The Effect of Expectation and Availability of Community-Based Formal Support Services on Psychological Well-Being of Senior Adults: A Comparison Between Rural and Urban China

Background and Purpose: With the rapid growth of elders in China, their care needs will not be met by current institutional systems. The provision of community-based formal support services (CBFSS) will be crucial for elders’ well-being. However, few studies examine how well the availability of specific types of services match with expectations, and whether this has an impact on well-being for elders.

This paper aims to examine the effect of expectations and availability of CBFSS on psychological wellbeing of seniors in China. It is hypothesized that: 1) having at least one expected CBFSS available will be positively associated with psychological wellbeing for Chinese elders, and 2) having CBFSS available, even not matched with expectations, will be positively associated with psychological well-being and this effect will be greater in rural areas.   

Methods: Data for this study are from the 2005 wave of the Chinese Longitudinal Healthy Longevity Survey. The sample includes a total of 15,191 community-dwelling adults aged 65 and older. Psychological wellbeing was measured by a self-reported 5-item scale. The match of expectations and availability of CBFSS was measured by a five-category variable: a) having at least one service available matched expectations, b) having one or more services available yet none of them matched with expectations; c) having no expectation and no service available, d) having no expectation but one or more services available, and e) having expectations but no services available (reference group). This variable was constructed by matching the availability and expectations of eight types of CBFSS (personal care, home visits, psychological consultation, shopping, social recreation, health education, human rights consultation, and neighborhood relationship). Other control variables include demographic variables, living arrangement, informal social supports, self-rated health, health habits, and social activity. Separate linear regression models were built with rural and urban elders.

Results: Rural Chinese elders who had at least one expected service available reported better psychological well-being, than those who had expectations but no services were available (b=0.47, p<0.01). This was not supported for urban Chinese elders. Conversely, urban Chinese elders who had one or more service(s) available, though none of them matched with expectations, had better psychological well-being (b=1.15, P<0.001). This was not supported with their rural counterparts. Interestingly, for both rural and urban Chinese elders with no expectations of CBFSS, having one or more services available, associated with better psychological well-being. This effect was stronger for rural (b=1.73, p<0.001) than urban (b=0.69, p<0.05).

Conclusions and Implications: Analysis from this study found that the match of expectation and availability of at least one type of CBFSS was associated with better psychological wellbeing of rural elders, but not for their urban counterparts. Regardless of expectations, having any CBFSS available improved psychological wellbeing for both rural and urban seniors. This study highlighted that Chinese elders are in need of more resources for community-based formal support services especial in rural areas. Policies should include developing infrastructures for these services as well as raising awareness of available formal support services for elderly in rural and urban China.