共找到 20 条结果
Worldwide, the population is ageing. As the population ages, so does the prevalence of age-related diseases such as arthritis, osteoporosis, diabetes, hypertension, cancer and dementia, increasing the demand on health and social care services. The evidence underpinning treatments and interventions for most health and social care issues is derived from populations younger than 80 years of age because this age group is often excluded from taking part in clinical trials. This raises concerns that many established treatments may not be the most suitable or effective approach for those aged 80 years or more. Our aim was to produce an interactive evidence and gap map to provide an overview of the volume, diversity and nature of the evidence on health and social care interventions that target adults over 80 years of age. We searched 18 databases: Medline, PsycINFO, HMIC, Social Policy and Practice, Ageline, CINAHL Complete, ASSIA, PQDT; Epistemonikos; Cochrane, CENTRAL, Campbell systematic reviews, Web of Science, SCI, SSCI, AHCI, CPCI-S, CPCI-SSH, and ESCI (in October 2022). Searches were updated in July 2024. Forward and backward citation searching was also undertaken in 2024 using CiteSearch, Scopus and Google Scholar. We included systematic reviews, randomised controlled trials (RCTs) and primary qualitative studies in the map that focused on the effectiveness and/or experience of any health or social care interventions for adults aged 80 years or more. All studies were independently screened for eligibility by two people at both title/abstract and full text stages. Interventions were categorised in line with the WHO definition of five domains that facilitate healthy ageing: building and maintaining intrinsic capacity, health services models and approaches, enabling environments and technologies, building and maintaining relationships and learning, growing and making decisions. Interventions could cut across multiple domains. The data extraction tool was developed on EPPI reviewer and was modified and tested through piloting and revising by the core team. The tool was informed by the research question and the structure of the map. As well as extracting data on population characteristics, intervention domain and sub-categories, we extracted additional data to enable filters, such as specific health conditions, and equity characteristics. Standardised tools were used to assess study quality for all studies: AMSTAR-2 for systematic reviews; Cochrane Risk of Bias tool (version 1) for RCTs; and the Wallace criteria for primary qualitative studies. Data extraction and quality appraisal were extracted by one person and checked by a second. We included 172 studies: 36 systematic reviews, 120 RCTs and 16 primary qualitative studies. Most of the systematic reviews were assessed as low or very low quality with only five assessed as moderate to high quality. Similarly, most of the RCTs were assessed to be at medium to high risk of bias, with only 27 RCTs assessed with an overall low risk of bias. Ten of the qualitative studies were assessed as high quality. Over a third of the studies (n = 67) in the map have been published since 2020. The majority of the evidence, over 90% (n = 157/172), was focused within the domain of building and maintaining intrinsic capacity, and within this domain, on either surgical and medical procedures (n = 75) or medicines and medical technologies (n = 54) in predominantly the cardiovascular, neuromuscular and digestive areas. Rehabilitation and behavioral interventions were also represented. Only a small number of studies focused on health conditions linked to ageing: frailty a focus of research in 14 studies, and falls in six studies. Only two studies addressed mental health therapies, and there were no studies focused on skin conditions, genitourinary health and or voice/speech conditions. The second most frequently represented domain was health service models and/or approaches (n = 38), predominantly relating to home visits (n = 15, all RCTs) and comprehensive geriatric assessment and integrated care (n = 5, all RCTs). The three intervention domains of enabling environments and technologies, building and maintaining relationships and learning, growing and making decisions were poorly represented in the evidence. The majority of studies measured physiological outcomes of health, such as measures of functional health, chronic health markers or symptoms, and adverse events; few studies assessed measures of well-being or psychosocial health. Sixteen studies reported on experiences of interventions, mostly from the experience of the older adult (n = 9) and were in relation to heart surgery and procedures, colon surgery, resuscitation, medicines review and preventative screening. Only 7% of outcomes in the map were in the psychological health and wellbeing category. Social health (including connectedness and participation) was not featured as an outcome in any studies. Studies were primarily conducted in Europe and Asia: these two regions representing over 75% of the evidence. There were several gaps evident in the map, including but not limited to, end-of-life care (including advance care planning) and healthcare delivery such as hospital-at-home and telehealth. Several potential research areas where synthesis might be valuable were also identified such as medicines optimisation, home visits, and specific health conditions such as osteoporosis treatments. As the worldwide population continues to age, it is increasingly important that we have evidence of appropriate effective interventions for those who have reached their 80s, 90s and beyond, a group often left out of trials. This evidence and gap map shows that currently there is a clear bias towards interventions orientated around a biomedical view of health focused on intrinsic capacity, and relatively little on the wider functional and psychosocial aspect of health, or on enabling environments, such as adaptations to health and care services, or models of care. There is also a clear need for more research to understand the experiences and preferences of interventions from adults aged 80 years or more. Research exclusively focussed on people aged over 80 targets medical treatments and surgical procedures, neglecting healthcare services or wellbeing, and much of it is poor quality. The Evidence and Gap Map (EGM) in brief: Most of the studies in people aged over 80 investigate medical procedures and treatments with a focus on basic health needs and the ability to function, with fewer studies about health and care services or wellbeing. What is this EGM about?: Our population is ageing, which means that people are living longer, and age-related illnesses such as arthritis, dementia and cancer are becoming more common. Studies investigating interventions (treatments, procedures, therapies and services) are often focused on people aged under 80, because those who are older are often excluded from taking part in trials. Therefore, the treatments that are considered best practice in a general population might not be the best option for people aged over 80. This EGM displays evidence of interventions from systematic reviews and randomised controlled trials (RCTs) and studies looking at experiences (qualitative studies) where the people being investigated were aged over 80. What is the aim of this EGM?: The aim of this EGM is to provide easy access to studies that investigate interventions for people aged over 80. The studies are grouped by types of interventions and outcomes. Overall, the EGM provides an overview of the volume and nature of evidence on interventions for this age group. What studies are included?: The EGM contains 172 studies investigating interventions for people aged over 80. The interventions are organized into five groups: building and maintaining intrinsic capacity (ability to function both physically and mentally), health services an/or approaches, enabling environments and technologies, building and maintaining relationships and learning, growing and making decisions. The EGM contains 36 systematic reviews, 120 RCTs and 16 qualitative studies. What are the main findings of this gap map?: Research in older people is becoming more common as the population ages. Over a third of studies (n = 67) in the map have been published since 2020. However, most of the research was moderate to poor quality. Most of the systematic reviews (n = 31) and RCTs (n = 93) were rated as low or very low quality. Only a small number of studies focused on health conditions linked to ageing, with frailty covered in 14 studies, and falls in 6 studies. Most of the studies (n = 157) were about building and maintaining intrinsic capacity, focusing on the treatment and/or prevention of diseases and health disorders. The categories with most studies were those that involved surgery (n = 75 studies), and those that involved medicines or medical devices (n = 54). Only two studies addressed mental health therapies, and no studies examined ‘end of life’, skin conditions, genitourinary health and or voice/speech conditions. Several studies (n = 38) examined health services and/or health approaches. Some of these (n = 15) were RCTs assessing the effectiveness of home visits and a smaller number (n = 5) assessed geriatric assessment. Surprisingly, there were no systematic reviews in the map covering those topics. The only systematic review in the health services category investigated admitting older adults with sepsis into intensive care units. Similarly, there were no systematic reviews in the categories of enabling environments and technologies and learning, growing and making decisions. The most common outcomes reported in the studies were physiological measures of health (such as blood cholesterol levels, or blood pressure), measures of physical function (such as strength, balance), chronic health symptoms and side effects and complications. Only 7% of outcomes in the map were in the psychological health and wellbeing category. Social health (including connectedness and participation) was not featured as an outcome in any studies. Sixteen studies reported on experiences of interventions, mostly from the experience of the older adult (n = 9) and were in relation to heart surgery and procedures, colon surgery, resuscitation, medicines review and preventative screening. What do the findings of the map mean?: This EGM provides information on systematic reviews, RCTs and qualitative studies that have examined the effectiveness of interventions for people aged over 80. This is important because people in older age groups are often excluded from research, meaning the interventions that are best for the general population might not be most suitable for them. While studies in people aged over 80 focus on basic health needs, older people are under-represented in studies about psychosocial aspects of health or enabling environments such as adaptations to health and care services. There is also a need for more studies examining how people aged over 80 experience treatments, therapies and services. How up-to-date is this EGM?: The EGM contains studies published up until July 2024.
Improving people's well-being is one of the most important goals of public policy, as well as one of the tasks of psychology as an applied branch of knowledge. To effectively implement these tasks, it is necessary to clearly understand what the well-being of people of different ages consists of. The study of the well-being of the elderly and senile people is especially relevant due to the entry of society into the phase of super-aging, also due to the fact that psychology goes beyond the ideas of aging as regression and decline. Analysis of the emotional component of the image of well-being in elderly and senile people allows us to identify the most subjectively significant components of well-being. Objective - to identify the features of the emotional component of the image of well-being in the perceptions of elderly and senile people. The study involved 264 elderly and senile people. The data were collected using the method of limited associations using the following instructions: provide 9 associations for the word «well-being» (3 words in the form of a verb, noun, adjective). The resulting associations were examined through the prism of the thesaurus of emotive vocabulary by L.G.Babenko. As a result, the most frequent associations were identified, from which only associates related to emotive vocabulary were subsequently selected. Comparison of older and younger people shows that the most frequent associations of emotive vocabulary are similar. Differences are found in less frequent associations. Semantic groups of associations are unique to elderly and senile people: successful, kindness, cheerful, live, vigorous, communicate. Emotive vocabulary in the thesaurus of elderly and senile people is less represented than in young people, which indicates a lower intensity of needs. The features of the emotional component of the image of well-being, manifested in the associations of elderly and senile people, are described. The emotional component of the image of elderly people is represented mainly by positive emotions. The emotions of the core zone of the image are happiness, joy, calm; the emotions of the middle zone are friendship, love, attraction; the emotions of the peripheral zone of the image are kindness and anxiety. Повышение благополучия людей является одной из важнейших целей государственной политики, а также одной из задач психологии как прикладной отрасли знания. Для эффективной реализации этих задач необходимо ясно понимать, в чем состоит благополучие людей разного возраста. Исследование благополучия у людей пожилого и старческого возраста особенно актуально в силу вхождения общества в фазу сверхстарения, а также в силу того, что психология выходит за пределы представлений о старении как о регрессии и упадке. Анализ эмоциональной составляющей образа благополучия у людей пожилого и старческого возраста позволяет выделить наиболее субъективно значимые компоненты благополучия. Цель работы — выявить особенности эмоциональной составляющей образа благополучия в представлениях людей пожилого и старческого возраста. В исследовании участвовали 244 человека пожилого и старческого возраста. Был применен метод ограниченных ассоциаций по инструкции — привести девять ассоциаций на слово «благополучие» (по три слова в форме глагола, существительного, прилагательного). Полученные ассоциации рассматривали через призму тезауруса эмотивной лексики Л.Г.Бабенко. В результате были выделены наиболее частотные ассоциации, среди которых впоследствии были отобраны только ассоциаты, относящиеся к эмотивной лексике. Сравнение людей пожилого и старческого возраста и молодых людей показывает, что наиболее частотные ассоциации эмотивной лексики у них сходны. Различия обнаруживаются в менее частотных ассоциациях. Уникальными для людей пожилого и старческого возраста являются семантические группы ассоциаций: успешный, доброта, веселый, жить, бодрый, общаться. Эмотивная лексика в тезаурусе людей пожилого и старческого возраста представлена меньше, чем у молодежи, что, возможно, указывает на меньшую напряженность потребностей. Эмоциональная составляющая образа благополучия у людей пожилого и старческого возраста представлена преимущественно положительными эмоциями. В качестве эмоций ядерной зоны образа благополучия выступают счастье, радость, спокойствие; средней зоны — дружба, любовь, влечение; периферийной зоны — доброта и беспокойство.
Biological aging predicts health outcomes beyond chronological age. The relative contribution of social, economic, and health factors to biological aging differences between Black and White adults remains unclear. In a cross-sectional analysis of 2,086 community-dwelling adults aged ≥60 years from the 2016 Health and Retirement Study (1,757 non-Hispanic White; 329 non-Hispanic Black), biological age was measured using DNA methylation-based GrimAge. Accelerated aging was defined as having a biological age older than expected for one's chronological age. We used logistic regression to assess the impact of race on accelerated aging and decomposition analysis to determine factors explaining differences in accelerated aging between Black and White participants. Covariate blocks were: age, education, wealth, social frailty assessed using a composite index measuring social connections, financial autonomy, neighborhood environment, volunteering and employment engagement, behavioral factors (physical activity, alcohol use, sleep disorder, body mass index); medical conditions; and physical disability. Black participants had higher accelerated aging than White participants (57.1% vs 41.8%; standardized mean difference, 0.3). In the staged decomposition of the biological aging gap, age and education explained 21.1% of the difference. The cumulative explained share rose to 51.8% with wealth, 77.6% with social frailty, 80.3% with health behaviors, 90.5% with medical conditions, and 91.6% with physical disability. In multivariable logistic regression adjusting for all domains, the racial difference was no longer significant. Social and economic factors largely explained accelerated biological aging differences between non-Hispanic Black and White adults. These findings identify policy-relevant targets to improve healthy aging.
The trend of demographic change is irreversible, and the aging of the rural population has become a significant factor undermining the foundations of food security. The relationship between this phenomenon and land ecosystems has not yet been thoroughly explored. To address this research gap, this study constructs an analytical framework of 'aging-factor allocation-ecological security' to empirically examine the impact of rural population aging on land ecological security and its underlying mechanisms. The results indicate that aging exerts a significant negative impact on land ecological security; however, within the pathway through which aging influence land ecological security, aging promotes land ecological security by facilitating the adoption of agricultural production services, increasing land transfers, expanding large-scale farming operations, and adjusting crop patterns. The results of the heterogeneity analysis indicate that the impact of rural population aging on land ecological security varies. The negative impact of aging on land ecological security is more pronounced in western regions, areas with rugged terrain, among those with a medium level of education, and in sample groups not experiencing a low birth rate. This finding provides a rationale for policy interventions, suggesting that increasing inputs into productive agricultural services, promoting land transfer and large-scale operations, and increasing subsidies for planting food may be important pathways to improving land ecology and increasing food security.
Social participation is a modifiable determinant of healthy aging and has been linked to better mental health and life satisfaction. However, evidence from rapidly aging East Asian societies remains limited, particularly regarding the discriminatory ability of social participation levels to identify older adults at risk of low well-being. This study examined associations between social participation and subjective well-being and evaluated item-level activity patterns among community-dwelling older adults. A cross-sectional study of 1,099 adults aged ≥ 65 years was conducted across rural and semi-rural communities in Taiwan. Subjective well-being was assessed using the WHO-5, and social participation using a multi-dimensional 12-item scale. Group comparisons, multivariable logistic regression, item-level correlations, and Receiver Operating Characteristic (ROC) analysis were performed. Older adults with high well-being reported significantly higher social participation than those with low well-being (40.0 ± 9.0 vs. 32.8 ± 9.6, p < 0.001). Social participation independently predicted high well-being after adjusting for age, gender, and living status (AOR = 1.089; 95% CI: 1.07-1.11). ROC analysis showed acceptable discrimination (AUC = 0.707), with an optimal cut-off score of 32 (sensitivity = 85.2%; specificity = 48.4%). All participation items correlated positively with well-being (p < 0.001), with visiting friends/relatives (r = 0.307) and health-related activities (r = 0.298) showing the strongest associations. Higher social participation is strongly associated with better subjective well-being in older adults, particularly through relational and health-oriented activities. Social participation scores may serve as a useful community-based indicator for detecting low well-being. Culturally sensitive interventions that promote meaningful, voluntary, and inclusive participation-alongside structural supports such as transportation and social prescribing-may help enhance psychological well-being in aging East Asian communities.
Depression is an established risk factor for dementia. However, it is unclear whether initiating psychiatric/psychological treatment of depression, particularly early initiation of such treatment, may reduce risk of dementia. We examined associations between initiation and immediate initiation of psychiatric/psychological treatment and subsequent risk of dementia in older adults. Participants aged ≥60 years from the Health and Retirement Study from 2012 to 2018 with self-reported newly diagnosed depression but no history of dementia were included and followed up through 2020. Two sets of analyses were performed to examine initiation and immediate initiation of psychiatric/psychological treatment in relation to subsequent risk of dementia. Logistic regression models with stabilized inverse probability of treatment and censoring weights were used to estimate cumulative incidence and risk ratios (RRs), and 95% confidence intervals (CIs) were calculated using 500 sets of bootstrapping. In analyses of 2269 non-unique participants with self-reported newly diagnosed depression, initiation of psychiatric/psychological treatment anytime after diagnosis showed no risk reduction of dementia. However, in other analyses of 1257 unique participants with self-reported newly diagnosed depression, immediate initiation of psychiatric/psychological treatment was associated with a lower risk of dementia across 8 years of follow-up (RR = 0.64, 95% CI: 0.37, 0.96). Therefore, timely initiation of psychiatric/psychological treatment may reduce the risk of subsequent dementia among older adults with newly diagnosed depression. These findings further emphasize the importance of early treatment in managing late-life depression.
Perceived community environment is important for shaping older people's participation in their communities and for their well-being. Social cohesion and social belonging are two important yet distinct dimensions of perceived community environment that may influence support-behaviour and well-being in different ways. However, previous studies often treated both belonging and support behaviour as components of social cohesion. As a result, the associations between social cohesion and belonging with support provision behaviors and well-being among community-dwelling older people remains underexplored. This study aims at addressing this gap. A longitudinal survey study design was employed. Data were collected among community-dwelling older people in the Netherlands across two waves with a six-month interval (N = 675). Multivariate linear auto-regressions and cross-lagged panel models (CLPMs) were used to explore the longitudinal associations among support provision, social cohesion, social belonging, and well-being. Sensitivity analyses using change-score regressions were conducted to assess robustness at the intra-individual level. We found that support provision, social cohesion, and social belonging were all positively associated with follow-up well-being. Cross-lagged analyses revealed distinct longitudinal relationships that, social cohesion at T0 was positively associated with increased support provision at T1, whereas social belonging at T0 was not. Sensitivity analyses confirmed that within-person increases in cohesion were associated with increases in support provision, while changes in belonging were not positively related to support changes. Our study offers a new understanding of how the community environment may influence older people's support behaviors. Findings suggest that social cohesion and social belonging play distinct roles in relation to support provision among older people. Practices aimed at facilitating mutual support and well-being may need to take specific roles of different dimensions of community environment into account.
Dementia is one of the most serious health issues in an aging society, placing a significant burden on patients and their families, while also posing considerable socioeconomic challenges at the national level. In response, the Korean government introduced the National Responsibility for Dementia Care policy in 2017 to improve healthcare accessibility for patients with dementia and reduce their financial burden. This study utilized the cohort data of patients with dementia collected from Ajou University Hospital between 2012 and 2022. To quantitatively assess the changes in healthcare utilization, we applied panel multivariate negative binomial regression and panel multivariate gamma regression analyses. The analysis identified key factors influencing healthcare utilization, including place of residence, presence of comorbidities, age, and duration of dementia. After the policy was implemented, there was a general decline in outpatient visits and medical expenditure, suggesting a positive effect of the policy on alleviating the economic burden on patients with dementia. Significant changes in healthcare utilization were observed among patients in the early stages of dementia, highlighting the importance of early diagnosis and home-based care services. The findings indicate a need for personalized treatment and the expansion of community-based healthcare services for patients with dementia.
As individuals with HIV live longer, many now face the health consequences of aging and multimorbidity, known as disability. Exercise can mitigate disability; however, engagement in exercise among adults living with HIV varies. Technology-based interventions, such as telerehabilitation, may help mitigate geographical, financial, and time barriers to community-based exercise (CBE). However, little is known about the experiences with technology uptake and usage among adults living with HIV. Understanding these experiences is essential to inform the design of inclusive, accessible, and sustainable online interventions. This study aimed to describe experiences with technology uptake and usage among adults aging with HIV participating in a 6-month online CBE intervention and explore how these experiences changed over time, from baseline to postintervention. We conducted a longitudinal qualitative descriptive study and secondary analysis using interview data from adults living with HIV who were engaged in a CBE intervention study in Toronto, Canada. Participants engaged in a 6-month online CBE intervention consisting of thrice-weekly exercise supervised biweekly through online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom). The technology used included Zoom software and a webcam, as well as the Sweat for Good YMCA app and the YMCA Virtuagym website; participants wore a wireless physical activity monitor (Fitbit Inspire 2) throughout. Participants completed interviews at baseline and postintervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data. Eleven participants completed at least one interview. We analyzed 19 interview transcripts from 11 participants (women: n=6, 55%; men: n=5, 45%; median age 52, IQR 45-60 y). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: (1) preparations for technology (technology setup), (2) interactions with technology (preferences for different types of technology, preferences for mode of delivery, and ease of usage), (3) facilitators and satisfaction with technology (facilitators to technology uptake and usage and satisfaction with technology), and (4) challenges and frustrations with technology (barriers to technology uptake and usage and frustrations with technology). Experiences with technology across participants were influenced by intrinsic contextual factors (prior exposure to technology) and extrinsic contextual factors (COVID-19 pandemic and technological and social support). Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use to increasingly burdensome over time. Results highlight the need to incorporate personal preferences and ongoing technological support when implementing online CBE with adults aging with HIV.
Bridging dementia research and policy remains a global challenge, with gaps in governance, capacity, data infrastructure, and contextual fit limiting the development and implementation of effective national dementia plans. To inform this issue, the Health Policy Professional Interest Area of ISTAART convened an expert discussion with researchers, clinicians, policymakers, and advocates, identifying three recurring challenges: difficulties translating research into actionable guidance, limited evaluation of real-world impact, and persistent inequities in access to dementia care. Building on these insights, this narrative review applies the Evidence-Informed Policy and Practice framework to examine how evidence is sourced, interpreted, and implemented across diverse settings. Integrating peer-reviewed literature, policy documents, and practice-based insights, the review highlights structural and institutional determinants of evidence generation; the contextual factors shaping evidence use; and system-level constraints and enabling mechanisms influencing implementation. The review highlights inclusive evidence generation, tailored translation, and delivery systems designed to support global dementia policy.
As population aging and digital transformation continue simultaneously in China, the digital divide among older adults has become an increasingly important social issue. This study examines the associations between multiple dimensions of the digital divide and depressive symptoms among older adults, as well as the potential role of bonding social capital. Drawing on three waves of data from the China Family Panel Studies (CFPS, 2018-2022), this study employs two-way fixed effects models and mediation analyses to examine the relationships between digital access, digital usage, digital outcomes, and depressive symptoms among older adults. Robustness checks were further conducted using propensity score matching (PSM), sample restriction adjustments, and replacement of the dependent variable. Internet access was significantly associated with lower levels of depressive symptoms among older adults (p < 0.05). Compared with non-Internet users, entertainment-oriented, instrument-oriented, and mixed Internet use were all significantly associated with lower depressive symptoms (all p < 0.05). Digital outcomes were also negatively associated with depressive symptoms (p < 0.01). Bonding social capital showed significant indirect pathways linking all dimensions of the digital divide and depressive symptoms, with mediating proportions ranging from 5.95% to 26.67%. Period heterogeneity analyses further indicated that the associations remained generally stable before and during the COVID-19 period, although mixed Internet use exhibited a significant structural difference across periods (p = 0.036). The findings suggest that the digital divide is closely associated with the mental well-being of older adults, while bonding social capital constitutes an important social pathway linking digital engagement and psychological health. Policy efforts should move beyond technological access toward broader digital empowerment and the construction of a more inclusive digital society for aging populations.
Population aging in rural China has increased caregiving demands for older adults living with disabilities, while formal long-term care resources remain limited. Evidence remains insufficient regarding how multidimensional caregiving burden is associated with depressive symptoms and whether formal and informal support buffer these associations. To examine the associations between multidimensional caregiving burden and depressive symptoms among rural caregivers and to investigate the buffering roles of formal and informal support, including heterogeneity by gender and educational attainment. Cross-sectional data from 781 rural caregivers in China were analyzed using multivariable linear regression models. Caregiving burden included overall burden and five dimensions: physical burden, psychological burden, financial burden, time-dependence burden, and social isolation. Formal support was measured by the availability of community care services, and informal support by caregivers' social networks. Stratified analyses were conducted by gender and educational attainment. All dimensions of caregiving burden were significantly associated with higher depressive symptoms. Financial burden and social isolation showed the strongest associations. Informal social support buffered the adverse effects of all burden dimensions, whereas formal community services mainly buffered physical and financial burden. Male caregivers benefited from both forms of support, while female caregivers relied primarily on informal support. Buffering effects were stronger among caregivers with lower educational attainment. Depressive symptoms among rural caregivers are closely associated with multidimensional caregiving burden. Policies should prioritize reducing financial strain and social isolation while strengthening both formal and informal support systems, particularly for women and less educated caregivers. Main findings: Financial burden and social isolation showed the strongest associations with depressive symptoms among rural caregivers of older adults living with disabilities, while informal social support consistently buffered caregiving stress.Added knowledge: This study demonstrates that formal and informal support systems differ in their buffering effects across caregiving burden dimensions and caregiver subgroups in rural China.Global health impact for policy and action: Strengthening community-based long-term care services and caregiver support systems may help reduce psychological distress among caregivers in rapidly aging rural populations in low- and middle-income countries.
This study aims to examine the importance of and challenges associated with chronic disease management in a super-aged society, highlight the role of laboratory medicine standardization, and propose standardization policies within the national healthcare system. This review analyzes the necessity and importance of laboratory medicine standardization in the management of chronic diseases and standardization strategies for key laboratory medicine tests for each chronic disease. A national laboratory medicine standardization system was established, and the National Medical Reference Laboratory is currently operating within the Korea Disease Control and Prevention Agency. Projects to standardize laboratory medicine are underway through quality assessments of laboratory medicine institutions and systems. To improve the quality of healthcare services in a super-aged society, the production of certified reference materials for laboratory medicine, implementation of legally enforceable policies, training for medical professionals, and continued investment are necessary. These efforts are expected to promote innovation in the healthcare system and to prepare for the future.
ObjectivesSocial security benefits are associated with better psychological health among older adults in resource-limited settings, yet the mechanisms underlying this association remain underexplored. We examined the role of healthcare accessibility in the relation between social security benefits and psychological health among older adults in Tanzania.MethodsWe analyzed cross-sectional data from a 2024 survey of Tanzanian adults aged 60 and above (n = 2,012) in four geographic zones. We examined associations using structural equation modeling (SEM) with bias-corrected bootstrapping (5,000 replications). Social security benefits (combining pension and health insurance receipt), self-reported healthcare accessibility, and psychological health (a composite of anxiety and depression symptoms) were included as primary variables.ResultsSocial security benefit receipt was significantly associated with better psychological health (β = -0.106, BCCI: -0.152, -0.060, p < 0.001). Healthcare accessibility was positively associated with psychological health and showed a significant association with the relationship between social security benefits and psychological health (β = -0.057, BCCI: -0.092, -0.022, p < 0.01), consistent with an indirect association in this cross-sectional analysis.ConclusionsHealthcare accessibility plays a significant role in the relation between social security benefits and psychological health, suggesting a pathway through which social security benefits may influence psychological health beyond direct financial mechanisms. These findings point to potential policy considerations, including administrative coordination between pension and health insurance schemes and interventions to improve healthcare accessibility for older adults. For low- and middle-income countries facing rapid population aging, integrated approaches to social security benefits and health systems may help maximize the health returns of social investments.
The US population is aging rapidly, increasing the future demand for assistance with aging in place. To examine the association between higher state allocation of long-term care spending to home- and community-based services (HCBS) and the likelihood of group quarters residence, coresidence with adult children, Medicaid enrollment, and migration among older adults with and without independent living difficulties. This repeated cross-sectional study used state-year fixed-effect models of American Community Survey microdata to analyze how changes in states' allocation of long-term care spending to HCBS was differentially associated with aging-in-place indicators and Medicaid enrollment among older adults with vs without independent living difficulties. The study was conducted and data were analyzed between October 2025 and April 2026. Share of state's long-term services and support budget on HCBS from 2008 to 2020. Medicaid enrollment, group quarters residence, coresidence with adult children, within-state migration, and out-of-state migration. Of the 7.35 million older adults in the sample, 17.1% had independent living difficulties. Those with independent living difficulties were older (mean [SD] age, 80.44 [8.73] vs 73.38 [6.80]), more likely to be female (66.7% vs 53.9%), less likely to be married (33.9% vs 59.6%), and less likely to be born in the US (83.9% vs 86.3%). Regression results indicated that a 20-percentage point increase in state HCBS share was associated with a 2.6-percentage point lower likelihood of group quarters residence (95% CI, -3.23 to -1.87), 0.8-percentage point lower likelihood of coresidence with an adult child (95% CI, -1.11 to -0.49), a 1.0-percentage point higher likelihood of residential continuity (95% CI, 0.64 to 1.29), 0.8-percentage point lower likelihood of within-state migration (95% CI, -1.08 to -0.43), and 0.2-percentage point lower likelihood of out-of-state migration (95% CI, -0.28 to -0.14) among older adults with independent living difficulties compared with those without. The results of this cross-sectional study suggest that higher shares of HCBS spending are associated with a higher likelihood of aging in place among older adults with independent living difficulties without markedly increasing Medicaid enrollment, supporting the targeted expansion of HCBS services.
Medicare home health is a critical source of skilled clinical care for homebound adults, but home health provision has declined since 2020. By identifying beneficiaries' characteristics associated with home health visit utilization in prior years, we sought to explore the implications of recent service reductions. Retrospective, secondary analysis of home health utilization using National Health and Aging Trends Study survey responses linked to Medicare home health claims files. One thousand four hundred sixty-five Medicare beneficiaries who responded to the National Health and Aging Trends Study and received home health between 2011 and 2015. Predictors of total nurse/therapist visits were assessed using negative binomial regressions. We measured the volume of home health as the number of annual visits by nurses (registered and licensed practical/vocational nurses) and by therapists (physical, occupational, and speech therapists). Predictors included beneficiaries' sociodemographic, functional, and health-related characteristics. Beneficiaries were 62.8% female, 80.2% White, and the mean age was 80. On average, beneficiaries received 15.9 nurse visits annually. Nurse visits comprised approximately half of all home health visits. Predictors of increased nurse visits included being unmarried (+7.0 visits), widowed (+4.8 visits), Medicaid enrollment (+5.2 visits), and dependence on others to manage medications (+5.6 visits). On average, beneficiaries received 9.8 therapist visits annually, comprising about a third of all home health visits. Predictors of additional therapist visits included instrumental activities of daily living disability (+3.7 visits), chronic illness multicomorbidity (+2.9 visits), and medication management needs (+2.8 visits). Clinical complexity, disability, and social vulnerabilities were associated with greater volumes of skilled home health provision from nurses and therapists from 2011 to 2015. Our results highlight care needs that may be underaddressed and inequities that may be exacerbated under current home health provisions.
Falls represent an important inflection point in later life, increasing the risk of future adverse outcomes. This study aims to examine the association between an index fall, that is, a fall in a participant with no recent history of falls, and subsequent change in functional status, requirements for social care, and falls-related health care utilization. Longitudinal analysis of population-representative data. Participants (n = 2454) aged ≥65 years from waves 1 to 3 of The Irish Longitudinal Study on Aging. Index falls were those reported at wave 2 in participants with no falls reported at wave 1. Falls/fractures, functional status (activities of daily living), and social care (home care, home help, and meals on wheels) were assessed by self-report. Regression models assessed the independent relationship between index falls and outcomes of interest. Twenty percent of participants (n = 493) reported an index fall. In participants who were functionally independent at baseline, an index fall was associated with functional impairment at 2-year follow-up (odds ratio [OR], 1.71; 95% CI, 1.19-2.47; P = .004). Almost 12% with index falls developed functional impairment. In those not requiring home care at baseline, an index fall was independently associated with an almost 3-fold higher likelihood of requiring home care (OR, 2.87; 95% CI, 1.38-5.97; P = .005) and a higher number of monthly home care hours (β = 0.76; 95% CI, 0.18-1.34; P = .010) at 2-year follow-up. Almost 12% with index falls required "new" social supports. An index fall was independently associated with future falls-related emergency department presentations (OR, 1.69; 95% CI, 1.14-2.49; P = .008), future fractures (OR, 1.52; 95% CI, 1.08-2.15; P = .018), but not more general practitioner visits during follow-up. This study demonstrates that even a single fall can signal a significant shift in the health and functional trajectories of community-dwelling older people, reinforcing the need for proactive and coordinated prevention strategies.
This study examines how national policies have framed substance use issues among older adults in Norway. An analysis of 18 Norwegian white papers published between 2003 and 2024 by the Ministry of Health and Care Services, the Ministry of Social Affairs, and related ministries was conducted through "What Is the Problem Represented to Be?" poststructural analysis. White papers acknowledge increasing alcohol and substance use among older adults and depict these developments as significant challenges for health and social services both at present and in the future. In response, the following three strategies are proposed: promoting active aging to address inactivity, which can contribute to substance use; combating loneliness and isolation, which represent both the causes and consequences of substance use among elderly individuals; and implementing preventive home visits to help older individuals manage daily challenges and recognize early signs of harmful substance use. Relevant policies primarily address alcohol and prescription drugs but largely ignore the so-called illicit substances. The strategies employed constitute a funnel, leading from broad and preventive strategies to narrow and curative strategies. Although this variation holds some promise, we argue that these policies inadvertently portray substance use in older adults as if all individuals with substance use problems share the same characteristics, experiences, and needs. This generalization risks exacerbating health inequalities among older adults who use substances.
The framework for healthy aging is still largely normative and developed in the context of high-income countries, thus failing to capture the life experiences of older adults in middle- and low-income countries. This study aims to explore the meaning of holistic well-being in Makassar City, shaped in accordance with the local urban context of Indonesia. This study used a qualitative approach with in-depth interviews of 45 participants consisting of older adults and older adult cadres selected using purposive sampling in 15 sub-districts in Makassar City. Data were analyzed using thematic analysis with MAXQDA 2024 software. This study identified a hierarchical model of holistic well-being comprising eight dimensions organized into four functional layers: Enabling Conditions (Functional Physical Well-Being, Financial Security), Engagement Pathways (Social Participation, Productive Engagement, Lifelong Learning Engagement), Mediating Core (Spiritual Life Orientation, Family-Centered Happiness, Social Embeddedness), Subjective Outcome (Psychological Serenity and Emotional Regulation). This study offers an empirically grounded, contextually situated understanding of well-being among older adults in an urban Indonesian setting, extending existing frameworks by foregrounding lived experience and relational interdependence.
Patient dignity is a foundational principle in geriatric care, yet how health regulations conceptualize and promote dignity for elderly patients remains underexplored. Israel offers a particularly instructive case given its universal healthcare system serving a diverse aging population. This study examines how Israeli state health regulations promote patient dignity and responsiveness in geriatric hospitals, and analyzes these regulatory provisions through the lens of Schwartz's refined theory of basic human values. We conducted a qualitative content analysis of 150 regulatory documents issued by Israel's Ministry of Health between 2009 and the present. Coding proceeded inductively using thematic analysis (Braun & Clarke, 2019), with AI-assisted software supporting coding identification and organization. Themes and sub-themes were subsequently mapped onto Schwartz's value framework through a theory-informed process. Four core dignity-related themes were identified: ethical treatment, patient-centered care, safety and comfort, and end-of-life care. Each theme was systematically mapped onto Schwartz's value dimensions: ethical treatment aligning with conformity and security; patient-centered care with self-direction and benevolence; safety and comfort with security, universalism-concern, and hedonism; and end-of-life care with universalism-concern, and self-direction. Schwartz's value framework offers an analytically productive lens for understanding how organizational regulations encode and enact human values in geriatric care. The findings point to concrete policy implications: regulations should be understood not merely as procedural tools but as value-oriented instruments that shape the moral culture of care organizations. Future research should examine how these regulatory values translate into actual clinical practice.