The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities.

OBJECTIVE: In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population. METHODS: Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction. RESULTS: In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver. CONCLUSION: Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

[The impact of demographic aging on the pension systems.]

This article discusses the economic consequences of demographic aging. The relevance of this topic is substantiated. The research problem of this article is to assess the strength of the influence of demographic aging on the financial condition of the pension system in the world. Abstracts of the «macroeconomics of aging¼ theses are reviewed with respect to the financial condition of pension systems with an increase in the share of people over working age. A geographical analysis of deviations of the place of countries in the rating of sufficiency of retirement income and the rating of the Melbourne mercer global pension index from the place of countries in the ranking of demographic aging is carried out. The retirement income sufficiency rating for 48 countries, the Melbourne mercer global pension index rating for 25 countries and the UN developed Old age dependency ratio (OADR) are used as the information base. It is concluded that there is no significant correlation between the aging of the population on the one hand and the financial condition of pension systems on the other. Additionally, it was concluded that there is a certain pattern between the strength of the influence of demographic aging and the economic and geographical region. A possible theoretical justification of the thesis of the thesis «macroeconomics of aging¼ is given. Non-demographic factors of influence on the financial condition of pension systems are considered.

Quality of Life in Australian Adults Aged 50 Years and Over: Data Using the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW).

OBJECTIVES: This study explored unique and personal domains associated with quality of life (QOL) in 153 mid-aged and older Australian adults over age 50, using an innovative measure of individualized QOL, the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW). METHODS: Demographic measures as well as the SEIQOL-DW were administered. The qualitative responses on this scale were analyzed by Leximancer, a text analysis program that extracts semantic meaning and relational information automatically from text. RESULTS: For the sample as a whole, the most important QOL domain was found to be Relationships, followed by Family, Health, Activities, Community, Security, Beliefs, Independence and finally Wellbeing. When the sample was broken down into age bands for analysis, the most important domain theme was Family (50-59 year olds), Relationships (60-69 year olds), Relationships (70-79 year olds), and Health (80+ year olds). CONCLUSIONS: The wide range of concepts elicited in each domain via Leximancer underscores the argument for analyzing QOL in an individualized way, as it was clear from these concepts that different domains had unique meanings to each person. CLINICAL IMPLICATIONS: Understanding QOL at the level of which domains in an individual are important to QOL in later life is critical to providing services to both healthy aged as well as those with health and mental health needs. The SEIQOL-DW affords clinicians a unique tool with which to describe an individual's unique and relevant quality of life areas, and affords a way to measure change in these areas as a result of interventions.

Old Age Care Preferences Among Chinese Middle-Aged Single-Child Parents and the Related Policy Implications.

We contrast rural and urban single-child parents' old age care preferences and factors determining their preferences. The results show that single-child parents are more likely to report specific old age preferences than parents with multiple children; urban single-child parents are also more likely to have specific old age care preferences than their rural counterparts. Pension/social insurance is most preferred by urban single-child parents; whereas the preferences of rural single-child parents are more diverse. The most significant rural and urban differences lie in the effects of social and medical insurance on the respondents' selection of care sources. Policy implications are discussed in the end.

Hong Kong Chinese aging adults voice financial care expectations in changing family and sociocultural contexts: implications for policy and services.

Despite being one of the world's wealthiest cities, approximately one-third of Hong Kong older adults live below the poverty line. Innovatively using the Photovoice research method, this study invited 36 Hong Kong Chinese aging adults to photograph images and voice their concerns and expectations regarding financial care. Insufficient government support, diminishing family support, insecurity and fear regarding future finances, and strong desire for self-sufficiency through early preparation and bridge employment were recurring themes observed in the participants' photographs and narratives. The shifting of the participants' financial care expectations from informal to formal sources in changing family and sociocultural contexts indicated that older people are in urgent need of policy reform from a needs-based to rights-based approach to foster empowerment and fulfill older people's rights of financial security, dignity and participation. Improving the retirement protection system should go hand in hand with encouraging family support and caregiving and creating age-friendly working environment for older residents. The findings of this study may have crucial policy implications for Hong Kong and other aging societies, especially those that share similar filial piety values and have seemingly ungenerous welfare systems.

Super-aging and social security for the most elderly in China.

This article is dedicated to an under-researched area, the demographic development and social welfare for the most elderly (aged ≥80 years) in The People's Republic of China. Based on national censuses conducted over the last six decades in China this study examined the development of the most elderly population in comparison with groups of younger elderly people. It is argued that population growth among the most elderly in China has occurred with unparalleled speed, a phenomenon referred to as second order aging. This study demonstrated that the proportion of individuals aged ≥80 years has increased more rapidly than any other age group among elderly people. Particular attention has been given to the issue of social security and social welfare for the most elderly based on the non-contributory old age allowances provided by various regions and provinces. A national unified program of social security for the most elderly in the population is still not in sight.

Origins and consequences of technology acquirement by independent-living seniors: towards an integrative model.

BACKGROUND: Living independently can be challenging for seniors. Technologies are expected to help older adults age in place, yet little empirical research is available on how seniors develop a need for technologies, how they acquire these technologies, and how these subsequently affect their lives. Aging is complex, dynamic and personal. But how does this translate to seniors' adoption and acceptance of technology? To better understand origins and consequences of technology acquirement by independent-living seniors, an explorative longitudinal qualitative field study was set up. METHODS: Home visits were made to 33 community-dwelling seniors living in the Netherlands, on three occasions (2012-2014). Semi-structured interviews were conducted on the timeline of acquirements, and people and factors involved in acquirements. Additionally, participants were interviewed on experiences in using technologies since acquirement. Thematic analysis was employed to analyze interview transcripts, using a realist approach to better understand the contexts, mechanisms and outcomes of technology acquirements. RESULTS: Findings were accumulated in a new conceptual model: The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS), which provides an integrative perspective on why and how technologies are acquired, and why these may or may not prove to be appropriate and effective, considering an independent-living senior's needs and circumstances at a given point in time. We found that externally driven and purely desire-driven acquirements led to a higher risk of suboptimal use and low levels of need satisfaction. CONCLUSIONS: Technology acquirement by independent-living seniors may be best characterized as a heterogeneous process with many different origins, pathways and consequences. Furthermore, technologies that are acquired in ways that are not congruent with seniors' personal needs and circumstances run a higher risk of proving to be ineffective or inappropriate. Yet, these needs and circumstances are subject to change, and the C-TAILS model can be employed to better understand contexts and mechanisms that come into play.

A cost of living longer: Projections of the effects of prospective mortality improvement on economic support ratios for 14 advanced economies.

The economic implications of increasing life expectancy are important concerns for governments in developed countries. The aims of this study were as follows: (i) to forecast mortality for 14 developed countries from 2010 to 2050, using the Poisson Common Factor Model; (ii) to project the effects of the forecast mortality patterns on support ratios; and (iii) to calculate labour force participation increases which could offset these effects. The forecast gains in life expectancy correlate negatively with current fertility. Pre-2050 support ratios are projected to fall most in Japan and east-central and southern Europe, and least in Sweden and Australia. A post-2050 recovery is projected for most east-central and southern European countries. The increases in labour force participation needed to counterbalance the effects of mortality improvement are greatest for Japan, Poland, and the Czech Republic, and least for the USA, Canada, Netherlands, and Sweden. The policy implications are discussed.

Fragmentation in social security old-age benefit provision in China.

Currently, in many countries most workers are covered by a national social security benefits program that applies equally in all parts of the country. In China, however, social security old-age benefits are provided in a highly fragmented manner. This article documents the high degree of fragmentation. It discusses both why that has occurred and the effects of the fragmentation on participants. It examines effects of the fragmentation on benefit levels, focusing on variations in the generosity of benefit formulas but also considering other measures of benefit adequacy. Fragmentation is seen to cause differences in benefit levels even within a single city. While the new National Rural Pension Scheme is a major improvement in the provision of retirement security for rural workers, important differences still exist in the social security programs for urban and rural workers.

Elderly care and the one-child policy: concerns, expectations and preparations for elderly life in a rural Chinese township.

Several studies have looked at the effect of the one-child policy on elderly care in China. This study compares the differences in concerns, expectations and preparations for elderly life of parents of reproductive age between one- and two-child families in a rural Chinese village. With support from the Bill and Melinda Gates Institute for Population and Reproductive Health, 800 one- and two-child families were surveyed from 2009 to 2010. The data showed that the parents of one-child families were significantly more concerned about being abandoned in old age. There was a discrepancy between parents' preferences and expectations for elderly care: while many parents "preferred" to live with their children in old age, only a small percentage "expected" to co-reside with their adult children. Some elders even preferred to live in elderly care institutions, indicating a change in the perception and accessibility of these institutions, which have historically been stigmatized and heavily restricted. As China's population ages, there is increased need for expanded services and alternatives to the traditional model of co-residence for the rural elderly.

Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354).

BACKGROUND: Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life. AIM: To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels. SUBJECTS AND METHODS: A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 µg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex. RESULTS: Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status. DISCUSSION: Our findings suggest that foods fortified with 1.4 µg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs.

The impact of health changes on labor supply: evidence from merged data on individual objective medical diagnosis codes and early retirement behavior.

The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration until retirement is modeled using single and competing risk specifications, observed and unobserved heterogeneity, and flexible baseline hazards. Wealth is used as a proxy for elapsed duration to mitigate the potential selection bias stemming from conditioning on initial participation. The competing risk specification distinguishes complete multiperiod routes to retirement, such as unemployment followed by early retirement. A result on comparison of coefficients across all states is offered. The empirical results indicate a strong impact of health changes on retirement and hence a large potential for public policy measures intended to retain older workers longer in the labor force. Disability responds more to health shocks than early retirement, especially to diseases of the circulatory, respiratory, and musculoskeletal systems, as well as mental and behavioral disorders. Some unemployment spells followed by early retirement appear voluntary and spurred by life style diseases.

[Aims, implementation and impact of the Charter of rights for people in need of long-term care and assistance]. / Ziele, Umsetzung und Wirkung der Charta der Rechte hilfe- und pflegebedürftiger Menschen.

All citizens have the right to dignified and respectful social care and assistance. The state and society as a whole have the responsibility to guarantee the realization of these rights. However, the question arises what is dignified and respectful long-term care and assistance for the individual? One possible answer is given by the German Charter of Rights for people in need of long-term care and assistance. The charter summarizes existing books of law such as the German Federal Constitution or the European Social Charter and translates them into a specific context of long-term care. It is written in a language easily understood by everyone and reflects the central situation of people in need of long-term care and assistance. It sets an explicit benchmark for health and social care in Germany. The Charter was developed in 2005 at the round table for long-term care, hosted by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth in collaboration with the Federal Ministry of Health and Social Security. The round table consisted of representatives of users, consumer groups and other stakeholders, but also of care providers and health and care insurance funds in Germany.Many institutions, such as residential homes and health care services have now successfully applied the Charter in their daily work and it has found its way into several books of law at national and regional levels. The following article gives an overview of the structure, content and intention of the Charter and also highlights examples of implementation and its effects on the care structure and daily work with people in need of long-term care.

Challenges For Middle-Income Elders In An Aging Society.

The United States is becoming an "aging society," in which the number of people older than age sixty exceeds the number of those younger than age fifteen. This transformation has major implications for many aspects of American life. The fundamental challenge relates to our core societal institutions-education, work and retirement, health care, housing, and the like-which were not designed to support a population with our future age distribution. While the most disadvantaged are at greatest risk of losses in physical and emotional well-being and economic security, it has become apparent that middle-income elders will face formidable economic challenges, and related reductions in access to health care and secure housing, in the next ten years. Innovative private- and public-sector initiatives, including both specific public policies as well as individual programs targeting access to health care, housing, and economic security, are needed to support this very large group. For the past decade the Research Network on an Aging Society, an interdisciplinary group of scholars, has been working to identify the critical elements of successful adaptation and to formulate strategies to develop the policies and programs referred to above and assess their effectiveness. Here I present an overview of such policy development and assessment strategies, with a special focus on the housing and other needs of the large older middle class of the future.

Mudanças na rotina de instituições delonga permanência para idosos em função da pandemia da COVID-19 / Changes in the routine of long-stay institutions for the elderly due to the COVID-19 pandemic

Objetivo: Identificar as mudanças surgidas como resultado das medidas implementadas em Instituições de Longa Permanecia para Idosos para a prevenção do contágio pelo novo coronavírus SARS-CoV-2 no município de Teresina no Estado do Piauí. Método: Trata-se de um estudo transversal de natureza quantitativa com os gestores de quatro instituições na cidade de Teresina no Piauí, realizada por meio de um formulário, estruturado e eletrônico, na plataforma Google Forms. Resultados: Foram implementados protocolos preventivos em todas as instituições, com foco em medidas de segurança para os idosos e focando em condutas de higiene, de forma unanime a obrigatoriedade do uso de máscara e suspensão de visitas. Conclusões: Foram analisadas quatro Instituições de Longa Permanência para Idosos e de acordo com os dados coletados as instituições passaram por processo de adaptação as necessidades que surgem para melhorar a qualidade de vida dos idosos institucionalizados.(AU)

Objective: To identify the changes that have arisen as a result of measures implemented in Long Stay Institutions for the Elderly for the prevention of contagion by the new SARS-CoV-2 coronavirus in the municipality of Teresina, State of Piauí. Method: This is a cross-sectional study of a quantitative nature with managers of four institutions in the city of Teresina, Piauí, carried out through a structured and electronic form, on the Google Forms platform. Results: Preventive protocols were implemented in all institutions, focusing on safety measures for the elderly and focusing on hygiene behaviors, unanimously the mandatory use of masks and suspension of visits. Conclusions: Four long-stay institutions for the elderly were analyzed and, according to the data collected as institutions, they underwent an adaptation process as needed to improve the quality of life of institutionalized elderly.(AU)

Objetivos: Identificar los cambios que han surgido como resultado de las medidas implementadas en Instituciones de Larga Estancia para Personas Mayores para la prevención del contagio por el nuevo coronavirus SARS-CoV-2 en el municipio de Teresina, Estado de Piauí. Método: Se trata de un estudio transversal de carácter cuantitativo con responsables de cuatro instituciones de la ciudad de Teresina, Piauí, realizado a través de un formulario estructurado y electrónico, en la plataforma Google Forms. Resultados: Se implementaron protocolos preventivos en todas las instituciones, enfocándose en las medidas de seguridad para los adultos mayores y enfocados en las conductas higiénicas, por unanimidad el uso obligatorio de mascarillas y suspensión de visitas. Conclusiones: Se analizaron cuatro instituciones de larga estancia para ancianos que, de acuerdo con los datos recolectados como instituciones, se sometieron a un proceso de adaptación según fue necesario para mejorar la calidad de vida de los ancianos institucionalizados.(AU)

Itinerário terapêutico de idosos vivendo com HIV/Aids: perspectivas da história oral / Therapeutic Itinerary of Elderly Living with HIV/Aids: Oral History Perspectives

Resumo Objetivo: Analisar o itinerário terapêutico de idosos vivendo com HIV em assistência num município do Oeste Catarinense. Metodologia: Estudo qualitativo com método história oral temática. A população foi composta por idosos que vivem há mais de cinco anos com HIV/Aids, assistidos em um Serviço de Atendimento Especializado. Foram realizados dois encontros para aproximação e três momentos de entrevistas em profundidade abordando questões relacionadas as trajetórias assistenciais dos sujeitos e sua relação com a doença. A análise de dados foi realizada por meio da análise temática de conteúdo. Resultados e Discussão: Os idosos tiveram seu diagnóstico em fase tardia o que mostra a dificuldade dos serviços de saúde em identificar precocemente o HIV na pessoa idosa. O tratamento foi centralizado na medicação com antirretrovirais, de maneira setorializada em serviço especializado e com equipe constituída por profissional médico, enfermeiro e farmacêutico. Também foi evidenciado baixo acesso a recursos não farmacológicos, como assistência psicoterapêutica. Considerações finais: A trajetória assistencial precisa ser qualificada na direção de garantir maior acesso as redes de saúde e as equipes interprofissionais para uma atenção à saúde integral que realize o diagnóstico precoce com vistas a reduzir os riscos de complicações e ofereça um cuidado integral e humanizado, que extrapole o uso de medicamentos.

Abstract Objective: To analyze the therapeutic itinerary of elderly people living with HIV assisted in a municipality in Western Santa Catarina. Methodology: Qualitative study with thematic oral history method. The population was consisted of elderly people who have been living with HIV/Aids for more than five years, assisted in a Specialized Care Service. Two meetings were held for approximation and three moments of in-depth interviews. Data analysis was performed through thematic content analysis. Results and Discussion: The elderly had their diagnosis at a late stage, use antiretrovirals in their therapeutic journey, they have the specialized service as the central treatment space and greater contact with the medical professional, nurse and pharmacist. Final considerations: The therapeutic itineraries were built in a way that diagnoses happen late, with treatment focused on medication, in a sectorized way and without a diverse interprofessional team.

Repercussões físicas, emocionais e sociais produzidas pelo HIV/AIDS na vida dos idosos / Physical, emotional and social repercussions caused by HIV/AIDS in the lives of the elderly: thematic oral history perspectives

Introdução: os dados epidemiológicos mostram um aumento da população idosa vivendo com HIV/AIDS no Brasil. Esta doença impacta de diferentes formas a vida da pessoa constituindo um desafio para os serviços de saúde. Objetivo: verificar as alterações físicas, emocionais e sociais produzidas pelo HIV/AIDS na vida de idosos. Metodologia: estudo qualitativo com método história oral temática. Realizado no Serviço de Atendimento Especializado (SAE) em HIV/AIDS de uma cidade do Oeste Catarinense com a inclusão de três idosos, duas mulheres e um homem, com média de idade de 66 anos e diagnóstico do HIV/AIDS há mais de cinco anos. Foram realizados cinco encontros, dois de observação no domicílio e três para realização da entrevista em profundidade com validação de todas as etapas. A análise dos dados foi realizada por meio da análise de conteúdo temática. A pesquisa foi aprovada no comitê de ética. Resultados e discussão: os idosos apresentaram sintomas físicos decorrentes da imunossupressão sendo o principal deles o emagrecimento, que se constituiu como um sinal de alerta para o diagnóstico do HIV/AIDS. As repercussões emocionais foram o medo e a angústia, mais presentes no momento do diagnóstico e início dos tratamentos. As repercussões sociais estiveram atreladas ao isolamento social, saída de grupos e perda do papel no trabalho. Considerações finais: o HIV/AIDS repercute na vida dos idosos e produz diferentes alterações, quer sejam físicas, emocionais e/ou sociais. Nessa direção, incluir essas demandas no planejamento de ações para esse grupo populacional tornará a assistência à saúde mais resolutiva.(AU)

Introduction: epidemiological data show an increase in the elderly population living with HIV/AIDS in Brazil. This disease affects people's lives in different ways and constitutes a challenge for health services. Objective: To verify the physical, emotional, and social repercussions caused by HIV/AIDS in the lives of the elderly. Methodology: a qualitative study which used thematic oral history as a method. The research was carried out at the Specialized Care Service (SAE) on HIV/AIDS in a city in western Santa Catarina, which included three elderly diagnosed with HIV/AIDS for more than five years. Two meet-ings were held for approximation and three moments of in-depth interviews with validation in all stages. Data analysis had performed through thematic content analysis, according to Minayo (2014). Results and discussion: The elderly presented physical symptoms resulting from immunosuppression, the main one being weight loss, which constitutes a warning sign for the diagnosis of HIV/AIDS. The emotional repercussions were the fear and anguish most present at the time of diagnosis and the beginning of treatments. The social repercussions were linked to social isolation, leaving groups, and losing the social role of work, being partially reintroduced. Final considerations: HIV/AIDS affects the lives of the elderly, producing different changes, whether physical, emotional, and social, and health services and an interprofessional team need to ensure a broader view of this whole context to qualify assistance.(AU)