Journal of Aging & Social Policy最新文献

With an aging population and projected increases in the number of older adults in need of care, especially those with chronic and progressive disease like dementia, family care is at the forefront of pressing social issues in the U.S. and worldwide. Time use data, including 24-hour time diaries (TD), daily diaries (DD), and ecological momentary assessments (EMA), may be especially helpful for shedding light on the often "invisible" care being given by American families caring for older adults. This review presents U.S. datasets that have TD, DD, or EMA available and proposes areas of future research including charting care and the impact on well-being, as well as expanding data collections.

As life expectancy increases and health improves, some working adults find that traditional retirement age is no longer desirable or feasible and may choose to postpone retirement from work. This study aims to explore the identity and work motivations of highly educated women in Israel who continue working beyond retirement age. By conducting seventeen in-depth semi-structured interviews with highly educated women working beyond retirement age, this qualitative-thematic analysis identifies five key factors influencing their decisions. The major themes include professional purpose, necessities driving their return, psychosocial determinants, social networks, and the role of human capital in facilitating employment opportunities. These insights highlight the need for policies promoting healthy aging and supporting post-retirement work engagement for women.

Eleven states implemented the Financial Alignment Initiative (FAI) to better align and care for beneficiaries eligible for Medicare and Medicaid. However, dually eligible beneficiaries could opt-out of the Medicare portion of the demonstration, potentially reducing the initiative's effectiveness. This study describes the extent and effects of opting-in/opting-out in Ohio during the demonstration. Data from the Ohio Department of Medicaid (November 2021) were analyzed, alongside interviews from 36 organizations providing long-term services and supports or acute care services. Of the 42% who opted out, 46% were aged 65 years and older, 43% were aged 45 to 64 years, and 29% were under 45 years. Opt-out rates were 39% for community well members, 44% for those receiving community-based long-term care, and 51% for long-stay nursing facility residents. Care managers and service providers reported challenges with those who opted out, including lack of access to care, poor communication, and insufficient information during care transitions. These issues created barriers to accessing coordinated care for dually eligible beneficiaries, particularly those with complex chronic conditions, limiting the success of the initiative in improving care quality and cost-effectiveness.

Elder abuse and neglect affect approximately 10% of Americans over age 60, with incidences rising as the population ages. Outcomes depend on frontline Adult Protective Services (APS) professionals' interpretation and implementation of policies and protocols, with historical reliance on subjective judgment causing variation in case handling. APS faces growing challenges including increasing case volumes, insufficient funding, and inconsistent practices. Recent improvement efforts have focused on structured decision-making tools and data analytics like the Identification, Services, and Outcomes (ISO) Matrix, designed to integrate empirical data collection with practice. This qualitative study examined ISO Matrix implementation in two APS programs in a West Coast state, analyzing APS professionals' experiences through focus groups. The analysis revealed tensions during the transition to standardized, data-driven decision-making, including optimism about using data to secure funding, challenges balancing standardized practices with complex case realities, staff-developed workarounds, and technological pitfalls. Findings highlight the need for greater flexibility in standardized tools to accommodate nuanced decision-making and emphasize humanizing approaches to technological innovation. By incorporating insights from frontline APS professionals, informatics systems can simultaneously serve institutional objectives by balancing administrative burdens with client needs while preserving professional discretion and enhancing accountability in safeguarding vulnerable older adults from abuse.

As the long-term care needs of older adults have increased, the marketization of care providers has become a commonly adopted policy in many countries; however, empirical research on its impact on service quality remains scarce. This study examines how the market shares of for-profit entities and new agencies affect the quality of long-term care in Korea. Administrative data from the Korean National Health Insurance Service and the Korean National Statistical Office were analyzed across 245 districts. Data were merged in 2016-2017 for service quality evaluation, and multiple imputation analysis was conducted to address observation variations and missing values. Findings indicate that higher market shares of for-profit providers and newly opened agencies are associated with lower service quality. Governments and local authorities should strengthen quality assurance in-home care by overseeing for-profit providers, seeking an optimal level of market shares among different care provider entities, and regulating the entry of newly established agencies into the already saturated care services market.

Small balances from tax-preferred retiremet accounts such as 401(k)s and IRAs can render some older adults ineligible for Medicaid, an important supplement to Medicare for older and disabled Americans who have low income and assets. The purpose of this study is to understand whether older low-income adults have assets in these tax-preferred accounts, hereafter defined contribution (DC) wealth, and whether DC wealth has implications for Medicaid eligibility. Using 2015-19 Medicare Current Beneficiary Survey (MCBS) data, the study finds half of all older adults with low income have either DC wealth or income from defined benefit (DB) pension plans and DC wealth is becoming more prevalent among younger cohorts of older adults, who are more likely to have DC wealth than DB income. Older adults with DC wealth are 5.5 percentage points less likely to be eligible for Medicaid than similar peers with DB income. In an exercise where DC wealth is hypothetically converted to an annuity, this eligibility gap falls by one-third to nearly one half. A possible policy solution would be to exclude DC wealth from the asset test, which would target the least advantaged beneficiaries and mimic the current eligibility criteria of the Supplemental Nutrition Assistance Program (SNAP).

Despite extensive research on social determinants of health, gaps remain in understanding how race and disability intersect to shape health disparities among older adults. This essay examines how structural inequities, including limited access to healthcare, inadequate housing, and economic instability, contribute to poorer health outcomes for racialized older adults with disabilities. Early-life disadvantages, such as growing up in underserved neighborhoods and experiencing systemic discrimination, accumulate over the life course, increasing the risk of chronic health conditions and financial insecurity in later life. Black and Hispanic older adults with disabilities experience disproportionately higher rates of hypertension and diabetes than their White counterparts, reflecting both historical and structural inequities. This essay emphasizes the need for longitudinal research to capture the cumulative effects of social determinants of health on marginalized populations, including Black, Hispanic, Indigenous, and Asian older adults with disabilities. It calls for culturally and disability-competent healthcare systems that incorporate bilingual navigation programs, tailored interventions, and specialized training for healthcare providers. Policy recommendations include strengthening anti-discrimination laws, increasing funding for community-based services, and improving access to telemedicine with a focus on digital equity. Addressing these barriers is essential to advancing health equity and ensuring that all older adults, regardless of race or disability, can age with dignity and well-being.

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.

Roughly 10,000 older adults turn 65 each day, an age which many people start to rely more on government supports to help meet their needs. In the United States, programs for older adults receive strong public support, but how attitudes toward these programs have shifted over time as the population ages is unclear. Furthermore, different groups may have different views. This study uses data from the 1984 to 2022 General Social Survey (GSS), a nationally representative survey of U.S. attitudes, to estimate trends in support for government programs for older adults. Attitudes toward more spending on Social Security and retirement have been stable, with slight increases over the last 40 years. Support for more government-provided care, which includes assistance with household tasks, payment for such care, and government direct care services, has increased over the last decade. Older adults, ages 65 and older, are less likely to support government spending on programs than adults ages 18-64. Differences in political affiliation are shrinking over time for Social Security but increasing for payment for care. The popularity of these programs suggests policymakers should seek to sustain them and introduce new programs to help offset the costs of care.

Social engagement, including participation in voluntary organizations, is vital for healthy aging. This study investigated the impact of the global pandemic on the participation of older adults aged 60 years and above in 10 types of voluntary organizations. Utilizing detailed COVID-19 data from the World Health Organization and the Integrated Values Surveys across 9 countries that collected data on voluntary organization participation before and during the pandemic, this study employed Difference-in-Difference models to estimate the pandemic's effect on the likelihood of older adults participating in voluntary services. The findings revealed a significant reduction in the likelihood (OR = 0.55, 95% CI: 0.46 ~ 0.65) and average number (β = -0.81, 95% CI: -0.98 ~ -0.64; IRR = 0.72, 95% CI: 0.67 ~ 0.78) of voluntary organizations older adults participated in. These effects persisted across age and gender groups as well as various types of voluntary organizations. The study underscores the importance of addressing the pandemic's adverse impact on older adults' social participation in order to promote the active and healthy aging of the population.