Factors Associated with Older Adults' Intention to Use Community-based Elderly Care：a Study Using the Decision Tree and Logistic Regression Models
Community-based elderly care may effectively contribute to the handling of serious elderly care challenges brought by an increasingly aging population in China.
To explore the factors associated with older adults' intention to choose community-based elderly care using the decision tree and Logistic regression models.
This questionnaire survey was conducted in three communities selected from Daqing by convenient sampling from August to December 2020. 500 eligible community-dwelling older adults (≥60 years old) were selected as the research objects. The decision tree and Logistic regression models were used to explore factors associated with these older adults' intention to choose community-based elderly care via analyzing their demographics, self-rated physical and mental health, and family and social support collected by the survey.
Altogether, 489 cases (97.8%) who effectively responded to the survey were included for analysis. The prevalence of intending to choose community-based elderly care in the respondents was 32.5% (159/489) . Logistic regression analysis revealed that the older adults' understanding level of community-based elderly care, views of elderly care, sense of loneliness, and intergenerational relationship had varying degrees of influence on their intention to choose community-based elderly care (P<0.05) . The decision tree analysis found that the older adults' understanding level of community-based elderly care, views of elderly care, sense of loneliness, social network, self-rated health, education level, and living status (alone or not) were key factors influencing their intention to choose community-based elderly care (P<0.05) . By both Logistic regression and decision tree analyses, understanding level of community-based elderly care, views of elderly care, and sense of loneliness were found to be three factors influencing older adults' intention to use community-based elderly care most. In exploring the factors associated with older adults' intention to choose community-based elderly care, Logistic regression analysis had an AUC of 0.985 (0.974, 0.996) with 94.34% sensitivity and 95.75% specificity, and decision tree analysis had an AUC of 0.980 (0.968, 0.992) with 88.05% sensitivity and 97.87% specificity, the performance of the two was similar (Z=-0.625, P=0.268) .
The combination of decision tree and Logistic regression model has high application value in the study of influencing factors of community pension willingness of the elderly. The prevalence of intending to use community-based elderly care was relatively low in Daqing older adults. To improve this, it is suggested to take actions to change older adults' traditional views of elderly care, to better their physical and mental health and family relationships.
Investigation on Advance Care Planning Behaviors in Elderly Chronic Disease Patients in the Community
As the physical function declines with age, and the disease progresses, elderly chronic disease patients face decreased cognitive function and abilities in communicating medical affairs and making relevant decisions, which will have a certain impact on the expression of end-of-life will. Early implementation of the advance care planning (ACP) for elderly patients will guarantee their medical decision-making autonomy. To facilitate the delivery of interventions to promote the implementation of ACP, it is important to study ACP behaviors and related stages of behavior change in this population.
To investigate ACP behaviors, and stages of behavior change as well as associated factors in elderly chronic disease patients in the community.
From May to July 2020, by use of convenience sampling, 410 elderly chronic disease patients were selected from the community with coverage of healthcare services delivered by Hanghai East Road Community Health Center, Zhengzhou, and were invited to attend a survey using the General Information Questionnaire and the Chinese version of Advance Care Planning Engagement Survey. Stepwise multiple linear regression was used to identify the influencing factors of stages of behavior change of ACP.
Altogether, 384 (93.7%) individuals who returned responsive questionnaires were included for analysis. Among the respondents who had been involved in ACP. 42 (10.9%) had "talked with family and friends about the medical decision maker", 39 (10.1%) had "talked with family and friends about medical care", 23 (6.0%) had "talked with the medical decision maker about decision-making flexibility", 12 (3.1%) had "asked doctors questions", but no one was involved in four main ACP behaviors. Two hundred and ninety-two (76.0%) respondents were in the pre-contemplation stage of behavior change, and 92 (24.0%) were in the contemplation stage of behavior change. Of the behavior change constructs, the total score of the knowledge showed no significant differences by socio-demographic factors (P>0.05) , but the total score of the contemplation differed significantly by education level, self-rated disease severity and healthcare-seeking related experience in recent five years (P<0.05) . Stepwise multiple linear stepwise regression analysis revealed that education level, hospitalization experience and medical-decision making in the past five years were associated with the contemplation of behavior change construct (P<0.05) .
Only some elderly chronic disease patients in the community had been involved in ACP, and had contemplated ACP behaviors. To promote patient engagement in ACP, it is suggested that medical workers should consider ACP as a continuous process composed of multiple behaviors rather than a single behavior during the delivery of health education, and guide patients to increase their understanding of ACP process based on contemplating their ACP behaviors, as well as offer patients targeted interventions based on their current stage of behavior change.
Mediating Role of Family Function between Disability Severity and Family Resilience in Home-living Older Adults with Disability in Minority Areas of Xinjiang
As a multi-ethnic and economically underdeveloped region, Xinjiang faces severe challenges coming with an aging population. To promote active aging under the circumstances of unsatisfied comprehensive strength and imperfect home care system, it is important for Xinjiang to give priority to groups with disabilities, improve family resilience via enhancing family functions, and gradually develop a family-centered home care system with community support.
To explore the mechanism of mediating action of family function between disability severity and family resilience in home-living older adults with disability in Xinjiang's minority areas, offering new ideas for relevant departments to improve family resilience of this population.
From July to August 2020, a household survey was conducted with older adults with disability, and their primary caregivers and core family members of 431 Uygur or Kazak households selected from Xinjiang's Bortala Mongol Autonomous Prefecture by use of stratified multistage sampling. Questionnaires including demographic questionnaire developed by our research team, Katz Index of Independence in Activities of Daily Living (Katz ADL) , Mini-mental State Examination (MMSE) , Family Resilience Assessment Scale (FRAS) , and the Family Concern Index Questionnaire (APGAR) were used in the survey to collect information regarding degree of disability, family resilience, and family functions of the older adults with disability. Spearman correlation analysis was used to explore the relationship of family resistance with disability severity, family function and its five functional components (adaptability, partnership, growth, affection, and resolve) . Multiple linear regression analysis and Bootstrap test were used to verify and examine the medicating effect of family function and its five components between disability severity and family resilience.
From the 431 households, older adults with disability, primary family caregivers, and core family members were selected at a ratio of 1∶1∶1 (each group contained 431 cases) . Among the older adults with disability, the prevalence of mild, moderate and severe disability was 46.9% (202/431) , 40.1% (173/431) , and 13.0% (56/431) , respectively. The prevalence of intact family function, moderate and severe family dysfunction in the households was 46.4% (200/431) , 43.6% (188/431) , and 10.0% (43/431) , respectively. The prevalence of low and high family resilience in the households was 51.7% (223/431) , and 48.3% (208/431) , respectively. Spearman correlation analysis revealed that disability severity of the older adults reduced with the increase of family function and its five components as well as family resilience (P<0.05) . And family resilience grew with the increase of family function and its five components (P<0.05) . Mediation analysis found that family function partially mediated between disability severity and family resilience, with an effect size accounting for 67.2% of the total effect. The components of adaptability, partnership, growth, affection, and resolve also partially mediated between disability severity and family resilience, with effect sizes accounting for 38.7%, 47.1%, 48.2%, 24.2%, and 25.3% of the total effect respectively.
Family function played a partial mediating role between the degree of disability and family resilience in home-living older adults with disability in minority areas of Xinjiang. In view of this, for those with severe disability, besides offering more medical assistance, relevant governments are suggested to pay attention to improving their family function by making use of family internal resources, so as to improve family resilience to enhance the quality of care for this population.
