Main conclusions

First, family members are the major providers of the six basic needs for LTC in this study. The spouse is the most important primary care provider of each kind of the basic needs. Sons, following the spouse, take the second important role in satisfying the needs for “Cared when sick”, “Cash or material” and “Discuss important things”

for the elderly. While for the daughters, following the spouse, take the second important role in satisfying the needs of “Housework”, “Talk heartily” and “Going outside together”. Comparing with these three main informal care providers, the role of others care providers is relatively small.

Secondly, among these six basic needs for LTC, including “Cared when sick”,

“Housework”, “Cash or things”, “Talk heartily”, “Discuss important things” and

“Going outside together”, the percentage of their being “always” satisfied was 71.2%, 60.1%, 40.5%, 54.7%, 58.2% and 55.8%, respectively. Therefore, except the “Cash or

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things”, more than half of other five kinds of needs for LTC could be always satisfied.

There is a only small proportion of the participants reported that the needs is satisfied

"Sometimes", "Seldom", "Never", or "Not needed".

Thirdly, there is a positive correlation between socioeconomic status and mental health among the Tibetan urban elderly (as shown in Figure 3.4). That is, the higher socioeconomic status of the Tibetan urban elderly, the better of their mental health;

the lower socioeconomic status of the Tibetan urban elderly, the worse of their mental health. A small difference was observed on the correlation between SES and mental health, with a slightly stronger in Tibetan elderly women than men (as presented in Figure 3.5 and Figure 3.6).

Fourthly, there is a negative correlation between mental health and NLTC among Tibetan urban elderly (as shown in Figure 3.4). Namely, better mental health of the Tibetan urban elderly would mainly indicate their fewer NLTC; while for those whose mental health is worse, their NLTC would be more. A significant difference was found about the relationship between mental health and the NLTC, and it was slightly stronger among the Tibetan elderly men than women (as presented in Figure 3.5 and Figure 3.6).

Fifth, SES of the Tibetan urban elderly had not only a direct impact on the need for LTC but also an indirect impact on the need for LTC through mental health. Both the direct and indirect effects are negative (as shown in Figure 3.4). It means that the higher socioeconomic status of the Tibetan urban elderly, the less their needs for the

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LTC; the lower socioeconomic status of them, the more needs for the LTC. A minor gender difference was observed on the association between SES and the NLTC, with a slightly stronger total effect in elderly men than women (as presented in Figure 3.5 and Figure 3.6).

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References:

Baron-Epel, O., & Kaplan, G. (2009). Can subjective and objective socioeconomic status explain minority health disparities in Israel? Soc Sci Med, 69(10), 1460-1467. doi:

10.1016/j.socscimed.2009.08.028

Bentler, Peter M, & Bonett, Douglas G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological bulletin, 88(3), 588-606.

Berkman, Lisa F, & Kawachi, Ichiro. (2000). A Historical Framework for Social Epidemiology.

NewYork: Oxford University Press.

Brennan, D. S., & Singh, K. A. (2012). Dietary, self-reported oral health and socio-demographic predictors of general health status among older adults. J Nutr Health Aging, 16(5), 437-441.

Browne, Michael W, & Cudeck, Robert. (1989). Single sample cross-validation indices for covariance structures. Multivariate Behavioral Research, 24(4), 445-455.

Chen, Bidan. (2013). The international comparison of the long-term care system for the elderly.

Journal of Communism Party of China of Xiamen(02), 42-46.

Chen, Weimin. (2002). Compative research of the elderly caring system in the European Union countries. European Research(02), 55-61+111.

Chen, Weimin. (2004). Care resources and its supply for the urban elderly. Chinese Journal of Population Science(S1), 119-122+178.

Fan, Xitao, Thompson, Bruce, & Wang, Lin. (1999). Effects of sample size, estimation methods, and model specification on structural equation modeling fit indexes. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 56-83.

Fiorillo, D., & Sabatini, F. (2011). Quality and quantity: the role of social interactions in self-reported individual health. Soc Sci Med, 73(11), 1644-1652. doi:

10.1016/j.socscimed.2011.09.007

Gong, F., Xu, J., & Takeuchi, D. T. (2012). Beyond conventional socioeconomic status:

examining subjective and objective social status with self-reported health among Asian immigrants. J Behav Med, 35(4), 407-419. doi: 10.1007/s10865-011-9367-z

Government of Canada. (2012). 2011 Census: Population and Dwelling Counts. Retrieved August 8, 2013, from

http://www.statcan.gc.ca/daily-quotidien/120208/dq120208a-eng.htm?WT.mc_id=twtB2 000

Hoi le, V., Thang, P., & Lindholm, L. (2011). Elderly care in daily living in rural Vietnam: need and its socioeconomic determinants. BMC Geriatr, 11, 81. doi: 10.1186/1471-2318-11-81 Honjo, K., Kawakami, N., Takeshima, T., Tachimori, H., Ono, Y., Uda, H., . . . Kikkawa, T.

(2006). Social class inequalities in self-rated health and their gender and age group differences in Japan. J Epidemiol, 16(6), 223-232.

Hoshi, T., Takagi, C., Inoue, N., Nakayama, N., Yuasa, M., & Sakurai, N. (2012). Causal effect of socioeconomic variables on the “three health factors” among elderly urban dwellers.

Japanese Journal of Health education and promotion. Japanese Journal of Health Education and Promotion, 20(3), 159-170(in Japanese).

104

Hoshi, Tanji. (2012). Health promotion for the people with focusing on the personal dream and thought. Japanese Journal of Health Education and Promotion, 20(4), 307-312(in Japanese).

Hoshi, Tanji, & Sakurai, Naoko. (2012). Social support setworks and health. The Quarterly of Social Security Research, 48(3), 304-318(in Japanese).

Hu, L.-T. , & Bentler, P.M. (1999). Cutoff criteria for fit indexes in covariance structure analysis:

Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55.

Huijts, T., Eikemo, T. A., & Skalicka, V. (2010). Income-related health inequalities in the Nordic countries: examining the role of education, occupational class, and age. Soc Sci Med, 71(11), 1964-1972. doi: 10.1016/j.socscimed.2010.09.021

Hwang, M. J., Yoon, D. P., Shim, W., & Lim, K. E. (2010). The impact of social status and risk behaviors on health status among elderly individuals in Korea. Soc Work Public Health, 25(2), 223-236. doi: 10.1080/19371910903070481

Inoue, Naoko. (2012). The chronological trend of the bedridden status and preventive factors and cumulative survival rate during three years in the Japanese urban elderly dwellers.

Bulletin of Social Medicine, 30(1), 1-12(in Japanese).

Jöreskog, Karl G, Andersen, Erling B, Laake, Petter, Cox, DR, & Schweder, Tore. (1981).

Analysis of Covariance Structures [with Discussion and Reply]. Scandinavian Journal of Statistics, 65-92.

Kagamimori, S., Gaina, A., & Nasermoaddeli, A. (2009). Socioeconomic status and health in the Japanese population. Soc Sci Med, 68(12), 2152-2160. doi:

10.1016/j.socscimed.2009.03.030

Kawachi, I., & Kennedy, B. P. (1997). Health and social cohesion: why care about income inequality? BMJ, 314(7086), 1037-1040.

Kim, Nae-Hwa, Hoyek, Georges El, & Chau, Diane. (2011). Long-Term Care of the Aging Population with Intellectual and Developmental Disabilities. Clinics in Geriatric Medicine, 27(2), 291-300. doi: http://dx.doi.org/10.1016/j.cger.2011.02.003

Kubo, Miki. (2012). A structure analysis of socioeconomic factors and health states for the urban elderly dwellers with cardiovascular diseases. Bulletin of Social Medicine, 30(1), 13-24(in Japanese).

Laporte, A., Croxford, R., & Coyte, P. C. (2007). Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status?

A Canadian experience. Health Soc Care Community, 15(2), 108-119. doi:

10.1111/j.1365-2524.2006.00672.x

Lin, Shanshan. (2013). The construction of long-term care insurance system in China and its financial balance. Journal of Fujian Normal University (social science series)(01), 28-34.

Marmot, Michael, & Wilkinson, Richard. (1999). Social determinants of health. NewYork:

Oxford University Press.

Martikainen, P., Moustgaard, H., Murphy, M., Einio, E. K., Koskinen, S., Martelin, T., & Noro, A.

(2009). Gender, living arrangements, and social circumstances as determinants of entry into and exit from long-term institutional care at older ages: a 6-year follow-up study of older Finns. Gerontologist, 49(1), 34-45. doi: 10.1093/geront/gnp013

105

Mavrinac, G. V., Sersic, D. M., & Mujkic, A. (2009). Cardiovascular and behavioral risk factors in relation to self-assessed health status. Coll Antropol, 33 Suppl 1, 99-106.

McKevitt, C., Fudge, N., Redfern, J., Sheldenkar, A., Crichton, S., Rudd, A. R., . . . Wolfe, C. D.

(2011). Self-reported long-term needs after stroke. Stroke, 42(5), 1398-1403. doi:

10.1161/strokeaha.110.598839

Mirowsky, J., Ross, C.E., & Reynolds, J. (2000). Links between social status and health status. In E.C. Bird, P. Conrad & A.M.(Eds.) Fremont (Eds.), Handbook of medical sociology (5th edition ed., pp. 47–67). Upper Saddle River,New Jersey: Prentice-Hall.

National Bureau of Statistics of the People's Republic of China. (2006, March 16, 2006). Report of the 1% population sampling survey of China in 2005. Retrieved October 16, 2013, from http://www.stats.gov.cn/was40/gjtjj_detail.jsp?channelid=2912&record=53

National Bureau of Statistics of the People's Republic of China. (2011, April 28, 2011). Report of the Sixth National Population Census in 2010 (no. 1). Retrieved October 16, 2013, from http://www.stats.gov.cn/tjgb/rkpcgb/qgrkpcgb/t20110428_402722232.htm

Reid, K. A., Smiley, E., & Cooper, S. A. (2011). Prevalence and associations of anxiety disorders in adults with intellectual disabilities. J Intellect Disabil Res, 55(2), 172-181. doi:

10.1111/j.1365-2788.2010.01360.x

Robert, S.A., & House, J.S. (2000). Socioeconomic inequalities in health: An enduring

sociological problem. In E.C. Bird, P. Conrad & A.M.(Eds.) Fremont (Eds.), Handbook of medical sociology (5th edition ed., pp. 79-97). Upper Saddle River, New Jersey:

Prentice-Hall.

Rong, Tai.Sheng. (2010). Amos and Research Method (Second edition ed.). Chongqing:

ChongqingUniversityPress.

Samuelsson, G., Sundstrom, G., Dehlin, O., & Hagberg, B. (2003). Formal support, mental disorders and personal characteristics: a 25-year follow-up study of a total cohort of older people. Health Soc Care Community, 11(2), 95-102.

Sani, F., Magrin, M. E., Scrignaro, M., & McCollum, R. (2010). In-group identification mediates the effects of subjective in-group status on mental health. Br J Soc Psychol, 49(Pt 4), 883-893. doi: 10.1348/014466610x517414

Shi, Weiwei, & Liu, Yijiao. (2011). Long-term care insurance system in Germany and its enlightment. Business Studies(03), 98-105.

Sorrell, J. M., & Durham, S. (2011). Meeting the mental health needs of the aging veteran population. J Psychosoc Nurs Ment Health Serv, 49(1), 22-25. doi:

10.3928/02793695-20101207-01

Theodossiou, I., & Zangelidis, A. (2009). The social gradient in health: the effect of absolute income and subjective social status assessment on the individual's health in Europe. Econ Hum Biol, 7(2), 229-237. doi: 10.1016/j.ehb.2009.05.001

Wang, Dewen. (2012). The plight of health care of the Chinese aged population and the way out.

Journal of Xiamen University (social sciences siries)(04), 90-98.

Wang, Lei, Lin, Sen, & Zhao, Ye. (2013). Reforming of Japan's long-term care insurance system and its implications. Local Finance Research(05), 75-80.

Wang, Yuhuan, Feng, Yanan, Hou, Weiwei, & Wu, Fuchen. (2013). The need for long-term care of the elderly who supported the development of Xinjiang and their care provider.

Chinese General Practice(14), 1268-1273.

106

Wengler, A. (2011). The health status of first- and second-generation Turkish immigrants in Germany. Int J Public Health, 56(5), 493-501. doi: 10.1007/s00038-011-0254-8

Wolfe, C. D., Crichton, S. L., Heuschmann, P. U., McKevitt, C. J., Toschke, A. M., Grieve, A. P.,

& Rudd, A. G. (2011). Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register. PLoS Med, 8(5), e1001033. doi:

10.1371/journal.pmed.1001033

Wu, Jiang, & Chen, Haibo. (2012). The introduction of the long-term care insurance system in Netherland. Studies of Social Security(05), 102-105.

Xie, An. (2004). The status, trends and characteristics of China's population ageing. Statistical Research(08), 50-53.

Xu, Lin. (1998). Social welfare problems and the strategy in the deprived areas of China. Xi'an:

People's Press of Shanxi Province.

Yin, Shangjing. (2011). Long-term care system in the developed countries. China Medical Herald(29), 156-157+159.

Yin, Shangjing, & Du, Peng. (2012). The need for long-term care of the elderly and its trend in China. Population Journal(02), 49-56.

Zhang, Kaiti. (2011). Who will care the disabled elderly? Social Work in China(11), 26-27.

Zhang, Kaiti, Sun, Lujun, Mou, Xinyu, Wang, Haitao, & Li, Mingzhen. (2011). The disabled elderly in the urban and rural areas of China Disablity Research(02), 11-16.

107