Associations between community-based integrated care services and disability trajectories of older adults: Evidence from China

With the rapid development of community-based integrated care services (CBICSs) globally, many studies have demonstrated their role in improving the health of older adults. However, few studies have focused on associations between CBICSs and disability trajectories of older adults. To this end, using eight waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, this study utilized a mortality-adjusted Group-Based Trajectory Model (GBTM) to identify activities of daily living (ADL) and cognitive trajectories among older adults in China, employed multinomial logistic regression to explore associations between CBICSs and disability trajectories, and examined home care and living areas as effect modifiers of these associations. This study identified three ADL trajectories: Group 1 ("stable throughout life", 31.89 %), Group 2 ("risky in later life", 44.68 %), and Group 3 ("high-risk", 23.43 %); and two cognitive trajectories: Group 1 ("stable throughout life", 48.36 %) and Group 2 ("high-risk", 51.64 %) among older adults. The findings suggested that older adults with CBICSs were more likely to be in the favorable ADL and cognitive trajectories. Heterogeneity analysis identified significant effect modification by home care, but no such effect was observed for living areas. These results provide important implications for policymakers and practitioners to promote the development of CBICSs and improve older adults' health.