Adults ◽

Social Exclusion ◽

Rural Areas ◽

Urban Areas ◽

Mining Industry ◽

Political Agency ◽

Active Involvement ◽

Neighbourhood Change ◽

Urban And Rural Areas ◽

High Level

AbstractAn inclusive neighbourhood is a key facilitator enabling older adults to age in place. Neighbourhoods have been identified as a dimension of social exclusion important to older adults, and it has been argued that older adults are particularly vulnerable to neighbourhood change. The aim of this study was to explore older adults’ experiences of neighbourhood exclusion within the context of neighbourhood change. Focus groups were undertaken in the urban and rural areas of a metropolitan borough in England involving a total of 41 older adults, with data analysed via thematic analysis. Urban areas in the borough studied have transformed following the closure of the mining industry, with a high level of deprivation in many areas, while some rural areas have undergone gentrification. Within the context of structural neighbourhood change, four themes were identified: community cohesion, political agency, feelings of safety and the physical environment. The themes were interlinked, which calls for collaboration across traditional lines of professional responsibility, and for research that encompasses different aspects of neighbourhood exclusion. This study contributes with knowledge on older adults’ experiences of exclusion, including novel findings on the importance of political agency and collective memory, and identifies actions to combat exclusion. An active involvement of older adults in the development of initiatives to tackle social exclusion is recommended.

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Health, Social, and Functional Characteristics of Older Adults With Continuing Care Needs: Implications for Integrated Care

Journal of Aging and Health ◽

10.1177/0898264318759856 ◽

2018 ◽

Vol 31 (7) ◽

pp. 1085-1105 ◽

Cited By ~ 1

Author(s):

Cara L. Brown ◽

Verena Menec

Keyword(s):

Older Adults ◽

Health Care ◽

Hospital Stay ◽

Integrated Care ◽

Personal Characteristics ◽

Health Care Use ◽

Continuing Care ◽

Level Of Care ◽

Functional Characteristics ◽

Care Needs

Objective: To identify older adults who could benefit from integrated care, we examined (a) health, social, and functional characteristics of older, hospitalized adults who required continuing care on discharge and (b) associations between these characteristics and potentially unnecessary health care use. Method: Personal characteristics were extracted from patient charts ( N = 214) and examined in relation to three outcomes: discharge to institutional care, unnecessary hospital stay (alternative level of care), and long hospital stay. Results: Twenty-nine percent of the sample was discharged to an institution, 32.7% was coded as alternate level of care, and 27.6% had a long length of stay. Independent predictors of potentially avoidable health care use were mental and behavioral issues, living alone, functional status, and preadmission concerns about the patient managing in the community. Discussion: High users of health care services were identifiable prior to hospital admission, supporting the use of community-based integrated care approaches.

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Scaling Geriatric and Telemedicine Care for Older Adults in Rural Areas Through Clinical Strategies and Training

Innovation in Aging ◽

10.1093/geroni/igaa057.2883 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 795-795

Author(s):

William Hung ◽

Becky Powers ◽

Stuti Dang

Keyword(s):

Older Adults ◽

Information And Communication Technologies ◽

Rural Areas ◽

Care Delivery ◽

Adult Population ◽

Geriatric Medicine ◽

Geriatric Care ◽

Care Needs ◽

Geriatric Team ◽

And Training

Abstract Telemedicine, the use of electronic information and communication technologies to deliver care, has grown substantially over the past few years, potentially benefiting older adults who have difficulty accessing and traveling to care locations. Given that providers and interprofessional staff with training in geriatric medicine often practice in urban rather than rural areas, older adults’ access to quality geriatric care is limited. Prior experiences with telemedicine adoption for geriatric team consultation, though limited in scope, were well accepted by older adults and demonstrated benefits such as identifying and meeting care needs for older adults. Bringing geriatric team care to large regions across the country requires further consideration of population needs, local contexts and training and enhancement of an interprofessional workforce to deliver geriatric care through telemedicine. The Veteran healthcare system has been a pioneer in telemedicine care and considers the use of telemedicine necessary for all providers in its system. This symposium aims to discuss approaches to identify and target older adults who may benefit from geriatric consultation, how care delivery is scaled through identifying common approaches and local adaptations, what the important elements are for providers and teams to deliver care effectively for the older adult population, especially those with multiple complex chronic conditions and functional limitations, and considerations for training the next generation of providers to provide care for older adults with complex conditions, particularly in rural areas with limited access.

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Association between primary caregiver type and mortality among Chinese older adults with disability: a prospective cohort study

BMC Geriatrics ◽

10.1186/s12877-021-02219-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yangyujin Liu ◽

Haoxue Li ◽

Bei Wu ◽

Xiaoting Liu ◽

Honglin Chen ◽

...

Keyword(s):

Older Adults ◽

Rural Areas ◽

Cox Regression ◽

Family Care ◽

Primary Caregiver ◽

Community Dwelling ◽

Care Needs ◽

Chinese Older Adults ◽

Demographic Transitions ◽

Healthy Longevity

Abstract Background Socio-demographic transitions have dramatically changed the traditional family care settings in China, caused unmet care needs among older adults. However, whether different primary caregiver types have different influences on disabled older adults’ health outcomes remain poorly understood. We aimed to examine the association between the type of primary caregiver (e.g., spouse and children) and death among community-dwelling Chinese older adults disabled in activities of daily living. Methods We used data from Chinese Longitudinal Healthy Longevity Survey. The analytic sample comprised 4278 eligible adults aged ≥ 80 years. We classified primary caregiver type into five categories: spouse, son/daughter-in-law, daughter/son-in-law, grandchildren, and domestic helper. We used Cox regression model to examine the association between primary caregiver type and all-cause mortality. Covariates included age, sex, residence, years of education, co-residence status, financial independence, whether living with children, number of ADL disability, number of chronic conditions, and self-reported health, cognitive impairment, and caregiving quality. Results Married older adults whose primary caregivers were son/daughter-in-law had a 38% higher hazard of death than those who had spouse as the primary caregiver. Married men who received care primarily from son/daughter-in-law or daughter/son-in-law had a 64 and 68% higher hazard of death, respectively, than those whose primary caregiver was spouse. The association between primary caregiver type and mortality among widowed older adults differed between urban and rural areas. Urban residents who had domestic helpers as the primary caregiver had an 16% lower hazard of death, while those living in rural areas had a 50% higher hazard of death, than those having son/daughter-in-law as the primary caregiver. Conclusions The quality of care of the primary caregiver may be a risk factor for mortality of disabled older adults in China. Interventions are necessary for reducing unmet needs and managing care burden.

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