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      Unmet needs in long-term care and their associated factors among the oldest old in China

      BMC Geriatrics

      BioMed Central

      Unmet needs, Long-term care, Oldest old, China

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          With a rapidly aging population and a decline in the availability of family caregivers, the number of elders in China who have unmet long-term care needs is increasing. Because unmet needs often have negative consequences, it is increasingly important to identify factors associated with unmet needs. Utilizing Andersen’s behavioral model of health services use, this study examines the roles of predisposing factors (demographics), enabling factors (resources), and need (e.g., illness level) in long-term care among the oldest old in China.


          Data from three waves (2005, 2008, and 2011) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed. Four sequential, logistic regression models were designed to investigate how predisposing factors, enabling factors, and need were associated with unmet needs in long-term care.


          Logistic regression analyses reveal that the significant factors for both rural and urban residents were economic status, someone other than a family member as the primary caregiver, caregivers’ willingness to provide care, timely medication, self-rated health, and self-rated life satisfaction. Significant factors among only urban residents were age, a son/daughter-in-law as the primary caregiver, activities of daily living (ADL) disabilities expectation of access to community-based care services, and optimism. Significant factors among only rural residents were gender and cognitive function.


          The risk of having unmet needs associated with ADL disabilities in long-term care is largely determined by the oldest old’s economic status and caregivers’ willingness to provide care for both rural and urban residents. Given that the availability of informal caregivers—mainly family members—is declining, it is crucial to provide financial assistance to the oldest old, to increase formal services such as paid home service and community-based care services, and to reduce family caregivers’ burden in order to reduce the unmet needs of the oldest old in China.

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              The Chinese household registration system (hukou), which divides the population into "agricultural" and "nonagricultural" sectors, may be the most important determinant of differential privileges in state socialist China, determining access to good jobs, education for one's children, housing, health care, and even the right to move to a city. Transforming one's hukou status from rural to urban is a central aspect of upward social mobility. Using data from a 1996 national probability sample, we show that education and membership in the Chinese Communist Party are the main determinants of such mobility.

                Author and article information

                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                12 April 2015
                12 April 2015
                : 15
                Department of Sociology, Virginia Tech, 650 McBryde Hall (0137), 225 Stanger Street, Blacksburg, Virginia 24061 USA
                © Zhu; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Research Article
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                © The Author(s) 2015

                Geriatric medicine

                china, oldest old, long-term care, unmet needs


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