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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Informal caregivers' preferences for self-care support services in caring for community-dwelling older adults with
Yueling Wang1, Runtian Lv2, Xiao Wei3
1School of Nursing, Qingdao University, Qingdao, 266071, Shandong Province, China.
Background:
The global aging population has intensified the need for community-based care, placing a significant burden on informal caregivers. While self-care is crucial for their well-being, evidence on specific service preferences remains scarce.
Objective:
To identify informal caregivers' preferences and willingness to pay for self-care support services, and to explore preference heterogeneity.
Methods:
A discrete choice experiment was conducted among 226 informal caregivers of older adults with disabilities enrolled in the long-term care insurance program in Qingdao, China. A two-stage sampling strategy was used: districts and county-level cities were first selected, followed by convenience sampling of eligible caregivers through community health service centers. Eight service attributes (2-4 levels each) were identified through literature review, qualitative interviews, and expert consultation. Preferences were analyzed using a mixed logit model. Relative importance scores and willingness-to-pay estimates were calculated. Interaction analyses explored heterogeneity.
Results:
Respite service frequency (24.0%) and comprehensive health guidance content (21.7%) were the most influential attributes, followed by respite service format (21.3%), sleep quality improvement (20.8%) and health guidance delivery format (11.1%). In contrast, exercise guidance (0.4%), physical examinations (0.8%) and cost (0.01%) exerted minimal influence on caregivers' choices. The estimated willingness-to-pay for weekly respite, relative to respite provided once every two months, was ¥3132.48 per month, while the willingness-to-pay for comprehensive health guidance (medication, traditional Chinese medicine, and nutritional guidance) was ¥2827.48 per month. Significant preference heterogeneity was observed, with variations associated with sociodemographic characteristics, health status, caregiver stress levels, and patient-reported outcomes.
Conclusions:
Informal caregivers prioritize frequent respite and integrated, nurse-delivered health guidance over cost considerations. Community nurses play a pivotal role in assessing caregiver strain, delivering individualized health guidance, coordinating respite services, and ensuring equitable access for vulnerable subgroups. Embedding structured, nurse-led caregiver self-care support within community long-term care systems may strengthen caregiver sustainability and improve overall care quality.
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