Challenges Of Ageing Population Research Articles

Population ageing and health financing: A method for forecasting two sides of the same coin

There is a perception that population ageing will have deleterious effects on future health financing sustainability. We propose a new method—the Population Ageing financial Sustainability gap for Health systems (or alternatively, the PASH)—to explore how changes in the population age mix will affect health expenditures and revenues. Using a set of six anonymized country scenarios that are based on data from countries in Europe and the Western Pacific representing a diverse range of health financing systems, we forecast the size of the ageing-attributable gap between health revenues and expenditures from 2020 to 2100 under current health financing arrangements. In the country with the largest financing gap in 2100 (country S6) the majority (87.1%) is caused by growth in health expenditures. However in countries that are heavily reliant on labour-market related social contributions to finance health care, a sizeable share of the financing gap is due to reductions in health revenues. We argue that analyses giving equal attention to both health expenditures and revenues steers decision makers towards a more balanced set of policy options to address the challenges of population ageing, ranging from targeting expenditures and utilization of services to diversifying revenue.

Demographic and social anxieties: the second demographic transition in Asia

Asia is now, predominantly, a continent of ‘low’ fertility—one of the features of the Second Demographic Transition. Across the continent, this feature of our population has sprouted concern and anxiety, primarily expressed in macroeconomic terms. Low fertility is directly linked to the twin challenges of population aging and stagnation/decline. We know, however, that maximizing human capital and institutional reform is a much more effective way of responding to these two ‘grand challenges’ in the short- and medium-term. Why, then, is there such a panic about the lack of babies? In this commentary, I argue that much of the concern is grounded in a ‘fear’ of some of the features of the Second Demographic Transition (SDT)—or, at least, a caricatured version of it—taking root in Asian societies. But how concerned should they be? The papers in this special issue clearly demonstrate that the pathway towards ‘full SDT’ has developed in a very uneven way, perhaps so much so that some may argue the SDT is not a viable tool for understanding family change in (much of) Asia. However, this caricature of what the SDT ‘is’ can be unhelpful. There is no doubt that ideals and attitudes are changing (even if many others are not). Therefore, if we rather consider the SDT as a “general narrative that leaves room for many sub-narratives”, the evidence from Asia clearly demonstrates that there are many sub-narratives operating within a general transition towards some of the key societal and familial features of the SDT.

Review of genome-wide association research of aging phenotypes

"Active health" has been emphasized in "Healthy China 2030" in dealing with the challenges of population aging, so the anti-aging strategies are requires to be more precise and effective at both individual and population levels. Aging is influenced by both genetic and environmental factors. In the recent 20 years, the research of genetics of human ageing has been greatly facilitated owning to the development of high-throughput sequencing techniques, statistical methodology for multi-omics data, as well as the growing qualified evidence of large-scale population-based genomic research. This paper provides a review of genome-wide association research of aging.

Older patients acutely admitted and readmitted to the same geriatric department: a descriptive cohort study of primary diagnoses and health characteristics.

Advancing age is associated with increased risk for acute admissions and readmissions. The societal challenges of ageing populations have made the prevention of readmissions come into focus. Readmission may be perceived as the result of inadequate treatment during index admission but may also be caused by the onset of new disease following a generally impaired health of geriatric patients. We aimed at comparing the diagnoses at index and readmission to illuminate this issue. This is a descriptive, retrospective cohort study of patients acutely admitted and readmitted (within 30days from discharge) to the same geriatric ward (November 1, 2017-April 30, 2018). Electronic medical records were scrutinised manually for discharge diagnoses and patient characteristics. Readmission rate was 10.7% (98 of 918 unique admissions). Mean age was 85.6 (men 56%). About 75% were readmitted with a new acute disease unrelated to index admission, most commonly pneumonia (27%), other infections (22%), and dehydration (14%). The health characteristics were long index length-of-stay (median 7; IQR 5-11), high Charlson Comorbidity Index (CCI ≥ 3, n = 49 (50%), polypharmacy (≥ 5 prescriptions) (94%), and hospitalisations 12months prior to index admission (57%). The majority of readmitted geriatric patients have contracted a new acute condition. Although being characterised by several adverse health characteristics, prospective studies comparing readmitted and non-readmitted geriatric patients are needed. Still, increasing the awareness of early recognition of acute disease onset in geriatric patients is warranted.

Introducing New Paths towards Public Primary Healthcare Services in Greece: Efforts for Scaling-Up Mental Healthcare Services Addressed to Older Adults.

The exponential growth in the aging population challenges the Primary Care Providers (PCPs) who provide health care services to older adults who are considered highly vulnerable and are in need of specialized healthcare services. The development of new policies and the adoption of appropriate health strategies by PCPs may improve the early detection and prevention of mental disorders in older adults. This reduces both queuing and costs in outpatient clinics while preventing stigma for patients and families. To this end, specialized training for PCPs at the Local Primary Health Care Unit (LPHCU) was provided in order to conduct efficient assessments of older adults (65 and above years old, without previously diagnosed depression or dementia, and willing to participate). The assessment is based on the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). Older adults identified with MMSE <20 and GDS >5 were referred to the psychiatric outpatient clinic. The aim of this study is to discuss evidence-informed policymaking in Greece with a focus on advancing mental health practices and scaling up quality primary healthcare services for older adults.

Study on Spatial Distribution Equilibrium of Elderly Care Facilities in Downtown Shanghai.

With the growing challenge of aging populations around the world, the study of the care services for older adults is an essential initiative to accommodate the particular needs of the disadvantaged communities and promote social equity. Based on open-source data and the geographic information system (GIS), this paper quantifies and visualizes the imbalance in the spatial distribution of elderly care facilities in 14,578 neighborhoods in downtown (seven districts) Shanghai, China. Eight types of elderly care facilities were obtained from Shanghai elderly care service platform, divided into two categories according to their service scale. With the introduction of the improved Gaussian 2-step floating catchment area method, the accessibility of two category facilities was calculated. Through the global autocorrelation analysis, it is found that the accessibility of elderly care facilities has the characteristics of spatial agglomeration. Local autocorrelation analysis indicates the cold and hot spots in the accessibility agglomeration state of the two types of facilities, by which we summarized the characteristics of their spatial heterogeneity. It is found that for Category−I, there is a large range of hot spots in Huangpu District. For Category−II, the hot-spot and cold-spot areas show staggered distribution, and the two categories of hot spot distribution show a negative correlation. We conclude that the two categories are not evenly distributed in the urban area, which will lead to the low efficiency of resource allocation of elderly care facilities and have a negative impact on social fairness. This research offers a systematic method to study urban access to care services for older adults as well as a new perspective on improving social fairness.

Routes to retirement, working conditions and quality of life in comparative perspective.

An important response to the challenges of ageing populations has been reforms to decrease the economic incentives for early retirement. For individuals with poor working conditions, however, there is a risk that each additional working year may have negative consequences on their quality of life after retirement. Using data from 12 countries and 3000 individuals from the SHARE (Survey of Health, Ageing and Retirement in Europe), this study analyses exit routes from work to retirement in a comparative perspective. Using group-based trajectory modelling, results indicated that poor late-working life working conditions was associated with exit routes with high reliance upon income from different transfer schemes. Using multilevel models, analyses then indicated that the generosity of these transfer schemes has a positive impact on post-retirement quality of life. Limitations and policy implication of the study are discussed at the end.

The availability of local primary care services, satisfaction with health services and self-rated health in older English adults: A population-based study

Primary care services can play an important role in addressing health inequalities and challenges of population ageing. The aim of this study is to investigate whether the availability of local primary care services can support satisfaction with health services and self-rated health in older people. This study was based on a population-based cohort study, Understanding Society: the UK Household Longitudinal Study, focusing on people aged ≥ 50 at Wave 3 (2011–2013; N = 14498) and Wave 6 (2014–2016; N = 13025) in England. Locations of primary care services, including general practitioner (GP) practices and other community health services, were identified from National Health Service Digital and linked to residential areas of the study participants. Multilevel Poisson regression modelling was used to investigate the associations between the availability of local primary care services, satisfaction with health services and self-rated health adjusting for sociodemographic factors, deprivation and urban/rural settings. Participants who had more GP practices in local areas were less likely to report dissatisfaction with health services in Wave 3 (IRR: 0.67; 95% CI: 0.52, 0.85) and Wave 6 (IRR: 0.74; 95% CI: 0.59, 0.92). No associations with self-rated health were found in both waves. These associations were similar across deprivation levels and urban/rural settings. The results suggest that increasing availability of local primary care services may improve satisfaction but not health in older people. To optimise the supportive role of primary care services in healthy ageing, future research should identify complex needs of health and social care in older people and their experience of using the services.

Factors influencing the use of and attitude toward community gardens in aged care facilities: The managers’ perspective

An increasing number of elderly people are living in aged care facilities in Japan, a country that is facing a globally unprecedented challenge of population aging. Due to the declining health status and mobility limitations of older adults, community gardens (CGs) are crucial for giving residents in aged care facilities contact with nature. However, there is a lack of research on the characteristics and perceptions of CGs in aged care facilities in Japan and how these factors can influence the use of and attitude toward CGs. In this study, a questionnaire was developed and sent to the managers of elderly housing with care services (EHCS) across the Tokyo metropolitan area (TMA) in Japan in 2020. The aim of the study was to examine the effects of the characteristics and perceptions of CGs on the frequency of gardening activities, leisure activities, and attitudes toward gardening activities. Data were collected from 44 EHCS managers and were analyzed by using descriptive and inferential statistics. The results indicated that the use of gardens (frequency of gardening activities, absence of leisure activities) was positively associated with the garden area, the number of garden equipment types, the presence of barrier-free design elements, interaction, community aesthetics, and a sufficient number of participants. Compared to a low frequency of gardening activities, a high frequency of gardening activities was also associated with a decreased building age and improved education about agriculture. The managers with negative attitudes had gardens managed only by residents, and they showed more concern about the reduced attractiveness of CGs and insufficient members. The study provides significant lessons for policy makers and facility managers to focus on the development of strategies that will establish and strengthen the cooperation between aged care facilities and community agencies and organizations to encourage community members to engage in CGs.

Digitization of Aging-in-Place: An International Comparison of the Value-Framing of New Technologies

Planning for aging populations has been a growing concern for policy makers across the globe. Integral to strategies for promoting healthy aging are initiatives for ‘aging in place’, linked to services and care that allow older people to remain in their homes and communities. Technological innovations—and especially the development of digital technologies—are increasingly presented as potentially important in helping to support these initiatives. In this study, we employed qualitative document analysis to examine and compare the discursive framing of technology in aging-in-place policy documents collected in three countries: The Netherlands, Spain, and Canada. We focus on the framing of technological interventions in relation to values such as quality of life, autonomy/independence, risk management, social inclusion, ‘active aging’, sustainability/efficiency of health care delivery, support for caregivers, and older peoples’ rights. The findings suggest that although all three countries reflected common understandings of the challenges of aging populations, the desirability of supporting aging in place, and the appropriateness of digital technologies in supporting the latter, different value-framings were apparent. We argue that attention to making these values explicit is important to understanding the role of social policies in imagining aging futures and the presumed role of technological innovation in their enactment.

Healthy working life expectancy at age 50 for people with and without osteoarthritis in local and national English populations

Retirement ages are rising in many countries to offset the challenges of population ageing, but osteoarthritis is an age-associated disease that is becoming more prevalent and may limit capacity to work until older ages. We aimed to assess the impact of osteoarthritis on healthy working life expectancy (HWLE) by comparing HWLE for people with and without osteoarthritis from ages 50 and 65 nationally and in a local area in England. Mortality-linked data for adults aged ≥ 50 years were used from six waves (2002–13) of the English Longitudinal Study of Ageing and from three time points of the North Staffordshire Osteoarthritis Project. HWLE was defined as the average number of years expected to be spent healthy (no limiting long-standing illness) and in paid work (employment or self-employment), and was estimated for people with and without osteoarthritis and by sex and occupation type using interpolated Markov chain multi-state modelling. HWLE from age 50 years was a third lower for people with osteoarthritis compared to people without osteoarthritis both nationally (5.68 95% CI [5.29, 6.07] years compared to 10.00 [9.74, 10.26]) and in North Staffordshire (4.31 [3.68, 4.94] years compared to 6.90 [6.57, 7.24]). HWLE from age 65 years for self-employed people with osteoarthritis exceeded HWLE for people without osteoarthritis in manual or non-manual occupations. Osteoarthritis was associated with a significantly shorter HWLE. People with osteoarthritis are likely to have significantly impaired working ability and capacity to work until older ages, especially in regions with poorer health and work outcomes.

Ожидаемая продолжительность здоровой жизни в контексте Десятилетия здорового старения ООН

The article examines the dynamics of the healthy life expectancy (HALE) in the world, in the WHO European Region and in Russia. It provides cross-country comparisons, revealing the main trends in the dynamics of healthy life expectancy at birth and at older ages. The author notes that the most intense growth in healthy life expectancy can be observed in low-income countries; as wealth increases, growth in healthy life expectancy slows down. The author analyzes the differences in healthy life expectancy between the regions of the Russian Federation. It is noted that the inequality between Russian regions is higher compared to the inequality between groups of low- and high-income countries, between WHO regions, and between countries of the WHO European Region. Russia is one of the countries for which the territorial aspect of inequality in all its manifestations is of great importance. The article discusses various methods for assessing healthy life expectancy, adopted in international and Russian statistics. The study concludes that the HALE indicator used by WHO is optimal for assessing the performance of health systems, for monitoring the health situation of the population. The indicators calculated by Eurostat and Russian statistics are based on the population's self-perceived state of health. Self-perceived health status is essential for assessing the quality of life and determining the need for health care, social services and care, although it is subjective. This is especially important in terms of promoting healthy ageing. The process of population ageing in the world is accelerating more and more. Medical, social, economic, psychological problems associated with the ageing of the population are most acute in economically developed countries. Increasing healthy life expectancy, active longevity, and the development of the ‘silver economy’ are responses to the global demographic challenge of population ageing. Active longevity sets new directions for the development of various spheres of society: medicine, social protection, education and the labour market. At the same time, active longevity creates new types of inequality in these areas, associated with the availability of the necessary resources both at the country level and at the level of population groups and individuals.

What We Learn in Later Life? Policy, Practice, and Future in China

Population aging has been a global phenomenon. In 2050 it is expected that one in six people will be aged 65 years or over in the world. With a large population, China chooses to implement the elderly education policy to respond to the challenge of population aging. In the policy system, China absorbs international ideals, such as lifelong learning, and active aging, into the national policies. However, in the practice, the elder’s curriculum exists an unbalanced state. The situation on rural elderly education lags far behind urban elderly education. This paper takes a chronological and historical approach to examine policies and practice in elder education in China. Recommendations are: (1) the national standard of curriculum for elderly education should be promoted. (2) the rural elderly should be paid more attention.

O papel da avaliação na prática avançada de enfermagem gerontológica baseada em competências

Population aging challenges healthcare systems, requiring gerontological advanced practice nurses (GAPN) to address specific and complex care requirements of older adults. GAPN implement evidence-based practices directed to patients and families, focusing on health promotion and protection, disease prevention, recovery, and rehabilitation. In competence-based gerontological advanced practice, comprehensive geriatric assessment is essential for implementing the care plan. In this theoretical essay we reflect about the role of assessment in competence-based advanced nursing practice directed to the care of older adults. From our perspective, geriatric assessment for a high-quality practice must be comprehensive, multidimensional, interdisciplinary, and planned. GAPN must have solid competencies for clinical skills and caring practices; education for health literacy; collaborative care; system management for continuity of care; ethics, advocacy, and moral agency; and evidenced-based practice inquiry. Gerontological models of care and GAPN competencies serve as frameworks to guide practice while assessment is fundamental for providing age-friendly care to older adults.

Active Ageing: The Need to Address Sub-National Diversity. An Evidence-Based Approach for Italy.

While active ageing has emerged as a main strategy to address the challenges of population ageing in Europe, recent research has stressed the need to increase knowledge on within-country differences to promote active ageing through appropriate policy responses. This article draws on the Active Ageing Index (AAI) to capture recent trends in active ageing in Italy with a focus on sub-national diversity. To this end, we compute AAI breakdowns by region separately for men and women for four different years: 2007, 2009, 2012 and 2018. Then, we use linear regression to describe the geographical and sex-specific patterns of change in the AAI over the considered period. The results demonstrate the diversity of regional outcomes and trends in the active ageing of Italian men and women, indicating that the widening geographic gap deserves further consideration by national and regional authorities in designing and implementing active ageing policies. By showing the persistence of disparities in the value of the indicator to the disadvantage of women, results also suggest the need to further integrate both the gender dimension and the life-cycle perspective into active ageing strategies. This article provides an example of how the AAI can be used as a practical tool by policy makers to monitor active ageing trends and outcomes at the sub-national level, and to identify target areas that require further action.

Ultrasound Measurement of Rectus Femoris Muscle Parameters for Discriminating Sarcopenia in Community-Dwelling Adults.

Sarcopenia patients require more medical attention and caretaking. As such, early detection of sarcopenia and appropriate interventions are crucial for decreasing medical costs and meeting the challenges of aging populations. The aim of the present study was to develop a reliable and accurate model to estimate muscle mass using ultrasound-derived parameters from the rectus femoris (RF), referenced by dual-energy X-ray absorptiometry. Cross-sectional study was performed. The study patients were recruited by Taipei Veterans General Hospital (No. 2016-07-013C) between 2016 and 2019. A total of 91 community-dwelling adults (35 men and 56 women) were enrolled in this study. Ultrasound measurements of RF muscle thickness (MT), cross-sectional area (CSA), and muscle volume (MV) were performed in B-mode. Muscle strength and physical performance were also examined. Multivariate linear regression was used to build models for the prediction of appendicular skeletal muscle index (ASMI) based on MT, CSA, and MV values. The accuracy of ultrasound RF measurements for predicting sarcopenia was evaluated by using receiver operating characteristic (ROC) curve analysis. The regression equations used for ASMI prediction (adjusted body mass index, sex, and leg length) had high precision and low error. Moreover, the MV model results were close to those of the CSA model and higher than those of the MT model. The ROC analysis showed that both MV and CSA had excellent discrimination when assessing sarcopenia (AUC=0.83 and 0.81, respectively), whereas MT showed acceptable discrimination (AUC=0.73). Ultrasound-derived RF MV was accurate when predicting ASMI and diagnosing sarcopenia in community-dwelling adults.

The Association between Social Support and Cognitive Impairment among the Urban Elderly in Jinan, China.

China is currently facing a severe challenge of population ageing. However, no study has specifically explored the association between social support and cognitive impairment in Chinese urban elderly aged 60 and older. We explored the prevalence of cognitive impairment and its relationship with social support among the urban elderly aged above 60 years in Jinan, China. A total of 522 urban elderly individuals were recruited using multi-stage cluster random sampling, of which 35.55% were males and 64.45% were females. The average age of all participants was 69.66 ± 8.91 years old. Social support was assessed using the Social Support Rating Scale. Cognitive status was assessed using the Mini-Mental State Examination. Data were collected through face-to-face interviews using structured questionnaires. Descriptive analysis, chi-square tests, and logistic regression analyses were conducted. After analysing the data from 512 participants, 154 (30.1%), 352 (68.8%), and 6 (1.2%) participants had high, moderate, and low levels of social support, respectively. In addition, 125 participants (24.4%) had a cognitive impairment, while the other 387 participants (75.6%) had a normal cognitive status. Binary logistic regression analyses showed that age, educational level, occupation or pre-retirement occupation, and social support were statistically associated with cognitive impairment. A significant association between social support and cognitive impairment was found among the urban elderly in Jinan, China, which provided useful information for the intervention of cognitive impairment. More attention should be paid to the social support of the urban elderly to effectively reduce the occurrence of cognitive impairment.

Mind the gap: population ageing and health financing sustainability

Abstract Background Models used to forecast the effects of population ageing on health financing usually only explore effects on health spending, while neglecting effects on health revenues. Methods Using publicly available data, we construct simulation models to project how changes in the population age mix affect both public sector health revenues and expenditures across a range of countries representing a diverse mix of health financing systems in Europe as well as the Western Pacific (Australia, Bulgaria, Japan, Slovenia, United Kingdom and Vietnam). Results By 2100, the largest gap between health revenues and expenditures due to population ageing under current health financing arrangements is expected in Vietnam; the majority of that health financing gap (87.1%) is attributable to expected growth in health expenditures. In Slovenia and Japan, the financing gaps are forecast to reach less than half that of Vietnam by 2100; however, the reasons for the increases in gaps vary. In Slovenia, nearly half of the increase in the gap (44.2%) is due to reductions in health revenues compared with just under one-third (28.7%) in Japan. Conclusions There is a perception that population ageing will have deleterious effects on the sustainability of public sector health financing. However, this is highly dependent on how financing systems are designed. Our simulation models demonstrate that comparative analyses that give equal attention to both health expenditures and revenues provide decision makers a balanced set of policy options for addressing the challenges of population ageing. The options range from targeting expenditures and utilization of services to diversifying revenue generation.

Ways to Overcome Poverty and Income Inequality in the Context of New Global Challenges: the Most Important Conclusions for Ukraine

The article examines the risks of deepening poverty and income inequality that arise from global challenges of population aging, job losses due to shrinking sales markets, trade wars, long-term quarantine and compliance with the safe distancing of people as part of restrictive measures against the spread of COVID–19, the nature of employment (remote work, temporary reduction of labor migration), and other norms in the fight against the dangerous contagious disease. Given the facts that the prevention of spreading and localization of dangerous diseases, their treatment, and the rehabilitation of patients affect all segments of the population, have negative effects on all areas of people’s lives and also add to the increase of socio-economic risks, including poverty and inequality, the study of this issue is extremely relevant. The financial implications of these challenges for many households lead to falling real incomes, and an increase in costs and debts, and their non-repayment, which generally cause sudden poverty and increasing inequality of income and property.&#x0D; Purpose of the article: To investigate the risks of poverty, including sudden poverty, the inequality of household incomes amid the fight against the COVID–19 pandemic, and it identifies ways to overcome them. Methods: A review of the scientific literature, a presentation of statistical data, and statistical research.&#x0D; Findings &amp; Value added: As a result of research, a list of new risks of poverty and income inequality is outlined, and preliminary assessments of the consequences of the COVID–19 for households are summarized; signs of short-term loss are generalized; the solvency of households as a possible precondition for sudden poverty is evaluated; cross‑country comparisons of poverty risk are made; the scheme of state aid to improve living standards of people during the outbreak of new dangerous diseases in the EU and Ukraine is generalized; ways to overcome poverty and income inequality are substantiated to restore the resilience of financially vulnerable households and ensuring the development of human capital.

Gender, health and ageing in Fiji: a mixed methods analysis

BackgroundWomen are disadvantaged by ageing: older women are more likely than older men to suffer from ill-health, have less access to health care and suffer discrimination within the health care system. Globally, there is a dearth of health research on gender and ageing with substantial knowledge gaps in low and middle-income country contexts. Part of a wider investigation on health and ageing in Fiji, our objective was to identify and describe gendered differences in healthy ageing in this Pacific Island context. We believe this to be the first such study in the Pacific region.MethodsApplying a health systems lens, we used a mixed-methods approach, encompassing analysis of cause of death data; focus group discussion to gather community and family attitudes to health services; and policy analysis, and then used data triangulation techniques to draw out key themes and insights.ResultsWe found that gender affects health outcomes among older persons, attitudes towards and experience of healthy ageing, and an older person’s access to and use of health services. We also found that while Fiji’s policy response to ageing has recognised the importance of gender, to-date there has been limited action to address gender differences. Gender (as oppose to sex differences) has direct and indirect implications for the health of older Fijians, while gendered inequalities and patriarchal norms appear to affect both men and women’s experience of ageing and the health system response. Further, gender and age discrimination may be intersecting, intensifying their separate effects.ConclusionThis study demonstrates the feasibility and importance of applying a gender lens to the study of healthy ageing. Our findings from Fiji may be relevant to other island nations in the south Pacific which share similar challenges of population ageing, a constrained health budget and geographically-dispersed populations. The data triangulation methodology may be considered an efficient and insightful way to examine gendered responses to healthy ageing elsewhere.