Individual-Level Active Aging Index and Quality of Life of Older People: A Population-Based Survey in Tehran.

Background: Iran is one of the fastest ageing countries in the world. The model of Active Ageing (AA) could be a strategy contributing in addressing the problem of population ageing in Iran. This study measured the status of AA in Iran and examined its associations with the health-related quality of life of older people. Methods: A quantitative cross-sectional survey of a random sample of 623 people aged 55 + years resident in Tehran was conducted. In total, 590 people responded. The AA was measured using the Active Ageing Index (AAI) questionnaire and the health-related quality of life was measured using SF-36 questionnaire. Associations between the domains and the overall AAI scores with the quality of life were examined by MANCOVA analysis in four models using the STATA software. Results: The score of overall AAI was calculated at 26.8 (men 33.9 vs. women 20.6) out of 100. We found a stronger association of the AAI with the physical component than the mental component of the SF-36. Generally the 1st (employment) and the 2nd (participation in society) domains of the AAI showed little or no association with SF-36, but there was an association between the 3rd domain (enabling environment for active ageing) and the SF-36 and a particularly strong associations with the 4th domain (independent, healthy and secure living capacity). Conclusions: Iranian elderly, particularly women, are experiencing relatively inactive life, which negatively influence on their health-related quality of life. To improve the AAI status in Iran, some aspects including "enabling environment" and "independent, healthy and secure living capacity" need special attention.

The extra costs associated with a cognitive impairment: Estimates from 15 OECD countries.

BACKGROUND: The objective of this study is to estimate the additional income required of a household containing an older adult member living with a cognitive impairment (CI) consistent with dementia (CID). METHODS: Secondary analyses were provided of data from the Survey of Health Aging and Retirement in Europe incorporating data of adults' age 65 years old and older across 15 OECD countries in 2013. We also analyzed longitudinal data of a smaller subset of respondents interviewed in a previous survey wave in 2011. We used OLS regression and the Standard of Living (SOL) approach to estimating the extra costs of disability. RESULTS: Households containing a member experiencing a CID are estimated to require 48% more income to maintain their SOL compared to similar households not including an adult with CID. Those with CI without dementia are estimated to have lower costs (14%). Those with longer-term CID are estimated to incur greater costs than those with a more recent onset of a CI. The extra costs are estimated to be lower in countries with more formalized public long-term care arrangements. We further identified out of pocket costs for home care services as a likely expenditure item driving these cost estimates. CONCLUSIONS: Results suggest that caring for a person living with dementia can lead to considerable expenses. These additional direct costs associated with dementia provide insights for households in anticipating the risks of financial insecurity as they grow older. Future research is needed to identify the consumption items driving these estimates.

Socio-economic and environmental impacts of COVID-19 pandemic in Pakistan-an integrated analysis.

The COVID-19 pandemic has affected about 210 countries with more than 67 million confirmed cases and over 1.5 million deaths across the globe including Pakistan. Considering the population density, health care capacity, existing poverty and environmental factors with more than 420,000 infected people and about 8300 plus mortalities, community transmission of the coronavirus happened rapidly in Pakistan. This paper analyses the short- and long-term effects of COVID-19 peak on the socio-economic and environmental aspects of Pakistan. According to the estimates, an economic loss of about 10%, i.e. 1.1 trillion PKR, will be observed in the FY 2021. Certain pandemic impediment measures like lockdowns, social distancing and travel restrictions taken by the Government have been thoroughly analysed to determine how they impacted the livelihoods of nearly 7.15 million workers. Consequently, a rise of 33.7% of poverty level is projected. While many negative impacts on primary, secondary and tertiary sectors of the economy such as agriculture, education and health care are observed, a drastic improvement in air quality index of urban centres of the country has been recorded amid lockdowns. With current economic crisis, fragile health care system and critical health literacy, a well-managed and coordinated action plan is required from all segments of the society led by the public authorities. Thorough assessment of COVID-19 scenario, management and control measures presented in this study can be assistive for the provision of policy guidelines to governments and think tanks of countries with similar socio-economic and cultural structure.

Dementia awareness, beliefs and barriers among family caregivers in Pakistan.

OBJECTIVES: Dementia research and services in Pakistan are limited. The following was explored in experiences of family caregivers of people with dementia in Pakistan: (a) to determine whether culture and religion play a role in caregiving; (b) to draw insights on how family caregivers cope, what barriers they face and what help they would be willing to accept and (c) to determine how these findings could be used to raise awareness and influence public policies in improving the lives of families living with dementia. METHODS: The experiences of family caregivers of people with dementia in Pakistan were explored via semi-structured interviews (10 in Lahore; 10 in Karachi). This was part of a larger qualitative study conducted about dementia in Pakistan. Caregivers interviewed were aged 35-80 (14 female). Most caregivers in the study were educated and affluent. Interviews were conducted in Urdu, translated into English and thematically analysed. RESULTS: Five themes emerged: knowledge and awareness; stigma; importance of religion and duty to care; use of day care centres and home-help; and barriers. A lack of dementia awareness exists in Pakistan. The religious duty to care for family influenced caregiving decisions. Day care centres and home-help were accessed and viewed positively. The caregivers also wanted extracurricular activities for people with dementia, support groups for caregivers and better training for healthcare staff. Novel findings included that caregivers felt that dementia should not be stigmatised, and awareness should be raised in Pakistan via TV, radio and social media, but not inside mosques. DISCUSSION: Additional research is necessary to determine if positive views of day care centres and home-help exist more widely. Attitudes and experiences regarding stigma may be different for caregivers of people with more advanced dementia. We recommend raising dementia awareness, allocating more funds to dementia services and an emphasis on home-based care.

Active Aging Index in Vietnam Relative to China, South Korea, Taiwan, and 28 European Union Countries.

OBJECTIVES: This study constructed an Active Aging Index (AAI) for Vietnam and compares Vietnam's AAI with those of China, Korea, Taiwan, and 28 countries in the European Union. METHODS: A survey of 1,105 people aged 55 or above in three provinces from the northern, central, and southern parts of Vietnam was conducted. Active aging was measured using the AAI; its 22 indicators were grouped into four domains: employment, social participation, independent/healthy/secure living, and enabling environments. RESULTS: Of the 32 countries reviewed, Vietnam ranked 11th. It ranked high for employment (1st) and social participation (5th) but low for independent/healthy/secure living (32nd) and enabling environments (26th). CONCLUSION: Three policy priorities were identified: maintaining a high preference-driven social and workforce participation rate among older adults; promoting medical care and healthy behaviors among older adults; and improving other poorly performing aspects of active aging, including voluntary activities, poverty risk, Internet usage, and lifelong learning.

Experiences of People With Dementia in Pakistan: Help-Seeking, Understanding, Stigma, and Religion.

BACKGROUND AND OBJECTIVES: The prevalence of dementia will increase in low- and middle-income countries like Pakistan. Specialist dementia services are rare in Pakistan. Public awareness of dementia is low, and norms about family care can lead to stigma. Religion plays a role in caregiving, but the interaction between dementia and Islam is less clear. RESEARCH DESIGN AND METHODS: Qualitative interviews were carried out with 20 people with dementia in Karachi and Lahore. Interviews were conducted in Urdu, translated to English, and respondents' views on help-seeking experiences, understanding of diagnosis, stigma, and religion were analyzed thematically. RESULTS: Although some people with dementia understood what dementia is, others did not. This finding shows a more positive perspective on diagnosis in Pakistan than previously thought. Help-seeking was facilitated by social and financial capital, and clinical practice. Stigma was more common within the family than in the community. Dementia symptoms had a serious impact on religious obligations such as daily prayers. Participants were unaware that dementia exempts them from certain religious obligations. DISCUSSION AND IMPLICATIONS: Understanding of dementia was incomplete despite all participants having a formal diagnosis. Pathways to help-seeking need to be more widely accessible. Clarification is needed about exemption from religious obligations due to cognitive impairment, and policy makers would benefit from engaging with community and religious leaders on this topic. The study is novel in identifying the interaction between dementia symptoms and Islamic obligatory daily prayers, and how this causes distress among people living with dementia and family caregivers.

Active Ageing in CIS Countries: Semantics, Challenges, and Responses.

Although the CIS countries are connected together by the legacy of breaking away from the Soviet Union, they have had a distinctive transition course and are rather diverse in terms of the population ageing challenges and policy responses in place. The commonality is that a comprehensive national strategy on ageing is lacking, and many of necessary reforms were put aside owing to political uncertainties, lack of societal consensus, and financial instability. The notion of active ageing is associated with the term "accelerated ageing," which is understood to be an individual living a life under harsh living conditions or a society experiencing rapid increases in the relative number of older persons, and therefore it carries a negative connotation. Yet, in the same spirit as the European Year for Active Ageing and Solidarity between Generations 2012, the CIS countries have initiated sectoral programmes towards enhancing employment of older workers, social participation of older people in the society in a wider sense and also measures promoting health and independent living of older persons.