Aged Care System Research Articles

Tobacco Use, Food Insecurity, and Low BMI in India’s Older Population

Background: Underweight is a prevalent condition among older adults in developing countries and poses a substantial burden on health, social, and aged-care systems. In this study, we examined the influence of tobacco use and food insecurity on the risk of being underweight among adults aged 60 or older in India. Methods: We used data from the 2017–2018 Longitudinal Aging Study in India. The sample size was 27,902 adults aged 60 years and above. We distinguished between smoking and smokeless tobacco use to examine how they may independently contribute to the outcome, while food insecurity was measured using the four-item version of the Food Insecurity Experience scale. Multivariable logistic regressions were conducted to assess the impact of tobacco use and food insecurity on the outcome. Additionally, we tested interactions between tobacco use and education, as well as between tobacco use and wealth. Results: The prevalence of underweight was 27% in the study population. Older adults who used smoking tobacco were twice more likely to be underweight than non-users (OR = 2.07, 95% CI = 1.79 to 2.40, p < 0.001), controlling for other confounders. The positive association between smokeless tobacco use and underweight was weaker but still significant (OR = 1.26, 95% CI = 1.11 to 1.42, p < 0.001). Food-insecure older adults were also more likely to be underweight (OR = 1.27, 95% CI = 1.10 to 1.48, p < 0.001). Other risk factors of underweight included males, rural residents, lower socioeconomic status (in terms of education, wealth, and caste), chewing disability, poor self-rated health, chronic lung disease, and tuberculosis. Interestingly, tobacco use moderated the relationship between wealth and underweight, such that smokers are more likely to be underweight as they become more affluent. Conclusions: Tobacco use and food insecurity have adverse implications on the nutritional status of the older persons in developing countries such as India. More targeted tobacco cessation measures and active food assistance programs for older adults are warranted to improve the overall health status of the older demographic.

OLG Model Analysis of Delayed Retirement and Social Pension Effects on Family-Based Elderly Care in China

Driven by the traditional concept of “Raising Children to Ensure Old-age Security”, China’s elderly care system has long relied on a family-centered approach, with intergenerational financial transfers (IFTs) serving as a major source of income for the elderly. However, as China’s population ages, the government’s plan to implement delayed retirement from 2025, along with pension reforms, is expected to reshape family-based eldercare and intergenerational financial dynamics. This paper employs an Overlapping Generation (OLG) model, grounded in unified growth theory, which incorporates a delayed retirement policy under the constraint of pension fund balance to examine the impact of adjusting the pension contribution rates (PCRs) and raising retirement age (RA) on IFT rates. The research findings indicate a negative correlation between RA, PCR, and IFT. Both policies have the potential to alleviate the burden on family-based eldercare. The integrated implementation of these two policies not only creates room for a phased reduction in pension contribution rates but also enables the effective utilization of senior workers’ expertise and experience.

On the Strategies and Efficiency of Care and Support Systems for Elderly Across Cantons in Switzerland

The Swiss Federal Council has formulated a policy requiring each canton to establish housing conducive to independent living during old age. Maintaining the independence of older adults at home rather than transitioning to more expensive institutional care has gained traction. This study investigates the heterogeneity of strategies arising from the autonomy granted to each canton. Using mandatory statistics from the Swiss Federal Statistical Office for 2020 on 1550 institutions for the elderly and 2546 at-home care providers, we rank the 26 cantons by permanent and temporary care and support, distinguishing between at-home and institutional care. We use univariate regressions to explain differences and perform efficiency analyses of the respective systems. We find that the French- and Italian-speaking cantons prioritise at-home care, while the German-speaking regions rely more on institutional care. The analyses reveal an inefficient stationary approach in German-speaking cantons, which often places elderly individuals with minimal care needs in institutions. Conversely, with an ambulatory approach favouring independence, cantons like Vaud and Valais prioritize counselling and at-home services, deferring entry into institutions and allowing for short convalescence stays. Our findings are relevant for governmental infrastructure planning and the property owners, investors, and property managers involved in senior housing decisions.

Research on the Current Status of Pension Models for Individuals with Mental Disorders in China

Objective: By analyzing the existing literature, this paper aims to explore the current situation of the pension model for patients with mental disorders in China and put forward corresponding suggestions for improvement. How: This study analyzes the current situation of the pension model for patients with mental disorders in China by referring to the views of experts and scholars, relevant cases and statistical data through the literature and review of CNKI. Focusing on the existing elderly care service system, policy support and social cognition, this paper reveals the main characteristics and existing problems of the current Chinese elderly care model for people with mental disabilities. By comparing the advanced pension models at home and abroad, this paper puts forward some suggestions on strengthening policy support and improving service system. Results: The research shows that China's existing pension models mainly include family care, institutional pension and community service. The main problems facing: insufficient service supply, shortage of professional talents, social cognition and discrimination. Home care is still the main way, more than 70% of people with mental disorders rely on home care, but face great pressure and challenges; The construction of institutional elderly care and community service systems is gradually developing, but there are still insufficient resources, low service quality, and uneven distribution between urban and rural areas. Policy suggestions: Strengthen the construction and improvement of community support system; Improve professional training to ensure service quality; Use scientific and technological means to assist the elderly and ease the shortage of human resources. It is suggested that we should strengthen the construction of community support system and improve the level of professional service in the future. Conclusion: In China, the mode of nursing care for patients with mental disorders is in the transition period, and family nursing is still the mainstream, but it also faces great challenges. Institutional care and community services have developed, but they are not yet sufficient to replace the role of the family. The future development direction should be multi-dimensional, forming a diversified and three-dimensional elderly care service network.

Intergenerational Support and Subjective Well-Being of Older Adults in China.

This study examines intergenerational support (IGS) and its impact on the subjective well-being of older adults in Chinese families, focusing on both upward and downward support. Data from the 2018 China Family Panel Studies show considerable mutual support between parents and children. Support from children to parents significantly improves the well-being of older adults, while support from parents to children has less impact. Contrary to expectations, the interaction between upward and downward support does not significantly affect the well-being of older adults. We categorized IGS into four family types and found that families with upward-IGS reported higher well-being than those with no IGS. Our findings underscore the central role of financial support and caregiving activities in enhancing the subjective well-being of older adults. These findings also suggest a policy recommendation for refining social eldercare systems in China to alleviate family pressures associated with eldercare responsibilities.

The attitudes and knowledge of family physicians regarding malnutrition in the elderly: a call for action

BackgroundMalnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly.MethodsBased on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years.ResultsSurveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients.ConclusionWe recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

Saparuik and Moknehi: Kinship-based Tensions in Care for Older People

This article provides information on a comparison of elderly care systems in two regions in Indonesia with different ethnicities and cultures, namely the Minangkabau in West Sumatra and the Abui of Alor. This article shows how the saparuik kinship in the Minangkabau community which is matrilineal with different customary constellations and how the patrilineal moknehi kinship in the Abui community takes care of elderly women. This paper explains the influence of caregivers’ life journey on their burdens of life. The burden of life perceived by caregivers arises from various factors. Among the various influencing factors are emotions, economy, knowledge, kinship and the right to manage inheritance. Kinship is a form of reciprocal relationship between various elements in both Minangkabau and Abui societies. In the Minangkabau ethnic group, the smallest kinship system in society is called saparuik kinship (Minang language), while the smallest kinship system in Abui is called moknehi (Abui language) which means “brother”. Paruik can be interpreted as “stomach”. While the word moknehi, which has variants in Abui such as muknehi, mokneng and motneng, likely derives from words moku “child” and neng “male”, whose meaning is equivalent to “brother, sibling”. Literally, saparuik are people who come from the same stomach or mother, while moknehi refers to people who come from the same mother and or father. People who are in saparuik are people who come from the same grandmother, while moknehi are male brothers who come from the same grandfather, who then develop into several extended families. Both extended families in paruik or moknehi consist of several nuclear families. Likewise, saparuik and moknehi consist of several extended families. The extended family in saparuik is formed in one grandmother (not a literal grandmother, the grandmother in this case is the mother of the grandmother or the grandmother of the grandmother), in one “rumah gadang”, and sharing inheritance. Otherwise, moknehi are not only formed in one grandfather, but also male great-grandfather and great-great-grandfather (male great-grandfather and great-great-grandfather in this case are father of grandfather and grandfather of grandfather), in one clan, and sharing inheritance.

Person-centred quality indicators for Australian aged care assessment services: a mixed methods study

BackgroundAged Care Assessment Teams are the assessment component of the Australian aged care system. Their purpose is to undertake needs-based assessments to determine an older person’s eligibility for, and access to Commonwealth-funded aged care services. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Quality measures have been developed and introduced in Australian residential aged care facilities. These however, have not considered the perspectives of those living in this setting. Quality measures for home care services have also been recommended.This research aims to address the gap in person-centred quality measures by asking current and future service users of aged care assessment services to vote on the importance of 24 person-centred quality indicators (PC-QIs), that were developed in a previous study using a modified Delphi method approach supported by engagement with a consumer led Advisory Board.MethodsThis mixed methods study used the RAND/UCLA Appropriateness Method to reach consensus on a final set of PC-QIs. Twenty-five community-dwelling older people in Brisbane, Australia, voted on the importance of 24 PC-QIs using a five-point Likert scale. A consensus statement for PC-QI elimination was determined prior to participants voting. Voting was undertaken with participants individually either face-to-face or via telephone, in their homes. To capture any narrative provided by participants regarding each PC-QI, participant voting sessions were audio-recorded and subsequently transcribed verbatim.Quantitative data from participant votes for each PC-QI were calculated and statistically described by median, interquartile range, consensus met, percentile, percentile rank, rank order, median and standard deviation. PC-QIs were then assessed against the consensus statement for elimination and rank ordered according to importance to participants. Content analysis of qualitative data from audio transcriptions was conducted to determine the presence of certain words supporting participant votes for each PC-QI.ResultsNo PC-QIs were eliminated during voting. Variation existed among participants’ ratings of importance for each PC-QI. Final quality domains, their respective title, quality indicator descriptor and supporting qualitative data are presented. Five PC-QIs had a median of five, no votes recorded below four, an interquartile range of zero, and a rank order score of one, two and four, out of a possible ten, indicating they were of highest importance to participants.ConclusionParticipants reached consensus on 24 evidence-based PC-QIs that represent measures of quality of aged care assessment services from the perspectives of current and future service users.

The efficacy and tendency of the gender digital divide and Smart Aging Policy in China

China is one of the most rapidly aging countries in the world, challenging the sustainable aging. The booming of digital technology is a double-edged sword. According to the Smart Aging Policies (SAPs), digital technology is supposed to be an effective way to address the challenges of the elder care system. However, the digital divide is causing additional problems. In this study, researchers aim to investigate whether the digital divide among older people could lead to gender-based discrepancies in elder care utilization, using data from the “China Elder Care Satisfaction Survey (CECSS).” Through logit regression analysis, in this study, researchers assessed the relationship between gender and digital elder care utilization, indicating the presence of a gender digital divide among older people. Our findings have important implications for facilitating minority groups to benefit more from SAPs and for advancing research on the gender digital divide among elders to promote sustainable aging.

Accountability in outsourced public service delivery: an Australian study

ABSTRACT We examine Australia’s aged care system to understand how the accountability architecture was shaped by outsourcing and explore the resulting implications for service outcomes. We conceptualize quality service provision as a boundary object – i.e. an idea, information, or other mechanism of governance – shared by stakeholders potentially with differing meanings across sites. We highlight NFPs’ emphasis on regular reporting with a compliance focus and muted outcome-based accountability. This accountability deficit was masked by the multi-layered principal–agent relationships. The study suggests the need for integrating outcome-based performance monitoring mechanisms of the state with those of outsourced service sites.

Towards sustainable development: Assessing social sustainability of Australian aged care system

AbstractThe importance of social sustainability, one of the three pillars of sustainable development, is increasingly recognised. Its implementation in the aged care system enhances stakeholders' quality of life and supports sustainable societal development. However, there is limited global research on social sustainability in aged care. This study aims to assess the overall social sustainability of the Australian aged care system and propose measures for its improvement. A conceptual framework was developed and applied to analyse the Final Report: Care, Dignity and Respect by the Australian Royal Commission into Aged Care Quality and Safety. The findings reveal that Australia's aged care system demonstrates significant deficiencies in social sustainability, with unequal access to care, services and facilities, and inadequate health and comfort for the elderly and their families. Employees contend with issues of unfair employment, insufficient compensation, unhealthy work environments, and inadequate education and training. Several measures are proposed to enhance social sustainability. This study provides a comprehensive analysis of social sustainability in the aged care system within a Western context. It enhances our understanding of the components of social sustainability in aged care, assesses its current status, identifies existing challenges, and provides possible directions for improvement. The insights from Australia's experience and potential solutions could inspire other countries to recognise the importance of social sustainability and reform their aged care systems towards sustainable development.

EXPLORING THE TRANSFORMATIVE SHIFT IN ELDERLY CARE FACILITIES: STRATEGIC AND FINANCIAL PERSPECTIVES FROM A GLOBAL, INDIAN, AND MANGALOREAN CONTEXT

This paper explores the historical evolution of age care homes globally, with a specific focus on India and Mangalore, examining their impact on commerce and management. Through archival research and observational data analysis, the study highlights challenges such as a lack of trained staff, poor management structures, and limited specialization in elder care. Recommendations include enhancing training programs, implementing structured management practices, and fostering strategic investments to improve the quality and sustainability of elder care services. Addressing these challenges can lead to a more effective and responsive elder care system, tailored to meet the diverse needs of aging populations. This paper delves into the historical development of age care homes worldwide, with a specific focus on India and Mangalore, examining their impact on commerce and management. The study utilizes archival research and observational data analysis to highlight challenges such as a lack of trained staff, poor management structures, and limited specialization in elder care. Recommendations include enhancing training programs, implementing structured management practices, and fostering strategic investments to improve the quality and sustainability of elder care services. Addressing these challenges can lead to a more effective and responsive elder care system, tailored to meet the diverse needs of aging populations. KEY WORDS: Age care homes, elder care, age care management, Grihasthashrama, Almhouses, Gerontology.

My parents are ageing, what the heck do I do?—Understanding Australia's aged care system to support older loved ones at home By C.Wilkinson, See Me Aged Care Consulting Pty Ltd. 2022. $26.91. Kindle edition $13.99. ISBN‐13: 9781922764263

My parents are ageing, what the heck do I do?—Understanding Australia's aged care system to support older loved ones at home By C.Wilkinson, See Me Aged Care Consulting Pty Ltd. 2022. $26.91. Kindle edition $13.99. ISBN‐13: 9781922764263

Fall Detection System for Elderly Care

Abstract: This project introduces a revolutionary Fall Detection System for Elderly Care, focusing on swift detection and immediate response to falls, particularly among wheelchair-bound seniors. In response to the escalating challenges posed by an aging population, Especially concerning the well-being of the elderly, the development of innovative solutions has become imperative. Central to these concerns is the prevalence of falls among seniors, which not only jeopardizes their physical health but also threatens their independence. Conventional fall detection methods have proven inadequate in providing timely assistance, underscoring the critical need for more advanced technologies. This project addresses this pressing need through the creation of a comprehensive Fall Detection System, with a specific focus on wheelchair-bound individuals. By seamlessly integrating state-of-the-art hardware and software components, the system aims to revolutionize elderly care by prioritizing safety and autonomy. At its core, the system utilizes the MPU6050 sensor module, renowned for its precision in monitoring body position and movement. Through the implementation of sophisticated algorithms, the software component meticulously analyzes real-time sensor data to swiftly detect falls. Upon detection of a fall event, the system autonomously triggers alerts to nearby healthcare services or designated contacts, ensuring a rapid response and timely provision of assistance to the elderly individual in need.

Home- and Community-based Elderly Care and the Life Satisfaction of Chinese Elderly Individuals

Objectives: With the accelerated aging of Chinese society, the demand for high-quality care services for the elderly population is rapidly increasing. In response, the Chinese government promotes the construction of home- and community-based elderly care (HCBEC) systems, which significantly influence the life satisfaction (LS) of this group. In this study, we analyzed the relationship between the accessibility of HCBEC and LS of the elderly population in China and further examined the underlying mechanisms. Methods: We analyzed data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) using an ordered logit model. Results: HCBEC significantly enhanced the LS of the elderly population, with more pronounced positive effects observed among females, unmarried persons, rural dwellers, and those with chronic diseases or physical disabilities. These services also increase their satisfaction by enhancing accessibility to anticipated care and medical services. Conclusions: This study theoretically complements research on LS. The use of large-sample data analysis ensures the reliability of the results, providing practical implications for China's proactive response to population aging and policy, and enhancing the subjective well-being of the elderly population.

Opportunities and challenges of integrating artificial intelligence in China's elderly care services

The challenge of elderly care presents a formidable task, demanding the collective attention of governmental bodies and diverse sectors of society. The integration of Artificial Intelligence (AI) into the research and development of Social Elderly Care Service (ECS) has emerged as a dominant trend, holding substantial importance in the establishment of an efficient ECS system. This study aims to serve as a comprehensive reference for the advancement of China's ECS system, achieved through the harmonious integration of a social ECS system with AI capabilities. This paper introduces the fundamental theory of AI, delving into the intricacies of the greyscale model of AI. Furthermore, it provides an overview of the current landscape of elderly care and elder care institutions, offering scientific data and insights to propel further research on AI development and system construction. Through an analysis of the existing research status, the study identifies prevalent issues within the AI-ECS integration, emphasizing pivotal factors influencing the construction of a robust social ECS system. To address these concerns, the study puts forth specific and viable policy recommendations. Notably, the questionnaire's statistics underscore that 83% of the elderly populace would opt for AI-driven solutions in selecting intelligent products, thereby underscoring the pivotal role of AI within the social ECS system. The challenges facing elderly care systems, including demographic shifts, resource constraints, and evolving societal norms, demand innovative solutions for providing efficient and effective care. This study addresses these challenges by exploring the integration of Artificial Intelligence (AI) into Social Elderly Care Services (ECS) in China. By delving into the theory of AI and assessing the existing research status, the study identifies key issues in AI-ECS integration and proposes viable policy recommendations. Insights from stakeholder surveys further highlight the importance of AI-driven solutions in meeting the needs of the elderly population.

Fit-for-purpose-The bottom-up redesign of the nursing home system: The Australian Aged Care System.

Nursing homes struggle to meet the needs of their residents as they become older and frailer, live with more complex co-morbidity, and are impacted by memory impairment and dementia. Moreover, the nursing home system is overwhelmed with significantly constraining organisational and regulatory demands that stand in the way of achieving resident-focused outcomes. These issues are compounded by the perceptions of poor working environments, poor remuneration, and poor satisfaction amongst staff. The system is beyond the state of 'reform' and requires a fundamental redesign based on first organisational systems understandings: a clearly defined purpose and goal, shared values, and system-wide agreed "simple (or operating) rules". A 'fit-for-purpose' future requires a complex adaptive nursing home system characterised by seamless 'bottom-up and top-down' information flows to ensure that the necessary 'work that needs to be done' is done, and a governance structure that focuses on quality improvement and holds the system accountable for the quality of care that is provided.

Adverse impacts in residential aged care facilities: The resident perspective.

Inclusion of consumer perspectives is a key component to person-centred health-care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents. The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory. Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self-determination, (iii) the impact of COVID-19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents. This research highlights the difference between health-care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well-being measures that capture elements that matter to older people.

The Long-cycle Elderly Care Service Model for Young People: A Case Study of Financial Elderly Care Services Based on Virtual Digital Human Technology

There is a lack of financial elderly care services for young people in China. Such services in traditional ways are unlikely to meet their future needs because of the decreasing workforce. Therefore, the current study aims to establish long-cycle financial elderly care services for young people through virtual digital human technology. Five young people are first interviewed about financial elderly care services; then, a survey is conducted for another sixty young people; after that, needs for financial elderly care services are extracted from the interview and the survey. Based on such needs, this study proposes a financial elderly service model built on design strategies including effective service touchpoints, clear communication, personalized service design, and immersive interaction, which is displayed on an App called REME. This model can be a reference for designing long-cycle elderly care systems.

Development of a smart health monitoring system for elderly care

Development of a smart health monitoring system for elderly care