Journal of Aging & Social Policy最新文献

Unmet needs for healthcare services are widely recognized as an indicator of inequalities in healthcare access and utilization. This study estimated inequalities in unmet needs for healthcare services as well as their contributing factors and reasons among middle-aged and older adults in China. Results indicated that 30.47% and 5.69% of the middle-aged and older population in China reported unmet needs for outpatient and inpatient services, respectively. Mostly pro-poor inequalities concerned unmet needs for both rural and urban residents. The coverage of public health insurance and individuals' health status contributed most to the inequalities in the unmet needs identified. The most prevalent reason for unmet needs was affordability, especially for poor or rural respondents. Despite the rapid development of universal healthcare, unmet needs for healthcare services still existed and remained high among people living in rural areas and with low incomes in China. Policy interventions should focus on improving the public health insurance system and targeting financial barriers to obtaining care, particularly vulnerable populations in China.

Rural China has been experiencing a significant rise in empty nesters among older adults, a mixed consequence of contemporary social issues such as population aging, urbanization, and migration. Focusing on rural older populations who have traditionally relied on private transfers from adult children as well as public assistance, this study used data from the China Health and Retirement Longitudinal Study 2018 and the propensity score matching method to investigate the crowding-out effect of China's primary public assistance program, Dibao, on financial transfers from adult children to their empty-nest older parents and older parents' relationship satisfaction with their adult children. Our findings reveal that Dibao significantly reduced financial transfers from adult children to their empty-nest older parents but enhanced older parents' relationship satisfaction with their adult children. Furthermore, this crowding-out effect was more significant in irregular and cash transfers, and among those with lower capability of engaging in grandchild caregiving. These results suggest a complex dynamic wherein Dibao reduced financial contributions from adult children to their older parents in rural China. This study contributes to understanding the mixed effects of social assistance programs on intergenerational transfers and relationships in the context of the rapidly changing social structure in China.

To fulfill the World Health Organization's (WHO) goal of active aging, it is essential to concentrate on the health of individuals with disabilities. However, there is a significant gap in research regarding the impact of disability on lifespan in low- and middle-income countries (LMICs). Additionally, the specific social determinants of health for middle-aged and older adults with disabilities are not well understood in LMICs. Our study aims to address these gaps by focusing on China's aging population. We utilized a Weibull regression model to predict individual lifespans and employed linear regression models to identify health determinants for people with disabilities. Our findings revealed that, compared to those without disability, the life expectancy of individuals with mild, moderate, and severe disabilities was reduced by 18%, 37%, and 53%, respectively, with even larger disparities in Quality-Adjusted Life Years (QALYs) at 19%, 39%, and 55%. Key determinants of health for middle-aged and older adults with disabilities included social contact, living areas, and labor market status. Consequently, we recommend three policy interventions: 1) improving access to social contact opportunities within communities; 2) reinforcing the pension system for both urban and rural residents; 3) expanding the elder care industry and enhancing fiscal transfers in rural regions.

The demand for home-based eldercare, especially for those with dementia, has been growing as societies age; in this context, the acute shortage of local care labor has resulted in the use of migrant workers in many countries. Taiwan, Singapore, and Austria, all emphasizing the family's responsibility for eldercare, have long histories of recruiting migrant workers for home-based eldercare. However, cases of mistreatment of migrant caregivers and care recipients have aroused public concern regarding migrant workers' care capabilities and working conditions. Migrant caregivers have also reported that their lack of care skills and sufficient rest hamper their work with care recipients who have dementia. This commentary provides a critical review of the laws and policies pertaining to live-in migrant care workers' care capabilities and working conditions; the effects of such legal frameworks; and recent changes in Taiwan, Singapore, and Austria. This article enhances our cross-country understanding of the advantages and disadvantages of using foreign labor for eldercare in private homes. Governments should enact legislation that supports live-in migrant care workers' care capabilities and welfare, thereby also improving the well-being of care recipients and their families.

In November 2020 an outbreak of ethnically and politically motivated armed conflict started in Tigray and expanded to the Amhara and Afar regions of Ethiopia, bringing a devastating impact upon civilians and disadvantaged groups. Persons living in those areas, including older adults, were forced to flee and seek refuge at internal displacement centers. Given the lack of scholarship on aging and humanitarian contexts, this study investigated the challenges faced by older individuals fleeing the war zone and settling in internal displacement centers during Ethiopia's armed conflict. A qualitative descriptive study was used in this cross-sectional investigation. Data from the in-depth interviews with 13 older adults were supplemented with key informant interviews and observations. Interview data was analyzed using thematic analysis. Findings revealed that the older adults escaping their homes and staying in the displacement center faced food shortages; inadequate shelter, clothing and bedding; lack of sanitation and hygiene supplies; inaccessible health services; social network destabilization; family disintegration; lack of care and support; and psychological stress, all of which negatively impacted their physical and psychosocial well-being. The findings call attention to the need for practical access to social and economic integration of older adults in the aftermath of the war as well as ongoing psychosocial intervention.

Systematic research has been conducted on the relationship between aging and consumer fraud victimization. But few empirical studies examine the reality of judicial dispute resolution in consumer fraud against older people from the perspective of older adults and judges in China. Based on 161 court rulings, this qualitative study explores the perceptions of older adults in litigation about their experiences of being defrauded in China, alongside judges' responses. Results reveal that common fraud patterns used by business perpetrators render older individuals more susceptible to fraud. Older plaintiffs strategically frame "old age" in litigation, potentially as a tactical maneuver, while also readily emphasizing the importance of procedural justice. Results further show that judges expressed either negative ageism or age-neutral discourse in response to fraud targeting older individuals. Findings highlight the need to enhance consumer education to prevent fraud and address ageist stereotypes among older people. Findings also highlight the need to encourage Chinese courts to consider individual case specifics, leading to fair judgments and the protection of older individuals from fraud while upholding their rights.

The need to optimize supports of Alzheimer's disease and related dementias (ADRD) care partners through policy innovation is high. This study sought to frame the care and support needs of multiple historically underrepresented populations who may be underserved and/or have difficulty accessing culturally specific services and determine specific policies that may reduce ADRD care partner burden and improve wellbeing. Qualitative data were gathered through interviews (N = 24) with leaders of organizations that support people living with ADRD and focus groups (N = 5) with dementia care partners from four communities historically underserved in the United States (Asian, Black, Indigenous, and Latinx). Organizational leaders also participated in a modified Delphi process to identify priorities for supporting care partners. Multiple themes were identified including: information resources; navigation and coordination within and across systems; access to clinicians, care teams, health/personal records; legal and financial issues; in-home and respite care; psychological and physical health support for care partners; and flexibility of schedules. Policy-related priorities for supporting care partners informed development of specific policy recommendations related to financing, supports, and respite. State and national policies can be enhanced to address these priorities across populations in ADRD care partner supports, especially for historically underserved groups.

Lower socioeconomic status (SES) is linked to earlier nursing home admission, but it is unclear if this remains true after accounting for health needs. This study examines SES-related inequalities in nursing home admission, controlling for health needs in an area of Switzerland with universal home-based care for older adults. Data were from the Lausanne Cohort 65+ study, including 3650 participants. SES was measured by education level, occupational class, and receiving means-tested benefits (a proxy for low income). Health needs were assessed with a set of physical and mental health variables. Cox proportional hazard models are controlled for demographics and health needs. Over 6 years, 115 (3.2%) participants were admitted to a nursing home. Lower education and receiving means-tested benefits were linked to earlier nursing home admission. However, after adjusting for all SES variables and health needs, associations between socioeconomic inequalities and nursing home admission did not remain significant. Lower SES is initially associated with earlier nursing home admission, but this is substantially explained by functional and cognitive impairment. The study suggests that access to long-term care in Switzerland is horizontally equitable but emphasizes the importance of preventing functional and cognitive decline in lower SES groups.

Little is known about the effect of implementing a long-term care insurance (LTCI) program on long-term institutional care admissions. This study employs a quasi-experimental design to examine the impact of China's LTCI pilot program on institutional care admissions among older adults. Using four waves (2013, 2015, 2018, and 2020) of the China Health and Retirement Longitudinal Study with 8,005 observations, difference-in-differences was applied to compare institutional care utilization between pilot and non-pilot cities before and after the 2016 policy implementation. Results demonstrate that LTCI significantly increases institutional care admission probability by 0.5%, indicating a profound behavioral impact despite modest absolute changes. The magnitude and direction of effect varies considerably across population subgroups. Age emerges as a key moderating factor, with older individuals showing stronger policy responsiveness. Functional disability presents a more complex pattern: while insurance coverage facilitates access for those with moderate care needs, the effect diminishes among severely disabled individuals for whom institutional care represents an unavoidable necessity. Metropolitan areas demonstrate substantially greater policy effectiveness compared to rural regions. The findings provide crucial evidence on how enabling factors in healthcare utilization operate within different demographic and geographic contexts, offering insights for policymakers designing LTCI systems in aging societies.

Changes in policies that restrict early retirement have raised the retirement age for many low-skilled older workers in Denmark. This study examines the prevalence of adversities among these workers and their impact on mental well-being. Using latent class analysis on Danish survey data from 5,453 low-skilled workers aged 57-62 years, five distinct adversity profiles were identified: "poor health" (17%), "adverse working conditions" (11%), "dire financial situation" (11%), "poor health and adverse working conditions" (8%), and "no adversities" (52%). Workers facing adversities report significantly lower mental well-being, with a higher risk of depression and increased stress levels, compared to those without adversities. The risk of poor mental well-being is highest among those experiencing both health and work-related adversities. Additionally, "job lock" - when workers wish to retire but cannot afford to - emerges as a key factor associated with reduced mental well-being across all adversity profiles. The findings suggest that efforts to extend working lives by limiting early retirement opportunities could have unintended implications for the mental well-being of low-skilled older workers. Notably, the findings indicate that firms actively engaging in supportive practices can mitigate some adverse effects, underscoring the critical role employers play in safeguarding the mental well-being of older employees.