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Background Social isolation is an increasing concern for older adults who live in the community. Despite some availability of social support programs to address social isolation, their effectiveness is not routinely measured. This study aimed to evaluate an innovative excursion-based program offering unique social experiences to older adults receiving aged care services. Methods This six-month before and after mixed-methods study evaluated the outcomes of an Australian excursion-based program which offered social and physical outings to bring older adults receiving aged care services into the wider community. The study combined two parts: Part 1 was a pre-post survey assessing the quality of life of older adults who received the excursion-based program for 6 months ( n  = 56; two time-points, analysed using signed rank test) and Part 2 involved qualitative in-depth, semi-structured interviews ( n  = 24 aged care staff, older adults and carers; analysed using thematic analysis). Results Older adults experienced a significant increase in quality of life scores ( p  < 0.001) between baseline and 6 months. Interviews confirmed these observations and suggested that benefits of participation included increased opportunities for social participation, psychological wellbeing, physical function, and carer respite. Interviews also revealed being in a group setting, having tailored, convenient and accessible activities, alongside supportive staff were key drivers in improving the wellbeing of participants. Conclusions Participating in an excursion-based community program may improve wellbeing in older adults. Aging policy should focus on prioritizing initiatives that promote social connectivity with the wider community and assist in improving outcomes for older adults.

Almost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals. To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision. Community care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment) and support workers (responsible for providing support in the home). Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview. Twenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72) years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools were completed by the majority of community care workers (93.1%). Assessment staff found it difficult to find time to deliver the intervention. Support workers were able to complete the intervention within their current service delivery period, with the initial assessment taking a small amount of additional time. Support workers reported enjoying the additional responsibility afforded by delivering the falls prevention program and seeing changes in their clients. The majority of clients (82%) reported enjoying the exercises, with 59% reporting that they felt it made a positive change in their health. Clients completed the exercises on average 4.8 (SD: 2.2) days per week. Community care workers who have completed appropriate training are able to deliver a falls prevention exercise program to their clients as part of their current services. Further research is required to determine whether the program reduces the rate of falls for community care clients and whether integration of a falls prevention program into an existing service is cost-effective.

Background China has entered a stage of moderate aging, characterized by a “90-7-3” eldercare pattern: 90% of the older adults opt for home-based care, 7% utilize community-based care, and 3% reside in institutional care facilities. With the rapid development of the digital economy, innovative solutions such as smart eldercare devices and telemedicine have emerged, offering new possibilities to enhance the efficiency and quality of eldercare services. However, while benefiting from digital technologies, the older adults generally face challenges posed by the “digital divide,” making digital literacy a critical factor constraining the digital transformation of eldercare services. Methods This study utilizes data from the 2020 China Longitudinal Aging Social Survey (CLASS 2020) to examine the impact of digital literacy on older adults’ utilization of community-based home care services (CHCS). Factor analysis was employed to measure digital literacy levels, while probit regression and Heckman’s two-stage model were applied for empirical analysis. Conclusion Our empirical analysis yields three key findings: (1) A significant negative relationship is found between digital literacy and the utilization of CHCS. This indicates that, on average, higher digital literacy is associated with a lower propensity to use CHCS. (2) Dimension-specific analysis reveals divergent impacts: Digital application literacy was positively associated with service utilization. However, device operation literacy, information acquisition literacy, and digital social literacy all exhibited significant negative correlations with service use. (3) Mechanism analysis indicates that digital literacy reduces older adults’ reliance on CHCS through multiple pathways, including increased alternative consumption expenditures, strengthened social and family support, and improved self-efficacy. Discussion The findings suggest that improved digital literacy may reduce older adults’ utilization of CHCS, providing important implications for optimizing the elderly care system in the digital era. While promoting digital literacy among older populations, policymakers should establish integrated online-offline service delivery models to achieve precise matching between seniors’ needs and care provision.

•Half of those with advanced dementia living in the community received paid care.•Family experiences were similar for those with no and part-time paid care.•Families of those with full-time paid care had fewer negative caregiving effects.•Paid caregivers play an important role in the collaborative dementia care team. Older adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience. Using data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving). About one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (–0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33). The provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.

Background The Home and Community-based Elderly Care Services (HCBS) pilot aims to improve access to preventive, rehabilitative, and long-term care for a rapidly ageing population. This study estimates the effect of HCBS on elderly mental and functional health and examines mechanisms and distributional heterogeneity Methods This paper linked the roll-out of HCBS pilots (2016–2020) to five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample included 25,287 respondents aged ≥60 years. This paper implemented a multi-period staggered difference-in-differences (DID) with individual and year fixed effects to estimate impacts on depressive symptoms (10-item CESD, 0–30; higher = worse) and physical status (ADL, 0–11; higher = worse). Mechanisms were tested using community elderly care intensity proxies, including home physician visits, family-doctor contracting, and routine preventive care. Results The HCBS significantly improved both mental and functional health. CESD scores declined by 0.396 (≈4.53% of the mean) and ADL scores by 0.224 (≈20.1% of the mean). Mechanism analysis showed increased use of routine preventive care (2.52 percentage points) and higher participation in home visits and family-doctor contracting, consistent with enhanced accessibility of elderly care services. Robustness checks found no differential pre-trends; effects were driven primarily by treated vs. never-treated comparisons (Goodman-Bacon weight ≈0.96), and remained significant under plausible deviations from parallel trends. Larger CESD improvements among those without chronic conditions and with higher education, and larger ADL gains among those with chronic conditions, lower education, and rural residents. Conclusions The HCBS significantly improved the mental and functional health of the elderly through enhancing the accessibility of community elderly care services. Prioritizing service continuity and tailoring supports to functionally vulnerable groups could further amplify health gains and reduce disparities. Clinical trial number Not applicable.

Background The general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services. Method This study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations ( n  = 122), memos and informal interviews with registered nurses ( n  = 8), and nurse assistants ( n  = 4). The transcribed texts were analyzed with interpretive content analysis. Results The inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues. Conclusions This study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

China’s rapid population aging and eroded family support capacity have heightened demand for sustainable eldercare solutions. To improve the capacity and quality of socialized eldercare services, China has initiated the community- and home-based elderly care services (CHECS) pilot program in 203 regions. This study explores its impact on older adults’ care patterns, aiming to address the need for effective eldercare approaches amid demographic and social changes. This study followed a quasi-experimental design and derived longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) for 2011 to 2020. We employed a staggered difference-in-differences (DID) approach to evaluate the effects of the CHECS pilot on older adults’ eldercare patterns across 5 key dimensions: living arrangements, care arrangements, economic sources, consumption expenditures, and spiritual comfort. The CHECS pilot significantly influences older adults’ care patterns across multiple dimensions. It increases the likelihood of hiring social personnel for care, reduces financial dependence on children, enhances financial self-sufficiency, and raises medical consumption expenditures. However, it decreases contact frequency with non-cohabiting children and does not affect living arrangements. These findings remain consistent across various tests. Notably, heterogeneous analysis shows stronger effects in regions with higher pension burdens and among vulnerable groups. Furthermore, CHECS also promotes greater use of community healthcare/eldercare services and shifts older adults’ perspectives on eldercare responsibilities. The implementation of the CHECS pilot significantly reshapes eldercare patterns in China across various dimensions, including care arrangements, economic resources, consumption expenditures, and spiritual comfort. CHECS demonstrates a viable, community-centered solution to aging and declining family support, offering an adaptable model for countries with similar eldercare pressures.

China’s rapidly aging population necessitates a sustainable social care system. Although the majority of Chinese disabled older adults live in their communities, the utilization rate of home- and community-based care (HCBC) services has been low. Moreover, family members still take the main responsibility for the care of disabled older persons and generally suffer from the stress of caregiving. To increase the use of HCBC services by disabled elderly families, this study examined which individual characteristics of both elderly individuals and their primary family caregivers were related to HCBC service use among disabled urban elderly individuals in a regional sample from the 2018 to 2019 Beijing Precise Assistance Need Survey (n = 34,153). Logistic regression was used as the baseline model, and a simultaneous equation model was established to address the jointly dependent variables. The results show that the degree of disability of disabled older adults has no significant effect on their service use, whereas their worse health status played a significant role in predicting respite care service use. Working status, a longer period of caregiving, and poor health of caregivers all significantly predict a greater likelihood of service use by elderly individuals. Caregivers with burdened feelings predicted a decrease in the likelihood of elderly individuals using services. Our findings show that primary family caregivers have an important influence on disabled elderly people’s use of HCBC services, but service use is more likely to compensate for the lack of care and expertise provided by family caregivers than to reduce caregivers’ caregiving burden.

Background Studies have shown a close association between home and community-based healthcare services (HCBHS) utilization and depressive symptoms in older adults. However, no studies have explored the underlying mechanism of this relationship in rural China. This study was designed to evaluate the roles of instrumental activities of daily living (IADL) and marital status in the association between HCBHS utilization and depressive symptoms in Chinese rural older adults. Methods Data were obtained from the 2018 China Health and Retirement Longitudinal Study, and 5,981 rural respondents (≥ 60 years old) were included. Depression scores were calculated using the ten-item Center for Epidemiological Studies Depression Scale. Moderated mediation analysis was carried out applying Hayes’ PROCESS macro (Model 7). Results HCBHS utilization had a direct and negative effect on depressive symptoms. Furthermore, marital status moderated the association between HCBHS utilization and IADL, which belonged to the indirect influence of the first half on the association between HCBHS utilization and depressive symptoms. HCBHS utilization was associated with IADL in single but not in married respondents. Conclusion The results demonstrated that marital status moderated the indirect relationship between HCBHS utilization and depressive symptoms, with HCBHS utilization being negatively associated with IADL among single but not married respondents. The government should focus on rural older adults, especially those who are single and have poor IADL function, and improve the provision of HCBHS to alleviate depressive symptoms.

Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their ability to continue living at home. Reablement is an innovative care approach aimed at optimizing independence. The reablement training program ‘Stay Active at Home’ for homecare staff was designed to support the implementation of reablement in the delivery of homecare services. This study evaluated the implementation, mechanisms of impact and context of the program. Methods We conducted a process evaluation alongside a 12-month cluster randomized controlled trial, using an embedded mixed-methods design. One hundred fifty-four homecare staff members (23 nurses, 34 nurse assistants, 8 nurse aides and 89 domestic workers) from five working areas received the program. Data on the implementation (reach, dose, fidelity, adaptations and acceptability), possible mechanisms of impact (homecare staff's knowledge, attitude, skills and support) and context were collected using logbooks, registration forms, checklists, log data and focus group interviews with homecare staff ( n  = 23) and program trainers ( n  = 4). Results The program was largely implemented as intended. Homecare staff's average compliance to the program meetings was 73.4%; staff members accepted the program, and particularly valued its practical elements and team approach. They experienced positive changes in their knowledge, attitude and skills about reablement, and perceived social and organizational support from colleagues and team managers to implement reablement. However, the extent to which homecare staff implemented reablement in practice, varied. Perceived facilitators included digital care plans, the organization’s lump sum funding and newly referred clients. Perceived barriers included resistance to change from clients or their social network, complex care situations, time pressure and staff shortages. Conclusions The program was feasible to implement in the Dutch homecare setting, and was perceived as useful in daily practice. Nevertheless, integrating reablement into homecare staff's working practices remained challenging due to various personal and contextual factors. Future implementation of the program may benefit from minor program adaptations and a more stimulating work environment. Trial registration ClinicalTrials.gov (Identifier NCT03293303 ). Registered 26 September 2017.