Analysis of the status quo of the Elderly’s demands of medical and elderly care combination in the underdeveloped regions of Western China and its influencing factors: a case study of Lanzhou

A questionnaire survey was conducted in four districts of Lanzhou (including Chengguan District, Qilihe District, Anning District and Xigu District; the location map of the study area is shown in Fig. 2) through stratified random sampling. Elderly residents, aged 60 years old or above were selected as survey subjects. A total of 7500 elderly people were surveyed with the distribution of the questionnaire concerning the eldercare service provision combining medical and elderly care.

Selection criteria: ①age ≥ 60; ②length of residence ≥ 6 months; ③elderly respondents without known significant cognitive impairment, severe illness and terminal illness and elderly people without visual and hearing impairment caused by various reasons; ④informed consent had to be sought and secured. 7500 questionnaires in total were administrated this time, and 7320 valid ones were collected.

Questionnaire concerning elderly people’s needs for combined medical and elderly care: Questionnaires covering personal characteristics, health status, economic status and elderly people’s understanding of a combined medical–nursing service, have been frequently adopted by scholars at home and abroad for investigating the need for an elderly nursing service combining medical and elderly care. To better compare with the results of related literature [11‐18, 31‐42], and perform an in-depth analysis of factors affecting the need for combining medical and elderly care, a questionnaire related to the eldercare needs of combining medical and elderly care has been designed by epidemiological and statistical experts and jointly compiled by the research team and elderly nursing management experts based on a full reference to relevant literature [11‐18, 31‐42] and national health policies. The in-house designed ‘Survey on the elderly’s needs of combination of medical and elderly care in Lanzhou’ was used as a survey instrument. The questionnaire was designed following the literature [11‐18, 31‐42], the China Health and Pension Tracking Survey and the Fifth National Health Service Survey-Family Health Questionnaire, as shown in Table 1.

Before the questionnaire was officially distributed, 100 retired residents were selected for pre-survey through convenience sampling. And a formal questionnaire was finalised after the questionnaire was revised according to the pre-survey results. The questionnaire is composed of general demographics, health status, medical endowment insurance and the knowledge of and expressed a requirement for combining medical and elderly care. A detailed questionnaire is provided by us as Supplemental Materials. See the Supplemental Materials.

The survey was conducted face to face by trained investigators familiar with working with elderly respondents. Investigators explained related concepts in the questionnaire during the survey considering that the elderly were not understanding the combination of medical and elderly care. Questionnaires were collected and checked by a specially-assigned person who was responsible for removing the invalid and the incomplete questionnaires. Questionnaires that qualified based on the investigators’ reviews were retrieved in time.

Software Epidata3.1 was used to log and proofread data in duplicate. Statistical software SPSS 18.0 was used for statistical treatment. The enumeration data used χ² test, and the influencing factors were analysed with a binomial logistic regression. Statistical significance in the differences would be confirmed in case of P < 0.05.

Table 2 presents the basic characteristics of the elders enrolled in the current study. Retired elderly people aged 60 years old or above were surveyed. Among them, the number of males and females are 3059, and 4261, accounting for 41.79, and 58.21%, respectively; and the elderly aged between 60 and 70 years old are 77.62%, aged between 71 and 80 years old are 21.64%, and aged more than 80 years old are 0.74%; also, there are 404 (5.52%) elderly people with elementary education or below, followed by 1437 (19.63%) with junior high school and 2560 (34.97%) with senior high school or technical secondary education, 2380 (32.51%) with junior college education and 539 (7.37%) with undergraduate or above. Moreover, 50% of the surveyed elderly who had worked in enterprises and public institutions before retirement enjoy stable retirement pay; 14.51% of the surveyed elderly have one child, 29.59% have two children and 55.90% have three children. In the survey, 3388 elderly people considered that they were in good health, accounting for 46.28%, while 44.64% considered their health to be not good enough and 664 elderly people (about 9.07%) considered they have poor health. The prevalence of chronic diseases among the elderly involved in the survey is 50.46%; 5231 elderly people can take care of themselves, accounting for 71.46%; while 1890 and 199 elderly people need help from others and cannot take care of themselves, respectively, accounting for 25.82 and 2.72%, respectively. 3930 elderly people have basic medical insurance for urban and rural residents, accounting for 53.69%; but only 590 elderly people have commercial medical insurance, accounting for 8.06%; 983 elderly people have no medical insurance, accounting for 13.43%; up to 3791 elderly people have endowment insurance for urban employees, accounting for 51.79%; the smallest proportion of elderly people, only 111 have commercial endowment insurance, accounting for 1.52%. There are 706 elderly people who do not have any endowment insurance, accounting for 9.64%; 2378 elderly people have a monthly income ranging from 2000 to 4000 yuan, accounting for 32.49%, followed by 2192 people with a monthly income ranging from 4000 to 6000 yuan and 1412 people with a monthly income larger than 6000 yuan. There are 5902 people choosing to live at home, accounting for 88.32%; people living alone account for 19.37% and 5902 (accounting for 80.63%) people live in other ways. More details are presented in Table 2.

Table 2 also displays an understanding of and demand for the combination of medical and elderly care for different sociodemographic characteristics of the elderly. Among the 7320 elderly people surveyed, 62.43% have never heard of the combined service, 29. 44% have heard of it but do not understand it; only 7.61% have a basic understanding of the model and only 38 people (accounting for 0.52%) have understood this model well. Meanwhile, 3772 out of the 7320 elderly people surveyed have a demand for the service combining medical and elderly care, accounting for 51.53%. Also, 41.75% of those who have a demand for a service combining medical and elderly care most want to obtain life care in the combined service, and nearly half of the elderly most want a medical care service integrating prevention, health care, medical treatment, with rehabilitation.

Through analysis, different genders, marital status, degree of education, occupation before retirement, number of children, monthly income, health self-assessment status, endowment insurance type, medical insurance type, current way of elderly nursing, old-age demands, self-care ability and knowledge about combining medical treatment and health care, it is found that the willingness to pay for the combination of medical and elderly care have statistical significance (P < 0.05) with the elderly’s needs for a combination of medical and elderly care in Lanzhou, whereas different ages, living styles and the prevalence rate of chronic diseases display no statistical significance (P > 0.05) with the elderly’s needs for a service combination in Lanzhou. More details are presented in Table 2.

Factors (including gender, marital status, degree of education, occupation before retirement, number of children, monthly income, health self-assessment status, endowment insurance type, medical insurance type, current model of elderly nursing, old-age demands, self-care ability and knowledge about combining medical treatment and health care and the willingness to pay for the combination of medical and elderly care) with statistical significance in the single-factor analysis were regarded as independent variables Xi; the elderly’s demand for the service combining medical and elderly care was taken as a dependent variable Y (Y = 1 indicates a demand for the service combining medical and elderly care, and Y = 0 indicates no demand for the service combining medical and elderly care) for conducting binomial logistic regression analysis. The relationship between the elderly’s demand for the service and various variables were obtained, as shown in Table 3.

Influencing factors were screened using the stepwise regression method. The inclusion criterion was α = 0.05 and the removal criterion was α = 0.1. The results of logistic regression on the combined service need are shown in Table 4. According to regression results, major influencing factors are comprised of the number of children, health self-rating, type of medical insurance, current model of elderly nursing, elderly nursing need, self-care ability of daily living, prior or acquired knowledge of the proposed service model and willingness to pay for the combination of medical and elderly care (P < 0.05, see Table 4).

Surveyed data of this study show that only 8.13% of the 7320 elderly people aged more than 60 years old in Lanzhou knew about and understood the service combining medical and elderly care. Among senior residents in Datong 25.0% were aware of the model of combining medical and elderly care, while only 6.0% understood well the model of combined medical and elderly care [11]. As can be observed from the study conducted by Hu et al. in Yinchuan, only 7.6% of the residents had a basic knowledge about the elderly nursing model of combining medical and elderly care and only 0.5% understood the combination model well [16]. Studies conducted by Zhou el al. in Urumchi show that 13.67% of the residents had heard of or at least knew about the service [17]. According to research conducted by Wang et al. in Changchun, 2.54 and 6.21% of the elderly people in the community well understood and had a basic knowledge of the elderly nursing model combining medical and elderly care, respectively [18]. The study conducted by Liu et al. in Karamay found that only 11.30% of the local residents knew and understood the proposed combined model [37]; and the study conducted by Wang et al. in Beijing shows that 12% of the elderly residents understood the model, while only 4.0% of those understood and actually used the combined model [38]. The results shown in this study are basically consistent with the above findings, indicating a low knowledge rate of the combined service model.

The combination of medical and elderly care is still at the exploratory stage in China and few investigations could be found on the demand rate for some combination of medical and elderly care, since most of the related research is dominated by theories, problems and countermeasures. This survey shows that the demand rate for the service combining service provision for the elderly in Lanzhou is 51.53%. The elderly people’s demands for this service were also reported in some domestic studies, for example, the demand for the elderly nursing service combining medical and elderly care for the elderly in cities and towns in Datong makes up 50.5% [11]; the demand for the service for the elderly in Chongqing is 53.00% [15]; the demand for the service for the elderly in Yinchuan accounts for 50.80% [16]; 56.21% of the elderly in Changchun demand the combined service [18]; the demand for the service for the elderly in downtown Zhanjiang is 54.60% [31]; 61.10% of the empty-nested elderly in Quanzhou communities need the service [32]; the demand for the service for the elderly in Karamay is 53.01% [37]; the demand for the service for retired residents in Tianjin is 61.9% [39]; a strong demand for the elderly nursing service combining medical and elderly care for elderly patients can be witnessed in Weifang, accounting for 97.40% [40] and 43.40% of the elderly in Qiqihaer have a demand for the combined service [41]. Compared with the above studies, a lower demand for the elderly nursing service combining medical and elderly care can be observed in Lanzhou.

It is generally recognised that the knowledge rate and the service demand for combining medical and elderly care are directly proportional, namely, the higher the knowledge rate, the higher the demand for the service combining medical and elderly care [31, 42]. For example, the research conducted by Wu et al. in Zhanjiang proves that elderly people’s knowledge rate of the service combining medical and elderly care in downtown Zhanjiang is 59.40%, and the demand rate for the service combining medical and elderly care is 54.60% [31]. Nevertheless, some studies also show that the knowledge rate of the service is not a factor influencing the demand for the service. For example, the studies conducted by Hu et al. in Yinchuan and by Liu et al. in Karamay show that the knowledge rates of the service are 7.60 and 16.11%, respectively, and their corresponding demand rates for the service are 50.80 and 53.01%, respectively [16, 37]. These figures are inconsistent with the knowledge rate (8.13%) and the demand rate (51.53%) for the service for the elderly in Lanzhou. The possible cause of the high demand rate is that Yinchuan, Karamay and Lanzhou are located in the undeveloped region of western China with a low level of economic and social development, and a high degree of an ageing population. The low knowledge rate of the service is affected by a plurality of factors, which is primarily due to the lack of publicity from the perspective of policy. The elderly aged 60 years old or above receive information via different channels from those of younger people. Effective channels that are accessible by the elderly, including television, newspapers, communities and nursing institutions should be selected for publicising the combined service, instead of new media such as the Internet, Sina blog, Weibo and WeChat etc. The publicity should also cover the elderly people’s children and family members. Government departments are responsible for strengthening the publicity in this regard. Favourable policies should be released promptly and rigorously publicised so that the elderly can obtain the favourable information quickly and effectively utilise various preferential policies provided by the country.

We also compared primary factors influencing the elderly’s needs for combining medical treatment and nursing in a different study. To ensure the comparability of the data, we collected data from literature reports using the same questionnaire as in this study [15, 31‐33]. In the above literature, the influencing factors on the demand for the combination of medical and elderly care were analysed by binary logistic regression analysis. Therefore, we used the forest map to compare the differences between the factors affecting different studies. As can be observed from Fig. 3, the primary influencing factors of the elderly’s demand for the service are varied. The primary influencing factor of the elderly’s demand for the service is a willingness to pay in Lanzhou, children’s support in Chongqing [15], the type of medical insurance in Zhanjiang [31], health management in Quanzhou [32] and age in Shihezi [34]. The above results show that related departments should formulate and develop planning and policies for the service following the actual situation.