Study On Preparation For Future Care Need Of One-child Elderly Parents And Its Effect On Stress Of Elderly Care

BackgroundChina ranks first in the number of elderly population in the world,there has 150.03 million people aged 65 or above at the end of 2016,accounting for 10.8%of the total population.Unlike the western developed countries,China gets old before getting rich,which results in more severe stress of elderly care.Since the implementation of the family planning policy,a large number of policy-oriented one-child families have emerged.At present,the first generation of one-child parents have gradually entered old age.The size of oldest one-child elderly parents will be further expanded in the next thirty years.The peak of elderly care in one-child family is around the corner in China.Due to the weakened family care function and unsound social system in our country,one-child parents are in a dilemma in the choice of elderly care models and face a greater care risk.If there is no good elderly care support system for one-child family,it will easily result in health problem and care crisis in this special elderly group,and derive related social problems.From now on,researches to date focusing on the sizable one-child parents in China are relatively weak,with more theoretical researches and less empirical researches.At present,few studies have examined the stress of elderly care and related coping style,and explored the appropriate model to solve the stress of elderly care among one-child parents.Therefore,before the peak of elderly care in one-child family coming,it is of great practical significance and social value to explore the stress of elderly care and corresponding measures,which is related to the overall well-off society and national health.ObjectivesThis study aimed to compare the difference of stress of elderly care,preparation for future care need and support received from child between one-child elderly parents and multiple-children elderly parents,so as to understand the plight of elderly care of one-child elderly parents,and to reveal the mechanism of preparation for future care need influencing stress of elderly care among one-child elderly parents,and regulating effect of support received from child on the relationship between preparation for future care need and stress of elderly care.This study also expected to provide an evidence-based foundation for the formulation of social support policy to improve the care problem of one-child elderly parents.MethodsA cross-sectional survey was conducted in Hangzhou.Multistage random sampling was applied to recruit one-child elderly parents and multiple-children elderly parents.A total of 1134 one-child elderly parents and 1284 multiple-children elderly parents from urban areas participated in the study.Data were collected from face-to-face interviews by trained college students through a household survey using a standardized questionnaires,and all the questionnaires were collected and checked on the spot.A 12-items scale was used to assess perceived stress of elderly care.It was consisted of stress of economic security,stress of everyday life care,and stress of emotional care,with each subscale 4 items.All items were rated on a 5-point scale ranging from 1=no stress to 5 =excessive stress.Then the scores were summed up and dichotomized as high stress if the sum score is above 3 and low stress if otherwise.Preparation for future care need is consisted of steps of preparation for future care need and contents of plan.Five steps(awareness,avoidance,gathering information,decision making and concrete planning)in the planning process were measured with 15 items from the Preparation for Future Care Needs measure.It starts with an enhancing awareness of approaching care needs(awareness)or avoidance of thinking(avoidance).Individuals then seek out information from networks of acquaintances and public media(information gathering)to weigh feasible solutions and personal preferences(decision making).Once the initial plans are formed,concrete activities are carried out to facilitate their implementation(concrete planning).All items were rated on a 5-point scale ranging from 1=not at all true for me to 5 =completely true for me.Then the scores were summed up and dichotomized as high level if the sum score is above 3 and low level if otherwise.Contents of plan including preferences for elderly care,living arrangement and caregiver were assessed.Support received from child including financial support,instrumental support and emotional support was assessed.Response to each items ranged from 1=never to 4=often.Then the scores were summed up and dichotomized as high support if the sum score is at or above the mean and low support if otherwise.SPSS 23.0 and Amos21.0 statistical software were used for data analysis.Chi-square test and binary logistic regression models were conducted to investigate the difference of stress of elderly care,preparation for future care need,and support received from child between these two elderly groups.Correlation analysis,multiple linear regression and structural equation models were used to evaluate the association among stress of elderly care,preparation for future care need,and support received from child among one-child elderly parents.Results1)Difference of stress of elderly care,preparation for future care need and support received from child between one-child elderly parents and multiple-children elderly parentsStress of elderly care:Compared with multiple-children elderly parents,a significantly more one-child elderly parents reported higher stress of elderly care(26.5%vs.15.8%,P<0.001),higher stress of economic security(33.7%vs.24.4%,P<0.001),higher stress of everyday life care(34.2%vs.18.1%,P<0.001)and higher stress of emotional care(12.4%vs.9.2%,P<0.010).After adjusting for confounding factors,one-child elderly parents still reported significantly higher stress of elderly care(OR=2.14,95%CI:1.63-2.82,P<0.001),stress of economic security(OR=1.66,95%CI:1.31-2.11,P<0.001),stress of everyday life care(OR=2.19,95%CI:1.71-2.80,P<0.001)and stress of emotional care(OR=1.67,95%CI:1.27-2.20,P<0.001).Steps of preparation for future care need:Compared with multiple-children elderly parents,more one-child elderly parents reported higher awareness(78.1%vs.72.2%,P=0.001),higher avoidance(51.3%vs.48.6%,P=0.181),higher gathering information(48.2%vs.41.6%,P=0.001),higher decision making(58.4%vs.51.1%,P=0.740)and higher concrete planning(33.2%vs.30.1%,P=0.111).But only the differences in awareness and gathering information were statistically significant(P<0.05).After adjusting for confounding factors,there was no significant difference in awareness and gathering information between these two groups(P>0.05).Contents of plan:Compared with multiple-children elderly parents,a significantly more one-child elderly parents chose non-family care(57.5%vs.33.5%,P<0.001),expected not living with child(53.7%vs.39.2%,P<0.001),and chose other people except child as caregiver(48.5%vs.28.8%,P<0.001)in the future.After adjusting for confounding factors,one-child elderly parents were more likely to choose non-family care(OR=1.85,95%CI:1.46-2.34,P<0.001),to expect not living with child(OR=1.47,95%CI:1.08-2.00,P=0.014),and to choose other people except child as caregiver(OR=1.47,95%CI:1.03-2.11,P=0.035).Support received from child:Compared with multiple-children elderly parents,a significantly more one-child elderly parents reported lower support from child(54.7%vs.41.6%,P<0.001),lower financial support(56.1%vs.43.7%,P<0.001),lower instrumental support(53.7%vs.36.2%,P<0.001)and lower emotional support(49.5%vs.43.3%,P=0.002).After adjusting for confounding factors,one-child elderly parents still reported significantly lower level of support from child(OR=1.54,95%CI:1.24-1.91,P<0.001),lower level of financial support(OR=1.58,95%CI:1.27-1.96,P<0.001),lower level of instrumental support(OR=1.78,95%CI-1.44-2.21,P<0.001)and lower emotional support(OR=1.42,95%CI:1.20-1.68,P<0.001).2)Relationship among preparation for future care need,support received from child and stress of elderly care among one-child elderly parentsThe results of multiple linear regression models showed that after adjusting for confounding factors,emotional support(β=-0.132,P=0.004)was significantly negatively related with stress of economic security,awareness(β=0.073,P=0.032)and gathering information(β=0.089,P=0.036)were significantly positively related with stress of everyday life care,decision making(β=-0.104,P=0.015)and emotional support(β=-0.100,P=0.032)were significantly negatively associated with stress of everyday life care,decision making(β=-0.115,P=0.006),emotional support(β=-0.112,P=0.014)and instrumental support(β=-0.201,P<0.001)were significantly negatively associated with stress of emotional care,financial support(β=0.096,P=0.023)was significantly positively related with stress of emotional care.The path model of stress of everyday life care had satisfactory model fit(CMIN/DF=2.449,P=0.086,GFI=0.998,RMSEA=0.036).The results of model showed that awareness had direct effect(β=0.070,P=0.036)and indirect effect(β=0.030,P<0.05)through gathering information and decision making on stress of everyday life care,gathering information had direct effect(β=0.130,P=0.001),and indirect effect(P=-0.053,P<0.05)through decision making on stress of everyday life care,decision making had direct effect on stress of everyday life care(β=-0.092,P=0.014),emotional support had direct effect(β=-0.134,P<0.001)and indirect effect through awareness(P=0.006,P<0.05)on stress of everyday life care,awareness had direct effect on gathering information(β=0.480,P<0.001)and decision making(β=0.079,P=0.003).The path model of stress of emotional care had satisfactory model fit(CMIN/DF=1.851,P=0.157,GFI=0.999,RMSEA=0.027).The results of model showed that decision making had no significant direct effect on stress of emotional care,emotional support had direct effect(β=-0.167,P<0.001)and indirect effect(β-0.105,P<0.05)through instrumental support on stress of emotional care,financial support had direct effect(β=0.159,P<0.001)and indirect effect through emotional support and instrumental support(β=-0.252,P<0.05)on stress of emotional care,instrumental support had direct effect on stress of emotional care(β=-0.205,P<0.001).ConclusionsCompared with multiple-children elderly parents,one-child elderly parents reported higher level of elderly care stress,lower level of support received from child and stronger willing to choose non-family care.But there was no difference in the steps of preparation for future care need between these two elderly groups.Besides,this study demonstrated that awareness,gathering information and decision making had direct or indirect effect on stress of everyday life care,all scales of support received from child had direct or indirect effect on stress of emotional care,emotional support had direct or indirect effect on stress of economic security and everyday life care,emotional care had partially mediated the relationship between preparation for future care need and stress of everyday life care.Some policy suggestions have been proposed from the perspective of micro and macro aspects to relieve the elderly care stress of one-child elderly parents.At the micro level:First,Health promotion campaign shall be carried out to encourage one-child parents to make advance preparation for elderly care.Second,the conception of elderly care among one-child elderly parents shall be promoted to change from passive coping to active coping.Third,only children are encouraged to live nearby with their parents to provide fulcrum for caring elderly parents.Fourth,only children should attach importance to the emotional care to their parents and maintain the emotional ties.At the macro level:First,the government shall perfect the incentive policy of one-child family and set up care fund for one-child elderly parents.Second,the government shall increase the support of family care and community care models to alleviate the stress of the only children.Third,the government shall expand the coverage and supply of institutional care and improve the quality of service.Fourth,the government shall encourage the self-care model and exert the subjective initiative of the elderly.