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Lai ETC, Chau AKC, Ho IYY, Hashimoto H, Kim CY, Chiang TL, Chen YM, Marmot M, Woo J. The impact of social isolation on functional disability in older people: A multi-cohort study. Arch Gerontol Geriatr 2024; 125:105502. [PMID: 38876082 DOI: 10.1016/j.archger.2024.105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES We assessed the relationship between social isolation and functional disability in older people. DESIGN Comparison of longitudinal cohort studies. SETTING AND PARTICIPANTS Harmonised longitudinal datasets from the United States, England, European countries, Japan, Korea, China and Hong Kong. METHODS Social isolation was operationalised as a composite score with five domains, such as marital status, living alone, and social contact with others. Functional disability was defined as whether the cohort participant had any difficulty in activities of daily living (ADL). In each dataset, we used robust Poisson regression models to obtain the relative risks (RRs) and the corresponding 95 % confidence intervals (CI). We combined the RRs to synthesize a pooled estimate using meta-analysis with random-effects models. RESULTS Overall, the social isolation composite score was not associated with ADL disability (pooled RR = 1.05, 95 % CI [0.97-1.14], n = 40,119). Subgroup analysis suggested social isolation composite score was associated with ADL disability in Asian regions (pooled RR = 1.09, 95 % CI [1.02, 1.16], but not in Western regions (pooled RR = 1.01, 95 % CI [0.96, 1.07]). The relationships between different domains of social isolation and ADL disability were heterogeneous, except that no participation in any social clubs or religious groups was consistently associated with ADL disability (pooled RR = 1.12, 95 % CI [1.04, 1.21]). CONCLUSION Targeting social isolation may prevent decline in functional abilities in older adults, providing an avenue to active and healthy ageing. Nonetheless, interventions tackling social isolation should tailor to the unique cultural and social underpinnings. A limitation of the study is that reverse causality could not be ruled out definitively.
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Affiliation(s)
- Eric Tsz-Chun Lai
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Anson Kai Chun Chau
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong; School of Psychology, University of New South Wales, Sydney, Australia
| | - Irene Yuk-Ying Ho
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Chang-Yup Kim
- School of Public Health, Department of Health Policy and Management, Seoul National University, Seoul, South Korea
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Michael Marmot
- Department of Epidemiology and Public Health, Institute of Health Equity, University College London, London, UK
| | - Jean Woo
- Institute of Health Equity, Chinese University of Hong Kong, Shatin, Hong Kong; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
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Zhang L, Shen S, Zhang W, Fang Y. What determines informal care need among community-dwelling older adults in China? Results from a longitudinal study. BMC Geriatr 2024; 24:597. [PMID: 38997678 PMCID: PMC11241955 DOI: 10.1186/s12877-024-04843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/23/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND With an intensified aging population and an associated upsurge of informal care need in China, there is an ongoing discussion around what factors influence this need among older adults. Most existing studies are cross-sectional and do not focus on older people living in the community. Conversely, this study empirically explores the factors that affect informal care need of Chinese community-dwelling older individuals based on longitudinal data. METHODS This study constructed panel data using the China Health and Retirement Longitudinal Research Study (CHARLS) from 2011 to 2018 for analysis. Generalized linear mixed models were used to analyze the factors affecting reception of informal care, and linear mixed models were used to analyze the factors affecting informal care sources and intensity. RESULTS During the follow-up period, 7542, 6386, 5087, and 4052 older adults were included in 2011-2018, respectively. The proportion receiving informal care increased from 19.92 to 30.78%, and the proportion receiving high-intensity care increased from 6.42 to 8.42% during this period. Disability (estimate = 4.27, P < 0.001) and living arrangement (estimate = 0.42, P < 0.001) were the critical determinants of informal care need. The rural older adults reported a greater tendency to receive informal care (estimate = 0.14, P < 0.001). However, financial support from children did not affect informal care need (P > 0.05). CONCLUSIONS At present, there is a great demand for the manpower and intensity of informal care, and the cost of informal care is on the rise. There are differences in informal care needs of special older groups, such as the oldest-old, living alone and severely disabled. In the future, the region should promote the balance of urban and rural care service resources, rationally tilt economic support resources to rural areas, reduce the inequality of long-term care resources, improve the informal care support system, and provide a strong community guarantee for the local aging of the older adults.
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Affiliation(s)
- Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China
| | - Shuyuan Shen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China
| | - Wenzheng Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang An Nan Road, Xiang An District, Xiamen, Fujian Province, China.
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Ji Y, Cho J, Xiang X. Activity Limitations and Depression Among Middle-Aged and Older Adults in China: The Moderating Impact of Assistance Adequacy. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-17. [PMID: 38600793 DOI: 10.1080/01634372.2024.2340739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
This study aimed to examine the risk and protective factors associated with depression in middle-aged and older Chinese adults with activity limitations. Data were obtained from the 2018 Wave 4 Survey of the China Health and Retirement Longitudinal Study. In the logistic regression analysis, health and functioning, losing a child, and a perceived lack of future assistance with daily activities increased the odds of depression. Conversely, receiving adequate assistance with daily activities lessened the depressive impacts of activity limitations, as indicated by a significant interaction effect. Enhanced long-term support for individuals with disabilities is necessary to improve mental health.
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Affiliation(s)
- Yuanyuan Ji
- School of Management, Nanjing Audit University Jinshen College, Nanjing, China
| | - Joonyoung Cho
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Luo J, Zhao D, Gao T, Sun J, Li P, Wang X, Wang X, Chai S, Li J, Zhou C. Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences? BMC Geriatr 2024; 24:87. [PMID: 38262963 PMCID: PMC10807140 DOI: 10.1186/s12877-024-04673-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND This study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas. METHODS The data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas. RESULTS The prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001). CONCLUSIONS Our study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.
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Affiliation(s)
- Jingjing Luo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Tingting Gao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, 250012, Jinan, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, 250012, Jinan, China
| | - Xuehong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Xueqing Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Shujun Chai
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Jiayan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, 250012, Jinan, Shandong, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012, Jinan, China.
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Fong JH. Utilization of Long-Term Care Services and the Role of Institutional Trust in South Korea. J Aging Soc Policy 2023:1-21. [PMID: 37820000 DOI: 10.1080/08959420.2023.2265776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/20/2023] [Indexed: 10/13/2023]
Abstract
With population aging, governments have become increasingly involved in the administration, funding, and regulation of formal long-term care (LTC) systems. We examine the association between institutional trust and formal LTC service utilization among older adults aged ≥60 years with care needs in South Korea's public LTC scheme. Using data from the Korean Longitudinal Study of Aging and hierarchical logistic regressions, we evaluate the respective roles of trust in government and trust in the LTC program on service utilization. Results show that trust in the LTC scheme is significantly associated with service utilization: a unit increase in the level of trust is associated with a 29% increase in the odds of service use on average, controlling for need-related factors (e.g., chronic conditions) and other covariates. Furthermore, the positive relationship between trust and LTC utilization increases in magnitude with age. Older adults who are aged 80 and above, unmarried, with more ADL limitations, with psychiatric disease, or with arthritis are more likely to utilize formal LTC services. Our findings are robust to variations in sample inclusion criteria. Policymakers and health administrators should pay attention to building and maintaining institutional trust in public LTC schemes through good governance and other relevant strategies.
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Affiliation(s)
- Joelle H Fong
- Assistant Professor, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
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Shaw BA, Yang TC, Kim S. Living Alone During Old Age and the Risk of Dementia: Assessing the Cumulative Risk of Living Alone. J Gerontol B Psychol Sci Soc Sci 2023; 78:293-301. [PMID: 36179214 PMCID: PMC9938918 DOI: 10.1093/geronb/gbac156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines the association between living alone during old age and dementia. Whereas most previous studies on this topic utilize measures of living alone status that were obtained at a single point in time, we compare this typical approach to one that measures long-term exposure to living alone among older adults and assesses whether dementia is more likely to occur within individuals with more accumulated time living alone. METHODS Data come from the Health and Retirement Study, with a follow-up period of 2000-2018. A total of 18,171 older adults were followed during this period, resulting in 78,490 person-waves analyzed in a series of multi-level logistic models. Contemporaneous living alone was recorded when a respondent's household size was equal to 1 in a given wave. Cumulative living alone was calculated by adding the number of living alone statuses up to a given wave. RESULTS Contemporaneous living alone was either not associated (male-only subsample), or inversely associated (female-only subsample) with dementia. By contrast, a one-unit (i.e., one wave) increase in cumulative living alone was associated with about a 10% increase in the odds of dementia for both men (odds ratio [OR] = 1.111) and women (OR = 1.088), net of several covariates, including marital status, age, social activities, and social support. DISCUSSION Living alone during late life is an important risk factor for dementia, but the cognitive effects of solitary living probably do not take hold immediately for most older adults and potentially demonstrate a dose-response relationship.
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Affiliation(s)
- Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany SUNY, Albany, New York, USA
| | - Seulki Kim
- Department of Sociology, University Nebraska, Lincoln, Nebraska, USA
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Jang Y, Kim J, Yoon H, Park NS, Chiriboga DA, Rice E, Kim MT. Older Korean Americans' Perceived Burdensomeness to Their Healthcare Partners: An Egocentric Network Assessment. J Aging Health 2023; 35:62-70. [PMID: 35580996 DOI: 10.1177/08982643221103057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives: The objective is to examine how older Korean Americans' perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants (egos) and their healthcare partners (alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of burdensomeness, the study suggests strategies to promote their health and healthcare use.
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Affiliation(s)
- Yuri Jang
- Edward R. Roybal Institute on Aging, Los Angeles, CA, USA.,Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jangmin Kim
- School of Social Work, 5116Texas State University, San Marcos, TX, USA
| | - Hyunwoo Yoon
- Department of Social Welfare, 65361Kongju National University, Gongju, South Korea
| | - Nan Sook Park
- School of Social Work, 7831University of South Florida, Tampa, FL, USA
| | - David A Chiriboga
- Department of Child and Family Studies, 7831University of South Florida, Tampa, FL, USA
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Miyong T Kim
- School of Nursing, 7174University of Texas at Austin, Austin, TX, USA
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Quashie NT, Andrade FCD, Meltzer G, García C. Living Arrangements and Intergenerational Support in Puerto Rico: Are Fathers Disadvantaged? J Gerontol B Psychol Sci Soc Sci 2022; 77:2078-2090. [PMID: 35240683 PMCID: PMC9683498 DOI: 10.1093/geronb/gbac044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine how intergenerational support varies by parents' living arrangements and whether there are gender differences in received support in Puerto Rico. METHODS Data come from the 2006-2007 Puerto Rican Elderly and Health Conditions Project, a representative longitudinal study of adults aged 60 and older in Puerto Rico (n = 2,288). We examined the association between parents' living arrangements (alone, with spouse/partner only, with children) and their receipt of functional (help with errands/housework/transport) and health (help when sick) support from children, and whether parents' gender moderates the association. RESULTS Intergenerational coresidence was associated with higher odds of receiving functional and health support than living alone. Women were more likely than men to receive both forms of support. Parents' gender significantly moderated the association between living arrangements and receiving health support-men living with their partners were less likely to receive health support from children than women in similar living arrangements. These associations persisted when analyses were restricted to those with disability. DISCUSSION Our findings suggest that parents' receipt of support from children is conditioned upon their living arrangement and gender, even when their functional health is jeopardized. We discuss these results in relation to the heterogeneous influence of living arrangements for older adults' support needs and provide suggestions for policy and directions for future research in rapidly aging Puerto Rico.
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Affiliation(s)
- Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, Rhode Island, USA
| | - Flavia C D Andrade
- School of Social Work, University of Illinois, Urbana-Champaign, Champaign, Illinois, USA
| | - Gabriella Meltzer
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York City, New York, USA
| | - Catherine García
- Department of Human Development and Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Syracuse University, Syracuse, New York, USA
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Park Y, Park S, Lee M. Analyzing Community Care Research Trends Using Text Mining. J Multidiscip Healthc 2022; 15:1493-1510. [PMID: 35873091 PMCID: PMC9297196 DOI: 10.2147/jmdh.s366726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study utilized text mining to analyze research trends around community care, which focuses on improving patients' quality of life by lessening the financial burden on caregivers and relieving patient discomfort. Methods To examine research trends by community care stage, Section 1 is set from 2017 to 2019, when the community care was implemented, and Section 2 from 2020 to 2021, after the end of the community care. Papers used for the analysis were extracted using the Korea Citation Index (KCI); a total of 132 articles were selected and subjected to text mining analysis. Results First, the main community care research areas included work, housing, economy, disability, and mind. Second, from 2017 to 2019, there was considerable interest in community care centered on households, and main keywords, such as nursing, family, and experience, appeared. Third, from 2020 to the present, there was high interest in community care centered on disabilities, and keywords, such as space, business, and Seoul City, appeared. Conclusion The results reveal the changing issues, with the implementation of community care. Overall, research has tended to focus on social and welfare systems, rather than health and medical systems. In the future, local, community-integrated health and medical care systems should be restructured and regional delivery systems established to make them more accessible.
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Affiliation(s)
- Yoonseo Park
- Department of Bio Medial Engineering, Ajou University, Suwon, Republic of Korea
| | - Sewon Park
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Munjea Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Ailshire J, Carr D. Cross-National Comparisons of Social and Economic Contexts of Aging. J Gerontol B Psychol Sci Soc Sci 2021; 76:S1-S4. [PMID: 34101809 DOI: 10.1093/geronb/gbab049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jennifer Ailshire
- Davis School of Gerontology, University of Southern California, Los Angeles, USA
| | - Deborah Carr
- Department of Sociology, Boston University, Massachusetts, USA
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