Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany

[Unmet health care needs of younger and older people in socially deprived regions: A qualitative interview study in the Ruhr area]

INTRODUCTION

Unmet health care needs are considered a key indicator of equity in access to health care. For younger people, they can lead to poorer health outcomes in adulthood, for older people, they are associated with an increased risk of mortality. Unmet needs were therefore investigated as part of a research project on "Improving the health-related life situation of young and old people in the Ruhr area."

METHOD

Unmet health care needs were surveyed with the help of semi-structured guideline interviews with younger and older people in the Ruhr area (n=29). Due to the spatial and social structure of the study region, the aim was to recruit especially people with a low subjective social status (SSS) for the study. The interviews were recorded, transcribed, and subjected to a qualitative content analysis and a supplementary frequency analysis. The reporting is based on the Standards for Qualitative Research (SRQR).

RESULTS

The respondents reported deficiencies in treatment and doctor-patient communication with GPs and specialists. The feeling of not being taken seriously due to age is cited several times by both age groups as a reason for unmet health care needs. Waiting times are particularly relevant in the case of specialist consultations, while co-payments for services mainly play a role in dentistry and orthodontics. Unmet needs are primarily reported by people with a medium SSS. Overall, almost two thirds of the respondents stated that they have or have had at least one unmet need. Participants with a low SSS report fewer unmet needs and do not mention any financial aspects as a cause. Explanations for this range from lower health literacy to the fear of being discredited.

CONCLUSIONS

The results provide indications of deficits in regional health care provision for younger and older people in the Ruhr region. Corresponding fields of action result from the areas of care and reasons identified as relevant for unmet health care needs. The reported findings also provide a basis for differentiated quantitative surveys with representative samples.

Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage

BACKGROUND

Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC.

METHODS

Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition.

RESULTS

In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities.

CONCLUSIONS

The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.

Inequalities in unmet health care needs under universal health insurance coverage in China

BACKGROUND

Expanding health insurance is a critical step towards universal health coverage due to its positive effect on reducing unmet health care needs and enhancing equitable access to health care. Despite previous studies on the socioeconomic factors associated with unmet health care needs, few studies have analysed the inequalities in such needs and the impact of universal health insurance coverage on addressing them. This study aimed to measure the contribution of social health insurance (SHI) coverage to inequalities in financially and non-financially constrained unmet health care needs among middle-aged and elderly Chinese adults.

METHODS

The study data were obtained from the China Health and Retirement Longitudinal Study (2011-2015). A total of 11,592 respondents reporting outpatient care needs and 6320 reporting inpatient care needs were included. The concentration index (CI) was employed to measure the extent of income-related inequalities in unmet health care needs. A decomposition method based on a probit model was used to investigate the contribution of SHI to the inequalities.

RESULTS

The incidence rates of unmet outpatient needs due to financial and non-financial constraints were 4.68% and 24.78%, respectively; these rates were 18.69% and 15.73% for unmet inpatient needs. The CIs of unmet outpatient needs due to financial and non-financial constraints were - 0.1872 and 0.0195, respectively; these values were - 0.1558 and 0.0352 for unmet inpatient needs. The percentages of the contribution of SHI to the CIs of financially constrained unmet outpatient and inpatient needs were 0.2639% and 1.8898%, respectively. Moreover, the percentages of the contribution of SHI to the CIs of non-financially constrained unmet outpatient and inpatient needs were - 0.4513% and - 6.4192%, respectively.

CONCLUSION

The universal coverage of SHI in China increased pro-poor inequalities in financially constrained unmet health care needs but decreased pro-rich inequalities in non-financially constrained unmet needs. Additionally, the contribution of SHI to inequalities in financially constrained unmet needs for inpatient care was stronger than that for outpatient care. Policy-makers are advised to introduce favourable reimbursement policies for patients with poor socioeconomic conditions and address both financial and non-financial barriers to promote equitable access to health care for the entire population.

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

BACKGROUND

Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample.

METHODS

Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: "Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say 'no difficulty', 'some difficulty', 'a lot of difficulty' or 'cannot do at all/ unable to do'?" Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors.

RESULTS

The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5-2.1), low socioeconomic status (PR 2.0, 95% CI 1.7-2.5), limitations to usual activities due to health problems (PR 1.9, 1.6-2.2), depressive symptoms (PR 1.7, 1.5-2.1), daily smoking (PR 1.6, 95% CI 1.3-1.8), low dental utilization (PR 1.6, 95% CI 1.4-1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5-2.1).

CONCLUSIONS

One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.

Socioeconomic Positions and Midlife Health Trajectories in a Changing Social Context: Evidence from China, 1991-2006

Cumulative (dis)advantage theory posits that socioeconomic disparities in health may increase with age. This study examines individuals' midlife health trajectories, taking account of how their life courses are embedded within changing social contexts. Using the China Health and Nutrition Survey (1991-2006), it examines the health gap between Chinese rural peasants and urban nonpeasants in three adjacent time periods, during which a rapid process of social change increased the inequalities between rural and urban areas. Findings show that the health gap increases more rapidly in the more recent time periods, with higher levels of inequality, indicating that health inequalities between the two groups are contingent upon the social contexts in which individuals' lives unfold. To better understand the differences observed over these time periods, further analysis will examine the roles of two structural factors: income inequality and differential access to medical care.

Drivers of patient perceptions of health system responsiveness in Germany

BACKGROUND

Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and accountable health care, little is known about patient-side drivers of HSR. This study aims to narrow this gap.

METHODS

A survey among 20,000 Germans with substitutive private health insurance included questions on HSR and patient characteristics such as health literacy (HL), experienced discrimination, and sociodemographic information. Survey data were linked to patient-level claims data. Logistic regression was applied to assess the association between HSR and patient characteristics.

RESULTS

The sample (age 54.0 ± 16.1; 60.5% male) contains 2951 respondents with outpatient physician care in the past year. Of the nine HSR items, eight are rated as (very) good (74.4%-94.3%), except for coordination between providers (60.2%). Patient characteristics highly influence HSR: patients with high HL, for instance, are more likely to assess responsiveness as (very) good (e.g., clear explanations from physicians: OR 4.17). Poor assessment of responsiveness is seen among users who experienced discrimination.

CONCLUSION

This study revealed new associations between HSR and patient characteristics. Incorporating this knowledge in practice would help strengthen patient-centred health services by considering patient experiences and expectations. This highlights that HSR can be used as a tool to evaluate and promote patient-centred health services. Future research should investigate additional drivers of HSR, both on the patient and the provider sides.

How local stakeholders' social representations shape the future of ageing in place: Insights from 'health and care social innovations' in Wallonia (Belgium)

This research attempts to study the social representations underlying health and care social innovations (HCSI) implemented in Wallonia, Belgium to shift ageing policies and management towards the ageing in place paradigm. A panel of 34 experts was interviewed to understand their representations using a Delphi-based methodology. The data were processed using thematic content analysis. The core of social representations of health and care social innovations was related to five key dimensions: D1, responding to unmet or emerging health and care needs; D2, defining (new) targets and beneficiaries of HCSI; D3, disrupting care practices; D4, mobilising a network of key actors; and D5, encouraging political recognition of HCSI to favour its viability and sustainability. Local stakeholders' social representations tended to recognise only the goal-oriented dimensions in innovations and ignore process-oriented aspects. The blind spots for workers' participation and empowerment may jeopardise their working conditions, causing a cascade effect on the quality of services and the care relationship. This affected how health and care organisations responded to innovation and might also compromise the long-term sustainability of ageing in place practices in Wallonia.

The association between healthcare needs, socioeconomic status, and life satisfaction from a Chinese rural population cohort, 2012–2018

This study aimed to examine the prevalence of unmet healthcare needs and clarify its impact on socioeconomic status (SES) and life satisfaction in a longitudinal cohort of the Chinese rural population. Data used in this study were obtained from a nationally representative sample of 1387 eligible rural residents from the Chinese Family Panel Studies. Generalized estimating equation (GEE) logistic regression models were used to examine the factors associated with unmet healthcare needs and the impact of unmet healthcare needs on respondents’ perceived SES and life satisfaction. Approximately 34.6% of respondents were male, 18.2% were ≤ 40 years, and 66.7% had completed primary education or below. Around 19% and 32.6% of individuals who healthcare needs were met reported an above average socioeconomic status and life satisfaction, respectively in the baseline survey. GEE models demonstrated that unmet healthcare needs were significantly associated with low perceived SES (Odds ratio = 1.57, p < 0.001) and life satisfaction (Odds ratio = 1.23, p = 0.03) adjusted by covariates. Respondents who were older, reported moderate or severe illness, and with chronic conditions were more likely to report the unmet healthcare needs.Unmet healthcare needs are longitudinally associated with low SES and life satisfaction among the Chinese rural population, the disparity in access to healthcare exists among this population.

Gender-Specific Factors Associated with Health-Related Quality of Life in Obese Korean Older Adults: Evidence from the 2020 Korean National Health and Nutrition Examination Survey

Given the increasing aging population in South Korea, the quality of life of older adults must be ensured. This cross-sectional descriptive study investigated the gender-specific factors associated with health-related quality of life in obese older adults aged 65 years and above based on Korean National Health and Nutrition Examination Survey (KNHNES) 2020 data. In total, 507 obese Korean older adults participated in the 8th KNHNES. Chi-square tests and logistic regression analysis were performed to determine the variation in health-related quality of life according to socioeconomic and health-related factors and assess their inter-relationships. The influencing factors of health-related quality of life in obese Korean older adults were national health insurance (odds ratio (OR) = 1.02, 95% confidence interval (CI): 0.40–2.21), private health insurance (OR = 0.36, 95% CI: 0.28–0.75), arthritis (OR = 6.64, 95% CI: 2.57–17.14), and good dietary lifestyle (OR = 0.07, 95% CI: 0.05–0.93) in men; and private health insurance (OR = 2.66, 95% CI: 1.05–6.72), arthritis (OR = 2.81, 95% CI: 1.44–5.51), and physical activity (OR = 4.33, 95% CI: 1.71–10.94) affected health-related quality of life in women. The importance of health behaviors should be considered in the development of health programs and interventions for improving the quality of life of older adults.

Trust, Sociability, and Quality of Life of Sub-Saharan African Migrants in Germany

Poor social integration is associated with poor quality of life among minority groups. The current study hypothesized that trust and sociability may significantly explain the quality of life performance among Sub-Saharan African migrants in Germany. Data from 518 migrants were analyzed. Hierarchical multiple linear regression models were calculated to assess the predictive effect of trust and sociability on aggregate quality of life. Results show that general trust and sociability explained about 21% of the variance in quality of life score (adjusted R ² = .206; p < .001) for the total sample. Socioeconomic and demographic features suggested an added predictive effect of about 8% for total sample (adjusted R ² = .279; p < .001), 10% for male (adjusted R ² = .322; p < .001) and 4% for female (adjusted R ² = .211; p < .001). The results support trust and sociability as essential in connecting to a new environment and enhancing the quality of life.

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg

OBJECTIVES

We investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need.

DESIGN

Cross-sectional survey conducted between February and December 2014.

SETTING AND PARTICIPANTS

4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over.

OUTCOME MEASURES

Six binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care.

RESULTS

The most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles.

CONCLUSIONS

Recent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.

[Self-perceived oral health and associated factors among adults in Germany. Results from GEDA 2019/2020-EHIS]

BACKGROUND AND AIM OF THE WORK

Information on the oral health of the population is important for the assessment of (preventable) disease burden, for the estimation and planning of health resources and costs, and for the evaluation of health inequalities. The aim of this work is to investigate for the first time self-perceived oral health, including associated factors, based on data from a nationally representative sample for the adult population in Germany.

MATERIAL AND METHODS

The data basis is the nationwide German Health Update study (GEDA 2019/2020-EHIS, n = 22,708 aged 18 years and older). In the telephone interview, the participants were asked how they would describe the state of their teeth and gums - "very good," "good," "fair," "bad," or "very bad." Sociodemographic, behavioral, and dental characteristics are examined as associated factors. Prevalences and results of multivariate binary logistic regressions (odds ratios, OR) are reported.

RESULTS AND DISCUSSION

Of the participants, 71.4% perceived their oral health as very good or good, 28.6% as fair to very bad. Difficulty in chewing and biting on hard foods (OR 4.0), unmet dental care needs (OR 2.3), male gender (OR 1.5), and not consuming fruits and vegetables daily (OR 1.2) were the most important associated factors for fair to very bad self-perceived oral health; for men, low education (OR 2,1), daily smoking (OR 1.6) and not receiving dental care annually (OR 1.4) were also important. From the results, starting points for promoting oral health can be derived.

Factors Influencing Unmet Healthcare Needs among Older Korean Women

The purpose of this study was to determine factors that influence the unmet healthcare needs of older women in Korea and to examine differences in the reasons for these unmet healthcare needs according to age and residential area. We analyzed data from the 2018 Korea Community Health Survey and enrolled 42,698 older Korean women in this study. Residential area, living arrangement, income, education, basic livelihood subsidy, activity of daily living, subjective health status, hypertension and diabetes, unmet healthcare needs, and the reasons healthcare needs were not met were assessed. Logistic regression analysis was performed to identify factors that influenced unmet healthcare needs. Chi-square tests were used to identify reasons for unmet healthcare needs according to age group and residential area. Of the participants, 4151 (9.7%) reported unmet healthcare needs over the past year. The primary reason participants could not use health services was "inconvenient transportation" (38.4%), followed by "financial burden" (28.4%) and "symptoms not severe" (16.8%). There were significant differences in "financial burden", "difficulty making appointments", "inconvenient transportation", and "symptoms not severe" according to both age group and residential area. Factors that influenced unmet healthcare needs were residential area, living alone, lower family income, lower educational level, basic livelihood subsidy, difficult activities of daily living, hypertension and diabetes, and poor subjective health. Older women in Korea living alone in urban and rural areas had more unmet healthcare needs of than those who lived with other people. To address the unmet healthcare needs of older Korean women, transportation and medical facilities need to be improved or established.

Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review

Background

Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.

Methods

We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.

Results

Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.

Conclusion

This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.

PROSPERO registration number

CRD42019123222.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-020-01375-1.

Medical crowdfunding in a healthcare system with universal coverage: an exploratory study

Background

In recent years, crowdfunding for medical expenses has gained popularity, especially in countries without universal health coverage. Nevertheless, universal coverage does not imply covering all medical costs for everyone. In countries with universal coverage unmet health care needs typically emerge due to financial reasons: the inability to pay the patient co-payments, and additional and experimental therapies not financed by the health insurance fund. This study aims at mapping unmet health care needs manifested in medical crowdfunding campaigns in a country with universal health coverage.

Methods

In this exploratory study we assess unmet health care needs in Germany by investigating 380 medical crowdfunding campaigns launched on Leetchi.com. We combine manual data extraction with text mining tools to identify the most common conditions, diseases and disorders which prompted individuals to launch medical crowdfunding campaigns in Germany. We also assess the type and size of health-related expenses that individuals aim to finance from donations.

Results

We find that several conditions frequently listed in crowdfunding campaigns overlap with the most disabling conditions: cancer, mental disorders, musculoskeletal disorders, and neurological disorders. Nevertheless, there is no strong association between the disease burden and the condition which prompted individuals to ask for donations. Although oral health, lipoedema, and genetic disorders and rare diseases are not listed among leading causes of disability worldwide, these conditions frequently prompted individuals to turn to crowdfunding. Unmet needs are the highest for various therapies not financed by the health insurance fund; additional, complementary, and animal-assisted therapies are high on the wish list. Numerous people sought funds to cover the cost of scientifically poorly supported or unsupported therapies. In line with the social drift hypothesis, disability and bad health status being associated with poor socioeconomic status, affected individuals frequently collected donations for their living expenses.

Conclusions

In universal healthcare systems, medical crowdfunding is a viable option to finance alternative, complementary, experimental and scientifically poorly supported therapies not financed by the health insurance fund. Further analysis of the most common diseases and disorders listed in crowdfunding campaigns might provide guidance for national health insurance funds in extending their list of funded medical interventions. The fact of numerous individuals launching crowdfunding campaigns with the same diseases and disorders signals high unmet needs for available but not yet financed treatment. One prominent example of such treatment is liposuction for patients suffering from lipoedema; these treatments were frequently listed in crowdfunding campaigns and might soon be available for patients at the expense of statutory health insurance in Germany.

Health and health-care utilisation in old age: the case of older men living alone

A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

Influencing Factors of Undermet Care Needs of the Chinese Disabled Oldest Old People When Their Children Are Both Caregivers and Older People: A Cross-Sectional Study

We examined the influencing factors of the undermet care needs of the Chinese disabled oldest old people when their children are both caregivers and are themselves older people. Data were obtained from a cross-sectional survey: the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. The study participants included 1617 disabled oldest old people whose primary caregiver were their children or children-in-law and were aged 60 years and over. The results showed that the prevalence of undermet needs remained high, with 49.6% disabled oldest old people reporting undermet care needs. Binary logistic regression analysis revealed that living in a rural area (OR = 1.309, 95% CI = 1.133-1.513) and a higher frailty index (OR = 1.103, 95% CI = 1.075-1.131) were significantly positively associated with higher odds for undermet care needs, while a higher annual household income (OR = 0.856, 95% CI = 0.795-0.923), more financial support from children (OR = 0.969, 95% CI = 0.941-0.997), higher care expenditures (OR = 1.044, 95% CI = 1.002-1.088), better caregiver's performance (OR = 0.282, 95% CI = 0.196-0.407) and sufficient income to pay for daily expenses (OR = 0.710, 95% CI = 0.519-0.973) were significantly inversely associated with higher odds for undermet care needs. This evidence suggests the importance of policies to establish a community-based socialized long-term care system and supporting family caregivers of the disabled oldest old people.

Healthy Ageing in Place: Enablers and Barriers from the Perspective of the Elderly. A Qualitative Study

BACKGROUND

Most elderly people wish to grow old at their own homes. The sociodemographic characteristics; home and neighbourhood conditions; and the social services support and networks are determinants in the possibility of "ageing in place". The present study aimed to explore the ageing in place phenomenon, as well as the enablers and barriers that interact in a healthy ageing from the perspective of the elderly connected to local entities.

METHODS

A generic qualitative design was proposed in the Health Region of Girona in Catalonia (Spain). Seventy-one elderly people were purposefully selected. Six focus groups were conducted, and data were thematically analysed.

RESULTS

Three key themes were generated: (1) Participants experienced ageing differently. The physical and mental health, the family environment and financial stability were key elements for life quality. (2) The perception of the elderly's role in the community depended on their age, health status and attitude towards life. (3) The participants identified several enablers and barriers to healthy ageing in place.

CONCLUSIONS

The promotion of older people's autonomy and wellbeing, together with the creation of an active network of health and social services, may improve the possibility for elderly to age at home and avoid or delay institutionalisation.

Socioeconomic inequalities in mental distress and life satisfaction among older Chinese men and women: The role of family functioning

Despite growing concern over socioeconomic inequality in health, few studies have focused on health inequality among older adults. The present study examined the independent and joint effects of socioeconomic status (SES) and family functioning on mental health and subjective well-being and explored the gender differences in such relations. Representative survey data on older adults (N = 1,432) were drawn from the third wave of the Hong Kong Panel Study of Social Dynamics conducted in 2015. Descriptive analyses and ordinary least-squares regressions were conducted for data analysis. The results demonstrate that receipt of means-tested welfare payments was associated with more severe mental distress and lower life satisfaction; living in private (as opposed to public or subsidised) housing was associated with better mental health; whereas holding investments and larger residence size were related to higher life satisfaction. Moreover, greater family functioning predicted better mental health and greater subjective well-being and mitigated the detrimental effects of low SES. Gender differences were observed concerning the effects of different predictors. The findings could inform the development of health-promotion services sensitive to gender and socioeconomic differences and facilitate integration of individual- and family-level services for older adults.

Barriers for women aged 50 years and older to accessing health care in Germany

For older and very old women in rural areas, the long distances involved and the limited availability of services can make accessing general practitioners and specialist physicians difficult. Based on data from the recent wave of the German Health Update (GEDA 2014/2015-EHIS), we have analysed the barriers to accessing health care for women in the age group 50 years and older in Germany. 21.0% of the women reported having had difficulties getting an appointment for an examination when it was needed during the twelve-month period before the interview. Fewer than 5% of the women reported distance as the reason for delayed medical examinations. Over the course of a one-year period, women in the large cities more frequently had to wait for an appointment for an examination than women in smaller towns. However, women in smaller towns reported more often that an examination had taken place late due to distance. The results are informative for the planning of health care services.

Adequate access to healthcare and added life expectancy among older adults in China

BACKGROUND

Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare.

METHOD

A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions.

RESULTS

At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors.

CONCLUSIONS

Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.

Unmet Medical Needs of Patients with Benign Prostate Enlargement

This study aimed to analyze the factors affecting the unmet medical needs of patients with benign prostate enlargement (BPE) based on Andersen’s behavioral model. The data were taken from the 2009–2016 Korea Health Panel Study and 3003 participants were used for analysis. “Unmet medical needs” was used as a dependent variable. Independent variables were predisposing variables: age, educational attainment, and marital status; enabling factors: income, job type, and insurance type; and need factors: lying in a sickbed, activity limitation, subjective health status, and having chronic diseases. Results showed that younger patients experienced a higher probability of unmet medical needs. Those with higher educational attainment had a lower chance of experiencing unmet medical needs. Patients with national health insurance were less likely to experience unmet medical needs. In addition, patients who experienced lying in a sickbed had a higher probability of experiencing unmet medical needs. Therefore, in order to reduce the unmet medical needs of patients with BPE, it is necessary to allow patients to be treated early and give them accurate information about the disease. In addition, access to medical care should be strengthened through continuous care focused on primary care.

The association between relative income and depressive symptoms in adults: Findings from a nationwide survey in Korea

BACKGROUND

Subjective income inadequacy may be associated with poorer mental health as income comparisons with others can decrease feelings of happiness. This study investigated the association between relative income and depressive symptoms in Korean adults.

METHODS

Data from the 2017 Korea Community Health Survey were used. Relative income was measured by comparing household and community income. Household income was calculated using equalized household income and community income based on the mean income level of the 253 local communities. Relative income was categorized into the high (community < household), middle (community = household), and low (community > household) groups. Analysis was conducted through multivariate logistic regression analysis.

RESULTS

Of a total of 201,326 study participants, 12,508 (6.2%) individuals had depressive symptoms. Compared to the high relative income group, the middle [Odds Ratio (OR): 1.23, 95 percent Confidence Interval (CI): 1.16-1.29] and the low (OR 1.58, 95% CI 1.50-1.66) groups showed gradually higher likelihoods of depressive symptoms. Such differences were magnified in individuals with low absolute household income or with experiences of unmet need.

CONCLUSION

Individuals with lower or equal household than community income had higher likelihoods of depressive symptoms, with such differences augmenting in those with low absolute income or experiences of unmet need. The findings infer the importance of monitoring individuals at poorer relative income standings in addressing mental health.

Differences in medical specialist utilization among older people in need of long-term care - results from German health claims data

BACKGROUND

Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.

METHODS

We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.

RESULTS

We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.

CONCLUSION

The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.

Educational inequalities in health after work exit: the role of work characteristics

Background

Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.

Methods

Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.

Results

The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.

Conclusion

Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.

Social Determinants and Disparities in Active Aging Among Older Taiwanese

This study assesses equity in active aging across social determinants among older Taiwanese. The data were collected from face-to-face interviews with adults aged 55 years or more in Taiwan in 2017 (n = 738). A total of 30 individual-level Taiwan active aging indicators were chosen, and the relationship between social determinants and active aging indicators were analyzed by logistic regression models. Women were more likely to participate in volunteering and other social groups and in lifelong learning activities, whereas men were more likely to be employed, to engage in physical activity, to feel safe from violence, and to use preventive care. Higher education was related to higher employment, social participation, independent living, lifelong learning, and a lower likelihood of poverty and severe cognitive impairment. Those living in rural areas were more likely to be employed, perform physical activity, feel physically safe, have better mental well-being, and have higher social respect and social integration ratings, whereas living in urban areas was related to greater access to medical care, owning assets, less severe cognitive impairment, greater likelihood of using information and communications technology, higher level of education, and higher access to convenient transportation. The significant disparities that exist in active aging may suggest inequality.

[Socioeconomic differences in health and need for care among the elderly]

In view of the continuing increase in life expectancy, the question arises as to the state of health in which these years of gained life can be spent. The research findings on social differences in health and life expectancy suggest that this question has to be answered differently for different population groups. Even after the age of 65, persons with a low socioeconomic status are more likely to be affected by chronic illnesses and complaints, functional limitations of everyday activities, as well as impairments of well-being and health-related quality of life. With a significant proportion of people with low socioeconomic status still dying prematurely, the increase in lifetime that is observed for all population groups could increase the social gap in health in later life. This implies the challenge of giving special attention to the needs of socially disadvantaged groups in policies and programs aiming to improve the health of older people and preventing the need for care.

Age and sex differences in the association between access to medical care and health outcomes among older Chinese

BACKGROUND

Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China.

METHODS

Based on four latest waves available so far from a national longitudinal study in mainland China in 2005-2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65-74, 75-84, 85-94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005-2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors.

RESULTS

Approximately 6.5% of older adults in China reported inadequate access to care in the period of 2005-2014; and the percentages increased with age and were higher among women at older ages (≥75 years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75-84) and old-old (85-94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65-74) and middle-old (75-84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75-84, and it was somewhat more pronounced in women than in men.

CONCLUSIONS

Increased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.

[Socioeconomic inequalities in health in later life]

BACKGROUND

Socioeconomic differences in health and life expectancy are key issues for public health and health policy. In the course of demographic change, in addition to childhood, adolescence and middle adulthood, old age is increasingly becoming the focus of attention in research on health inequalities, with a special emphasis on the transition from working age to retirement.

OBJECTIVE

How do health inequalities change in the transition from middle to older age and then to very old age?

MATERIAL AND METHODS

This article reviews the studies available for Germany, supplemented with new analyses based on the German Health Update study and the German Socioeconomic Panel study. In order to set the findings in the context of international research on health inequalities in old age, selected studies from other countries and international comparative studies are additionally considered.

RESULTS

Social differences in health and remaining life-expectancy also exist in older age, although to a slightly lesser extent than in middle age. There is evidence that as age progresses, health inequalities narrow in some health domains but there is also isolated evidence that health inequalities may widen with age.

CONCLUSION

The existence of health inequalities in old age indicates that older people from disadvantaged social groups have a particular need for healthcare and support. This poses special challenges for the medical, nursing and psychosocial care system as well as for the social security systems.

Too soon to worry? Longitudinal examination of financial planning for retirement among Spanish aged workers

The present study analyzes the relationship between three distal antecedents-financial literacy, confidence in retirement, and economic well-being-and financial planning for retirement evaluated at two different times. We used longitudinal data with repeated measures of financial planning for retirement obtained from a sample (N = 269) of active Spanish workers aged 45-62 years. The results confirm that self-perceived financial knowledge, confidence in retirement, and economic well-being are associated with financial planning for retirement at three and six months. The stability of financial planning for retirement over time was a relevant finding in the present research, even though different measures have been employed in the two waves and financial planning decreases slightly at three months. While the first step of planning, at three months, has predictive power over the second, at six months, there are possible moderators in the relationship between financial planning for retirement at time 1 and time 2, which were not explored. The implications of the results both for financial education and Policy-makers are discussed. Future lines of research can explore these relationships including objective measures of income, as wealth accumulation.

Ageing, Health and Equity-Broad Perspectives Are Needed to Understand and Tackle Health Challenges of Ageing Societies

Demographic change and the evolving demands on healthcare systems, especially in the provision of healthcare and long-term care for a growing number of older people, are among the greatest social challenges of the next decades.[...].