Macro-Demographics and Ageing in Emerging Asia: the Case of Indonesia.

In common with a number of other emerging economies in South East Asia, Indonesia is confronting rapid demographic transition at a low level of per capita income. The fourth largest country in the world by population size, Indonesia will face new challenges for fiscal sustainability and policy design, as in coming decades its labour force begins to shrink, and the older population becomes relatively more numerous. In this paper, we demonstrate how strong data sources, from international agencies, national sources, and surveys of the Health and Retirement Study (HRS) family, are available and can be combined to generate a statistical profile of an emerging economy. Such profiles have value in themselves but can also be used as the basis for specifying macroeconomic models of demographic transition, of the overlapping generations (OLG) type, and for various other purposes. The profile presented here will serve to inform both policymakers and the broader community of the long-run trends which will inexorably impact Indonesian society in coming decades. It indicates that major social protection policy development will be needed over the next period to avert widespread hardship, especially among older cohorts.

Factors relating to depressive symptoms of caregivers for older care recipients in Indonesia.

Objectives: Family care is a large part of an informal workforce and there are increasing unmet demands for ageing populations, particularly in low and middle-income country settings. This study investigates relationships and care requirements for older care recipients and their caregivers within the household and identifies factors relating to depressive symptoms among caregivers of older persons.Method: Data were derived from the Indonesian Family Life Survey (IFLS Wave 5). Multiple logistic regressions were used for analyses. Outcomes were Center for Epidemiologic Studies Depression Scale (CES-D score ≥10 as having moderate to severe depressive symptoms).Results: Over half of care recipients aged 50 years and over reported requiring intermediate or high-level care intensity. Primary caregivers were most often spouses for older males and adult children for older females. Factors associated with depressive symptoms among caregivers were not working (adjusted odds ratio, AOR 1.86; 95% Confidence Interval 1.19- 2.90), primary school education (AOR 5.01; 1.96-12.8), living in rural area (AOR 1.38; 1.01-1.88), and having multiple older care recipients in the household (AOR 1.98; 1.43-2.75). Having care recipients with medium or high functional limitation levels (AORs 2.27; 1.51-3.42 and 3.36; 2.00-5.63, respectively) and not receiving household co-resident support were associated with caregivers' depressive symptoms (AOR 1.32; 1.01-1.89).Conclusion: To meet the anticipated future demands for elderly care, addressing factors relating to depressive symptoms, especially amongst those not working, low education, living in rural areas could help mitigate adverse effects for caregivers. Caregivers could benefit from the provision of adequate support, including screening for depressive symptoms.

The ageing prisoner population: demographic shifts in Australia and implications for the economic and social costs of health care.

PURPOSE: The Australian prisoner population has experienced a dramatic increase in the number of older inmates over the past decade, consistent with the greying of the prisoner population that is being observed worldwide. Reviews suggest the need for further evidence and practice outside of the USA. This paper aims to review and discuss the cost and social implications of the rising health-care needs of this population in Australia. DESIGN/METHODOLOGY/APPROACH: A review of international research and policies is presented, as well as the results of basic economic modelling relating to the expected rise in health-care costs of the ageing prisoner population in Australia. FINDINGS: Taking into consideration the continued rise in incarceration rates, the calculations show that the health costs of prisoners could increase by anywhere between 17% and 90% depending on whether the increase of older prisoners continues as it has in the past decade. These trends are likely to continue over the next decade and will result in higher health costs of prisons under a number of different imprisonment scenarios. Policy responses in Australia have been slow so far, with most initiatives being undertaken in the USA with promising results. PRACTICAL IMPLICATIONS: The authors suggest that in the absence of a coordinated policy response, covering a range of interventions, costs will continue to increase, particularly as this population continues to age more rapidly than the general population due to an accumulation of risk factors. Well-conceived interventions would be a worthwhile investment from both financial and social perspectives. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first commentary to acknowledge this rising public health issue and to both review and model its implications for the future.

Pain and Its Impact on Functional Health: 7-Year Longitudinal Findings among Middle-Aged and Older Adults in Indonesia.

Pain is a growing public health issue worldwide, but there is limited population-based evidence in low- and middle-income country settings. Using nationwide Indonesian Family Life Survey (IFLS) data in 2007 and 2014, this research sets out to investigate the associations between changes in pain status between two time points and its impact on functional health outcomes among middle-aged and older adults in Indonesia. Analyses focused on 7936 adults aged 50 years and older in 2014 who responded to both waves. Functional health was assessed using a composite score of functional limitations (range 20-100), representing difficulty in performing activities of daily living, and grip strength (kilograms). Multivariate linear regression models were used to analyse associations between pain measured in 2007 and 2014 and functional health in 2014. Severe pain in the latest wave of IFLS was associated with older age, female, lower education, having chronic conditions or depressive symptoms. Notably, those who reported 'low-medium' pain in 2007 and 'severe' pain in 2014 belonged to the most vulnerable group with worst functional health outcomes (4.96 points higher limitation scores and 1.17 kg weaker average grip strength). Findings have implications for public health policy in monitoring and management of pain including related co-morbidities as an increasingly critical component of population ageing.

A Sustainable Long-Term Health Care System for Aging China: A Case Study of Regional Practice.

This article documents the Qingdao Long-term Care Medical Insurance (LTCMI) program and analyzes its recipient demographics, costs of program expansion and potential drivers of costs. About 10% of the program's clients received institutional care, while the rest received care at home or in other residential locations. More than 60% of recipients were aged 80 years and older. Analysis of exit (mostly due to mortality) patterns of clients from the Qingdao long-term care system suggests that exit rates were correlated with being older than 80 years at the time of joining, gender, types of long-term care being received (institutional or residential) and entry-level activities of daily living scores. The beneficiary recipient structure of the Qingdao LTC system suggests that under current per unit costs, expanding coverage to all would only cost about 0.1% of Gross Domestic Product in China. Such a system will not only provide frail elderly people with long-term medical care services, but also greatly relieve the pressure on hospitals caused by aging patients, and systematically distribute medical resources in the long run, thus contributing to its sustainability.

Does retirement age impact mortality?

The relationship between retirement and mortality is studied with a unique administrative data set covering the full population of Norway. A series of retirement policy changes in Norway reduced the retirement age for a group of workers but not for others. Difference-in-differences estimation based on monthly birth cohorts and treatment group status show that the early retirement programme significantly reduced the retirement age; this holds true also when we account for programme substitution, for example into the disability pension. Instrumental variables estimation results show no effect on mortality of retirement age; neither do estimation results from a hazard rate model.

Electroporation of RNA stimulates immunity to an encoded reporter gene in mice.

Electroporation is the application of high-voltage short-duration pulses to transiently permeabilize cells, permitting the cellular uptake of macromolecules, including nucleic acid. Although much attention has been focused on DNA vaccines, antigen-encoding RNA molecules may also stimulate immunity. Several methods are being examined in an effort to enhance the efficacy of nucleic acid delivery. One such method is the application of electroporation. The present study was designed to develop electroporation for use as a method of RNA delivery in conjunction with the Semliki Forest virus (SFV) RNA vector system for stimulation of immunity. Expression of SFV-based ß-galactosidase and luciferase vectors was observed in the muscle after electroporation. Although some tissue damage was induced following intramuscular injection and electroporation with SFV vector RNA encoding LacZ at optimum pulse conditions, immunity to LacZ was efficiently induced. Following two immunizations, there was a higher IgG2a antibody response with the viral vector delivery and a higher IgG1 response in electroporated rSFV-LacZ RNA immunized mice.

Aged-care support in Japan: perspectives and challenges.

This article explores economic aspects of the market for long-term care (LTC) in Japan. As the world's most rapidly aging nation, it is of interest to understand that country's current LTC system and projections of LTC utilization patterns and costs, as well as their potential drivers. Since Japan appears likely to experience important shortfalls in LTC in the future, the authors also discuss alternate forms of provision.

Successful application of targeted electrochemotherapy using novel flexible electrodes and low dose bleomycin to solid tumours.

Electroporation is the application of very brief electric pulses to cells or tissues to render the cell membranes transiently and reversibly permeable, facilitating cellular uptake of otherwise impermeant molecules. Flexible electrode arrays were developed which may be used with endoscopic and laparoscopic devices for delivery of therapeutic electroporation. Their efficacy in enhancing the delivery of bleomycin, an impermeant drug, was assessed in vitro and in vivo in both human and murine cancer cell lines, and growing tumours (xenografts). These flexible electrodes consistently and predictably deliver the permeabilising electric pulses requisite for in vivo electroporation, and would be suitable for electrochemotherapy of endoluminal tumours when incorporated into an endoscopic delivery system.