Since 2016, 15 pilot cities in China have implemented a long-term care insurance (LTCI) policy. The aim of this research was to explore the outcomes and evaluate the performance of the LTCI policy in the Chinese pilot cities and estimate the willingness of Chinese citizens to expand the formal implementation of LTCI policy in China. We gathered data from 1500 elderly people aged over 60 years in 15 pilot cities (100 surveys for each city) and the effective response rate was 77.8% (1167/1500). We relied on statistical analysis to elicit the outcomes and performance of LTCI implementation and an ordinal logit regression to analyze the factors associated with the extension of the LTCI policy. We examined factors associated with the perception according to sex, age, degree of disability, choices of care, living location, number of children, and monthly income. Among these factors, the relationship between living location and number of children of the family and the outcomes and performance of the LTCI policy in the pilot cities was significant. The rest of the factors showed no significance with the implementation of the LTCI in Chinese pilot cities. This study is among the first to explore the attitudes of Chinese citizens among those who have benefited from the LTCI policy in the pilot cities and contributes to identifying the outcomes of the LTCI in pilot cities to assist policymakers in their further implementation in China. Full article

The purpose of this study is to investigate the direct and indirect relationships among death anxiety, religious doubt, and depressive symptoms in older adults. This study also investigates race as a moderator for these relationships. This study used data from the Religion, Aging, and Health Survey. Participants identified as Christian, identified as Black or White, lived in a non-institutionalized household within the U.S., were retired, and spoke English. Using PROCESS, results revealed that religious doubt partially mediated the relationship between death anxiety and depressive symptoms. Furthermore, moderated mediation models revealed that race moderated the relationship between religious doubt and depressive symptoms. Specifically, there was significant, positive relationship between religious doubt and depressive symptoms for participants who identified as Black but not White. Results highlight how religious doubt can influence depressive outcomes among the geriatric communities of color. Limitations and future directions are also discussed. Full article

Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays. Full article

The aim of this study was to explore the relationship between socioeconomic status (SES), physical health and the need for long-term care (NLTC) of the Chinese elderly, and further, to provide evidence-based advice for establishing an LTC system in China. A cross-sectional survey was conducted in Shandong Province, China in 2017 by using multi-stage random sampling method. Data were collected from elderly individuals aged 60 years and older by self-designed questionnaires through face-to face interviews. A total of 7070 participants were finally included in the database (40.3% male, 59.7% female). Chi-square test analysis and structural equation modeling (SEM) were conducted to clarify the association between SES, physical health and NLTC among the Chinese elderly men and women in Shandong Province. The results of the SEM analysis showed that physical health exerted a strong and negative effect on the NLTC for both genders, with a slightly stronger effect found among the elderly men. SES was found to be significantly and negatively related to the NLTC among the elderly women, while no statistical significance was found for the association between SES and NLTC for elderly men. A significant and positive association between SES and physical health was observed among the elderly men and women, with a slightly stronger effect among the elderly women. Implications for lowering the NLTC and developing an LTC system were addressed based on the findings above. Full article

With the aim of probing into the life satisfaction of retired urban elderly in China with respect to old age support systems, this study examines the effect of pension reform with its existing inequalities across demographic and social groups on the life satisfaction of retired urban residents. The complementary role of intergenerational assistance and self-support on the life satisfaction of beneficiaries and non-beneficiaries of the pension scheme was analyzed using an ordered logit regression model with 2015 national representative data from China’s Health and Retirement Longitudinal Survey. Our sample consists of a cross-sectional data set of 3815 retired urban elderly aged 60 and above. The empirical results depict that though enjoying benefits from the public pension scheme generally enhances life satisfaction, beneficiaries of the Government and Institution Pension and Enterprise Employee Basic Pension are more advantaged than beneficiaries under the Urban-Rural Social Pension Scheme. The pension inequalities existing at provincial levels and across social groups such as gender and residence registration status also affect life satisfaction adversely. Women and rural ‘Hukou’ registered retired urban residents are at an apparent disadvantage. Getting financial and emotional support from children broadly improves life satisfaction. Non-beneficiaries of the public pension benefit more from the financial support of children than public pension beneficiaries. There is also a positive effect of cohabiting with children on life satisfaction when retired urban residents are single as compared to being married. Financial and physical self-support ability in forms of good health, home ownership and wealth management enhance life satisfaction significantly. However, largely, retired urban elderly have a higher life satisfaction when they are financially independent of children and are supported by state pension schemes. Our findings indicate that self-support ability of the elderly together with pension benefits are more effective in enhancing the life satisfaction of retired urban elderly in China. It is recommended that government institute policies to promote personal finance initiatives by the elderly while improving the pension scheme and reducing pension inequality. Full article

Background: The rapid development of new technologies has recently raised interest in the use of assistive robots in the care of older people. The success or failure of robots’ implementation is mediated by their acceptance by users. The aim of the study was to answer the question of how both older people and caregivers perceive the possibility of using an assistive robot for nutritional support. Methods: Opinions of 252 respondents (126 older—aged 65 and above; 126 younger ones—aged below 65) from five European countries were collected using the Users’ Needs, Requirements, and Abilities Questionnaire. Results: The majority of participants positively assessed the possibility of using a robot to improve the diet of older people by giving advice on healthy eating or monitoring the amount of food consumed by the owner. An age-related difference was observed, as older people less frequently accepted the reminding of meal times or drinking liquids than younger participants. Four key categories related to the robot’s role in the diet of older people were identified: matching the needs, robot’s characteristics, ethical issues and technical/financial issues. Conclusions: Our preliminary research has shown a positive approach to robots in the context of their nutrition-related aspects. An indication has been made of the need to include older people and other stakeholders in the process of designing these functionalities and modeling human–robot interactions based on communication theories. Full article

Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident’s quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings. Full article