The Southeast Asian American population aged 55 or above remains understudied in research on advance directives (AD), despite their importance for end-of-life decision-making and quality of care. This study examined factors associated with AD completion among older Vietnamese and Filipino Americans, guided by Andersen's Health Service Use Model. Using a cross-sectional survey among 192 Vietnamese Americans and 140 Filipino Americans aged 55 or above, this study found that older age was significantly associated with higher odds of AD completion, whereas greater family conflict and lower income were associated with lower odds of AD completion. Acculturation was positively associated with AD completion among Filipino Americans, whereas a favorable AD attitude was positively associated with AD completion among Vietnamese Americans. These findings underscore the importance of addressing economic barriers and family conflict in AD completion. By recognizing different patterns of acculturation, AD attitude, and AD completion between the two ethnic groups, the findings highlight the importance of acknowledging heterogeneity within Asian Americans to develop culturally tailored approaches to promote advance care planning effectively.
As countries implement delayed retirement policies to address population aging, reduced availability of grandparental childcare emerges as an unintended consequence that may further depress fertility intentions. This study examines whether household income improvement and formal childcare provision can mitigate the fertility-suppressing effects of diminished grandparental care. Using factorial survey experiments embedded in a national Chinese survey, fertility intentions were assessed under randomized scenarios. Results show grandparental care absence reduced second- and third-birth intentions by 9.82 and 3.97% points, respectively. Annual household income increases and formal childcare availability had the potential to offset these declines. Individuals with higher socioeconomic status required larger improvement in household income to achieve similar fertility intention levels, while affordable, high-quality formal childcare consistently benefited all subgroups. These findings provide novel experimental evidence that integrating delayed retirement reforms with targeted childcare support and sufficient economic incentives may help preserve fertility intentions.
As populations age globally, fostering empathy and positive attitudes toward older adults among younger generations becomes increasingly important. This study evaluates two interventions - aging simulation suits and reading literature (reading and comprehending scenarios related to older adults) - to foster empathy, positive attitudes, charitable behavioral intentions, and caring intentions toward older adults among young people. Using a randomized experimental design, eligible participants were assigned to four groups: waitlist control, reading literature, aging simulation, and a combined intervention, completing pre- and post-intervention questionnaires. The results indicated that intervention groups showed statistically significant improvements in attitudes toward caring for older adults, trait empathy, charitable behavioral intentions, and caring behavioral intentions compared to the control group. Notably, the combined intervention group using both aging simulation suits and reading literature achieved the highest adjusted mean values for trait empathy (AMV: 4.042, 95% CI: 3.946-4.138, p < .05) and caring behavioral intentions (AMV: 6.083, 95% CI: 5.916-6.250, p < .05), followed by the group using aging simulation suits alone. The simulation suit group showed the most consistent improvements across all measures, with medium effect sizes (Cohen's d ranging from 0.39 to 0.61). These findings suggest that integrating aging simulation with reading literature approaches effectively fosters empathy and promotes positive caregiving behaviors, paving the way for age-inclusive societies and improved care quality for the aging population.
Home and Community-Based Services (HCBS) support the better health and well-being of older adults, but there are significant disparities in their availability across regions. HCBS availability can be influenced by neighborhood characteristics such as socio-economic status, demographics, and rurality. This study investigates the spatial correlation between neighborhood characteristics and HCBS availability in Virginia. Data from the National Neighborhood Data Archive (NaNDA) and Senior Navigator were used for the analysis. Results indicate a positive correlation between population density and HCBS availability in most areas. However, Southside Virginia suffered from lower HCBS availability despite a significantly older adult population. Findings suggest that policymakers consider the spatial distribution of HCBS and neighborhood characteristics in resource allocation decisions.
Rapid population aging in Hong Kong heightens risks of social isolation and purposelessness among older adults. The Community Care Team (CCT) program, launched by the government in 2023, recruits and trains volunteers for grassroots care activities with the aim of strengthening community resilience, i.e. the collective capacity to mobilize resources, sustain social support, and respond to challenges such as emergencies or social crises. This three-wave longitudinal study examined the effects of volunteering in the CCT program on psychological well-being in adults aged 55-79 (67 volunteers, 108 controls). Assessments at baseline, 3 months, and 8 months measured psychological well-being, prosocialness, self-efficacy, meaning in life, resilience, and loneliness. Volunteers demonstrated significant improvements compared to controls. Meaning in life mediated the prosocialness- psychological-well-being relationship, with a chained pathway via self- efficacy. Moderation showed stronger benefits for those with lower resilience or higher loneliness. Findings support expanding CCT-like programs to enhance mental health and sustainable eldercare.
Environmental policies are associated with a reduction in air pollution and climate risks, yet their benefits to public health remain unclear. This study detects changes in air pollution, climate, and health outcomes after implementing the Clean Air Act (CAA) in China in the period from 2000 to 2020, using data from the China Health and Retirement Longitudinal Study (2011-2020) linked with remotely sensed PM2.5 and O3 concentration datasets, temperature records, and CO2 emissions among 22,561 adults aged 45 years and over. The difference-in-difference (DID) approach was used to identify the effects of the CAA on health outcomes, and the growth curve modeling (GCM) was used to examine the longitudinal relationship between air pollution, climate change, and health outcomes. The results show that while climate conditions were partially linked to poorer health status, health advantages of the CAA were mostly attributable to PM2.5 reduction rather than climate mitigation. Further analyses, interacting air pollution with extreme temperatures, indicate that air pollution would exacerbate detrimental health effects of climate change. This study highlights the importance of public health initiatives and recommends that air pollution and climate change be prioritized jointly in environmental strategies.
Homelessness among older adults is a growing yet under-researched public-health and social-welfare concern in Iran. This study examined the perceived consequences of homelessness among 27 older adults (aged 60 years or older) residing in shelters in Tehran. Thematic analysis identified five interconnected domains: physical health decline and unmet chronic-care needs; profound mental-health burden characterized by hopelessness; social exclusion and loss of social roles; dependence on insecure survival economies; and structural exclusion due to loss of identity documents. Homelessness in later life represents multidimensional deprivation that accelerates aging, undermines dignity, and limits access to social entitlements.
Despite major policy and societal changes over two decades, trends in the demographic and health sorting of nursing home residents remain underexplored. This study focuses on sorting by one demographic factor - race - over time between nursing homes and local communities, and within nursing homes, by another demographic factor - age - as well as health status. Racial sorting is measured using the dissimilarity index, including novel measures of Black, Indigenous, and people of color (BIPOC)/white and Hispanic/white comparisons alongside the established Black/white measure. Racial sorting is higher in nursing homes than in the community for Hispanic/white comparisons, whereas for Black/white and BIPOC/white comparisons, community racial sorting exceeds that in nursing homes. Within nursing homes, racial sorting is highest for Black/white comparisons, higher among older than younger residents, and lowest for those with serious mental illness - possibly reflecting payment source heterogeneity among older residents. Over the study period, overall racial sorting decreased, yet increased within age and health subgroups. These findings underscore the need to understand drivers and consequences of multidimensional sorting in long-term care.
Loneliness and stress are increasingly prevalent among aged 65 years and older and have been linked to poor health outcomes and limited access to care. These psychological factors often intersect with social determinants of health (SDH), yet little is known about how SDH mediate their effects on healthcare utilization. This study used 2023 Behavioral Risk Factor Surveillance System (BRFSS) data to examine the relationships between loneliness, stress, and healthcare access among U.S. adults aged 65 and older (N = 62,878). Key outcomes included having a personal healthcare provider and attending a routine checkup. Ten SDH indicators, including income, education, emotional support, and transportation stability, were examined as mediators using logistic regression and path analysis. Older adults without loneliness or stress were significantly more likely to report better healthcare access. However, higher income, education, and lack of food assistance exhibited suppressor effects, weakening the positive relationship between emotional well-being and provider access. In contrast, transportation stability enhanced this association. Emotional support and life satisfaction fully mediated the relationship between loneliness, stress, and routine checkups. These findings highlight the complex role of SDH in healthcare access, suggesting that both emotional and structural supports are needed to reduce disparities among aging populations.
As global populations age, urban green spaces are emerging as critical yet underutilized assets for promoting healthy aging. This study aims to examine how global scholarship has evolved in linking green space exposure to physical, psychological, and social well-being among older adults. Using bibliometric analysis of 364 peer-reviewed articles published between 2002 and 2024, we employed VOSviewer, CiteSpace, and SCImago Graphica to identify key trends, co-authorship patterns, and thematic clusters. The results highlight a growing interdisciplinary focus on mental health, social cohesion, and accessibility, with China and the United States leading in publication volume and international collaboration. Five thematic clusters were identified, reflecting a shift from physical health toward multidimensional concerns. This study offers policy-relevant insights by proposing strategies such as equitable access, age-sensitive design, and community engagement to enhance the role of green infrastructure in aging policy frameworks - particularly in low- and middle-income countries.
Caregiver-employees provide unpaid adult care while simultaneously managing employment. The negative health and employment impacts incurred by caregiver-employees have drawn attention to caregiver-friendly workplace policies internationally, which is the focus of this research. Aging populations and changing workforce demographics present challenges for work-life balance. Using PRISMAs methodological guidelines, a comprehensive search strategy to explore the availability of carer-friendly workplace policies was implemented using 17 databases, as developed in consultation with a health science (SS) and a commerce (IP) librarian. Articles included in the review were published between May 1, 2019, and May 31, 2023, written or translated to English, and specifically discussed the provision of unpaid adult care. A total of 45 articles were included in the review, with 53 unique workplaces identified. Using descriptive statistics and content analysis, this study specifically names organizations, their location, and the carer-inclusive policies currently being offered. Workplaces in the finance, technology and healthcare industry/sectors offered the most caregiver-friendly accommodations. Web/App based supports are emerging rapidly among workplaces. Organizational culture change was found to be the most prominent transformative support. The results of this study can inform international policy in response to adapting labor markets to increasing demands of unpaid care.
The ability to manage money is crucial for independent living in later life, yet financial capacity often declines with age and cognitive impairment. This study explored how social care practitioners in England understand and enact responsibilities when older people experience difficulties managing money. Data from 28 semi-structured interviews with practitioners across local authorities, housing, homecare and voluntary organizations were analyzed via thematic analysis and triangulated with 19 professional guidance documents. Practitioners commonly recognized financial difficulties but felt untrained and uncertain about their role. Most reported "signposting," i.e. directing older people elsewhere rather than offering support, despite often not knowing which services could help. Professional guidance emphasized empowerment and safeguarding but provided little practical direction for routine financial support. The paper argues that signposting functions as an institutional mechanism that deflects responsibility for financial wellbeing, leaving many older people in a "missing middle" between financial inclusion policy and safeguarding. Strength-based approaches risk reinforcing this neglect. Policies should clarify practitioner roles, expand workforce training on financial capacity, and integrate social care with financial inclusion and consumer protection agendas. Supporting financial capability in the presence of cognitive decline must become a core element of aging and social care policy.
As populations age, more older adults require support with decision-making, often relying on informal caregivers. This multi-methods study explores how informal caregivers in the Netherlands participate in healthcare and financial decision-making for older adults, what factors are associated with their involvement in the decision-making process, and how different legal measures facilitate their participation in decision-making. Drawing on survey data from 815 caregivers and 13 in-depth interviews, the study identifies various types of involvement - from supported to substituted decision-making - with mutual decision-making as a distinct category. Participation is affected by the type, complexity and impact of decisions, the older adult's decision-making abilities, wishes and preferences, and the involvement of others. The need for legal authority varies by relationship and caregiving role. While ex lege measures generally suffice for medical decisions, financial matters often require voluntary measures, which appear inconsistently recognized in practice. When voluntary arrangements are not feasible, adult guardianship measures may offer legal clarity. Although some international rights bodies call for the abolition of substituted decision-making regimes like adult guardianship, this study highlights their practicality in certain contexts. The findings call for legal and policy frameworks that both empower informal caregivers and safeguard the well-being of older adults.
Unpaid family caregivers are the primary source of long-term care (LTC) for older adults. Little is known about how public insurance-funded payments boost family caregiving in China. To investigate the reasons for providing public insurance-funded family care within the LTC system, this study conducted 16 in-depth interviews with family caregivers in Guangzhou, China. The findings indicate that affordability and availability of alternatives to family care (both paid and unpaid) are crucial for explaining family caregiving under the LTC insurance program. Additionally, motivations for family caregiving include financial compensation, endorsement of family values, and the norm of intergenerational exchange. The findings of this study contribute to policy recommendations supporting family caregiving, including increased benefit levels, professional training for caregivers, and the provision of respite services.
Older adults in LMICs face specific challenges related to aging, often overlooked due to poverty and underdevelopment. These challenges strain social policies and healthcare resources, particularly in poorer nations, where access to essential services is limited. This qualitative study explored the lived experiences of older adults in Botswana in the context of ecological theory. Specifically, it examined the role of technological factors, economic conditions, and social policies in shaping their needs and challenges. The snowballing technique was used to select 30 participants from four of Botswana's seven urban and rural districts. Older adults need smartphones to enable internet services and avoid some of the challenges. Despite their limited numbers, smartphones were found to aid in accessing services, particularly mobile banking, and maintaining relationships through regular communication. Thematic analysis identified poor pension point services, inadequate transportation, limited healthcare access, financial instability, and social exclusion as challenges experienced by the older population, some of which can be curbed by the availability of internet services. Community-based programs and targeted policies tailored to Botswana's context are needed to address the challenges indicated. LMICs must formulate ways to secure additional resources to fulfill the increased demands of the aging populace. Programs should also be implemented to enhance the quality of life for older adults.
Turnover among long-term care workers threatens care quality and workforce sustainability in aging societies. This study examines the link between job burnout and turnover intention among South Korean nursing home caregivers, focusing on the moderating role of compensation satisfaction. It further explores whether municipal allowances amplify this buffering effect. Findings reveal that while burnout increases turnover intention, compensation satisfaction mitigates this relationship - but only among those receiving municipal allowances. Although the three-way interaction of burnout, compensation satisfaction, and municipal allowance was not statistically significant, subgroup analyses indicated that allowance provision provides the material context within which compensation satisfaction can exert its buffering role. These results underscore the need for equitable, regionally supported compensation structures to enhance caregiver retention and reinforce psychological resilience in long-term care environments.
As Saudi Arabia experiences demographic shifts due to rising life expectancy and declining fertility rates, its health and social care systems face challenges in meeting aging population needs. These challenges are accompanied by high prevalence of chronic diseases, changing family structure, and limited aged-care infrastructure. This qualitative descriptive study explored stakeholders' perspectives on barriers and facilitators to improving care for older people in Saudi Arabia. Sixteen semi-structured interviews were conducted with academics, policymakers, health professionals, administrators, and service providers across health, social, private, and nonprofit sectors. Reflexive thematic analysis identified seven themes. Barriers included workforce shortages and skills gaps, resource limitations, infrastructure and accessibility challenges, and sociocultural and family-related issues. Facilitators include optimizing infrastructure, workforce development and training, and implementing flexible and culturally appropriate care models. Recommendations include expanding geriatric training programs, establishing long-term care facilities within hospitals, integrating virtual medicine services, developing financial support and workplace policies for family caregivers, and developing culturally sensitive respite care models. Findings suggest that improving care for older people in Saudi Arabia requires an integrated approach that balances formal services with community and family support. Implementing practical, context-specific interventions is essential to enhance quality of life while preserving cultural values and social cohesion.
China's aging population has intensified reliance on paid caregivers, yet systemic neglect in policy and research perpetuates workforce vulnerabilities. This study employs Social Network Theory to analyze how fragmented structural and relational networks shape the experiences of rural-to-urban migrant caregivers in Shanghai. A qualitative multiple case study approach was utilized, incorporating interviews and observations with paid caregivers (n = 26), care recipients (n = 22), family caregivers (n = 22), and supervisors (n = 4). Findings reveal that caregiving outcomes are shaped by the interplay between upstream factors (cultural expectations, migration patterns) and downstream factors (social support, agency resources). Cultural incompatibilities, such as dietary practices and dialect differences, strain caregiver-family trust, while live-in work conditions limit caregivers' social networks and exacerbate emotional stress. Despite institutional efforts like digital platform use, rural migrant caregivers face technological barriers due to uneven literacy. Policy gaps in standardized training and labor protections further marginalize this workforce, undermining China's elder care sustainability. Recommendations include culturally adaptive training programs, equitable migration policies, and technology upskilling to bridge structural divides. These findings offer a blueprint for aging societies worldwide to realign long-term care systems around human-centered networks, emphasizing caregiver well-being to enhance elder care quality and equity.
China's rapidly growing oldest-old population (aged ≥80) faces significant challenges in financial security. This study sought to quantitatively evaluate the effect of old age subsidy on the mental health of older Chinese. Data were from China Health and Retirement Longitudinal Study 2011-2020, including 27,940 respondents residing in the provinces with a universal old age subsidy policy. Eligibility was restricted to individuals aged ≥80. Fuzzy regression discontinuity analysis evaluated the effects of receiving the subsidy on three mental health outcomes (depressive symptoms, life satisfaction, and cognition). Results showed that individuals just above age 80 who received the subsidy had similar mental health scores compared to those just below age 80 who did not receive the subsidy. The treatment effect was null across all three mental health outcomes, with robust p-values >0.05 and 95% CIs that included zero. Findings remained consistent in subgroup analyses, after adjusting for covariates and comparing different algorithms. There is no strong evidence that old age subsidy significantly improved the mental health of older Chinese. This may be attributed to the study's statistical underpower, low benefit level, improper usage, highly restrictive age eligibility, decreasing impact of financial condition in older age, and other factors.
China's Long-Term Care Insurance (LTCI) pilot program was introduced to address the growing demand for care services amid rapid population aging. While existing studies have primarily focused on individual- and household-level outcomes, less is known about the policy's broader market-level effects. This study examines whether and to what extent the implementation of LTCI promotes innovation in the older adult care market. Using panel data on care-related patent applications from 2010 to 2021, we apply a staggered difference-in-differences (DID) approach to estimate the causal impact. The results indicate that LTCI significantly increases the number of care-related patent applications in pilot cities, particularly the number of invention patents, which reflect more substantive innovation. Robustness checks using placebo tests and a combined propensity score matching and difference-in-differences (PSM-DID) approach confirm the reliability of the findings. These results suggest that, beyond its welfare function, LTCI can generate positive externalities by stimulating innovation and fostering the development of the care market for older adults.
