Old-age Care Research Articles

"I Do Not Believe We Should Disclose Everything to an Older Patient": Challenges and Ethical Concerns in Clinical Decision-Making in Old-Age Care in Ethiopia.

Clinical decision-making in old-age care is a complex and ethically sensitive process. Despite its importance, research addressing the challenges of clinical decision-making in old-age care within this cultural context is limited. This study aimed to explore the challenges and ethical concerns in clinical decision-making in old-age care in Ethiopia. This qualitative study employed an inductive approach with data collected via semi-structured interviews with 20 older patients and 26 health professionals recruited from healthcare facilities in Ethiopia. Data were analysed using reflexive thematic analysis. Our analysis identified three key themes. First, participants highlighted perceptions that older patients' religious beliefs interfere with the clinical decisions both older patients and health professionals make. Second, older patients often receive limited information from health professionals about their diagnosis and treatment. Third, families of older patients appear to strongly influence clinical decisions made by older patients or health professionals. This research enhances the understanding of clinical decision-making in old-age care within Ethiopia, a context where such research is scarce. As a result, this study contributes towards advancing the deliberation of ethical dilemmas that health professionals who work with older patients in Ethiopia might face. A key implication of the study is that there is a need for more ethics and cultural competence training for health professionals working with older patients in Ethiopia.

New rural pension scheme, intergenerational exchange, and intergenerational economic support of the rural elderlies: a study from the perspectives of classical altruism theory and exchange motivation theory

As the severity of rural old-age care in China becomes increasingly evident, the manner in which rural elderly individuals obtain economic support has emerged as a significant societal concern. Central to this paper is the question of whether the new rural pension scheme, as the first government-provided institutional pension, influences the longstanding intergenerational economic support within families. Drawing upon classic altruism theory and exchange motivation theory, this study analyzes the complex rural social reality in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2013 and 2015, we employ a two-part model to examine the policy effects of new rural pension scheme, as well as the 2014 pension insurance reform and pension increase. Our findings reveal that (1) altruism and exchange motivation coexist in the rural Chinese social reality and jointly influence the behaviors of rural families. (2) Intergenerational economic support for the elderly in rural Chinese families primarily depends on the exchange motivation aspect of intergenerational care. Thus, it is vital to strengthen the intergenerational support of the family in addressing the pensions of the elderly in rural China.

Policy-makers and Population Ageing in Bangladesh: A Dearth of Attention

AbstractPolicy responses to population ageing have seldom been studied in Bangladesh. This article contributes to this research stream by asking to what extent policy-makers in Bangladesh are aware of the rapidly growing older population and care needs in the country and how this awareness is reflected in their policy initiatives. The concept of inattention is introduced to investigate phenomena from a public policy perspective. Data were collected via open-ended interviews with key policy-makers in Bangladesh’s government and other local stakeholders. Their responses were transcribed and coded for thematic content analysis. The findings show that policy-makers in Bangladesh have paid very little attention to the rapidly growing older population and their care needs. Without considering social, economic and demographic circumstances, the government has left full responsibility for old-age care to family members. No specific health or social care facilities have been built for older adults. Instead, limited coverage pension schemes for government employees and the Old Age Allowance (OAA) for financially vulnerable older adults remain the only measures taken thus far. However, these means-tested OAAs are very limited in terms of both their level and coverage. The lack of policy attention to older adults’ needs has led to a situation in which many older persons, especially in rural areas, are left without any support or care from their family, the government or third-sector organisations. More research is needed to guide the government and other organisations in developing adequate policies to support older adults in Bangladesh.

Research on the Harmonious Development of China's Old-age Care Institutions

With the development of socialization, old-age care institutions have been paid attention to in the old-age security system. After the occurrence of the "Black Heart Retirement Home" incident, we have to consider the imbalances in the development of old-age care institutions. Analysis of the current imbalance and its causes, hoping to find a solution to the problem of imbalance, to effectively prevent the occurrence of similar incidents, and solve the worry of the elderly.

Research on the income and expenditure forecast of long-term care insurance fund in Shihezi City based on community care.

This study forecasts the income and expenditures of the long-term care insurance fund, provides a basis for formulating the raising standard of the long-term care insurance fund, and explores the measures to improve the pilot work of long-term care insurance. By using the exponential smoothing and ARIMA models to forecast the income and expenditure of the old-age care insurance fund in 2022, the problems existing in the operation of the long-term care insurance fund are discussed. In 2022, the income of the old-age insurance fund was 28.8934 million yuan, and the fund compensation expenditure was 28.4070 million yuan, with a slight balance of the fund. The highest relative errors of income and expenditure forecast models are -2.03% and - 2.76%, respectively. According to the results of fund expenditure, the annual financing standard should be 132.93 yuan/person, and the individual financing standard should be 66.47 yuan/person. Through the integration of personal payment, welfare, sports lottery public welfare income, social donations, and other ways, we can gradually establish a multi-channel risk-sharing financing. We will appropriately raise the standard for individual financing and the annual contribution standard for individuals from 50 yuan to 66.47 yuan. This will promote sustainable development of long-term insurance system.

A Psychological Study of the Socialization of the Elderly with Their Families

As China's urbanization process accelerates, population mobility is accelerated, and the urban adaptability and old-age care of elderly migrants to cities cannot be avoided. The rapid development of urbanization has changed the population structure in urban and rural areas, which in turn affects the transformation of old-age care models. In order to explore the changes and dilemmas of old-age care for elderly migrants in the process of urbanization, taking "elderly migrants" as the research object, this study explores a series of psychological changes in the process of urban socialization for elderly migrants. The study summarizes the changes and difficulties faced by elderly migrants in their living, livelihood, and social interaction in the process of urbanization, mainly analyzes the specific problems existing at the psychological level, and further analyzes the self-identity of elderly migrants. It is reflected in various aspects such as family contribution, social interaction, cultural inheritance, economic independence, and self-realization. In order to better adapt to the changes in new environment and lifestyle, the study focuses on the needs and psychological changes of elderly migrants, and promotes the attention and research of relevant groups in society.

顶山市城市社区养老托育服务供给状况研究——基于QCA 方法的组态分析

Population ageing has always been a topic of great concern, and in recent years, with the emergence of the declining birthrate, China's population structure is also facing new challenges. With the national policy of intergenerational integration of old-age care and childcare, Pingdingshan City has also begun to face the problem of how to develop old-age care and childcare. Among them, the problems are mainly manifested in the insufficient supply of professionals, medical and health services, and early childhood enlightenment education services. In view of these problems, this paper puts forward a number of suggestions to strengthen the construction of talent team, publicize the advantages of urban community elderly care services, connect multiple resources to enhance sustainable development capacity, and increase government financial and policy support, so as to promote the sustainable development of elderly care in Pingdingshan City.

Need analysis for geriatric care services in a tertiary care teaching hospital: a patient perspective analysis

Background: In India, aging population is increasing every year. So, healthcare industry needs to set up a geriatric unit soon. Development of geriatrics and old-age care systems in India will make elderly people independent and improve their lifestyle, life expectancy, and quality of life while decreasing the cost of care. This study looks at the views of patients who are 60 years or older, as well as need for a full-fledged geriatric unit in a tertiary care hospital. Methods: This study used questionnaires to get information from patients about the need for a geriatric care service in the chosen tertiary care teaching hospital. The study was conducted between March 2022 to July 2022 Results: Over 96% of the patients opined that elderly patients require a separate health care setup from the regular health care system. The study showed that 69.9% of the patient respondents opined that they require an attendant each time they visit a hospital. Also, 51.6% of the patients did not go to their doctor's appointments because they needed someone to accompany them to the hospital. Conclusions: A study shows that older people rely on family members to check out healthcare facilities. If a new geriatric unit has the latest facilities, 96.8% of the patients will take advantage of them. Hence, a well-established geriatric department in the selected hospital is the need of the hour.

Based on the Coupling Model of the Rural Revitalization and the Urban Old-age Care

With the development of society, the core problem of the elderly care in China has changed from solving poverty and material scarcity to how to meet the spiritual needs of the elderly. Under the social background of the timely completion of poverty alleviation goals and tasks in the new era, the construction of a "win-win" mechanism for urban elderly care and rural revitalization, the use of the environmental advantages of beautiful villages and idle housing, help urban elderly care, while giving play to the intellectual advantages and knowledge and skills of urban elderly, add wings to rural revitalization, not only help solve the talent bottleneck of rural revitalization, Moreover, it can meet the high-level spiritual needs of the elderly such as self-realization and achieve the purpose of quality old-age care. Therefore, promoting the combination of rural areas and urban elderly care is one of the important ways of rural revitalization.

Linking neighborhood green spaces to loneliness among elderly residents—A path analysis of social capital

Population aging poses a central challenge to human society in the 21st century, and a notable correlation has been found between loneliness and age, particularly old age. Loneliness not only substantially impacts the physical and mental well-being of elderly residents but also escalates the burden of old-age care and medical services. As the global trend of aging continues to intensify, tackling population aging and its associated problems has become a common strategic choice of nations worldwide. Grounded in the mediating effect of social capital, this paper explores both the impact and mechanism by which the use of neighborhood green spaces mitigates loneliness among elderly residents. The findings show that, in terms of overall effects, the use of neighborhood green spaces effectively mitigates negative living conditions and psychological problems, thereby fostering the alleviation of loneliness in elderly residents. From a mediating effects perspective, relationship networks, interpersonal trust, and reciprocity norms within social capital play distinct roles in the relationship between the use of neighborhood green spaces and the reduction of loneliness in elderly residents. The direct effect is not statistically significant, which implies a comprehensive mediating role of social capital. In aging neighborhoods, it is imperative to recognize the role of green spaces in promoting elderly well-being and to ensure ample provision of such spaces. Additionally, considering the decline in physical functions among elderly residents, it is crucial to acknowledge their unique sensory thresholds and usage characteristics and compare these to other age groups. Thus, implementing appropriate aging-friendly reforms in green space planning becomes essential to align the allocation of green space resources with the specific needs of elderly residents while catering to the broader population.

"Yes, that's me singing to myself": Jackie Kay's "These are not my clothes" as a Self-Affirming Narrative of Care in Old Age.

Fictional stories set in care homes have increased in the last decades and, with them, the perspectives from which care homes are constructed and represented have become diversified. Care home stories. Aging, disability, and long-term residential care. Transcript Verlag]. Through the alternative worlds that are offered by literary narratives, these stories allow the reader to glimpse into the increasingly varied possibilities of care that a residential settlement can offer. At the same time, they highlight the attributes attached to human beings once their bodies are not regarded as fully functional or able by their carers and society at large. Jackie Kay's short story "These are not my clothes" (2011) presents a highly symbolic care-home narrative in which constant practices of depersonalized care and infantilization lead to the inevitable dehumanization of the residents and their eventual deterioration. Through the viewpoint of its female protagonist, Margaret, Kay creates a personal, poignant and, at times, also humorous narrative of care that undermines prevailing images of the so-called fourth age as a period of extreme cognitive deterioration. Drawing from theories of care and the interdisciplinary field of aging studies, especially in connection with theories of embodiment and old age and social approaches to aging, this article offers a close reading of Kay's short story as both an assertive narrative on the fourth age, and as an insubordinate story of care, which can serve as a model to both gerontologists and care practitioners.

The lucky and unlucky daughter: Gender, land inheritance and agrarian change in Ratanakiri, Cambodia

AbstractIn many agrarian societies, women come to own land, and people secure care in old age through land inheritance. The social norms guiding inheritance shape gendered, generational and class‐based relations of power in rural areas, and intra‐family land rights can be lost when inheritance norms shift. In Cambodia's northeastern Ratanakiri province, rapid agrarian change over the past decade—including the expansion of land grabs, cash cropping and Khmer in‐migration—is transforming decision‐making around inheritance. Based on a large sample of qualitative interviews and focus groups carried out in 2016 and 2020 with Indigenous and Khmer communities, we focus on the ways in which intergenerational and gendered obligations of care are being reconfigured as land scarcity and inequalities within rural areas become more pronounced. We argue that social norms around land inheritance are in flux, with a proliferation of diverse practices emerging including a shift from matrilineal to bilateral inheritance amongst some Indigenous families, the deferment of marriage and inheritance decisions due to a lack of land and parents taking on debt to buy land and secure care in older age. These changes are reconfiguring gendered and generational identities in relation to land and have potentially negative consequences for land‐poor families, in particular, for poor Indigenous women. These changes are symptoms of a larger ‘crisis of care’ in rural communities.

Intelligent Nursing System for the Elderly Based on Big Data

The current problem of providing for the aged in China is extremely serious. As a weak member of society, the basic right of the elderly is the harmonious and stable development of society, especially in China, where the problem of aging is extremely severe, and the general pension institutions cannot fully and meticulously meet the precise needs of different elderly people. Therefore, this paper mainly studies the intelligent nursing system for the elderly based on big data, aiming to meet the requirements of the elderly of different ages for the elderly through the combination of big data and old-age care. This old-age care model is based on the usual application environment, the internet “big data” as the foundation, accurately applying intelligent technology to provide nursing services for the elderly, and providing interconnected, intelligent, convenient, and efficient old-age care services for the elderly, thus building a real-time, safe, convenient, and low-cost old-age care mechanism.

Need for Care in Old Age: Characterization of Informal Caregivers and the Care Situation with Regard to Care Levels in Home Care

In Germany, people in need of care can be supported by benefits from care insurance. Prerequisite is an official assessment of the need for care, which is carried out by assigning care levels (1 to 5) according to the Second Care Strengthening Act. One of the reasons for introducing care levels was to pay more attention to the needs of people with dementia. In this article, characterization of care levels were based on characteristics of care recipients, their relatives, and the care situation. The aim was to map the current state of health care and providing practical suggestions to improve health care. Data was collected as part of the cross-sectional study "Benefits of being a caregiver" by a written survey of informal caregivers throughout Bavaria on aspects of the caregiving situation as well as on current and desired future use of 15 care services. To compare care levels, group differences were analyzed using χ2-tests and one-factor analysis of variance. The effect size measures odds ratio and Cohen's d were reported for significant group differences comparing care levels 1 and 4. The sample consisted of 958 cases of people in need of care aged 65 and above. The proportion of people with dementia increased significantly with care level. For informal caregivers, subjective burden, functional coping strategies, and the caregiving motive of not wanting to place the care recipient in a nursing home increased with care level. Informal caregivers of those with higher care levels spent significantly more time on supporting activities of daily living and supervision; they received more informal help, and more often lived together with the care recipient in a household. For 9 of the 15 care services surveyed (e. g. 24-h care), current use increased significantly with increasing care level. However, we recorded a low overall utilization rate of care services across all care levels (M=2.20; SD=1.90). As a result of the Second Care Strengthening Act, people with dementia get good access to care insurance benefits. The increasing amount of time required for assisting in activities of daily living and supervision is reflected by care levels. Despite the increasing caregiving burden, care services are rarely used. Therefore, we recommend that measures to increase the use of support and counselling services be expanded.

Children's Opportunities and Constraints in European Parent Care Over Time: A Within-Family Approach.

The role of children's caregiving has received substantial attention in studies on care in old age. Previous research shows that children's care provision is strongly intertwined with both their individual and siblings' situation regarding employment and geographic parent-child distance. This study uses data from six waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), taking a within-family approach, to examine how caregiving is (re-)distributed between siblings over time. The provision of continuous parent care is observed more frequent and volatile in European countries with a family-based care system. The results from family fixed-effects regression models demonstrate that children working less than siblings persist in caregiving more. Living closest to parents facilitates children to keep up care efforts, while changing to living closest enhances the start of parent care. This study suggests that geographic distance is vital in the long-term organization of parent care between siblings.

Aging in Place with Few Children and Social Services-- Understanding Structural and Cultural Lags in Rural China.

This study uses mixed methodologies to reveal how structural and cultural changes are changing the connotations of home and aging in rural China. Based on surveys (n = 830) and 33 intensive interviews with older migrant workers, this study found that having rural public pensions, adult children living nearby, and owning land in their hometowns were associated with the respondents' desire for aging in place (AIP). Moreover, although the image of the rural home is idyllic, the reality is difficult. Aging migrant workers are gaining a strong sense of financial independence and their children's lack of parental care. The authors argue that having no social-care services, while adult children are rarely available for old-age care, is changing the connotations of AIP in rural China. These social and cultural transformations are making AIP more of a romantic ideal than a practical reality for migrant workers.

Willingness and influencing factors of old-age care mode selection among middle-aged and older adults in Henan Province, China

BackgroundThe choice of old-age care methods or places plays an important role in improving the quality of life and well-being of older adults. This study aimed to analyze the choices of various old-age care modes (OCMs) among middle-aged and older adults (MOA) aged 40 years and older in Henan Province, China, and to explore the influence of personal health status, perspectives on old-age (POA) and external support received on their choices.MethodsThis study analyzed the data from the previous survey which included 911 MOA. The mean comparison method was used to analyze the evaluation of MOA prior to selecting OCMs, and the effect of individual characteristics, external support received, and personal health status on the choice of OCM for MOA was assessed by Logistic regression (LR) and Concentration Index. The Mediation Effect Model was used to explore effect manner and scope of MOA’ POA in their choice of OCM.ResultsThe overall scores for MOA on the choice of the home-based, community-family, retirement village, nursing homes OCM were 4.06 ± 0.81, 3.70 ± 0.88, 3.72 ± 0.90, 3.49 ± 0.97, respectively. The LR model indicated that education level, number of children, relationship between family members and the relationship with neighbors affected the choice of OCM for MOA (P < 0.05). Difference in OCM selection was relatively the largest based on the individual’s POA (Concentration index = -0.0895 ~ -0.0606), and it was shown to play a mediating role in other factors influencing the choice of OCM for MOA (Mediation effect = -0.002 ~ 0.013).ConclusionsThe evaluation of MOA on choosing a non-home OCM was generally, and the number of children and external support received were shown to have a relatively substantial impact on the choice of OCM among MOA, however, their power was affected by MOA’ POA. Policy makers could encourage the MOA’ selection of non-home OCM by improving the relationship among MOA persons while positively transforming their POA.

Chinese Women's Concept of Childbirth Based on the Social Media Topic "What Does Childbirth Mean to a Woman": Content and Thematic Analysis.

In recent years, women's fertility desire has attracted increasing attention in China. This study aims to detect attitudes toward giving birth among young female users on Douban, a very popular Chinese social media platform. A total of 2634 valid posts from 2489 users discussing the topic "What does childbirth mean to a woman" on Douban were crawled and retained for analysis. We utilized content and thematic analysis methods to capture users' concepts of childbirth. The findings reveal that a significant majority of users conveyed generally neutral (1060/2634, 40.24%) or negative (1051/2634, 39.90%) attitudes toward childbirth, while only about one-fifth of users expressed positive (523/2634, 19.86%) sentiments. Notably, posts with negative attitudes garnered more replies and likes, and the proportion of posts expressing negativity exhibited fluctuations over time. Health risk (339/2634, 12.87%) emerged as the most frequently cited aspect of childbirth cost, with subjective happiness and the fulfillment of mental needs identified as primary benefits. Surprisingly, only a minimal number of posts (10/2634, 0.38%) touched upon the traditional objective benefits of raising children for old-age care. Thematic analysis results suggest that discussions about fertility on social media platforms might contribute to an exaggerated perception of health risks among women. Additionally, a lack of knowledge about childbirth was observed, partially attributable to longstanding neglect and avoidance of communication on these matters, likely influenced by traditional cultural biases. Moreover, there is a prevailing assumption that women should naturally sacrifice themselves for childbirth and childcare, influenced by the idealization of the female figure. Consequently, women may harbor hesitations about having a baby, fearing the potential loss of their own identity in the process. The results indicate a shift in the perception of childbirth among modern Chinese women over time, influenced by their increasing social status and the pursuit of self-realization. Implementing strategies such as public education on the health risks associated with pregnancy and delivery, safeguarding women's rights, and creating a supportive environment for mothers may enhance women's willingness to undergo childbirth. RR2-10.2196/preprints.50468.

The willingness and influencing factors to choose institutional elder care among rural elderly: an empirical analysis based on the survey data of Shandong Province

BackgroundThe ageing of the population has become an escalating problem in China, which has led to an increasing demand for healthcare throughout society. The care services of elderly institutions, as a more mature way of aging, can alleviate various social problems brought about by ageing to a certain extent. The aim of this paper is to explore the degree of acceptance of institutional care by rural elderly people in Shandong Province and the factors that influence whether rural elderly people accept institutional care services.MethodologyBased on the theory of planned behavior, an analytical framework was constructed for the willingness of rural elderly people to receive nursing services from elderly care institutions. Using survey data from 192 rural elderly people in Shandong Province, descriptive statistics, binary logistic regression, and horizontal comparative analysis methods were used to analyze the willingness of rural elderly people to provide for the elderly and its influencing factors.ResultOnly 17.71% of respondents expressed willingness to receive services from elderly care institutions. Among them, education level, trust in elderly care institutions, and support from adult children have a significant positive impact on whether rural elderly people receive nursing services from elderly care institutions; The number of children, the level of understanding of elderly care institutions, neighbors' choices of elderly care methods, and their ability to contribute to the family have a significant negative impact on whether rural elderly people receive nursing services from elderly care institutions. There are significant differences in the willingness and influencing factors of rural elderly people to provide for the elderly among different regions.ConclusionThe non-acceptance of institutional care by rural older people is a general phenomenon rather than a sample characteristic, thus justifying the supplementary status of institutional care services. The pension intention of the rural elderly in Shandong Province is obviously affected by personal will factors, and the influencing factors are various. The traditional concept of old-age care in Shandong province has a strong path-dependent effect on the choice of the rural elderly. There is heterogeneity in the willingness and influencing factors of the rural elderly in different regions and countries. Based on this, this paper puts forward the following suggestions: strengthen the spiritual and cultural construction of residents; The government should pay attention to the correct guidance of public opinion; And increase pension subsidies. It is hoped that reduce the burden of national elderly care through these suggestions.

The everyday life occupations of older women in social vulnerability in Brazil

ABSTRACT Population aging is widely discussed due to the impacts of increased life expectancy, especially in socially vulnerable populations. This descriptive-exploratory qualitative study aims to understand older women’s perceptions of their occupations in a socially vulnerable community. The participants were 11 women, aged 60 years or older, living in Vila Marçola, Aglomerado da Serra, Minas Gerais, Brazil. Semi-structured interviews were carried out and the content was analyzed by using thematic analysis. Findings indicated four care dimensions: 1) Household care and caring for other people, 2) Community care, 3) Self-care, and 4) Expanding the experiences of care in old age. Older, mostly black, and poor women from Vila Marçola highlighted the unequal living conditions in Brazil. These women were overloaded with occupations, especially paid and unpaid household care, and did not have access to or stability in other occupations. However, retirement allowed them to participate in educational and social projects, increasing their occupational repertoire. This study contributes to the construction of intersectional knowledge in the field of occupational science, expanding the understanding of the socio-cultural dimensions that involve the diversity of people around the world, especially in situations of social vulnerability.