Background: Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family’s internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults. Objective: This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors. Methods: A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects. Results: Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition. Conclusions: Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.

Objective This study aimed to define the end-of-life (EOL) healthcare utilisation and its cost and determinants for cancer patients and to proactively inform related strategies in mainland China. Design A population-based retrospective study. Setting and participants Data from 894 cancer patients were collected in urban Yichang, China from 01 July 2015 to 30 June 2017. Outcome measures Emergency department (ED) visits, outpatient and inpatient hospitalisation services, intensive care unit (ICU) admission and total costs were used as the main outcomes. Results In this study, 66.8% of the 894 patients were male, and the average age was 60.4 years. Among these patients, 37.6% died at home, and patients had an average of 4.86 outpatient services, 2.23 inpatient hospitalisation services and 1.44 ED visits. Additionally, 5.9% of these patients visited the ICU at least once. During the EOL periods, the costs in the last 6 months, 3 months, 1 month and 1 week were US$18 234, US$13 043, US$6349 and US$2085, respectively. The cost increased dramatically as death approached. The estimation results of generalised linear regression models showed that aggressive care substantially affected expenditure. Patients with Urban Employee Basic Medical Insurance spent more than those with Urban Resident-based Basic Medical Insurance or the New Rural Cooperative Medical Scheme. The place of death and the survival time are also risk factors for increased EOL cost. Conclusion The findings suggested that the EOL cost for cancer patients is associated with aggressive care, insurance type and survival time. Timing palliative care is urgently needed to address ineffective and irrational healthcare utilisation and to reduce costs. Ethics and dissemination This study was approved by the Ethics Committee of the Tongji Medical College, Huazhong University of Science and Technology (IORG No.: IORG0003571). All the data used in this study were de-identified.

Background: Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders. Methods: Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors. Results: In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat. Conclusion: Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

Background: Although the health of the floating elderly population is an important part of active and healthy ageing, it is neglected in current Chinese society. Based on the general consensus that social interaction can affect the health of the floating population, this study explored whether the interaction type, mode and frequency influenced the health of the floating elderly population in China and investigated the variability of these influential effects. Methods: This study used the China Migrant Population Dynamic Survey Data 2017 and selected 5239 floating elderly individuals over 60 years old. Self-rated health was used to assess the comprehensive health status of respondents. Social interaction was measured by the interaction type, mode and frequency. Descriptive statistical analysis was used to analyse the health and social interaction status. An ordinal probit model was used to estimate the influential effects and differences on health caused by social interaction. The 2SLS model was used to examine the mutual causality relationship between interaction frequency and health, and a robustness test was conducted. Results: A total of 44.6% interacted with local residents, 14.2% participated in interaction activities based on geographical relations, and only 4.3% and 7% participated in interactions based on business and interest, respectively. Interacting with natives improved individuals’ self-rated health by 18.5%; specifically, geographical interaction increased self-rated health by 40.9%, occupational interaction increased it by 25.2%, interest-based interaction increased it by 41.2%, and interaction frequency improved the self-rated health (β = 0.128). In addition, sex, education level, personal income, and floating into the eastern region had a positive effect on individuals’ health. However, age, spouse and hukou exerted a negative effect. Conclusions: This study demonstrated that interacting with local residents could improve the health of floating elderly population, and revealed that interest-based interaction and their frequency had a positive impact on health. The government should speed up the construction of the voluntary service system and encourage the floating elderly population to realize their personal value in social interaction. In addition, the reform of the hukou system should be further promoted, so as to remove institutional barriers to the social interaction.

This study was conducted to investigate the trajectory of hospitalization costs, and to assess the determinants related to the membership of the identified trajectories, with the view of recommending future research directions. A retrospective study was performed in urban Yichang, China, where a total of 134 end-stage lung cancer patients were selected. The latent class analysis (LCA) model was used to investigate the heterogeneity in the trajectory of hospitalization cost amongst the different groups that were identified. A multi-nominal logit model was applied to explore the attributes of different classes. Three classes were defined as follows: Class 1 represented the trajectory with minimal cost, which had increased over the last two months. Classes 2 and 3 consisted of patients that incurred high costs, which had declined with the impending death of the patient. Patients in class 3 had a higher average cost than those in Class 2. The level of education, hospitalization, and place of death, were the attributes of membership to the different classes. LCA was useful in quantifying heterogeneity amongst the patients. The results showed the attributes were embedded in hospitalization cost trajectories. These findings are applicable to early identification and intervention in palliative care. Future studies should focus on the validation of the proposed model in clinical settings, as well as to identify the determinants of early discharge or aggressive care.

Background: Disparities in the utilization, expenditures, and quality of care by insurance types have been well documented. Such comparisons have yet to be investigated in end-of-life (EOL) settings in China, where public insurance covers over 95% of the Chinese population. This study examined the associations between health insurance and EOL care in the last six months of life: outpatient visits, emergency department (ED) visits, inpatient services, intensive care unit (ICU) admissions, expenditures, and place of death among the cancer patients. Methods: A total of 398 patients diagnosed with cancer who survived more than 6 months after diagnosis and died from July 2015 to June 2017 in urban Yichang, China, were included. Descriptive analysis and multivariate regression models were used to investigate the bivariate and independent associations, respectively, between health insurance with EOL healthcare utilization, expenditures and place of death. Results: Urban Employee Basic Medical Insurance (UEBMI) beneficiaries visited EDs more frequently than Urban Resident-based Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS) beneficiaries (marginal effects [95% Confidence Interval]: 2.15 [1.81–2.48] and 1.92 [1.59–2.26], respectively). NRCMS and UEBMI beneficiaries had more hospitalizations than URBMI beneficiaries (1.01 [0.38–1.64] and 0.71 [0.20–1.22], respectively). Compared to URBMI beneficiaries, NRCMS beneficiaries and UEBMI beneficiaries had ¥15,722 and ¥43,241 higher expenditures. Similarly, UEBMI beneficiaries were most likely to die in hospitals, followed by NRCMS (UEBMI vs. NRCMS: 0.23 [0.11–0.36]) and URBMI (UEBMI vs. URBMI: 0.67 [0.57–0.78]) beneficiaries. Conclusions: The disproportionately lower utilization of EOL care among NRCMS and URBMI beneficiaries, compared to UEBMI beneficiaries, raised concerns regarding quality of EOL care and financial burdens of NRCMS and URBMI beneficiaries. Purposive hospice care intervention might be warranted to address EOL care for these beneficiaries in China.