Determinants of Future Care Preparation Among Community-Dwelling Older Adults with Chronic Diseases: A Mixed-Method Study

Background: The global population is aging rapidly, leading to a surge in older adults with chronic diseases and an increasing demand for geriatric care services. Future care preparation is a proactive coping strategy aimed at pre-allocating care resources. However, a significant proportion of older adults do not engage in care preparation, underscoring the importance of bolstering care planning efforts and comprehensively understanding the contributing factors among community-dwelling older adults. This study aimed to explore the status and influencing factors of preparation for future care among community-dwelling older adults diagnosed with chronic diseases. Methods: A convergent mixed-method design was employed from May 2024 to July 2024. The sample consisted of older adults with chronic diseases recruited from five community hospitals in Zhejiang Province, China. Quantitative data were analyzed using t-tests, one-way ANOVA, multiple linear regression, and network analysis to identify key factors and their strengths of association in the network related to preparation for future care. Deductive thematic analysis was used to analyze the interview data. Triangulation was conducted to identify the multiple factors influencing preparation for future care. Results: A total of 362 older adults participated in the quantitative study, and 16 older adults participated in the qualitative study. Multiple linear regressions indicated that participants who were older age, with fewer adult children, more chronic diseases, lower health literacy, higher resilience, and greater availability of chronic illness resources were associated with better overall preparation for future care. In network analysis, chronic illness resources demonstrated the strongest positive relationships with preparation for future care. The qualitative analysis identified six main themes, including the influence of traditional culture and family structure, the effects of long-term care resources, the impact of socioeconomic status, the significance of family relationships and social interaction, the influence of health status and mobility, and the role of mental health. Through triangulation, three meta-themes and nine meta-subthemes were identified as multidimensional factors influencing preparation for future care. These included predisposing factors (beliefs in filial piety, family structure, age, and health literacy), enabling factors (access to care resources, economic status, and social support), and need factors (physical health and mental health). Discussions: Devising strategies is essential to address older individuals' beliefs regarding future care preparation, disease management, and psychological adjustment. Encouraging proactive conversations about future care within families, providing family support, and enhancing care resources through healthcare providers are crucial steps in supporting older adults in preparing for their future care needs.