The future of the elderly population health status: Filling a knowledge gap

Projections of functional dependence among the late middle-aged and older population from 2018-2048 in China: a dynamic microsimulation

BACKGROUND

The population of China is aging rapidly. However, the long-term trajectories of functionally dependent late middle-aged and older Chinese people are currently absent. The present study aimed to estimate the population size and proportion of late middle-aged and older adults with difficulties and dependence on activities of daily living (ADL) and instrumental activities of daily living (IADL) in China from 2018 to 2048.

METHODS

We constructed a dynamic microsimulation model to project the population size and proportions of late middle-aged and older Chinese people who have difficulty and dependence in ADL and IADL from 2018-2048. The model was populated with a representative sample of the target population and allowed individual-level interaction between risk factors, diseases, and health outcomes. Analyses by socioeconomic subgroups were also conducted.

RESULTS

Almost 25% and 38% of late middle-aged and older people in China will become ADL- and IADL-dependent by 2048, respectively. Also, 17% of the target population will be severely ADL-disabled by 2048. The inequity in functional status across subgroups by sex, educational level, and urban/rural residency will become substantial.

CONCLUSIONS

The numbers and percentages of China's functionally difficult and dependent late middle-aged and older population will increase by magnitudes as of the mid-21st century, the pressure of which is compounded by its disproportionate distribution across subgroups. To alleviate the overwhelming challenge, efforts to improve the functional status of the underserved subpopulation should also be iterated.

Concept analysis of self-neglect in the elderly: a hybrid model

PURPOSE

Clarifying the concept of elder self-neglect.

METHODS

Researchers investigated the concept of elder self-neglect using a hybrid approach, including theoretical, fieldwork, and final analysis phases. After an extensive review of related literature to define the concept of self-neglect and describe its characteristics, the fieldwork phase was carried out to illustrate its empirical features. Accordingly, it led to the extraction of the elder self-neglect attributes from the first two phases.

FINDINGS

Elder self-neglect includes "subjective and objective high-risk behaviors pertinent to physical and spiritual health as well as restricted social interactions, disregarding the living environment, and a lack of compliance to personal hygiene routines that the elderly demonstrate deliberately or unintentionally. Various factors can contribute to such behaviors, including individual features, poor physical performance, elderly-oriented psychological disorders, financial challenges, detrimental stressors, unsuccessful social interactions, inaccessible supportive resources, inadequate educational resources, and inappropriate cultural norms. Consequently, such behaviors result in impaired physical and psychological health status, higher risk of misbehavior, poor quality of life, extra caregiving-treatment burden, and affected mental security in society."

CONCLUSION

Given that elder self-neglect is considered a relatively unknown concept in Iran, the study findings can pave the way for future extensive research in the Iranian context by clarifying the concept. It can play a significant role in developing related tools to design more efficient interventions and improve the quality of nursing care services.

IMPLICATIONS FOR NURSING PRACTICE

The elder self-neglect concept can lead to numerous health-related disorders among the elderly in society. Nurses cannot deal with an unknown phenomenon without exploring and identifying its exact meaning. It is, therefore, imperative to illustrate the different dimensions of this concept to help create a deep understanding among the nurses and perform timely diagnosis and interventional procedures.

Talent management of international nurses in healthcare settings: A systematic review

AIM

To identify and systematically review current scholarship on talent management of international nurses in healthcare organizations.

BACKGROUND

As nurse shortages persistently pose challenges for healthcare organizations globally, one of the primary strategies employed to address these shortages is employment of international nurses. To date little has been done to systematically review and collate contemporary research on talent management of this strategically important cohort. Talent management is a holistic construct that can support healthcare organizations to attract, develop, motivate, and retain talented employees to drive organizational performance. This systematic review isolates, appraises and collates available evidence on talent management practices for international nurses.

STUDY DESIGN

Systematic literature review.

DATA SOURCES

Searches of PubMed, EBSCO and Scopus were made covering literature from 2012-2022.

REVIEW METHODS

This study followed Cochrane protocol for Systematic Reviews and key search terms were developed in consultation with University of Limerick library. As a key aim of the review was to provide evidence for the development of effective talent management practices, only peer-reviewed academic papers and empirical studies were included. Initial articles screening was conducted by two reviewers and full articles review was conducted by the entire research team. Findings were combined in a data extraction template for further analysis.

RESULTS

This review includes 62 articles thematically analysed under the headings recruitment and selection, retention and turnover, career progression, professional development, discrimination and racism, culture and communication.

CONCLUSION

No articles were found that directly address talent management for international nurses. Although there are studies that address aspects of talent management independently, more research is required on talent management as a holistic process for international nurses to inform evidence-based practice.

IMPACT

This research emphasizes the importance of talent management for retention of international nurses in healthcare settings. It provides a knowledge base for healthcare organisations to enhance employee retention and ensure quality care for patients, as well as setting the foundation for future studies in this area.

Old age takes its toll: Long-run projections of health-related public expenditure in Luxembourg

This paper simulates long-term trends in Luxembourg's public expenditure on healthcare and on long-term care. We combine population projections with micro-simulations of individuals' health status that account for their demographic, socio-economic characteristics and their childhood circumstances. Model equations estimated on data from the SHARE survey and from several branches of Social Security provide a rich framework to study policy-relevant applications. We simulate public expenditure on healthcare and long-term care under different scenarios to evaluate the separate contributions of population ageing, costs of producing health-related services, and the distribution of health status across age cohorts. Results suggest that rising per capita expenditure on healthcare will mostly result from production costs, while rising expenditure on long-term care will mostly reflect population ageing.

Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA)

Background: Demographic ageing is a population health success story but poses unprecedented policy challenges in the 21st century. Policymakers must prepare health systems, economies and societies for these challenges. Policy choices can be usefully informed by models that evaluate outcomes and trade-offs in advance under different scenarios. Methods: We developed a dynamic demographic-economic microsimulation model for the population aged 50 and over in Ireland: the Irish Future Older Adults Model (IFOAM).  Our principal dataset was The Irish Longitudinal Study on Ageing (TILDA). We employed first-order Markovian competing risks models to estimate transition probabilities of TILDA participants to different outcomes: diagnosis of serious diseases, functional limitations, risk-modifying behaviours, health care use and mortality. We combined transition probabilities with the characteristics of the stock population to estimate biennial changes in outcome state.   Results: IFOAM projections estimated large annual increases in total deaths, in the number of people living and dying with serious illness and functional impairment, and in demand for hospital care between 2018 and 2040.  The most important driver of these increases is the rising absolute number of older people in Ireland as the population ages. The increasing proportion of older old and oldest old citizens is projected to increase the average prevalence of chronic conditions and functional limitations. We deemed internal validity to be good but lacked external benchmarks for validation and corroboration of most outcomes. Conclusion: We have developed and validated a microsimulation model that projects health and related outcomes among older people in Ireland.  Future research should address identified policy questions. The model enhances the capacity of researchers and policymakers to quantitatively forecast health and economic dynamics among older people in Ireland, to evaluate ex ante policy responses to these dynamics, and to collaborate internationally on global challenges associated with demographic ageing.

Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA)

Background: Demographic ageing is a population health success story but poses unprecedented policy challenges in the 21st century. Policymakers must prepare health systems, economies and societies for these challenges. Policy choices can be usefully informed by models that evaluate outcomes and trade-offs in advance under different scenarios.

Methods: We developed a dynamic demographic-economic microsimulation model for the population aged 50 and over in Ireland: the Irish Future Older Adults Model (IFOAM).  Our principal dataset was The Irish Longitudinal Study on Ageing (TILDA). We employed first-order Markovian competing risks models to estimate transition probabilities of TILDA participants to different outcomes: diagnosis of serious diseases, functional limitations, risk-modifying behaviours, health care use and mortality. We combined transition probabilities with the characteristics of the stock population to estimate biennial changes in outcome state.  

Results: IFOAM projections estimated large annual increases in total deaths, in the number of people living and dying with serious illness and functional impairment, and in demand for hospital care between 2018 and 2040.  The most important driver of these increases is the rising absolute number of older people in Ireland as the population ages. The increasing proportion of older old and oldest old citizens is projected to increase the average prevalence of chronic conditions and functional limitations. We deemed internal validity to be good but lacked external benchmarks for validation and corroboration of most outcomes.

Conclusion: We have developed and validated a microsimulation model that predicts future health and related outcomes among older people in Ireland.  Future research should address identified policy questions. The model enhances the capacity of researchers and policymakers to quantitatively forecast future health and economic dynamics among older people in Ireland, to evaluate ex ante policy responses to these dynamics, and to collaborate internationally on global challenges associated with demographic ageing.

The effect of smartphones on the self-rated health levels of the elderly

Background

Due to the penetration of Internet use and the popularity of “Internet + elderly care” among seniors in recent years, the elderly are gradually integrating into the information society. This study examined the impact of smartphones on the self-rated health levels of the elderly.

Methods

We studied 3042 elderly people over 55 years of age in Jiangxi, China in 2018. The effect of smartphones was measured from three aspects: smartphone usage, smartphone usage ability, and smartphone usage purpose, and the multivariate ordered logistic model was applied. Furthermore, considering the potential endogeneity of the smartphone usage of elderly people, the propensity score matching (PSM) method was used to analyze the net effect of smartphones on the health levels of the elderly.

Results

(1) The use of smartphones had a significant positive impact on the self-rated health levels of the elderly, with its significance being at the level of 1%. Smartphone usage ability, and using smartphone to learn or search for health information, had significant positive impacts (at the level of 5%) on the self-rated health levels of the elderly. (2) The k-nearest neighbor matching, kernel matching and radius matching methods were used to calculate the net effect of smartphone usage on the self-rated health levels of the elderly. The results were 13.26, 15.33 and 14.80%, respectively. (3) The age of the participants significantly (at the level of 1%) negatively affected their self-rated health levels. Other characteristics of the elderly, including income, education level, living with children or spouse and children’s living conditions, significantly (all at the level of 1%) positively affected their self-rated health levels.

Conclusions

Smartphone usage, smartphone usage ability, and smartphone usage purposes all improved the self-rated health of the elderly. The Internet factor should be focused on in the process of active aging. We should improve the Internet use ability of the elderly through voluntary training or public lectures.