Global Health Research Center, Duke Kunshan University, Academic Building 3038, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.
Rory Meyers College of Nursing, New York University, New York, USA.
BMC Geriatr. 2021 Apr 21;21(1):268. doi: 10.1186/s12877-021-02219-5.
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.
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.
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.
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.
社会人口结构的转变极大地改变了中国传统的家庭照料模式，导致老年人的照料需求得不到满足。然而，不同类型的主要照料者（如配偶和子女）对失能老年人的健康结果是否有不同的影响尚不清楚。本研究旨在探讨社区居住的失能中国老年人的主要照料者类型（如配偶、子女、孙子女、家政服务员）与死亡之间的关系。
我们使用中国健康长寿纵向研究的数据。分析样本包括 4278 名年龄≥80 岁的合格成年人。我们将主要照料者类型分为五类：配偶、子女/儿媳、女儿/女婿、孙子女和家政服务员。我们使用 Cox 回归模型来检验主要照料者类型与全因死亡率之间的关系。协变量包括年龄、性别、居住地、受教育年限、共同居住状况、经济独立状况、是否与子女同住、日常生活活动障碍的数量、慢性病的数量以及自我报告的健康状况、认知障碍和照料质量。
有配偶作为主要照料者的已婚老年人的死亡风险比有子女/儿媳作为主要照料者的老年人高 38%。有子女/儿媳或女儿/女婿作为主要照料者的已婚男性的死亡风险分别比有配偶作为主要照料者的男性高 64%和 68%。丧偶老年人的主要照料者类型与死亡率之间的关系在城乡之间存在差异。有家政服务员作为主要照料者的城市居民的死亡风险降低了 16%，而农村地区有家政服务员作为主要照料者的居民的死亡风险则增加了 50%。
主要照料者的照料质量可能是中国失能老年人死亡的一个危险因素。有必要采取干预措施来减少未满足的需求和管理照料负担。
