Aging Population Research Articles

Health care expenditure, economic growth, and population ageing in Japan: empirical evidence using the nonlinear ARDL approach

ABSTRACT In Japan, health care expenditure (HCE) has increased with the rapid ageing of the population. It raises concerns on how the public health care insurance system should be sustained in the future, since the dependence on public burdens is growing under the government’s difficult financial conditions. This study investigates the cointegration relationship between HCE, GDP, and the population ageing rate (AGE) in Japan for the period 1960–2019 by using the nonlinear ARDL approach. The results revealed that per capita HCE may increase more significantly during an economic downturn than during an economic improvement in the long-run. Moreover, an increase in AGE has a positive effect on per capita HCE. These findings show the need to achieve stable economic growth and seriously address the issue of ageing for policymakers in Japan.

Adaptations of the work environment facilitating the professional activity of seniors

Analysis of demographic trends indicates that there is an increasing proportion of people who can be described as elderly. In Poland, the population aged >60 years is expected to increase to 10.8 million in 2030 and to 13.7 million in 2050, i.e., around 40% of total population. In line with the general trend, the issue of the aging of the professionally active population is becoming more relevant. The average age of the world's working population is steadily increasing. In the European Union, workers aged 55-64 years accounted for 50% of the total workforce in 2013, and already 59% in 2018. In Poland, in 2018, people aged 55-64 years accounted for 49% of the employed population. The low percentage of people working at this age is due, among other things, to employers' attitudes towards employing older people, perceiving them as employees who are more difficult to manage and have health problems. Moreover, working conditions of seniors are not adapted to their age capabilities. It is necessary to reduce the burden of physical work, especially in awkward positions, carrying loads, monotonous work and piecework. It is important to create work organization in which it is possible to refer to the experience of older people, who should have freedom of action, without time pressure and the need to perform many tasks at the same time. The ever-increasing social dependence on information technology tools creates new problems for seniors. Taking into account age-related difficulties in acquiring new knowledge, it is important to provide them with simplified tools that are easier to use. The scope of necessary actions to enable the aging population to work is very wide, ranging from legislative, technological and organizational changes, ending with education addressed both to people responsible for employee safety (including occupational health services) and to current and potential employees. Med Pr Work Health Saf. 2024;75(3).

Promoting active mobility in old age through urban design

In an ageing society, maintaining independent mobility into old age is an important objective. Mental and physical wellbeing depends not only on individual health status, but also to alarge extent on the spatial conditions. Local politics and municipal administrations can influence this, especially in urban planning. This discussion article brings together perspectives from public health and urban planning on urban development and mobility against the background of health equity.The results of the AFOOT (Securing urban mobility of an ageing population) cross-sectional study on socio-spatial conditions in small- and medium-sized towns in northwestern Germany and walking and cycling by older people show the importance of residential environmental factors such as proximity to everyday destinations, walking and cycling infrastructure, and street connectivity. Preferences for the design of an age-friendly living environment and the quality of public spaces exist in terms of urban design quality, quality of stay, and safety in public spaces.In order to improve spatial conditions, the situation needs to be recorded using defined indicators and monitoring, and the perspectives of older people need to be integrated. Strategies and measures to promote active mobility in old age are aimed at the multifunctional design of public spaces, the prioritization of active mobility on everyday trips, and ensuring the accessibility of everyday destinations through urban development. Cross-sectoral cooperation between urban planning, transport planning, and public health is essential to promote the active mobility and health of older people.

Frequent Alzheimer’s disease neuropathological change in patients with glioblastoma

Abstract Background The incidence of brain cancer and neurodegenerative diseases is increasing with a demographic shift towards aging populations. Biological parallels have been observed between glioblastoma and Alzheimer’s disease (AD), which converge on accelerated brain aging. Here, we aimed to map the co-occurrence of AD neuropathological change (ADNC) in the tumor-adjacent cortex of patients with glioblastoma. Methods Immunohistochemical screening of AD markers amyloid beta (Abeta), amyloid precursor protein (APP) and hyperphosphorylated tau (pTau) was conducted in 420 tumor samples of 205 patients. For each cortex area we quantified ADNC, neurons, tumor cells, and microglia. Results Fifty-two percent of patients (N=106/205) showed ADNC (Abeta and pTau, Abeta or pTau) in the tumor-adjacent cortex, with histological patterns widely consistent with AD. ADNC was positively correlated with patient age and varied spatially according to Thal phases and Braak stages. It decreased with increasing tumor cell infiltration (p<0.0001) and was independent from frequent expression of APP in neuronal cell bodies (N=182/205) and in tumor necrosis-related axonal spheroids (N=195/205; p=0.46). Microglia response was most present in tumor cell infiltration plus ADNC, being further modulated by patient age and sex. ADNC did not impact patient survival in the present cohort. Conclusion Our findings highlight frequent presence of ADNC in the glioblastoma vicinity, which was linked to patient age and tumor location. The co-occurrence of AD and glioblastoma seemed stochastic without clear spatial relation. ADNC did not impact patient survival in our cohort.

Labor market trends and the need for reengineering higher education

The dynamics of the labor market have changed considerably and are currently experiencing a major shift. The skill levels that used to be enough in the workplace have become inadequate for the current workplace requirements. At least in the case of the United States, the kind of jobs that allowed work from home during the pandemic typically required college education; this may be a silver lining for colleges. Coupled with this, the admission test optional policies opened the doors of colleges for many otherwise disadvantaged students. The life cycle duration of technical skills has become shorter than ever before. Issues in innovation, demographic shifts, socio-cultural issues, aging population and technological advances are driving educators, employers, and policy makers to re-examine higher education to address the skill gaps currently existing in the workplace. This paper brainstorms some of these topics and propose solutions for policy makers.

Renal and patient outcomes of emergency hemodialysis in elderly individuals: a retrospective cohort study.

The aging population, commonly defined as individuals aged 65 and above, faces an increased risk of kidney-related diseases. This study investigates emergency dialysis in the elderly population, focusing on indications, clinical and laboratory findings, renal status, and mortality rates. The data of 442 elderly patients (≥ 65years old) who underwent emergency dialysis at a tertiary university hospital were retrospectively examined. Demographics, comorbidities, emergency dialysis indications, clinical presentation, method, complications, pre/post-dialysis status, and follow-up were assessed. 74.9% of the patients had a history of chronic kidney disease (CKD). Emergency dialysis was mainly initiated due to hypervolemia (43.7%) and uremic symptoms (29.2%). Hypotension was the most common dialysis-related complication (34.4%). The mortality rate was 34.6%; among the survivors, 15.2% achieved complete renal recovery, while 32.5% and 52.3% developed dialysis-independent and -dependent CKD, respectively. In multivariate analysis, blood urea, serum sodium, mean arterial pressure, dyspnea, tachypnea, and tachycardia on admission were found to be associated with mortality. Our study provides insights into emergency dialysis challenges in the elderly population, emphasizing the need for personalized interventions and further research to improve care and outcomes in this growing demographic.

Non-Invasive Sensors Integration for NCDs with AIoT Based Telemedicine System

Thailand’s hospitals face overcrowding, particularly with non-communicable disease (NCD) patients, due to a doctor shortage and an aging population. Most literature showed implementation merely on web or mobile application to teleconsult with physicians. Instead, in this work, we developed and implemented a telemedicine health kiosk system embedded with non-invasive biosensors and time-series predictors to improve NCD indicators over an eight-month period. Two cohorts were randomly selected: a control group with usual care and a telemedicine-using group. The telemedicine-using group showed significant improvements in average fasting blood glucose (148 to 130 mg/dL) and systolic blood pressure (152 to 138 mmHg). Data mining with the Apriori algorithm revealed correlations between diseases, occupations, and environmental factors, informing public health policies. Communication between kiosks and servers used LoRa, 5G, and IEEE802.11, which are selected based on the distance and signal availability. The results support telemedicine kiosks as effective for NCD management, significantly improving key NCD indicators, average blood glucose, and blood pressure.

Postoperative use of sleep aids and delirium in older adults after major surgery: A retrospective cohort study.

Sleep aids are commonly prescribed to treat sleep disturbance, a modifiable risk factor for postoperative delirium in older patients. The use of melatonin receptor agonists in the postoperative period has been increasing. The comparative safety of melatonin receptor agonists, zolpidem, and temazepam remains uncertain. This retrospective study included 22,083 patients ≥65 years old who initiated melatonin receptor agonists, zolpidem, or temazepam after major surgery in the Premier Healthcare Database 2009-2018. We performed propensity score-based overlap weighting and estimated the risk ratio (RR) and risk difference (RD) of postoperative delirium as the primary outcome and a composite of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality as secondary outcomes. The mean age of the study population was 78 (SD, 7) years and 50% were female. There was no significant difference in the risk of postoperative delirium among patients treated with melatonin receptor agonists (3.4%, reference group), zolpidem (2.9%; RR [95% CI], 0.9 [0.7-1.2]; RD [95% CI] per 100 persons, -0.3 [-1.1 to 0.6]), and temazepam (3.1%; 0.9 [0.7-1.1]; RD [95% CI] per 100 persons, -0.5 [-1.2 to 0.3]). The risks of delirium or new antipsychotic initiation, pneumonia, and in-hospital mortality were also similar among all groups. Melatonin receptor agonists were not associated with a lower risk of postoperative delirium and other adverse outcomes compared with zolpidem and temazepam in older adults after major surgery.

Associations of hypertension, diabetes and heart disease risk with body mass index in older Chinese adults: a population-based cohort study

ObjectiveObesity is a well-established risk factor for disease. Controversy exists regarding the relative risk of morbidity and mortality in individuals who are overweight or underweight compared with individuals with a...

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study

BackgroundIndia is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population.MethodsA community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person.ResultsThe prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02–1.09). Physical inactivity (AOR 1.68, 95% CI 1.027–2.77) and lack of social support (AOR 1.57, 95% CI 1.01–2.45) also increased the likelihood of multimorbidity.ConclusionThere is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Enhancing clinical service design for multimorbidity management: A comprehensive approach to joined-up care for diabetes, chronic kidney disease, and heart failure.

Multimorbidity is becoming the norm rather than the exception, especially among the ageing population and people with lower socio-economic status. In addition to the rising healthcare cost, multimorbidity poses considerable difficulty in the delivery of adequate holistic care for affected patients. This review presents a discussion of the current barriers to delivering holistic care to people with multimorbidity and proposes a model of clinical care for people living with cardiovascular-kidney-metabolic (CKM) syndrome as an exemplar of a multimorbidity cluster. Single organ/disease services may not be able to provide optimum care to people with multimorbidity due to the potential complex interactions between multiple disease symptoms and management. In addition, people with multimorbidity may be required to attend multiple appointments in different healthcare centres. This may negatively impact access to services due to time and financial burden. Other barriers include co-ordinating communication between healthcare professionals and reduced continuity of care. Optimising CKM health requires patient-centred care led by an interdisciplinary care team who ideally should possess CKM competencies utilising a shared care protocol to coordinate evidence-based care and use of telehealth to empower patients. Stakeholders and policymakers need to adapt new policy models to establish and enhance CKM care models by allocating funds and implementing frameworks for educational reforms. A CKM service has the potential to increase the uptake of cardiac and renal protective medications as well as optimising metabolic care, increase capacity in both primary and secondary care, improve quality of life and clinical outcomes, reduce patient inconvenience, and importantly allow rapid translation of advances in cardiorenal metabolic diseases into clinical practice.

Emotion expressions and cognitive impairments in the elderly: review of the contactless detection approach

The aging population in Canada has been increasing continuously throughout the past decades. Amongst this demographic, around 11% suffer from some form of cognitive decline. While diagnosis through traditional means (i.e., Magnetic Resonance Imagings (MRIs), positron emission tomography (PET) scans, cognitive assessments, etc.) has been successful at detecting this decline, there remains unexplored measures of cognitive health that could reduce stress and cost for the elderly population, including approaches for early detection and preventive methods. Such efforts could additionally contribute to reducing the pressure and stress on the Canadian healthcare system, as well as improve the quality of life of the elderly population. Previous evidence has demonstrated emotional facial expressions being altered in individuals with various cognitive conditions such as dementias, mild cognitive impairment, and geriatric depression. This review highlights the commonalities among these cognitive health conditions, and research behind the contactless assessment methods to monitor the health and cognitive well-being of the elderly population through emotion expression. The contactless detection approach covered by this review includes automated facial expression analysis (AFEA), electroencephalogram (EEG) technologies and heart rate variability (HRV). In conclusion, a discussion of the potentials of the existing technologies and future direction of a novel assessment design through fusion of AFEA, EEG and HRV measures to increase detection of cognitive decline in a contactless and remote manner will be presented.

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Personalized starting age of gastric cancer screening based on individuals' risk profiles: a population-based prospective study.

The current recommended starting age for gastric cancer (GC) lacks unified guideline and individualized criteria. We aimed to determine risk-stratified starting age for GC screening in China based on individuals' risk profiles, and develop an online calculator for clinical application. In this multi-center population-based prospective study, we divided participants enrolled during 2015-2017 (n = 59,771, aged 40-69) into screened and unscreened groups and observed them for primary endpoints-GC occurrence, all-cause and GC-specific deaths. The median follow-up was 6.07 years. To determine the reference starting age, the effectiveness of GC screening was assessed by age-groups after propensity-score-matching. Further, we categorized the calculated individual risk scores (using well-established risk factors) by quantiles. Subsequently, we used age-specific 10-year cumulative risk curves to estimate the risk-stratified starting age-when the individual's risk level matches reference starting age risk threshold. During follow-up, 475 GC cases, 182 GC deaths and 1,860 all-cause deaths occurred. All-cause and GC-specific mortality decreased among screened individuals aged ≥45 and 50-59 years, respectively. Thus, the average population (reference) starting age was set as 50 years. The 10-year cumulative risk of GC in average population aged 50 was 1.147%. We stratified the starting age using eight risk factors, and categorized participants as low-, medium-, and high-risk individuals, whose risk-stratified starting age was 58, 50, and 46, respectively. While high-risk individuals warrant 3-5 years earlier GC screening than average population (age 50), low-risk individuals can tolerate delayed screening. Our online, personalized starting-age calculator will help risk-adapted GC screening (https://web.consultech.com.cn/gastric/#/).

Bridging the Digital Divide: The Collision and Integration of Media Intelligence and Age-friendliness in the Context of Aging

With the aging of the global population, the integration between media intelligence and age-friendliness becomes particularly important. Media intelligence, through technological means such as big data and cloud computing, enables personalized contents delivery and intelligent interaction. However, these advanced technologies often deviate from the usage habits and needs of the elderly. Older people may be unskilled in using smart devices, feel overwhelmed by information overload, and have concerns about privacy protection. Therefore, it is necessary to find a balance point in the collision between media intelligence and through technological means such as big data and cloud computing so that media intelligence can better serve the elderly. This paper aims to explore the collision and integration of media intelligence and age-friendliness in the context of aging and proposes corresponding strategies to bridge the digital divide.

Identifying critical age and gender-based metabolomic shifts in a Japanese population of the Tohoku Medical Megabank cohort

Understanding the physiological changes associated with aging and the associated disease risks is essential to establish biomarkers as indicators of biological aging. This study used the NMR-measured plasma metabolome to calculate age-specific metabolite indices. In doing so, the scope of the study was deliberately simplified to capture general trends and insights into age-related changes in metabolic patterns. In addition, changes in metabolite concentrations with age were examined in detail, with the period from 55–59 to 60–64 years being a period of significant metabolic change, particularly in men, and from 45–49 to 50–54 years in females. These results illustrate the different variations in metabolite concentrations by sex and provide new insights into the relationship between age and metabolic diseases.

The relation between MIND diet with odds of attention-deficit/hyperactivity disorder in Iranian children: a case-control study

ABSTRACT This study aims to investigate the association between the MIND index (Mediterranean- Dietary approaches to Stop Hypertension diet Intervention for Neurodegenerative Delay) and attention-deficit hyperactivity disorder (ADHD) in the Iranian children. It builds upon existing research that highlights the role of dietary antioxidants in alleviating psychological disorders, cognitive impairments, and memory deficits. Additionally, previous studies have separately explored the beneficial effects of the Mediterranean and DASH diets on these issues. A case-control study was undertaken in Iran, involving a sample of 360 children and adolescents aged 7–13 years. Participants were divided into two groups, namely the case group (n = 120) and the control group (n = 240), with age and sex being matched between the groups. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) was employed for the diagnosis of ADHD. The MIND diet score was computed using the food intake data acquired from the Food Frequency Questionnaire (FFQ) completed by the subjects. The mean ± SD for the age and BMI of the study population was 8.76 ± 1.64 years and 16.90 ± 3.58 kg/m2, respectively. The mean score of MIND in this study was 27.93. After adjustment for potential confounder in the final model, subjects in highest compared to the lowest quartile of MIND diet score had significantly lower odds of ADHD (OR = 0.59, 95% CI 0.37–0.83; P-trend = 0.019). This study provides valuable evidence suggesting that adherence to the MIND diet is associated with decreased odds of ADHD.

Motivations Influencing Relocation to the Suburbs: The Case of Izmir

The ongoing urbanization trend has led to various challenges including environmental degradation, and decreased welfare among city dwellers. While economic factors have historically been the primary driver of urban migration, recent research suggests that unplanned urbanization and the problems it brings such as decreased green spaces, traffic congestion and air pollution are gaining significance. As a result, a group of people has been relocating from urban to suburban areas, seeking an improved standard of living. This shift reflects a complex interplay of factors including demographic, socioeconomic, and sociocultural shifts. Since the onset of the COVID-19 pandemic, there has been an increased interest in suburban areas due to remote work opportunities and concerns about urban living conditions. This study examines motivations for suburban living in Izmir, Turkey, focusing on Villakent neighbourhood. Through surveys and interviews with residents, it explores demographic characteristics and reasons for choosing suburban life. The research is based on the results of a sample of 123 participants of a survey questionnaire and 15 in-depth interviews. Findings have indicated that the participants’ desire to live in a house with a garden and the discomforting crowds in the city centers were the important factors in suburban relocation. In interviews, it was also revealed that the affordability of housing in the suburbs compared to city centers is also an important factor in choosing to settle in the suburbs. Additionally, the COVID-19 pandemic has had an impact on suburban relocation, and the earthquake risk in Izmir has also increased people's desire to move away from city centers. In the interviews, the preference for Villakent was discussed along with its positive and negative aspects in detail. Policymakers must consider these insights to address urban challenges and promote sustainable urban development.

Social Participation and Loneliness in Older Adults in a Rural Australian Context: Individual and Organizational Perspectives

A rise in aging populations globally calls attention to factors that influence the well-being and health of older adults, including social participation. In Australia, rural older adults face cultural, social, and physical challenges that place them at risk for isolation. Thus, research surrounding social participation and healthy aging is increasingly relevant, especially in rural areas. This qualitative study in a remote town in Western Australia explores barriers and facilitators to older adults’ social participation. To investigate multiple perspectives, 23 adults aged 50+ and 19 organizations from a rural town were interviewed. A stakeholder reference group was engaged to refine the research design and validate the findings. Feedback from early interviews was used to refine the data collection process, thus enhancing the validity of the findings. Thematic analysis showed that health and mobility issues, inadequate infrastructure, poor sustainability, and cultural tensions commonly impacted social participation. Themes of rural town culture, cultural power dynamics, and rural stoicism were identified as cultural aspects that inhibited participation. Based on results of this study and the supporting literature, recommendations for inclusive activities include supporting community-designed programs, utilizing culturally sensitive language and personnel, expanding services using existing community resources, and diversifying older adults’ roles in existing groups.

Effect of combined physical–cognitive training on the functional and cognitive capacity of older people with mild cognitive impairment: a randomized controlled trial

BackgroundThe increase in population aging highlights the growing prevalence of mild cognitive impairment, prompting the adoption of interventions that combine physical exercise and cognitive training to improve health and cognitive performance in older adults. The aim of this study was to analyze the efficacy of a combined program on physical and cognitive health in older people with cognitive impairment.MethodsA 12-week randomized controlled clinical trial involving 95 participants (aged 72.12 ± 4.25 years), 47 individuals participated in a control group (CG) that only underwent cognitive stimulation, while 48 individuals were in an experimental group (EG) that participated in a combined program. Balance was measured using the Tinetti scale, upper body strength was assessed with the arm curl test, lower body strength was evaluated with the 30-s chair stand test, flexibility was tested using the back scratch test and chair sit-and-reach test, physical function was measured with the Timed Up and Go test, cognitive function was assessed using the Mini Mental State Examination, cognitive impairment was evaluated with the Montreal Cognitive Assessment, verbal fluency was tested with the Isaac test, and executive functions were assessed using the Trail Making Test.ResultsThe results of the study show significant improvements in both physical and cognitive aspects, such as balance, gait, upper and lower body strength, flexibility, physical function, cognitive function, cognitive impairment, verbal fluency, and executive functions in the group that carried out the intervention compared to the control group.ConclusionA combined program for older individuals with mild cognitive impairment leads to enhancements in physical and cognitive health. These improvements underscore the importance of integrating physical exercise with cognitive training as an effective strategy for enhancing overall health and quality of life in older adults.Trial registrationNCT05503641.