Preferred Care Patterns and the Associated Factors of Integrated Health Care and Social Care among Community-dwelling Older Adults in China

Background: Since the aging society has put forward a request for integrating the resources of health and social care, understanding older adults’ preferences in care patterns is crucial. Objectives: A large-sample survey was conducted for analyzing the preferred care patterns of community-dwelling older adults in China and assessing the influencing factors. Methods: 1184 older adults were recruited by a cluster-randomized sampling method in three cities (including Chengdu, Jiaozuo, and Wuxi) located in the east, middle, and west areas of China. Individual characteristics and preferred care patterns were measured by questionnaires. Five preferred care patterns were classified, i.e., home-based health and social care (home-based HC/SC), community-based health and social care (community-based HC/SC), home-based health care but community-based social care (home-based HC but community-based SC), community-based health care but home-based social care (community-based HC but home-based SC), and institutional-based care. Local health authorities of the cities coordinated to identify communities and contact community workers to help carry out the investigation. Except for descriptive analysis and chi-square test, multivariate logistic regression and random forest model were applied to obtain reliable results on the predictor variables of preferred patterns and variable importance. Results: 47.71% of the sample prefer home-based HC/SC, and 25.58% prefer community-based HC/SC, followed by institutional-based care (14.44%), home-based HC but community-based SC (8.02%), and community-based HC but home-based SC (4.22%). Multivariate logistic regression indicated that compared with those preferring home-based HC/SC, participants characterized as male, aged≥80, impaired or no capability showed a lower preference of community-based HC/SC, while living with spouse only, reside in Wuxi, monthly income≥5000 showed a higher preference of community-based HC/SC. Living either with spouse only or with children was associated with a higher preference of home-based HC but community-based SC, while impaired or no capability is related to a lower preference in choosing this pattern. Characteristics of residing in Jiaozuo and with monthly income between 2000~5000 were associated with a higher preference of community-based HC but home-based SC. Those aged≥80, educated by college or university and above, resided in Jiaozuo or Wuxi, with monthly income≥5000, and with no or unclear access to medication showed a higher preference in institutional-based care. The results of the random forest model agreed with the results of the logistic regression. Education, living arrangement, age, resident city, and monthly income were the most relevant predictors, followed by gender, number of chronic diseases, self-care capability, and access to medication. Conclusion: A higher percentage of community-dwelling older adults chose the preferred pattern of “home-based HC/SC”, followed by the pattern of “community-based HC/SC”. The different choices of preferred care patterns were influenced by gender, age, education, living arrangement, city, income, access to medication, and number of chronic diseases. Implications: Efforts should focus on strengthening home- and community-based care to effectively promote the performance of source integration in the next step. This study also confirmed that preferred care patterns were characterized by an obvious individual variability, therefore, health providers and policymakers should carefully consider the differences in making targeting strategies of service delivery.