Geographical accessibility of medical resources, health status, and demand of integrated care for the elderly: a cross-sectional survey from Western China

Abstract

Abstract Background WHO calls for the Integrated Care for Older People (ICOPE) system to cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study aims to clarify the ICOPE demands in Western China and analyze the impact of geographic accessibility of medical resources (GAMR) on ICOPE demands and the potential mechanism of health status. Methods A cross-sectional questionnaire survey was conducted among 1200 people aged 60 years and above selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demands, health status, and GAMR. Propensity score matching was used to analyze the impact of GAMR on ICOPE demand. The Sobel mediation test with a bootstrapping process was used to analyze the mediating effect of self-rated health status on the impact of chronic disease on ICOPE demand in different GAMR groups. Results Of the total participants, 1043 were eligible for the study. The mean score of ICOPE demands among all participants was 3.68 (SD = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (ATT = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345,p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of elderly with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01). In the low GAMR group, multimorbidity directly affected ICOPE demand independent of self-rated health (β = 0.342, p < 0.001) and indirectly affected ICOPE demand through self-rated health (β = 0.036, p < 0.05). Conclusion The elderly population in Western China has a high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both the elderly with multimorbidity and self-perceptions of healthy and unhealthy, opens the mediation path of the subjective health status between the complications and ICOPE demand, and increases the ICOPE demand gap.