Services For Older Adults Research Articles

Factors that influence the need for mental health services for older adults in Europe

Abstract Background Mental health is an integral component of health, and affects close to a 100 million Europeans. Little is known about the predictors of older adult’s mental health demand among health systems in European countries. This study is based on the Andersen’s Behavior Model, that predicts that predisposing characteristics, enabling factors, and behavioral factors, influence need or demand factors of healthcare services. Aim This study has two overall objectives: (i) to investigate the determinants of older adults’ mental health services demand; and (ii) examine the relationship between predisposing characteristics, and enabling resources, with services demand. Methods Data from Wave 9, of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 47, 345 older adults. Analysis: The Omnibus test was used to evaluate the fit model and Multinomial Logistics Regression were performed to test the null hypothesis that predisposing characteristics, enabling resources, and behavioral factors are not predictors of need or demand. Findings Predisposing characteristics such as gender (b=-.43, s.e.=.017, p<.001) and age (b=-1.96, s.e.=2.2, p<.001), and enabling factors such as homecare (b = 2.40, s.e.=0.1, p<.001), social support (b=-.26, s.e.=0.012, p<.001), financial support receiving (b=.51, s.e.=.086, p<.001), income (b=.09, s.e.=.009, p<.001), and behavioral factors such as use of technology are predictors of mental health services need or demand [Chi-Square= 3319.58, df = 15 and p <.001]. Implications for Policy and Practice Initiatives for the care of older adults should not only aim to increase access to care services for sub populations such as older adults with mental health but also consider enabling resources such as financial and social support and behavioral factors such as use of technology. Key messages • Demand for mental health services for older adults are influenced by predisposing, enabling and behavioral factors. • Investing in financial services, social support and technology may reduce the demand for mental health services among older adults.

Older people’s challenges accessing health services in central Nepal: a qualitative study using the domain of access framework

BackgroundLow- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.MethodsThis qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.ResultsHypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.ConclusionsThis study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.

Effects of an individual cognitive stimulation intervention on global cognition, memory, and executive function in older adults with mild to moderate Alzheimer's disease.

To determine the efficacy of a 12-week individual cognitive stimulation (iCS) intervention on global cognition, memory, and executive function of older adults with mild to moderate Alzheimer's disease (AD). Protocolized analysis using data from a multicenter, single-blind, randomized, parallel two-arm RCT of iCS for older adults with probable AD. A sample of 142 people with probable Alzheimer's disease attending 13 Portuguese institutions providing care and support services for older adults were selected. Intervention group (n = 72) received 24 iCS sessions, twice a week for 12 weeks. Control group (n = 70) maintained their activities as usual. Outcomes included global cognitive function (Mini-Mental State Examination, and Alzheimer's Disease Assessment Scale-Cognitive Subscale), memory (Memory Alteration Test, and Free and Cued Selective Reminding Test), and executive functioning (Frontal Assessment Battery). All participants were assessed at baseline (T0), after the intervention (T1), and 12 weeks follow-up (T2). The results showed significant improvements in memory performance at follow-up for the intervention group and greater stability in global cognition in the intervention relative to the control group. The current iCS protocol shows effectiveness in cognitive functioning in older adults with probable AD, particularly for memory upon completion of the intervention and at follow-up, adding further support to previous iCS studies showing similar results and to the effectiveness of the current intervention.

Elderly Care Provision under National Policy on Older Persons 2013: A Cross-Sectional Study in Dhaka City, Bangladesh

Bangladesh is undergoing a notable demographic transition, characterized by a substantial rise in the proportion of elderly individuals within its population. This demographic transition presents a range of economic, social and cultural issues that necessitate prompt attention and intervention. The aim of this study was to examine the current state of elderly care services and facilities available for older adults in urban landscape by taking into account the ‘National Policy on Older Persons 2013.’ This study was conducted in Dhaka city by employing a cross-sectional study design. The study population covers elderly people aged 60+ years, living in Dhaka City for more than five years continuously and are able to speak well with someone. The study was based on a sample of 240 and the respondents were chosen using convenient sampling technique. The data were collected through face-to-face interview using structured questionnaire and they were analyzed utilizing descriptive statistics. This study found that the existing elderly care services and available opportunities are below the satisfactory level for most of the older adults of the city, even though the ‘National Policy on Older Persons 2013’ was adopted a decade ago. The elderly people in Dhaka city encountered a number of difficulties considering their physical health, psychological and social well-being. In the case of availability of the affordable and quality healthcare services for older adults in their community, 30.4% of the respondents said that the availability, accessibility and affordability of quality healthcare services are very poor, followed by 24.6% below average and 26.3% at the average level. Nearly 75% of the study people said that they had ever experienced unfair treatment for being aged. Indeed, they receive care and support in an inconsistent, disorganized and incoherent manner. The study clearly revealed that there is a need to prioritize person-centered care as well as integrated care system for the effective management of the ageing population in Bangladesh. Jagannath University Journal of Science, Volume 11, Number 1, June 2024, pp. 118−134

New Brunswick HEARS: outcomes of a community-delivered hearing intervention adapted for older adults in Atlantic Canada

Objective To assess acceptability and benefit of a community-based hearing intervention delivered at no cost to lower-income older adults with untreated hearing loss in New Brunswick, Canada. Design Mixed method pre-post intervention study investigating aspects of communication function and social support at baseline and three months post-intervention. Study Sample 124 of 175 independent-living older adults screened at the study site and in local community centres in low-income neighbourhoods were recruited into the study. Results In 70 (56.5%) participants self-identified as female and 54 (43.5%) as male, with mean age of 74.5 years, mean effect sizes measured from baseline to 3-months post-intervention were 0.99 (large) for HHIE-S, 0.58 (medium) for DSSI, and 1.02 (large) for LSEQ indicating significant improvement in self-perceived communication function, social support and listening self-efficacy, respectively. Conclusion The HEARS program is feasible to implement, despite Covid-19 pandemic related challenges, highly acceptable to participants, and associated with a range of benefits that include improved communication function, self-efficacy and social support. The success of HEARS in a new population in a second Canadian province indicates its adaptability and suitability for scaling to extend the reach of hearing services for older adults who may not otherwise access care.

Design of Social Infrastructure and Services Taking into Account Internal Migration by Age Cohort

Abstract Background European cities and regions are facing depopulation and an ageing population, leading to a shift in the demand and supply of goods and giving rise to the silver economy. This demographic change has an impact on urban and regional planning, which is influenced by both internal and external migration. Objectives Based on the hypothesis that the attractiveness of locations also depends on the age of the inhabitants, the paper investigates the gravitational effects on the intensity of migration flows by age cohorts. Methods/Approach This study examines how factors that influence the retention or attraction of people towards specific areas affect migration between age groups at different hierarchical spatial levels, using the gravity model implemented at the Slovenian spatial levels NUTS 2 and NUTS 3. Results Distance is least important for the 65-74 age group, while wages influence only the youngest cohorts. The capacity of care homes has a significant influence on the attractiveness of older cohorts to move between NUTS 2 regions. There is a high correlation between the factors at the municipal and NUTS 3 levels for the population aged 75+. The factors at NUTS 2 and NUTS 3 levels show a strong correlation for those under 65. Conclusions These results can form a basis for the development of the silver economy as they show the need for adapted infrastructures and services for older adults. As the age structure is changing, authorities should adapt infrastructures and services to the different levels of central places/regions. The growing number of older people makes research into optimal solutions for long-term care a crucial factor for the silver economy.

How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study.

Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=-.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=-.23) but not at T6. At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology.

A scoping review of barriers to accessing aged care services for older adults from culturally and linguistically diverse communities in Australia

The ageing population of the culturally and linguistically diverse (CALD) population is increasing in Australia. This is because the number of early migrants in Australia is ageing, coupled with increasing family reunification. This scoping review aimed to describe the nature and extent of research on the barriers to aged care services for CALD older adults in Australia using Penchansky and Thomas’s Access to Care Framework of five A's dimensions: availability, accessibility, accommodation, affordability, and acceptability. Arksey and O’Malley’s five-step scoping review framework was adopted to search 6 databases from inception till August 2024. Title/abstract and full-text screening were conducted using predefined inclusion and exclusion criteria, with supplementary search of references from included articles to identify additional articles. Findings show that while all the five A's of access to care services were barriers for CALD older adults, accommodation and acceptability of services were the major areas of concern due to the lack of cultural sensitivity of such services in Australia. An additional barrier captured and termed as Awareness was noted in some of the included studies, highlighting the need to expand the five A's to 6 A’s. Researchers, practitioners, and policymakers on ageing could leverage these findings to improve cultural practice sensitivities when supporting these populations.

Costs and resource distribution of direct services for HIV in Uganda

ObjectiveIn high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of...

Vestibular Assessment In Patients With Self-Reported Dizziness And A History Of Falls

Abstract Background World Falls Guidelines recommend that any patient with a history of falls and reporting dizziness should be screened for Benign Paroxysmal Positional Vertigo (BPPV) (Montero-Odasso et al.,2022). Diagnosing and treating BPPV in particular has been shown to reduce the incidence of falls in older adults, however, it is widely underdiagnosed (Li et al., 2023). This audit explored compliance with falls guidelines in a day hospital setting where falls work up assessments take place on older patients (75 years and older). It aimed to identify reasons why vestibular assessments may not have been undertaken and establish methods to improve compliance with the undertaking of vestibular assessments where indicated. Methods A retrospective chart was undertaken for patients who attended a day hospital service for older adults between January and April 2023. A Microsoft excel sheet was used to track data. All data was anonymised and stored on a password encrypted HSE networked drive accessed in the day hospital. Results A total of 97 charts were reviewed, with 31 patients reporting to have experienced dizziness with falls. For 33% of those patients (n=10), a vestibular screen was not carried out. For 7 out of 10 of these patients a screen was not carried out due to insufficient staff training in the area, with one patient not having been referred to physiotherapy, also secondary to insufficient staff training. Conclusion Facilitating adequate access to training in vestibular rehab for healthcare professionals is an essential part of ensuring BPPV and other vestibular disorders are diagnosed and treated in patients with self-reported dizziness and falls. Training as part of undergraduate degrees could be considered to ensure BPPV is diagnosed and treated in a timely manner. Additional staff training was provided in the day hospital setting in question and a re-audit of vestibular screening will take place in summer 2024.

Utilizing a Geriatric Emergency Multi-disciplinary Service (GEMS) To Improve Care For Nursing Home (NH) Residents In The Emergency Department (ED)

Abstract Background The GEMS team provides an age attuned service for older adults living with frailty who present to the ED. Under the governance of a Geriatrician older adults living with frailty receive a Comprehensive Geriatric Assessment (CGA) and a collaborative plan of care. NH residents are often the most frail cohort of patients. They can sometimes be referred to the ED with needs that could be managed in the community. Moreover, transfer is associated with a higher risk of mortality (Lemoyne et al. 2019). To address this, all NH residents are classified as priority one by the GEMS Team. Pathways have been developed to the Community Integrated Hub for the Older Person (ICPOP), General Practitioners and Community Palliative Care Teams. The goals is to provide the right care, in the right place and at the right time. Methods Plan, Do, Study, Act (PDSA) Quality Improvement Methodology was utilized. Data was collected on all NH patients presenting to ED and interrogated over a 3-month period. Results 27 patients presented to ED from a nursing home during the collection period. (n=16) 60% of patients were discharged. 89% were living with severe frailty. 100% received a CGA, Advanced Care Planning and family liaison. (n=5) referred to ICPOP. (n=6) referred to Palliative Care through the GP. Conclusion The majority of patients reviewed were living with severe frailty and likely beginning the final journey of their lives. A CGA on presentation to ED ensures the goals of care are aligned with the persons will and preference. Alternative care pathways in the community enabled patients to be discharged back to the nursing home with appropriate follow-up supports. Reference 1. Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC geriatrics. 2019 Dec; 19:1-9.

Cross-Validation of the Financial Exploitation Vulnerability Scale

ABSTRACT Objectives The present study is a cross-validation of the Financial Exploitation Vulnerability Scale (FEVS), a measure of contextual risk for financial exploitation. Methods The sample was drawn from both the community and the SAFE program, a service for older adults who have been financially scammed. FEVS was administered within a larger assessment battery. The total score ability to differentiate exploitation groups and its correlates were examined. ROC analysis and logistic regression evaluated the clinical utility of the FEVS to detect exploitation. Results were compared to the initial validation study. Results FEVS score was significantly higher for those who were exploited and correlated with age. ROC analysis revealed adequate detection of financial exploitation. FEVS total score remained a strong predictor of exploitation when compared to demographic factors and several measures of cognitive functioning. Conclusions Cross-validation demonstrates strong evidence that the FEVS detects financial exploitation in older adults, beyond the ability of many known risk factors. Clinical Implications FEVS is an evidence-based tool for identifying exploitation and is accessible to many professionals working with older adults. Items query contextual factors that allow professionals to support clients with the appropriate standard of care.

Older adults’ decisions regarding mobility to age in place in medium- and high-rise multi-storey residential buildings in urban settings: A case study of South East Queensland, Australia

Population ageing and urbanisation requires a more thorough understanding and monitoring of older adult residential mobility trends. Many older adults move to urban areas and previous studies have been carried out on ageing in place in traditional low-rise residential buildings. However, there is little in the literature about the important push and pull factors influencing older adult moves to medium- and high-rise multi-storey residential buildings in urban areas as they age. This case study research considered the housing migration model of push and pull factors used in elderly residential mobility and investigated the older adults' decision-making regarding mobility to age in place in medium- and high-rise multi-storey residential buildings in South East Queensland, Australia. The study revealed how the older adults expressed a desire to age in place in multi-storey residential buildings in urban areas and identified it as an important element of quality of life. Many older adults chose to move house to high density urban areas from low density urban areas between the ages of 65 and 84. The ‘pull’ factor to significantly influence the decisions of movers was a low maintenance property and lifestyle change from a large suburban home whereas the ‘push’ factor was upkeep difficulties of the house related to old age. This study makes empirical contributions to knowledge in ageing residential mobility trends in urban areas and concludes by providing policy recommendations for developing more effective housing, public spaces, transportation, and community activities and services for older adults, including highlighting a number of recommendations for future research.

‘Mind the gap’: tensions, transitions and tactics in Canadian and Norwegian community services for older adults

This article compares community services provided to older adults living in Bergen, Norway, and Toronto, Canada. We investigate the gaps that are left unattended in the respective jurisdictions and consequently maintained by the organizations. Our findings reveal the importance of community organizations in positively influencing the initial transition from independence to needing more supports. Our findings show differences between the jurisdictions in the experiences of care gaps for diverse groups of providers and clients, while the overall importance of community organizations for older adults is shared in both jurisdictions, particularly by filling gaps between the formal and informal care systems.

Effect of older adults willingness on telemedicine usage: an integrated approach based on technology acceptance and decomposed theory of planned behavior model

BackgroundTelemedicine, as a novel method of health management system, has demonstrated to have a significant impact on health levels. However, a challenge persists in the form of low usage rates and acceptance among older adults in China. There are accumulating evidence that willingness will affect the telemedicine usage among older adults. This study investigates factors influencing older users’ trust in adopting telemedicine technology, thereby promoting actual use.MethodsA questionnaire survey was conducted with 400 urban seniors aged 60 and above. Drawing from the Technology Acceptance Model (TAM) and the Decomposed Theory of Planned Behavior (DTPB), the author combines elements such as Perceived Usefulness, Perceived Ease of Use, Subjective Norms, Service Environment, Self-Efficacy, Behavioral Intention to Use, and Usage Behavior. The aim is to explore the interrelationships between these factors.ResultsPerceived Usefulness (PU) and Service Environment (SE) significantly and positively impact Behavioral Intention (BI) to use telemedicine, with Trust (TR) identified as a crucial mediating variable. Enhancing trust can substantially increase older adults’ intention to use telemedicine services. Furthermore, the study reveals a significant relationship between older adults’ trust in telemedicine and factors such as Perceived Usefulness (PU), Service Environment (SE), Subjective Norms (SR), as well as Emotional Risk (ER) and Cost Risk (CR), the latter two tending to decrease Trust(TR).ConclusionsThis paper constructs and validates a combined model based on TAM and DTPB, comprehensively exploring the potential factors influencing the older adults’ intention to use telemedicine. The findings suggest that telemedicine services for older adults should prioritize improving user perception and enhancing trust throughout the service process to effectively increase their willingness to use these services.

Assessment of needs, challenges, and re-design considerations for culturally sensitive provision and delivery of palliative care supports and services for older adults who prefer to age and die in place in diverse India.

As the global older adult population continues to grow, challenges related to managing multiple chronic conditions (MCCs) or multimorbidity underscore the growing need for palliative care. Palliative care preferences and needs vary significantly based on context, location, and culture. As a result, there is a need for more clarity on what constitutes palliative care in diverse settings. Our objective was to present an international perspective on palliative care in India, a culturally diverse and large ancient Eastern middle-income country. In this narrative review article, we considered three questions when re-designing palliative care for older adults aging-in-place in India: (I) what are the needs for palliative care for persons and their families? (II) Which palliative care domains are essential in assessing improvements in the quality of life (QoL)? (III) What patientreported measures are essential considerations for palliative care? To address these questions, we provide recommendations based on the following key domains: social, behavioral, psychological, cultural, spiritual, medical, bereavement, legal, and economic. Using an established and widely reported conceptual framework on aging and health disparities, we provide how these domains map across multiple levels of influence, such as individual or family members, community, institutions, and health systems for achieving the desired QoL. For greater adoption, reach, and accessibility across diverse India, we conclude palliative care must be carefully and systematically re-designed to be culturally appropriate and community-focused, incorporating traditions, individual preferences, language(s), supports and services from educational and health institutions, community organizations and the government. In addition, national government insurance schemes such as the Ayushman Bharat Yojna can include explicit provisions for palliative care so that it is affordable to all, regardless of ability to pay. In summary, our considerations for incorporating palliative care domains to care of whole person and their families, and provision of supports of services from an array of stakeholders broadly apply to culturally diverse older adults aging in place in India and around the globe who prefer to age and die in place.

Indonesian dentists' views on providing oral health care for older adults

BackgroundWith demographic changes in aging populations, dentists require special care protocols to treat older adults with diverse and complex oral health needs and problems. Knowledge, positive attitudes, and sufficient practice experience are essential components for promptly treating older adults. However, many dentists encounter multiple barriers influencing their willingness to provide care for older adults. This study assessed Indonesian dentists' knowledge, attitudes, and practices (KAP) in providing oral health care (OHC) for older adults, including their willingness and barriers.MethodsA cross‐sectional survey was conducted with 392 dentists employing an online questionnaire between April and June 2022. The respondents' KAP was categorised utilising a modified Blooms' cut‐off point of ≥60%. Data were analysed using descriptive statistics, the x2 test, and logistic regression.ResultsMost dentists demonstrated adequate knowledge (62.2%), a positive attitude (95.4%), sufficient practice experience (91.6%), and a high willingness (98%) to provide OHC services for older adults. However, 91.4% encountered barriers primarily related to interpersonal communication, disease complexity and polypharmacy, and patient functional status. Significant associations were found between dentists' attitudes toward practices and willingness to attend geriatric dentistry training with knowledge.ConclusionImplementation of continuing professional development (CPD) in geriatric dentistry, the inclusion of geriatric dentistry into the undergraduate curriculum, and enhancing clinic accessibility for older adults may improve dentists' preparedness and benefit the future provision of OHC for older adults in Indonesia.

Inequity in the utilization of the home and community integrated healthcare and daily care services in older adults with limited mobility in China

BackgroundThis study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services (“home and community care services” for short) among older adults in China and to investigate the inequity in services utilization.MethodsCross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.ResultsAbout 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.ConclusionsThis current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.

The Impact of Perceived Community Services for the Elderly on Self-Rated Health: An Analysis Utilizing a Mediated Latent Growth Model.

This study aims to investigate the relationship between older adults' perceived community services for the elderly (PCSE), life satisfaction (LS), and self-rated health (SRH). Data from four rounds of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018 were used. A total of 2454 older adults were obtained. Unconditional Least Squares (ULS) was used to measure PCSE, LS, and SRH growth trajectories without covariates. Finally, a mediating latent growth model was constructed using Mplus 8.3 to examine the mediating role of LS in the relationship between PCSE and SRH after adjusting for some demographic characteristics. The results from the ULS method indicate that the intercepts and slopes for PCSE and LS are significantly negatively correlated (β 1 = -0.629, β 2 = -0.579, p < 0.001). Additionally, there is a significant positive correlation between the intercept and slope of health levels (β = 0.774, p < 0.001). Using a parallel growth model, significant regression coefficients were found between the intercept of PCSE and the intercepts of SRH and LS (β 1 = -0.335, β 2 = 0.378, p < 0.01). Similarly, the regression coefficients between the slope of PCSE and the slopes of SRH and LS were also significant (β 1 = -0.532, β 2 = 0.344, p < 0.01). Furthermore, the regression coefficient between the intercept of LS and the intercept of SRH was significant (β = 0.415, p < 0.001). The regression coefficient between the slope of LS and the slope of SRH was also found to be significant (β = 0.729, p < 0.001). It is essential to ensure adequate supply and accessibility of community services for older adults. LS especially is, and should be a promising target for assessing the quality of life and utilization of PCSE supply.

Internal tension or external pressure? Study on the influencing factors of the diffusion of education policies for older adults in China – Based on the analysis of China’s provincial panel data from 2016 to 2023

ABSTRACT The development of education for older adults through policy measures has become an important means for governments to actively cope with population aging. Taking the number of education policies for older adults adopted in 31 provinces of China from 2016 to 2023 as an example, this study empirically analyzes the factors influencing the diffusion of education policies from dimensions of internal tension and external pressure. The results showed that the level of economic development, natural population growth rate, older adults dependency ratio, child dependency ratio, illiterate population over 15 years old, number of local libraries inside the province and the adoption of education policies for older adults in adjacent provinces significantly affected the adoption of education policies for older adults in each province. After the introduction of regional variables, it is found that there are significant differences in the adoption of education policies for older adults by provincial governments in different regions of China. The policy responsiveness of eastern provinces is the best, followed by the central, and the western is the worst. The above results indicate that provincial governments in China are not only affected by the supply level of education services for older adults and their service demand within the province, but also affected by the adoption behavior of other provinces when making decisions, which is the result of rational thinking and competitive pressure. The above results provide China’s experience for the diffusion and implementation of education policies for older adults in a wider range.