| Objectives(1)The study aimed to investigate the status and influential factors of QOL among LTCI elderly beneficiaries.(2)The study aimed to investigate the status and influential factors of caregiver burden among the caregivers of LTCI elderly beneficiaries.(3)The purpose of this study was to explore the relationship between QOL among LTCI elderly beneficiaries and caregiver burden among their caregivers.(4)The study also conducted a qualitative research on the family caregivers of LTCI elderly beneficiaries.The purpose of this study was to investigate the caregiving experience of family caregivers in the process of providing care services and being managed by home care institution after their care recipient received LTCI services,in order to provide scientific basis for reducing the burden of caregiver,improving the QOL for elderly beneficiaries and optimizing long-term care insurance policy.MethodsThe study adopted mixed methods research design,and it consisted of two parts:Part I: Quantitative researchFrom December 2018 to July 2019,a convenience sample of 161 LTCI elderly beneficiaries and their caregivers(n=161)were recruited and investigated at the meanwhile.A cross-sectional survey was conducted by World Health Organization Quality of Life-BREF,Barthel Index,Self-rating Depression Scale,Self-rating Anxiety Scale,Zarit Caregiver Burden Interview and so on.The purpose was to analyze the status and influential factors of QOL for elderly beneficiaries as well as caregiver burden of their caregivers.Part II: Qualitative researchFrom July to September 2019,a purposive sample of 14 family caregivers for LTCI elderly beneficiaries was recruited and interviewed.Semi-structured interviews were conducted and recorded,in order to investigate the family caregivers personal feelings and suggestions on home care services of long-term care insurance.Colaizzi phenomenological analysis method was adopted for processing and managing the data.Results1.Quantitative research results1.1 The status of QOL among LTCI elderly beneficiaries(1)The WHOQOL-BREF mean score of the elderly beneficiaries was 41.17(SD 7.79),and it was significantly lower(t=14.789,P<0.001)than the counterparts in China 50.26(SD 9.13).And the average score of its four dimensions in descending order: environment,social relationships,psychological and physical.The scores of four dimensions of WHOQOL-BREF were significantly lower than the counterparts in China(P<0.001).In this study,more than half of the respondents(57.2%)reported that their health was dissatisfied or very dissatisfied,and 24.8% of the respondents reported that their QOL was poor or very poor.(2)The results of univariate analysis showed that there were significant differences in QOL of the elderly beneficiaries based on elevator equipment of the residence,frequencies of outdoor activities per week,duration as beneficiary of LTCI,ADL,frequencies of hospitalization in the past year,subjective well-being,depression,anxiety,type of caregivers and life satisfaction of their caregivers(P<0.05).1.2 The influential factors of QOL for the LTCI elderly beneficiariesThe results of multiple linear regression analysis found that frequencies of hospitalization in the past year,frequencies of outdoor activities per week,subjective well-being,depression and anxiety influenced the QOL for the LTCI elderly beneficiaries(P<0.05).The higher level of QOL among elderly beneficiaries was significantly correlated with 2 or more hospitalizations in the past year,more outdoor activities per week,higher level of subjective well-being as well as lower degree of depression and anxiety.1.3 The status of caregiver burden among caregivers of the LTCI elderly beneficiaries(1)The median score of caregiver burden was 26.00,and it was significantly higher(Z=5.244,P<0.001)than the counterparts in China 21.12(SD 10.32).The median scores of personal burden and responsibility burden in ZBI were 17.00 and 6.00 respectively.In addition,about 70% of the caregivers in this study have varying degrees of caregiver burden.(2)The results of univariate analysis showed that there were significant differences in caregiver burden based on domicile,occupation,type of primary caregiver,relationship with care recipient,care time,the average monthly rest time,life satisfaction,situations in need of help during care services,condition of suffering from a chronic disease,living condition of care recipient and frequencies of outdoor activities per week among care recipient(P<0.05).1.4 The influential factors of caregiver burden among caregivers of the LTCI elderly beneficiariesThe results of multiple linear regression analysis found that life satisfaction,relationship with care recipient,care time and frequencies of outdoor activities per week among care recipient were the influential factors of caregiver burden(P<0.05).The higher level of caregiver burden was significantly related to higher self-rated life satisfaction,the closer relationship with care recipient,the longer care time,and more outdoor activities per week among care recipient.1.5 Spearman correlation analysis results showed that the environmental dimension of WHOQOL-BREF was negatively correlated with ZBI's total score,personal burden and responsibility burden(r=-0.302,P<0.01;r=-0.240,P<0.01;r=-0.321,P<0.01).2.Qualitative research resultsThe caregiving experience of family caregivers was investigated in their process of providing care services and being managed by the home care institution.Three themes were extracted,including harvest of family caregivers(i.e.reduction of financial burden,enriched nursing knowledge and skills,changed of caregiving thinking,receiving timely care and guidance,felt warm from social support),harvest of the care recipient(negative emotions were improved,care problem were solved)and the inadequacies of the management mode(i.e.the access requirements for family caregivers were relatively single,the supervision mode of daily care need to be improved,and lack of social protection among working age family caregivers).Conclusion1.The LTCI elderly beneficiaries had a lower level of QOL,accompanied by serious multiple chronic conditions and mental health problems.The influential factors of QOL among elderly beneficiaries include frequencies of hospitalizations in the past year,frequencies of outdoor activities per week,subjective well-being,depression and anxiety.2.The caregiver burden for most caregivers was at the mild and moderate level,but the problem of caregiver burden was widespread.The influential factors of caregiver burden include life satisfaction,relationship with care recipient,care time and frequencies of outdoor activities per week among care recipient.3.There was a negative correlation between the score of environmental dimension of QOL and the total score of caregiver burden,personal burden and responsibility burden.Based on the influential factors of QOL among LTCI elderly beneficiaries and caregiver burden for caregivers,nurses should formulate targeted nursing intervention,in order to improve the QOL for LTCI elderly beneficiaries and reduce the caregiver burden for caregivers.4.The compensation for care expenses,training of caring knowledge and skills as well as the guidance and health education of nurses play an important role in the process of family caregivers providing care services and being managed by home care institutions.All of these not only reduce the financial burden and caregiver burden of family caregivers,improve the QOL of their care recipients,but also promote the standardized development of LTCI home care services.It also confirms that LTCI home care services play a positive role for reducing caregiver burden of family caregivers and improving QOL of elderly beneficiaries in the care process. |
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