Research on the impact of mutual elderly care on the physical and mental health of rural elderly in China

Research on the impact of mutual elderly care on the physical and mental health of rural elderly in China

The core idea of mutual care is that the healthy elderly will take care of the frail elderly, solving the problem of old age through the intergenerational transfer of old age resources. As the problem of population aging becomes more and more serious, mutual care as an innovative model for the elderly has received extensive attention from academics, and a variety of perspectives. Individual factors, family factors and social factors are the main influencing factors of participation in mutual aid for the elderly10,11,12. Xu X analyzed it from a social capital perspective and concluded that society contributes significantly to the realization of mutual aid for rural older people in all cases. There are significant gender and regional differences in the impact of social and psychological capital on the realization of mutual aid among rural older people13. In concrete practice, the four models of mutual aid homes, time banks, senior citizen associations & social organizations, and party building & mutual aid for the elderly have been widely promoted. However, according to the results of Luo Jian’s Meta-analysis, the willingness rate of the elderly in China to participate in the mutual aid elderly care model is 57%. This data indicates that although the mutual care model has a certain market potential in China, it still needs to be further promoted and optimized14.

In the research progress on the mental health of the elderly, different aging modes have different effects on the mental health of the elderly. Some scholars have pointed out that Chen Yajing confirmed that the mental health of rural family-aged elderly is better than that of social-aged elderly15. Yu Fei-Ping confirmed that the combination of medical and nursing aging methods can promote the mental health of the elderly16. Wen Shao Zheng17 concluded that: community-based home care services improve the mental health of disabled older adults. Heterogeneity in the impact of community-based home care services on the mental health of older people with disabilities, as well as the significant improvement of health services on the mental health of older people with disabilities.

Regarding the progress of research on the physiological health of the elderly, some scholars have pointed out that community-based elderly care services can directly alleviate the health vulnerability of the elderly18, Social participation can help to alleviate the deterioration of the health of the elderly, and can reduce the risk of chronic diseases, and have a positive and significant impact on all types of health19,20. There are also scholars from the perspective of intergenerational support of the family to analyze the family to conclude that the intergenerational support of the children can improve the physical health of the elderly21. Analyzing from the social level, social support is significantly positively correlated with physiological health22.

Currently, in the research mechanism on rural mutual care and the physical and mental health of the elderly, some scholars chose 5000 elderly people aged 65 years or older in five official elderly care service areas in A city, Saitama Prefecture, Japan, as the research subjects. The results of the study pointed out that mutual aid relationships could effectively improve the mental health of elderly people living alone in poor economic conditions and reduce the fear of future isolation23.

However, there are fewer studies on the relationship between mutual aid and the physical and mental health of rural elderly in China. Clarifying the impact of mutual aid on the physical and mental health of rural elderly will enable us to correctly recognize the current status of mutual aid implementation and provide a reference for the reform of active aging.

Research objects and methods

Research objectives

The China health and retirement longitudinal study (CHARLS) aims to collect a set of high-quality microdata representing households and individuals of middle-aged and elderly people aged 45 years and above in China. To analyze the problem of population aging in China and to promote interdisciplinary research on aging. The CHARLS national baseline survey was conducted in 2011, covering 150 district units, 450 village units, and 17,000 people in approximately 10,000 households.

Data from CHARLS 2018 was used to select older adults whose residence type was rural and who were ≥ 60 years of age or older, and 8369 study participants were finally included after removing missing values and retaining important key variables.

Selection of variables

Dependent variable: participation or non-participation in mutual care for the elderly

Mutual social care is no longer simply a matter of building facilities or helping each other, but a continuous effect and reallocation of informal social resources in rural areas. Make full use of the idle time and resources of all kinds of human resources in rural areas (especially the elderly), and develop various forms of social old-age care models of mutual assistance in funds, services and culture24. The corresponding question in the questionnaire is “Have you carried out the following social activities in the past month?”. In the questionnaire, the corresponding question is “Did you do any of the following social activities in the past month?”, of which five options are “Visiting the door, socializing with friends”, “Playing mahjong, chess, cards, going to the community room”, “Offering help to relatives, friends or neighbors who do not live with you”, “Participating in social activities”, “Participating in social activities”, and “Participating in social activities”. “Participate in volunteer activities”, and “Take care of a sick or disabled person who is not with you”. If you participate in any of the five behaviors, you are assigned a value of 1. If you do not participate in any of the five behaviors, you are assigned a value of 0.

Dependent variable: physical and mental health of older persons

Mental health of rural older adults

Depression in middle-aged and older adults was measured using the 10-item simplified version of the depression scale of the CHARLS questionnaire (center for epidemiological survey, depression scale, CES-D). The scale has 8 negatively oriented questions and 2 positively oriented questions. All 10 questions of the scale were scored on a 4-point scale (rarely or not at all = 0, not too much = 1, sometimes or half the time = 2, most of the time = 3). The two positive mood questions were reverse scored, and then the scores of the 10 questions were summed to construct a composite index of depressed mood in older adults, which was scored in the range of 0 to 30 points. A score of 10 or less was defined as not having a depressed mood, and a score of 10 or more as having a depressed mood, with higher scores indicating a more severe level of depression and a lower level of mental health in older adults25.

Physical health of rural older persons

There are various indicators to measure the physical health of older adults, including but not limited to self-assessed health status, chronic diseases, ADL, IADL, etc. In this paper, drawing on existing research26, the activities of daily living scale (ADL) was used as a measure of physical health in older adults. The scale includes 6 entries of dressing, bathing, eating, getting in/out of bed, toileting, and controlling urination and defecation. The above questions are measured in a 4-level scale, which assigns I am completely able to take care of myself as a score of 0, have some difficulty but can do it independently as a score of 1, need help as a score of 2, and completely unable to take care of myself as a score of 3. The scores of the 6 questions are then added together, a score of 0 is defined as a healthy elderly person, and a score greater than 0 is defined as a disabling Older people. The specific assignment of each variable is shown in (Table 1).

Table 1 Assignment of values to each variable.

Research methods

Descriptive statistical analysis

Stata 16.0 was used for data merging, screening and cleaning; descriptive analysis was performed using percentages; binary logistics regression was used to regress the physical and mental health of the elderly with mutual care as the independent variable, and the factors influencing the physical and mental health of the elderly in rural areas by the independent variable were tested and analyzed. Differences were considered statistically significant at P < 0.05.

Endogenous treatment

Effectiveness assessment of the treatment group average treatment effect (ATT) for depression and ADL in rural older adults using PSM propensity score matching.

In this study, Di is the independent variable, which takes the value of 1 when rural older adults choose to participate in mutual aid for the elderly, and vice versa takes the value of 0; Yi(1) and Yi(0) are the dependent variables, which denote the follow-up effects of the treatment group and the control group, respectively; Xi is a series of covariates of whether or not the sample i participates in mutual aid for the elderly; and P(Xi) is the propensity score of whether or not rural older adults participate in mutual aid for the elderly. To ensure the accuracy of the estimation, we combed the samples with K-nearest neighbor matching, radius matching and kernel matching. Finally, the analysis of heterogeneity was performed to analyze the influencing factors on the health of the elderly in the countryside.

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