This study shows that there are 861 people (82.79%) living at home who can live independently in Ningxia, China. In addition, there are 179 people (17.21%) who are completely or partially unable to live independently. According to a survey on ADL abilities in older adults living in other regions of China, 8% of the older adults living in Guangdong, Shanghai, Shanxi, Hubei, and Heilongjiang provinces cannot live independently . A study investigating the ADL abilities of older adults living in Beijing, China found that 87.9% of them can live independently . According to a survey conducted by the National Committee on aging, the number of older adults who live independently in urban areas in China is 85.40%, and in rural areas, it is 79.00%. Therefore, compared with the national average or that of other regions in China, the number of ADL limitations of older adults in Ningxia is greater . At present, the aging population in Ningxia is increasing. At the end of 2018, the number of individuals aged 60 and over was 945,500, accounting for 13.74% of the total population . With the increasing number of older adults and the impact of diseases, the number of disabled older adults will also increase, and the number of ADL limitations will continue to increase. This finding reminds us to address the level of ability to perform ADL by older adults, especially older adults living at home, and to address the daily needs of the disabled older adults. With the gradual increase of disabled older adults in Ningxia, the implementation of related disability insurance policies, such as long-term care insurance, can provide assistance to a large number of disabled older adults. The government should formulate assessment and judgment criteria for measuring the incapacity of older adults in Ningxia Hui Autonomous Region as soon as possible and formulate corresponding subsidy policies. Such policies could alleviate the huge economic and care burden brought by disabled older adults in Ningxia.
The factors associating with ADL performance in the older adults are complex. The individual’s natural attributes, living environment, economic status, disease status, and injury status are the main factors affecting ADL performance in older adults . The results of this study show that one’s age, ethnicity, educational level, economic situation, marriage status, and whether one has a disease are all factors associating with their ability to perform ADL independently.
Several studies have shown that older adults’ ability to perform ADL is negatively correlated with age. The older the individual is, the lower the ability to perform ADL. In addition, the rate of decline in the ability to perform ADL increases with age [26, 27]. The survey also found that the proportion of individuals over 80 years old with ADL difficulty was significantly higher than that of individuals who were 60–79 years old, and the difference was statistically significant (P < 0.001). With an increase in age, the functions of the older adults gradually decline, and problems associated with comorbidities also appear. The ability to perform ADL also decreases rapidly, and the proportion of individuals with disabilities increases. Therefore, age is associated with older adults’ ability to perform ADLs. The pension policy, such as a long-term care insurance system, should focus on the disability of older adults, especially disability assessments and subsidies for older adults over 80 years old. For older adults over 80 years old, community workers should also conduct disability assessments and functional maintenance exercises on time. Once an individual becomes incapacitated, life care and financial subsidies should be carried out in time.
Ningxia Hui Autonomous Region is a place where many ethnic groups live together, including Han, Hui, Uygur, Dongxiang, Kazak, Salar, and Baoan individuals. This study found that ethnicity is associated with ADL performance in older adults. The ADL performance of members of the Han nationality is better than that of ethnic minorities, and the risk of ADL limitations in members of the Han nationality is much lower than that of ethnic minorities. This result is related to the living environment of ethnic minorities in Ningxia. Many ethnic minority older adults live in relatively remote or rural areas, and they do not have pension insurance . They are unable to obtain good health care and endowment insurance. Insurance similar to the long-term care insurance system can provide basic protection for ethnic minority older adults when they are disabled. For older ethnic minorities, regular ADL performance assessments should become one of the works of community workers to provide them with timely help.
In addition, the level of education and economic status was also associated with the ADL performance of older adults living at home. The higher the level of education is, the better the ADL performance of the older adults. According to the results of this study, older adults who have received an education have a lower risk of ADL limitations than those who are illiterate. The risk of ADL disability is increasing among older adults with a low socioeconomic status. An older adult follow-up survey in Taiwan, China showed that there was a negative correlation between social class and ADL performance after controlling for the level of education . The results of this study also show that the ADL performance of older adults with good economic conditions is significantly higher than that of older adults with poor economic conditions. It may be that well-educated and high-income older adults have a higher capacity and more resources to deal with a disability. In addition, they are less likely to be severely disabled than those with a low level of education and low income. Older adults with poor economic status are often lacking support from a social health care system or can obtain only limited medical resources. Therefore, for older adults with low income and education levels, the long-term care insurance system should provide more subsidies. After the disability assessment of older adults living at home, financial subsidies are provided according to the disability level and economic status of older adults.
The study also found that older adults with spouses have better ADL performance than those without spouses. Most older adults with spouses can support each other and help each other to achieve self-care. In this study, there were 789 older adults (84.29%) who had a disease and could live independently, and only 72 people (69.23%) were in good physical health and could live independently. Studies have found that chronic diseases, such as diabetes, cataracts, strokes, and bronchial diseases, are the leading causes of the decline in ADL in the older adults in China. Alzheimer’s disease is also one of the severe diseases affecting the ADL performance of older adults . The results of this study are inconsistent with the results of previous studies. It may be that more older adults with diseases than older adults without diseases participated in the survey. Therefore, we conducted a multivariate analysis. The results showed that the risk of ADL limitations in older adults with a disease was higher than that of those without the disease. This result is consistent with previous research conclusions. A variety of diseases leading to declines in sensory function, including vision, hearing, swallowing ability, or physical disabilities, in older adults can cause a severe decline in ADL performance, hindering older adults living at home from living independently. It is recommended that Ningxia accelerate the establishment of a long-term pension insurance system to include family members in paying caregivers to reduce the pension burden of the whole society .
This study does have some limitations. Due to resource and time constraints, this study did not investigate the current status of ADL performance in older adults in all cities in Ningxia. Only three cities were selected for investigation. A more comprehensive survey will be conducted in future research to complement the findings of this study.