ABSTRACT Previous studies have not amply explored the next move of older adults currently spending their retirement abroad. This paper examined the future migration decisions of East Asian retirees in the last stage of life marked by frailty, dependency, and abjection (i.e. the fourth age). A survey of Chinese and Japanese retirees in Thailand (n = 204) was conducted during 2019–2021. Binary logistic regression analysis indicated that age, income, religion, residence, Thai spouse/partner, and property at origin were significantly associated with future migration decisions (p < .05). Future research and policymaking should enhance Thailand’s capacity to facilitate fourth age living.

ABSTRACT With population aging, governments have become increasingly involved in the administration, funding, and regulation of formal long-term care (LTC) systems. We examine the association between institutional trust and formal LTC service utilization among older adults aged ≥60 years with care needs in South Korea’s public LTC scheme. Using data from the Korean Longitudinal Study of Aging and hierarchical logistic regressions, we evaluate the respective roles of trust in government and trust in the LTC program on service utilization. Results show that trust in the LTC scheme is significantly associated with service utilization: a unit increase in the level of trust is associated with a 29% increase in the odds of service use on average, controlling for need-related factors (e.g., chronic conditions) and other covariates. Furthermore, the positive relationship between trust and LTC utilization increases in magnitude with age. Older adults who are aged 80 and above, unmarried, with more ADL limitations, with psychiatric disease, or with arthritis are more likely to utilize formal LTC services. Our findings are robust to variations in sample inclusion criteria. Policymakers and health administrators should pay attention to building and maintaining institutional trust in public LTC schemes through good governance and other relevant strategies.

ABSTRACT Hip fractures, strokes, and heart attacks are common acute health events that can lead to long-term disability, care utilization, and unmet needs. However, such impacts, especially in the long term, are not fully understood. Using data from the Health and Retirement Study, 1992–2018, this study examines the long-term trajectories of individuals suffering such health shocks, comparing with individuals not experiencing health shocks. Hip fracture, stroke, and heart attack are confirmed to have severe implications for disability. In most cases of stroke and heart attack, informal caregivers provide the daily support needed by survivors, whereas following hip fracture, nursing home care is more relevant. These health shocks put individuals on worse trajectories of disability, care utilization, and unmet needs. There is no long-term recovery or convergence with individuals who do not suffer shocks. Unmet need is prevalent, even pre-shock and among individuals who do not experience health shocks, emphasizing the importance of preventative care measures. These findings support policy action to ensure hospitalized individuals, especially those aged 50 and above, receive rehabilitative services and other post-acute care. Furthermore, hospitalization is an event that requires the detection and addressing of unmet care needs beyond the short run.

ABSTRACT Nursing homes receive complaints when actual care provided to residents misaligns with desired care, suggesting that person-centered care (PCC) and honoring resident preferences in care delivery may help prevent complaints from arising. We explore whether nursing home implementation of a PCC tool, the Preferences for Everyday Living Inventory (PELI), is related to measures of complaints. Publicly available data on Ohio nursing homes was used to examine 1,339 nursing home-year observations. Regression techniques were used to evaluate the relationship between the extent of PELI implementation and four complaint outcomes: any complaint, number of complaints, any substantiated complaint, and number of substantiated complaints. Nursing homes with complete PELI implementation were less likely to have any complaints by 4.7% points (P < .05) and any substantiated complaints by 11.5% points (P < .001) as compared to partial PELI implementers. When complete PELI implementers did have complaints, they were fewer than partial PELI implementers. Complete PELI implementers were not immune from receiving complaints; however, the complaints they did receive were fewer in number and less likely to be substantiated as compared to communities who only partially implemented a PCC tool.

ABSTRACT Evidence suggests that enrollment in a health insurance scheme is associated with higher levels of formal healthcare utilization among older adults, especially those with low income in sub-Saharan Africa (SSA), including Ghana. This study examines the prevalence of formal healthcare utilization and associated factors among older adults with low income and health insurance subscription enrolled in a social intervention program (known as the Livelihood Empowerment Against Poverty [LEAP] program) in Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted in 2018 among 200 older adults aged 65 years and above enrolled in the LEAP program. The results showed that almost 9 in 10 (87%) older adults utilized formal healthcare services for their health problems. Older adults who received family support, rated themselves to be physically active and had non-communicable diseases (NCDs) were more significantly likely to utilise formal health care services than their counter parts. We recommend that health policies and programs for older adults with low income and health insurance subscription under the LEAP program should consider the roles of family support, physical activeness and NCDs in influencing their use of formal healthcare services.

ABSTRACT Despite major restrictions on economic activity due to the first lockdown starting in March 2020, public financial support helped to limit the financial consequences of the COVID-19 pandemic in Germany. However, certain groups were more affected than others. Most significantly, people in the lowest income quintile were more affected than those who had higher levels of income prior to the pandemic. Although this aspect has also been analyzed in other studies, less is known about how income shocks affected living standards. In the present manuscript we combine descriptive and multivariate analysis in order to analyze changes in household income for people over the age of 45 years and changes in living standards for those who report negative changes in income. Results indicate that people over the age of 45 years with lower levels of income prior to the pandemic have been hit harder in terms of both lost income and the impact on their living standards. Furthermore, wealth seems to be relevant as a means of avoiding a drop in living standards in the event of a negative income shock. Results also indicate that by the end of 2020 and beginning of 2021 there is a recovery in living standards to pre-COVID levels. These results show the relevance of focusing on the needs of the most vulnerable groups when defining public financial support in times of crisis.

ABSTRACT As population aging continues to become a major demographic trend globally, it is essential to examine the demographic shifts at the micro-level to understand the changing scenario of older populations. A lack of adequate data in India on older populations is a hindrance to the government’s efforts to provide social security for them. This study uses gridded population data to analyze the spatial patterns, micro-level trends, and the share of older populations in India for 2030 and 2040. The study’s findings demonstrate that India has seen a dramatic shift in population aging trends, with large intra-state variability. The micro-level analysis shows that certain districts have a higher percentage of older people. Further, the share of older populations is predicted to rise considerably over the next two decades. The results highlight the need to shift from national and state-level policies to a more localized approach. The findings provide a comprehensive analysis of population aging at the micro-level in India and highlight the need for targeted policies and programs to ensure the well-being of older populations. The results of this study can inform policymakers in their efforts to provide social security for older people and improve their quality of life.

ABSTRACT Comparative adult guardianship law and other alternatives, especially in an Asian context, is an under-investigated area. This paper attempts to fill the gap in the literature by comparing the adult guardianship law and other alternatives from the perspectives of Singapore and Japan. The central argument of this paper is that in order for the law of adult guardianship to be widely adopted in Asian societies like Singapore and Japan - where much of adult guardianship related issues are governed by informal familial arrangements; this would require governments to do more than the mere enacting of adult guardianship legislation. To encourage widespread adoption, governments must embark on a robust public awareness campaign to promote the adult guardianship scheme, provide institutional support, and simplify the process for people wishing to sign up to the scheme and enact the appropriate safeguards against abuse. Such conditions are present in Singapore, whereas in Japan, these are lacking which explains the lower take-up rate with Japanese people preferring informal arrangements. Another key difference between Singapore and Japan is that the former relies primarily on family and relatives to act as adult guardians, while the court in the latter jurisdiction insists on the appointment of professionals like lawyers to act as adult guardians. It is surmised that this factor explains the lower take-up rate of formal adult guardianship in Japan as compared to Singapore due to the costs involved in engaging professional guardians. This paper also explores the alternatives to adult guardianship in both systems. Alternatives to formal adult guardianship is important because there will be a substantial portion of the population of older adults who would prefer these alternatives for various reasons.

ABSTRACT This study aimed to investigate whether social participation (SP) can decrease depressive symptom severity in disabled older adults. A total of 5,937 disabled participants (4877, 1970, 219, and 8 participants responding 1, 2, 3, 4 times, respectively), obtained from the China Health and Retirement Longitudinal Study, were enrolled in our analysis. Based on pooled Ordinary Least Square regressions, SP was associated with decreased depressive symptom severity, and this association was significant in recreational activities and interacting with friends. For brain-disabled respondents, the association was not significant. SP is effective in decreasing depressive symptom severity in disabled older populations. Diversified activities and targeted interventions should be applied to specified older disabled populations to prevent depression.

ABSTRACT Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer’s disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.