Challenges Of Ageing Population Research Articles

Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization’s World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy (“living well”), the well unhealthy (“living with illness”), the unwell unhealthy (“living with frailty”), and the end-of-life (EoL) (“dying well”). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as “wellness kampungs” and “share-a-pot”. A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National Healthcare Group, innovative projects to address the needs of the frail elderly have been developed in the areas of: (a) admission avoidance through joint initiatives with long-term care facilities, nurse-led geriatric assessment at the emergency department and geriatric assessment clinics; (b) inpatient care, such as the Framework for Inpatient care of the Frail Elderly, orthogeriatric services, and geriatric surgical services; and (c) discharge to care, involving community transitional care teams and the development of community infrastructure for post-discharge support; and an appropriate transition to EoL care. In the area of EoL care, the National Strategy for Palliative Care has been developed to build an integrated system to: provide care for frail elderly with advance illnesses, develop advance care programmes that respect patients’ choices, and equip healthcare professionals to cope with the challenges of EoL care.

Young People Caring for Their Parents: A Collaborative Study in Japan and Sri Lanka

Population aging is a global problem, but its magnitude and manifestation vary across countries. Japan faces the challenge of a super-aged society, whereas Sri Lanka is experiencing rapid demographic transition: a problem in the Asia Pacific region that needs urgent attention. The degree to which young adults provide support for aging parents depends on their awareness/consciousness of older adults, and differs according to social images that influence intergenerational relationships. This quantitative study investigated young adults' opinions and perceptions toward their aging parents and intergenerational activities, and explored their care consciousness and anticipated challenges. Representative samples of 1064 university students from Japan and 600 students from Sri Lanka (aged 20–22 years) completed a self-administered questionnaire. Students who had an attitude of discrimination toward older people also perceived older adults as having a significant amount of experience and knowledge. They believed in traditional forms of caregiving with social support and appeared to have developed values to prepare themselves to face the challenges of population aging. Overall, female students were more concerned about population aging than male students. However, with the aging population increasing, opinions and social values about older adults face dramatic social challenges, despite maintenance of cultural and religious traditions.

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

Building a Humane Society for Older People: Compassionate Policy Making for Integration, Participation, and Positive Ageing Within a Framework of Intergenerational Solidarity

ABSTRACTThis article explores the global challenge of population aging with a specific focus on the concepts of integration and participation of older people in society within the context of “realizing a society for all ages” as promoted by the United Nations. It is proposed that governments worldwide need to embrace new ways of thinking about population aging that include strategic initiatives for strengthening the social contract that fosters generational interdependence. The meaning of “positive aging” is explored at both the individual and social levels, with implications for quality-of-life issues involving intergenerational relationships. The point is made that while the promotion of positive aging is commendable on both philosophical and health grounds it can be problematic for those older people who for a range of legitimate reasons are unable to fulfill the notion of positive or active aging. The longevity revolution will require the emergence of a more humane society that undertakes to reconceptualize what older age means, together with exploring new ways of enhancing the citizenship status of older people through the development and promotion of innovative intergenerational relationships. A call is made for a wider engagement of the citizenry in the processes involved in the formulation and implementation of policy making.

Malthus’ population theory is still wrong

In this article, I try to answer the question—“Will Malthus continue to be wrong?”, one of the 125 most challenging scientific questions raised by Science at its 125th anniversary ceremony, through a comprehensive review and analysis of historical backgrounds, population growth vs. economic development trajectories in recent decades, current new challenges, and future perspectives. Based on evidence from various theoretical and empirical studies in multiple fields, I conclude that Malthus’ initial population theory is wrong in the past, present, and future. It has also been recognized that the new Malthusianism, which warned societies that quick population growth due to high fertility would put pressure on natural resources and the environment, and proposed birth control programs with voluntary contraception use, has made useful contributions to human development in the past decades. Given the fact that China’s population has already entered the era of very slow growth and will decline in a dozen years, could we (as scientists) rest without worries about natural resources and environmental protections? Our answer is “No”, because scientific research and policy analysis need to be strengthened to better understand the impacts of changes in the number and structure of family households on energy consumption, population aging, and sustainable development. Various studies have shown that household size has been shrinking in recent years, causing a quick increase in the number of households (including many living alone or empty-nest elders). Consequently, while the population growth rate is largely reduced and will become negative in a dozen years, energy consumption will substantially increase because households (rather than individuals) are the primary units of energy usage. Aside from energy use, plenty of research evidence suggests that older adults who live in small “empty-nest” households have significantly worse cognitive function, self-rated health, and life satisfaction compared to those elderly who live with or nearby their children and grandchildren. Empirical data analyses also show that three-generation co-residence or nearby living arrangements increase the workforce participation of female adult children and associated financial and health benefits, since grandparents traditionally take on care responsibilities for grandchildren. The analysis indicated that the old parents benefit more from emotional care provided by their adult daughters and sons-in-law compared to sons and daughters-in-law. To strengthen natural resource and environmental protections as well as to face the serious challenges of population aging, we propose that China needs to take two major policy actions. First, strongly enhance scientific and technical innovations in the fields of clean and efficient energy, emission reduction, protection of soil and water resources from pollution, and preservation of biodiversity. Second, implement a policy to promote three-generation co-residence or nearby living arrangements to reduce the negative effects of shrinking households on energy consumption, population aging, and sustainable development, More specifically, referring to successful policy programs that promote three-generation families in Singapore, we suggest that: (1) implement nationwide economic incentive policies to encourage adult children to live with (or nearby) their old parents; (2) encourage and support young migrants from the poor northwestern regions to go back to their hometowns to develop business and to reunite with their old parents, or bring their left-behind old parents to live with them in the cities; (3) encourage older parents to live with (or nearby) an adult daughter and son-in-law, even if they have both a son and a daughter. This would not only be beneficial for taking better care of old parents, but would also gradually change the tradition of daughters marrying out of their own families, which would help to eliminate son preference and reduce the high sex ratios at birth in China. In sum, the policy to encourage three-generation co-residence or nearby living arrangements is a win-win program that benefits both the elderly and their children, which is useful to address the serious challenges of population aging. It is also an effective way to slow down the quickly growing number of households and thus significantly reduce energy consumption and enhance environmental protection and sustainable development.

Designing Fit for Purpose Health and Social Services for Ageing Populations.

Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization’s World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course. The complementary perspective is the prevention of frailty, which has physical, cognitive, social and psychological dimensions. Therefore, services for older people should encompass medical as well as social components. The need and evolution for a transition in health and social services in Hong Kong, a special administrative region of China which has a population with the world’s highest life expectancy, is presented as an example of how one developed economy attempts to meet the challenges of population ageing. There is a need to shift to integrated care in the community instead of specialty dominated hospital care, and to establish regular activities in the community to adopt and maintain a lifestyle that reduces frailty and disability (or promotes intrinsic capacity). A top down approach with financial incentives, together with public education to help drive policy changes, are key drivers of change. It is expected that there will be much heterogeneity between different countries in terms of barriers and facilitators, such that each country needs to document their needs and design appropriate services.

Multiple Helices as Agents of Change? The Case of the Neighborhoods of the Future Project and the Development of Direction for Policy and Practice on Health, Happiness and Wellbeing for the next Generation of Older Adults

This article describes a case study on a project to create cooperation between international (EU) and national governments, small and large enterprises, universities and non-governmental charitable and social organizations. It explains the nature of the project and investigates the implications of the project for the discourse concerning the Triple Helix. The project, still in progress at the time of writing, required the stimulation of large scale and pervasive innovative responses to the challenge of aging populations in European countries, particularly as regards the creation of appropriate homes and neighborhoods that will enable the new generation of older adults to live well, happily and healthily. People in this new generation is conventionally referred to as baby boomers, the largest, longest lived, healthiest, wealthiest, longest working older generation that Europe has ever seen. The paper describes the first stage of the project - the creation of an inclusive dialogue between the different parties. Then it presents a discussion of the learnings from the case study for organizers of other similar dialogues, based upon an in-depth interview with the initiator of the project, who is also one of this article’s co-authors. It also proposes a new configuration of Triple Helix model. We conclude this paper by presenting a question that Triple Helix participants as agents of change will have to answer in the future.

Assessment of shoulder mobility in women over 60 years of age after one-sided mastectomy

The overall risk of contracting various diseases, including breast cancer, increases with age. An on-going process of population ageing challenges modern physiotherapy with the need to have functional capacity in older people appreciably enhanced. The issue of anthropometric assessment of the range of motion and shoulder muscle strength is presently much underrated in the physical rehabilitation management of women patients after radical one-sided mastectomy. The study aimed to assess the functional mobility of a shoulder expressed as a range of motion, in conjunction with the assessment of shoulder muscle strength, in women patients over 60 years of age after radical one-sided mastectomy. The study comprised 24 patients (mean age 65 years) recruited from the Department of Rehabilitation, Holy Cross Cancer Centre, Kielce. All patients had undergone modifi ed radical mastectomy using the Madden technique, and an adjuvant therapy. The shoulder range of motion, i.e. flexion, abduction, internal and external rotation, was evaluated by a goniometer. Elevation, protraction and retraction movements were evaluated using an anthropometric device. A dynamometer was applied to assess the strength of select muscle groups within the shoulder during elevation, protraction and retraction motions. Statistical analysis was made with the aid of STATISTICA 12.0 software, having adopted a 0.05 alpha level as statistically signifi cant. The movements of fl exion, abduction and external rotation of the upper extremity were signifi cantly reduced on the mastectomy side. The range of motion and muscle strength during shoulder elevation, protraction and retraction were significantly diminished on the operated side (12% - 14%), compared to the non-operated one. 1. Functional mobility of the shoulder was signifi cantly reduced on the mastectomy side. 2. Results of the present study highlight the need to extend the scope of rehabilitation regimens offered to older women after radical one-sided mastectomy.

Gerontological training programs offered by Latin American universities: Number, characteristics, and disciplinary contents

ABSTRACTOne of the challenges of population aging is to ensure that there are enough trained professionals to meet the changing, specific needs of aging populations. The aim of this study was to describe the number, geographical distribution, and general characteristics of gerontological training programs offered by Latin American universities and to analyze their disciplinary content and the degree of similarity among programs. One hundred undergraduate and postgraduate programs with gerontological content were found to be offered by Latin American universities. Information on the institutional affiliation, academic level, management, length, and content of the programs was analyzed. Descriptive statistics were run and content analysis was performed on the programs’ syllabuses to address the objectives of the study. Results show that despite being a relatively young region of the world, the majority of Latin American universities offer gerontological programs. However, the nature of this course offering seems to be quite diverse across countries. Moreover, the analysis of the programs’ disciplinary content indicates that the program providers take a multidisciplinary approach to gerontology. The great diversity of programs and their multidisciplinary contents suggest a low degree of standardization of gerontological training in Latin America.

How to Fill the Working-Age Population Gap in Asia: A Population Accounting Approach

The world faces growing challenges of aging populations. Asia is no exception with rapidly increasing life expectancies and falling fertility rates. To help policy makers address these issues, this paper examines three sociopolicy options: (i) extending the retirement age, (ii) augmenting labor migration within the region, and (iii) through using population accounting methodology with the goal of increasing fertility rates. When the retirement age is extended from 65 to 70, the overall dependency ratio in 2050 would decline from 56.7% to 44.7%. If the 2010 dependency ratio were to be maintained, the region would need to import significant numbers of workers aged 15‒44 even as those aged 45‒64 would be in surplus. India, Pakistan, and the Philippines will be major sources of surplus labor. Raising fertility rates to the 2.1% replacement level will increase the dependency ratio for the time being, but will eventually reduce it over several decades depending on each country’s demographic structure.

社区养老服务需求调查研究

从老年人自身需求为出发点，设计社区养老服务制度，是理性的选择。应对人口老龄化挑战，探索适合我国国情的养老服务方式，社区养老是链接家庭养老和社会化专业养老的平台，适合我国国情。调查发现，社区养老服务存在的问题主要有服务管理机制与责任不明确、政府投入社区养老服务的资金相对不足、社区养老服务基础设施不完善、社区养老服务专业人才短缺、社区养老服务项目供需不平衡。依次提出的政策建议包括：明确政府责任、完善社区养老基础设施、构建社区养老服务多元供给机制、发挥家庭养老保障的功能、建立社区全科医生服务模式、培养社区老年护理人才。 It is a rational choice to design a community pension service system from the point of view of the elderly’s own needs. To cope with the challenges of population aging, to explore the way of pension services that are suitable for China’s national conditions, community endowment is a platform to link the family pension and socialized professional pension, which is suitable for China’s national conditions. The survey found that the problems of community pension service mainly are the service management mechanism and the responsibility are not clear, the government’s investment in the community pension service is relatively insufficient, the community pension service infrastructure is imperfect, the community pension service professional talent is shortage and the community pension service project supply and demand are imbalanced. Followed by the proposed policy recommendations include: a clear government responsibility, improving the community pension infrastructure, building community support services diversified supply mechanism, playing the role of family pension security, the establishment of community general practitioner service model, training community care for the elderly.

Gerontoludic Design

Considering the popularity of digital games among older adults and the challenge of population ageing, this article identified a need for an integrated game design framework aimed at older audiences. An analysis of the literature on play in later life demonstrated how the literature is dominated by two themes, i.e., the benefits of playing digital games and the issue of accessibility. While this underlying model has been demonstrated to contribute to successful designs, it also risks reducing games to its motivational characteristics and ageing to cognitive and physical decline. The author therefore reviewed the literature on game design and later life to develop a design approach that considers the multi-faceted nature of ageing as well as the intrinsic value of digital games. The resulting “Gerontoludic Design Framework” sets meaningful play as the intended outcome of game design for older adults, identifies iterative player-centered design as its preferred design approach, and extends the MDA framework by suggesting age-specific aesthetics and mechanics.

Fiscal Challenges of Population Aging in Brazil

In recent decades, population has been aging fast in Brazil while old age pensions and healthrelated spending have increased. As the population ages, the spending trend threaten to reach unsustainable levels absent reforms. Increasing the retirement age is key, but by itself will not provide sufficient savings to close the pension system financing gap, and reforms reducing replacement rates are necessary. In the area of health, there is scope for improving expenditure efficiency by strengthening outpatient care and regional networks, and developing clinical guidelines for cost-effective treatments and drugs. Reforms are urgent, so that they can be gradual.

Fiscal Challenges of Population Aging in Brazil

Fiscal Challenges of Population Aging in Brazil

International Variation in Ageing and Economic Dependency: A Cohort Perspective

Within this analysis of demographic and economic dependency ratios for 45 countries around the world, we reiterate the importance of age- and gender-specific employment levels as well as their determinants when discussing the economic challenges associated with population ageing. Building upon existing research on economic dependency, we portray and discuss cohort variation in employment and its possible effect on the challenges of population ageing, focusing on the implications of high youth unemployment, the role of changes in female employment and the evolution of retirement patterns across cohorts. The insights from our analysis reaffirm findings elsewhere that younger populations may not be as well off in the light of demographic change as an analysis of their demographic structure alone would suggest and stress the importance of considering the cohort dimension of employment in this discussion.

The Structure and Effectiveness of Health Systems: Exploring the Impact of System Integration in Rural China.

Introduction:Facing the challenges of aging populations, increasing chronic diseases prevalence and health system fragmentation, there have been several pilots of integrated health systems in China. But little is known about their structure, mechanism and effectiveness. The aim of this paper is to analyze health system integration and develop recommendations for achieving integration.Method:Huangzhong and Hualong counties in Qinghai province were studied as study sites, with only Huangzhong having implemented health system integration. Questionnaires, interviews, and health insurance records were sources of data. Social network analysis was employed to analyze integration, through structure measurement and effectiveness evaluation.Results:Health system integration in Huangzhong is higher than in Hualong, so is system effectiveness. The patient referral network in Hualong has more “leapfrog” referrals. The information sharing networks in both counties are larger than the other types of networks. The average distance in the joint training network of Huangzhong is less than in Hualong. Meanwhile, there are deficiencies common to both systems.Conclusion:Both county health systems have strengths and limitations regarding system integration. The use of medical consortia in Huangzhong has contributed to system effectiveness. Future research might consider alternative more context specific models of health system integration.

Demografia polityczna i możliwości dla polityki pronatalistycznej w Polsce

Political demography links demographic findings with public policies aimed at achieving state goals. Current challenge of population aging causes threat to internal financial stability and well-being of the elderly. Aging also questions countries’ international position due to possibly reduced financial capability to maintain geopolitical power, and in extreme situation of lowest low fertility also due to continuous, unstoppable decline in the population size. In case of Poland, aging alone would result in almost doubling expenditure on pensions and healthcare. To respond to social and geopolitical challenges, the government should primarily focus on policies aimed at stimulating births. To foster pronatalist policies, factors affecting fertility may be grouped into five categories: economic, cultural, psychological, infrastructural and unplanned. All these factors influence childbearing behaviour simultaneously. Some of them constitute barriers to fertility (which need to be eliminated) and the others facilitate fertility (and they need to be strengthened). The barriers include financial constraints, individualistic values, financial insecurity, union instability, insufficient support network and lack of family-friendly employment. Identified facilitators in turn include pension system linking benefits with number of children (family pension system) and family-oriented aspirations and values with religion as a vital ingredient. Father commitment to family life impacts both as facilitator and by eliminating barriers.

The Challenges of Aging Population: Demographic Development of Labor Force and Immigration Policy

Given that the amount of elderly population in Finland is growing fast, the author takes a look at the economic policies that aim at combating the challenges brought by aging population in developed countries. The degree of urbanization of a capital city can be determined by the level of demographic changes over time. In this study, the author uses the urban data to analyze the determinants of demographic changes, which have a significant impact on regional policies and regulations. The results reveal important insights on the implications of migration and employed labor force on the regional economy. It is acknowledged that factors such as quality of human capital, labor mobility and housing facilities are integral parts of demographic development. One of the important predictors of demographic changes is labor mobility. The results of ARIMA-models show how the number of employed labor force will change in future in the capital region. New research opportunities are opened in the policy control of inbound and outbound migration to the capital city as well as in the strategic implications of income gap on the regional economy.

An ageing world and the challenges for a model of sustainable social change

Purpose – Although the world is rapidly ageing, the alarming explosion of youth unemployment seems to have removed the workforce ageing issue as a priority from the policy agenda. The purpose of this paper is to test and investigate the main needs and willingness to work among the older population, as well as the main advantages for organizations employing older workers. Design/methodology/approach – The main research objectives were: first, to explore the effect of demographic and socio-economic predictors on an older person’s intention to work; and second, to focus on the main advantages that should induce organizations to retain older workers in their workplace. The paper is based on a survey and an interdisciplinary review of the literature. Findings – The study indicated that educational level led to improved active behaviours in the labour market. In other words, people who obtained a higher level of education showed a greater likelihood to desire a prolongation of working life, while lower educational attainment may have lessened the willingness and capacity of older people to remain in the workforce. The main benefits for organizations with older workers are highlighted. Research limitations/implications – The survey has a number of limitations: the sample is small and was completed with reference to a single country, making it difficult to generalize results beyond this country study; the questionnaire relied solely on a few areas, while it would be better to gather additional information; the survey only targeted retired people, while it would have been interesting to also collect answers from workers nearing retirement. The association between individuals’ educational levels and their intention to work in later life suggests that continued development of educational programmes for workers could favour greater retention in the workplace. Practical implications – As the ageing population is an increasing phenomenon, the participation of older people in the labour force and lifelong learning should become commonplace in the perspective of a more equitable society. The main challenge is to rethink retirement, by abolishing the mandatory retirement age and by providing more flexible work options. Social implications – Changes in national system and corporate strategies are required to meet the economic challenges of ageing populations. Originality/value – This study advances research on age management because it provided evidence that educational background plays a fundamental role in determining the willingness to return to work. In addition, the paper proposes a new integrated approach of sustainable social change.

Understanding the role of contrasting urban contexts in healthy aging: an international cohort study using wearable sensor devices (the CURHA study protocol).

BackgroundGiven the challenges of aging populations, calls have been issued for more sustainable urban re-development and implementation of local solutions to address global environmental and healthy aging issues. However, few studies have considered older adults’ daily mobility to better understand how local built and social environments may contribute to healthy aging. Meanwhile, wearable sensors and interactive map-based applications offer novel means for gathering information on people’s mobility, levels of physical activity, or social network structure. Combining such data with classical questionnaires on well-being, physical activity, perceived environments and qualitative assessment of experience of places opens new opportunities to assess the complex interplay between individuals and environments. In line with current gaps and novel analytical capabilities, this research proposes an international research agenda to collect and analyse detailed data on daily mobility, social networks and health outcomes among older adults using interactive web-based questionnaires and wearable sensors.Methods/DesignOur study resorts to a battery of innovative data collection methods including use of a novel multisensor device for collection of location and physical activity, interactive map-based questionnaires on regular destinations and social networks, and qualitative assessment of experience of places. This rich data will allow advanced quantitative and qualitative analyses in the aim to disentangle the complex people-environment interactions linking urban local contexts to healthy aging, with a focus on active living, social networks and participation, and well-being.DiscussionThis project will generate evidence about what characteristics of urban environments relate to active mobility, social participation, and well-being, three important dimensions of healthy aging. It also sets the basis for an international research agenda on built environment and healthy aging based on a shared and comprehensive data collection protocol.