40-Year Projections of Disability and Social Isolation of Older Adults for Long-Range Policy Planning in Singapore

Oral and systemic health in Singapore: Revisiting the past to define the future

OBJECTIVES

This study aimed to identify studies exploring oral and systemic conditions using Singapore data.

METHODS

Studies were searched using the databases PubMed, Embase and Web of Science, with no publication date or language restrictions. Studies analysing Singaporean data were included in this review.

RESULTS

Six domains were identified: pregnancy and gingivitis; tooth eruption, dental caries and early-life factors; Crohn's disease and oral microbiome; diabetes and periodontal diseases; number of teeth, chewing ability and cognitive status; and oral health and pneumonia. Using data from Singapore, oral-systemic studies have prompted reflections on the aetiopathogenesis of oral disorders, such as common causes connecting oral and systemic chronic conditions. Moreover, it is speculated whether oral conditions could be used as a marker to predict future systemic diseases or whether early-life factors could affect the development of oral and systemic immune responses.

CONCLUSIONS

While Singapore provides opportunities to explore challenges connected to healthy ageing, it also explores health development in many stages of life. Singapore has been prioritizing investigations on a healthier life, and new initiatives are paving the way for oral health research across the lifespan.

Advocating for Older Adults in the Age of Social Media: Strategies to Achieve Peak Engagement on Twitter

Background

Over the last decade, many organizations dedicated to serving the needs and interests of older adults have turned to social media platforms, such as Twitter, subsequently rebranded X, to improve the visibility of age-related issues. However, notwithstanding their growing digital presence and participation, minimal attention has been paid to the use of social media among these advocacy groups. To achieve policy change, advocacy organizations must first be able to engage and mobilize audiences.

Objective

Our study aims to elucidate how different tweet features affect the time it takes for posts uploaded by age advocacy organizations to reach peak engagement.

Methods

We collated 204,905 tweets from 53 age advocacy organizations posted over a 12-year period. The engagement score of each tweet was calculated by combining well-established metrics, namely likes, retweets, quote tweets, and replies. We ran Cox models with tweet features as predictors and time-to-peak engagement as the outcome. "Peak engagement" (event) refers to engagement scores above the 75th percentile, and "time" refers to months taken to reach peak engagement per tweet.

Results

Approximately 1 in 2 tweets (n=103,068, 50.3%) had either no hashtags or just 1 hashtag. Around two-thirds (n=131,220, 64%) of the tweets included a URL. Visual information was highly underused, with most tweets not including GIFs (n=204,202, 99.7%), videos (n=199,800, 97.5%), or photos (n=143,844, 70.2%). Roughly half (n=101,470, 49.5%) of the tweets contained mentions and 9.3% (n=19,009) of tweets were replies. Only 4.5% (n=9285) of tweets were quote tweets. Most tweets were uploaded in the afternoon (n=86,004, 42%) and on a weekday (n=180,499, 88.1%). As hypothesized, features associated with peak engagement were the inclusion of visual elements like photos, which increased peak engagement by 3 times (P<.001), and the use of 3 or more hashtags (P<.001). Quote tweets increased engagement by 3 times (P<.001), as compared to regular tweets, controlling for account-level covariates. Tweets from organizations with a higher tweet volume were 40% less likely to reach peak engagement (P<.001).

Conclusions

Social media as a networked platform has the potential to reach users on a global scale and at an exponential speed. Having uncovered the features that are more likely to reach peak engagement on Twitter, our study serves as an invaluable resource for age advocacy organizations in their movement to create a more age-inclusive world.

Innovations for an Aging Society through the Lens of Patent Data

BACKGROUND AND OBJECTIVES

An aging population creates fertile ground for devising innovations for older adults. By using patents as a proxy for inventive activity, this study sets the stage for understanding the latest innovations being designed for the older population. Insights will pave the way for a better understanding of inventions that could render society more age-friendly on the innovation front.

RESEARCH DESIGN AND METHODS

To identify the latest innovations targeted at the older population, we collected all patents (N = 326) issued in 2021, specifically those issued between January 5th and December 28th. Upon removing irrelevant data, 120 patents were retained in the data set. Both inductive and deductive modes of reasoning informed our content analysis of the data.

RESULTS

Three themes surfaced. About half (49.2%) of the patents focused on "Preventive Health, Safety, and Independence" (Theme 1). About 38.3% pertained to "Anti-Aging" (Theme 2) and 12.5% were about the "Pathologization of Old Age" (Theme 3).

DISCUSSION AND IMPLICATIONS

This is the first study that evaluates the state of innovations for an aging population. While there are inventions aimed at optimizing the well-being of older adults, there are also those designed due to beliefs that see old age as a problem to solve. As the world experiences a demographic shift, it is imperative that collective ingenuity be harnessed to build a society conducive to all facets of the aging experience.

Age Advocacy on Twitter Over 12 Years

BACKGROUND AND OBJECTIVES

Discussions on age-related issues have begun taking place in earnest, but exactly what dominates public consciousness about these issues is a topic that has yet to kindle scholarly attention. This study analyzes tweets uploaded by age advocacy organizations that have attracted the highest levels of engagement on Twitter.

RESEARCH DESIGN AND METHODS

We collected 403,426 tweets from 53 accounts. These tweets were posted over 12 years, from 2009 to 2021. After applying our exclusion criteria and collating the top 1% of tweets with the highest levels of engagement, 2,054 tweets were retained for analysis. Both inductive and deductive approaches informed our qualitative content analysis.

RESULTS

Five themes emerged. "Issues Related to Alzheimer's Disease or Dementia" (Theme 1) formed the majority of tweets (62%; N = 1,278). Theme 2 "Rising Health Care or Retirement Costs" was the second largest theme (25%; N = 506). Seven percent of the tweets were on "Reframing Aging and Combating Ageism" (Theme 3; N = 138). "Matters Affecting Caregivers" surfaced in Theme 4 (4%; N = 81). Two percent of the tweets were on "Intersectional Concerns" (Theme 5; N = 51).

DISCUSSION AND IMPLICATIONS

As age advocacy organizations step up to engage the public constructively in matters regarding later life, there is a compelling need to quell public anxiety about old age and to sensitize society to the struggles confronted by older adults. In undertaking the range of activities needed to do so, age advocacy organizations should consolidate efforts even as they rethink existing strategies to effectuate change.

Portrayals of older adults in over 3000 films around the world

BACKGROUND

Presently, most film analyses related to older adults are peculiar to American cinema. However, film industries outside the United States are influential in their own right. As ageism is a pan-cultural phenomenon, it is important to explore filmic representations of older persons globally. This study is the first to offer a portrait of how filmic portrayals of older persons differ across regions.

METHODS

We leveraged a 200-million-word movie corpus comprising over 25,000 scripts from 88 countries in 11 regions. The movies span a period of nearly 90 years, from 1930 to 2018. We identified synonyms of "older adult(s)" and compiled the top descriptors that co-occurred most frequently with them. Seventeen thousand five hundred and eight descriptors were generated from 3384 movies. Using these descriptors, we calculated the valence of filmic portrayals of older adults on a scale of 1 (most negative) to 5 (most positive) in each region.

RESULTS

Positive representations of older adults in movies were lacking in all 11 regions. Four regions fell into the neutral zone and the remaining seven in the negative zone. Representations of older persons were the least negative in East Asia and South Asia, and most negative in Southeast Asia as well as the Middle East and North Africa (MENA). Our topic modeling revealed that older adults were portrayed as venerable in both South and East Asia. Meanwhile, older people were associated with death in MENA. The idea that society is ill-equipped to handle an aging population was hinted at in Southeast Asia.

CONCLUSIONS

As societies worldwide navigate a major demographic turning point, it is vital that filmmakers rethink portrayals of old age. In articulating the filmic narratives surrounding old age in different regions, our study lays the foundation to combat ageism on the big screen.

Videos about older adults on TikTok

Besides being one of the fastest growing platforms since entering the social media fray in 2016, TikTok is notably monopolized by teenagers, which makes it a veritable source of information not to be overlooked by gerontologists. Currently, most studies regarding age stereotypes on social media have examined content on Twitter and Facebook. Our study explores how older adults are portrayed on TikTok and the factors associated with these portrayals. We analyzed 673 videos with the hashtags #Boomer and/or #OkBoomer that received over 5.4 billion views and categorized them into nine topics. Five of these topics (e.g., 'Warmth/Coldness') were extracted from previous studies on age stereotypes. The remaining four topics were unique to our dataset (e.g., 'Wealth Gap'). The outcome variable was 'Negative Age Stereotypes' which was rated on a binary scale. One in two videos about older adults featured negative content. As hypothesized, videos containing negative age stereotypes were more likely to be about the 'Values and Beliefs of Older Adults' (7 times), 'Negative Encounters with Older Adults' (8 times) or 'Older Adults Antagonizing the Young' (13 times). Conversely, videos which portrayed older adults as 'Warm' were 43% less likely to contain negative stereotypes. As the phenomenon of an aging population fast unfolds, it is imperative that society relinquishes its tendency to stereotype individuals on the grounds of age. By examining the possible mechanisms driving negative stereotypes of older adults on TikTok, our study provides the basis upon which such stereotypes can be counteracted. In doing so, it paves the way both to improve the well-being of older persons and to foster intergenerational solidarity.

Granfluencers on TikTok: Factors linked to positive self-portrayals of older adults on social media

Lately, there have been news reports on the rise of older content creators on various social media outlets. However, while journalists have picked up on this topic, scholars have been slow to accord it any attention. Our study delves into this topic and looks at how older TikTokers' self-perceptions of aging are expressed in their videos. Specifically, we analyze the valence of the content of these videos and factors associated with older adults' self-presentations. TikTok has only gone from strength to strength since its global launch in 2017. Even as stay-at-home orders and safe distancing protocols amid the COVID-19 pandemic have led to a dramatic increase in the consumption of media across various platforms, TikTok stands out among its rivals in terms of growth and user activity. Given its wide reach, content on TikTok has the potential to influence public opinion. We collated 1,382 videos created by TikTokers aged 60 and above with at least 100,000 followers. These videos amassed over 3.5 billion views. Following previous studies, three raters coded each video for valence (negative-neutral-positive). We found that women created twice as many videos as men. The middle-old group (ages 75-84) created more videos than the young-old and oldest-old groups. Positive videos outnumbered negative ones by 10 times. As hypothesized, themes linked to positive self-portrayals were 'physical functioning' (p < .001) and 'social interaction' (p < .001). Conversely, 'cognitive functioning' (p < .001) evidenced a negative association, controlling for age and gender of the user. This is one of the first studies on older adults' self-portrayals of aging on TikTok. Our findings suggest that older adults tend to portray themselves positively across various domains on the application. If used purposefully, TikTok may serve as a promising platform for improving public perceptions of old age.

Media attention toward COVID-19 across 18 countries: The influence of cultural values and pandemic severity

BACKGROUND

Current media studies of COVID-19 devote asymmetrical attention to social media, in contrast, newspapers have received comparatively less attention. Newspapers are an integral source of current information-that are syndicated and amplified by social media to a wide global audience. This is the first-known study to investigate the impact of cultural values and pandemic severity on media attention towards COVID-19. Findings lay the groundwork for targeted public health communications that are culturally nuanced.

OBJECTIVE

We investigated the impact of cultural values and pandemic severity on Media Attention towards COVID-19 across 18 countries.

METHODS

We tracked the global volume of COVID-19 coverage (to measure media attention) over 8 months in a news media database of 12 billion words with 30 million articles from over 7,000 news media sites. Predictors of Media Attention towards COVID-19 came from the Oxford COVID-19 Government Response Tracker (incidence and mortality) and Hofstede's Cultural Values.

RESULTS

Media attention toward COVID-19 increased 55 times over 8 months. Higher rates of new cases and deaths predicted this exponential increase. Countries with higher power distance, uncertainty avoidance, and long-term orientation, were associated with increased media attention, controlling for covariates.

CONCLUSIONS

Cultural values play a significant role in the news media's attention toward COVID-19, controlling for pandemic severity. We provided a framework to design targeted public health communications that are culturally nuanced.

A Parsimonious Taxonomy of The Newly Retired: Spousal and Disability Combinations Shape Part or Complete Retirement

The inadequate classification of retiree sub-groups ultimately results in misaligned policy. To generate sets of sub-groups that may be appropriately targeted for policy and interventions, variables are used that reflect the social structure of retirees, particularly the options of partial and complete retirement, marital status, gender, as well as the retirement status of the spouse, where relevant, and disability. Three sets of longitudinal Australian data were combined, each reflecting a four-year period (2003-2007, 2007-2011, 2011-2015) during which the individuals aged 45 to 69 retired (n = 1179). A multiway frequency analysis was performed to develop an inductive, combinatorial model of retirement from work. The resulting parsimonious taxonomy of sub-groups of the newly retired reflected main effects and interactions of key social-structural variables. Notably, a key driver of the pattern of results was that couples tend to coordinate their retirement behavior in both the decision to retire and form of retirement. Non-partnered retirees were more likely to be women. Disability was also a driver of retirement for non-partnered retirees, regardless of gender. Identifying sub-groups based on combinations of retiree characteristics can better inform policy design, appropriate health promotion interventions and potential specific triggers for enacting those policies. Overall, marital status, spousal retirement behavior and disability may each present a more useful basis for a taxonomy of retirement than more individually oriented age- and wealth-based systems.

Ageism on Twitter during the COVID-19 pandemic

The COVID-19 crisis has sparked a resurgence of scholarly interest in the issue of ageism. Whether the outbreak thwarts or facilitates efforts to combat ageism hinges upon public sentiments toward the older demographic. This study aims to explore discourse surrounding older adults by analyzing 183,179 related tweets posted during the COVID-19 pandemic from February to December 2020. Overall, sentiments toward older adults became significantly less negative over time, being the least negative in April, August, and October, though the score remained below the neutral value throughout the 11 months. Our topic modelling analysis generated four themes: "The Need to Protect Older Adults" (41%), "Vulnerability and Mortality" (36%), "Failure of Political Leadership" (12%), and "Resilience" (11%). These findings indicate nascent support for older adults, though attempts to show solidarity may well worsen benevolent ageism.

A playbook for effective age advocacy on Twitter

BACKGROUND

Central to raising awareness of ageism are advocacy organizations dedicated to serving the needs and interests of older adults. Although many of these organizations have cultivated an online presence, inquiry into the effectiveness of age advocacy work on social media remains an untapped area. Our foray into this topic explores how different tweet features predict the level of engagement of posts uploaded by age advocacy organizations on Twitter.

METHODS

Tweets (N = 403,426) were collected from 53 accounts and spanned 12 years from July 2009 to October 2021. After applying our exclusion criteria, 204,905 tweets were retained for analysis. We analyzed the tweet features (predictors) and engagement level (outcome variable) using a linear mixed-effects model.

RESULTS

Tweets with higher engagement are those with a URL, with at least three hashtags, with visuals (GIF, photo, or video), which are quote tweets, and which are posted in the evening or at night Central Standard Time (CST), adjusting for account-level variables (e.g., follower count). Conversely, tweets with more than one mention, which are replies and which are uploaded in the morning are associated with lower engagement.

CONCLUSION

The rise of digital media means that advocates have the opportunity to communicate their messages to reach a critical mass. This is the first known study to offer an evidence-informed playbook for age advocacy organizations to optimize outreach efforts by maximizing online engagement. These results represent a crucial step in ongoing efforts to tackle ageism, an issue that has long been under-discussed.

Not Too Old for TikTok: How Older Adults are Reframing Aging

Background and Objectives

Although reputed for being the virtual playground of teenagers, TikTok has since made its way to older adults, some of whom have become content creators with millions of followers. Despite their immense sway over audiences, as well as their potential to reconfigure socially constructed notions of aging, these older TikTok personalities have been given scant attention in gerontological literature. We fill this gap by exploring how older adults use TikTok to engage in discourses on old age.

Research Design and Methods

We compiled the most viewed videos of users aged 60 and older with at least 100,000 followers, generating 1,382 videos with over 3.5 billion views. Videos that did not feature older adults engaging in discourses on aging were excluded, resulting in 348 videos for content analysis. Both inductive and deductive approaches guided the qualitative analysis.

Results

Three themes emerged: Nearly 3 in 4 videos featured older adults “Defying Age Stereotypes” (71%; Theme 1), 18% featured them “Making Light of Age-Related Vulnerabilities” (Theme 2), and 11% involved older adults “Calling out Ageism” (Theme 3).

Discussion and Implications

This is the first known study exploring how older adults consciously engage in discourses of aging through their participation on TikTok. Our findings highlight the potential for older adults to be put at the vanguard of a movement aimed at challenging socially constructed notions of old age.

Cohort profile: Singapore's nationally representative Retirement and Health Study with 5 waves over 10 years

The Retirement and Health Study (RHS) is Singapore's largest nationally representative cohort with over 15,000 participants (aged 45-85 years) followed across five timepoints in 10 years (2014-2024). Accounting for sample weights, the sample represents 1.2 million Singaporeans and permanent residents of a total population of 5.5 million. The RHS sought consent to link survey responses to relevant administrative data, enabling the cross-validation of self-reports with national databases. There are 10 sections in the RHS with over 400 questions, 50% of which are on respondents' physical and mental health, healthcare utilization and insurance; the remaining 50% are about employment history, retirement adequacy, wealth, and household expenditure. The RHS was set up to provide microdata to compliment administrative data for whole-of-government policy making given that Singapore will reach super-aged status by 2026. Sample findings include a need for older adults to balance between immediate financial needs and investments regarding their pension funds. Also, 86% of older adults preferred to transit into partial retirement by reducing workloads. On the health front, existing studies utilising the RHS have revealed latent classes of disabilities, and that intentions to seek employment can mitigate disability developments. Another study reported that physical disability and social isolation was projected to increase, with ethnic disparities in social functioning. Overall, the RHS will be used for evidenced-informed policy agenda setting and evaluation across domains of health, finance, retirement adequacy, social and family development.

OUP accepted manuscript

Background and Objectives

The recent entry of the hashtag #OkBoomer into social media vernacular underscores the collective frustration of younger people with a group whose views they find increasingly incompatible with theirs. Most social media analyses in gerontology focus on the content on Twitter and Facebook, with content on TikTok virtually unexplored. Given the burgeoning popularity of TikTok among younger people, we assess the content of TikTok videos with the hashtags #OkBoomer or #Boomer to distill the undercurrents of hostility expressed by younger people toward Baby Boomers.

Research Design and Methods

We collated TikTok videos (N = 332) with the hashtags #OkBoomer or #Boomer, which received over 5.4 billion views. Both inductive and deductive approaches guided the qualitative content analysis of the videos.

Results

Five themes emerged. Most videos (79%) described “Negative Encounters with Baby Boomers” (Theme 1); 58% were about “Conflicting Values/Beliefs between Baby Boomers and Younger People” (Theme 2); 39% were about “Baby Boomers Antagonizing Younger Generations” (Theme 3); 22% of the videos made references to the “Karen Meme” (Theme 4); and 7% bemoaned the existence of a “Wealth Gap” between Baby Boomers and younger people (Theme 5).

Discussion and Implications

Findings reveal that the usage of the hashtags #OkBoomer and #Boomer is highly nuanced, at times explicitly ageist, and at others, emblematic of a phenomenon far more complex than ageism. There is a need to leverage social media as a space to foster interaction between older and younger people. Society is ultimately well served by intergenerational interaction.

Reframing aging during COVID-19: Familial role-based framing of older adults linked to decreased ageism

BACKGROUND

Contributions of older adults amid the COVID-19 pandemic have been eclipsed by discourse positioning them as an at-risk population. We assess whether age-based framing (e.g., senior citizen) is associated with more negative stereotyping in the media compared to familial role-based framing (e.g., grandparent) across 8 months, from a baseline period (October 2019-December 2019) to the onset of the pandemic (January 2020-May 2020).

METHODS

Leveraging a 12-billion-word news media database-with over 30 million news articles from over 7000 websites-we identified the most common synonyms for age-based framing (e.g., senior citizen) and familial role-based framing (e.g., grandparent). For each framing category, we compiled the most frequently used descriptors every month, amassing 488,907 descriptors in total. All descriptors were rated from 1 (very negative) to 5 (very positive) to determine a Cumulative Aging Narrative Score (CANS) for age-based and familial role-based framing.

RESULTS

Age-based framing of older adults increased negative stereotyping in the media by seven times compared to familial role-based framing during COVID-19. The percentage of positive topics for age-based framing was significantly lower during COVID-19 (35%) than before (61%). Conversely, the percentage of positive topics for familial role-based framing was higher during the pandemic (91%) than before (70%).

CONCLUSION

This is one of the first empirical studies on whether framing older adults based on age or role is linked to more negative stereotypes during COVID-19. We argue for a more role-centered approach in framing older adults so that their contributions are acknowledged and valued by society.

The Prevalence and Correlates of Disability in Singapore: Results from a Nationwide Cross-Sectional Survey

Objective: The study aims to estimate the prevalence of disability and the association of disability with socio-demographic correlates and health outcomes among the Singapore population. Methods: Face-to-face interviews were conducted with a representative sample of Singapore’s population. Using the Washington Group’s questionnaire, disability was defined using both the ‘standard’ (a lot of difficulty or higher in one or more domains) and the ‘wider’ threshold (of ‘some’ or greater difficulty). Data on socio-demographic correlates, self-reported lifestyle, physical activity, chronic conditions, and health-related quality of life were also collected. Results: The prevalence of any disability using the standard threshold was 3.1% (95% CI: 2.4–4.1). When separated by disability type, mobility (1.8%) was the most prevalent, followed by vision (0.8%), cognition (0.5%), hearing (0.3%), and self-care (0.2). In the adjusted regression analysis, lower education and unemployed and economically inactive status (versus employed) were significantly associated with disability. Conclusions: Although this prevalence is lower than other countries, it is a significant finding in terms of actual numbers and impact at both the individual and the societal levels. Our findings also highlight the need to strengthen health services and preventive interventions targeting older adults and those who are physically inactive to reduce the burden of disability in these groups.

Emergency hospital admissions among older adults living alone in the community

Background

Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity.

Methods

We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity.

Results

Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity.

Conclusions

Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.

Societal Narratives on Caregivers in Asia

Although there has been an increase in awareness of the struggles experienced by caregivers, discourse on caregiving remains confined mostly to academia, policy circles or the family unit. There have been suggestions that public discourse on informal caregiving dwells overwhelmingly on the outsize toll it takes on the health of caregivers. However, few studies have examined societal narratives on caregivers-a gap our study aims to fill. We leveraged an online media database of 12 billion words collated from over 30 million articles to explore societal narratives on caregivers in six Asian countries. Computational linguistics and statistical analysis were applied to study the content of narratives on caregivers. The prevalence of societal narratives on caregivers was highest in Singapore-five times higher than Sri Lanka, which evidenced the lowest prevalence. Findings reveal that the inadequacies of institutional care as well as the need to train and empower caregivers are pressing issues that need to be prioritized on the policy agenda in Asia. Of broader significance, the diverse capabilities across Asia present opportunities for cross-country learning and capacity-building.

The Impact of Aging Policy on Societal Age Stereotypes and Ageism

Background and Objectives

While studies have researched ageism in public policy, few investigated the impact of aging policy on ageism—typically, an unintended consequence. Ageism is linked to $63 billion in health care costs, so its antecedents are of interest. We test the association between Aging Policy Agenda Setting and Societal Age Stereotypes and hypothesize a mediating pathway via Medicalization of Aging, moderated by demographics.

Research Design and Methods

Scholars identified Singapore’s Pioneer Generation Policy (PGP) as one of the largest policy implementations in recent years, where the agenda was set by the Prime Minister at an equivalent State of the Union address in 2013, and US$7 billion allocated to fund outpatient health care costs for aged 65 years or older. More than 400,000 older adults received a PGP card and home visits by trained volunteers who co-devised a personalized utilization plan. We leveraged a 10-billion-word data set with more than 30 million newspaper and magazine articles to dynamically track Societal Age Stereotype scores over 8 years from pre- to postpolicy implementation.

Results

Societal Age Stereotypes followed a quadratic trend: Prior to the Aging Policy Agenda Setting from 2010 to 2014, stereotypes were trending positive; after 2014, it trended downward to become more negative. Medicalization of Aging mediated the relationship between Aging Policy Agenda Setting and Societal Age Stereotypes. Furthermore, Old-age Support Ratio moderated the mediational model, suggesting that the impact of policy on medicalization is stronger when a society is more aged.

Discussion and Implications

We provided a framework for policymakers to ameliorate the unintended consequences of aging policies on societal ageism—if unaddressed, it will exert an insidious toll on older adults, even if initial policies are well-intentioned.

Anti-Asian Sentiments during COVID-19 across 20 Countries: Analysis of a 12-billion-word News Media Database

Background

US president Joe Biden signed an executive action directing federal agencies to combat hate crimes and racism against Asians, which have percolated during the COVID-19 pandemic. This is one of the first known empirical studies to dynamically test whether global societal sentiments toward Asians have become more negative during the COVID-19 pandemic.

Objective

This study aimed to investigate whether global societal sentiments toward Asians across 20 countries have become more negative, month by month, from before the pandemic (October 2019) to May 2020, along with the pandemic (incidence and mortality rates) and cultural (Hofstede’s cultural dimensions) predictors of this trend.

Methods

We leveraged a 12-billion-word web-based media database, with over 30 million newspaper and magazine articles taken from over 7000 sites across 20 countries, and identified 6 synonyms of “Asian” that are related to the coronavirus. We compiled their most frequently used descriptors (collocates) from October 2019 to May 2020 across 20 countries, culminating in 85,827 collocates that were rated by 2 independent researchers to provide a Cumulative Asian Sentiment Score (CASS) per month. This allowed us to track significant shifts in societal sentiments toward Asians from a baseline period (October to December 2019) to the onset of the pandemic (January to May 2020). We tested the competing predictors of this trend: pandemic variables of incidence and mortality rates measured monthly for all 20 countries taken from the Oxford COVID-19 Government Response Tracker, and Hofstede’s Cultural Dimensions of Individualism, Power Distance, Uncertainty Avoidance, and Masculinity for the 20 countries.

Results

Before the pandemic in December 2019, Jamaica and New Zealand evidenced the most negative societal sentiments toward Asians; when news about the coronavirus was released in January 2020, the United States and Nigeria evidenced the most negative sentiments toward Asians among 20 countries. Globally, sentiments of Asians became more negative—a significant linear decline during the COVID-19 pandemic. CASS trended neutral before the pandemic during the baseline period of October to November 2019 and then plummeted in February 2020. CASS were, ironically, not predicted by COVID-19’s incidence and mortality rates, but rather by Hofstede’s cultural dimensions: individualism, power distance, and uncertainty avoidance—as shown by mixed models (N=28,494). Specifically, higher power distance, individualism, and uncertainty avoidance were associated with negative societal sentiments toward Asians.

Conclusions

Racism, in the form of Anti-Asian sentiments, are deep-seated, and predicated on structural undercurrents of culture. The COVID-19 pandemic may have indirectly and inadvertently exacerbated societal tendencies for racism. Our study lays the important groundwork to design interventions and policy communications to ameliorate Anti-Asian racism, which are culturally nuanced and contextually appropriate.

Societal Age Stereotypes in the U.S. and U.K. from a Media Database of 1.1 Billion Words

Recently, 194 World Health Organization member states called on the international organization to develop a global campaign to combat ageism, citing its alarming ubiquity, insidious threat to health, and prevalence in the media. Existing media studies of age stereotypes have mostly been single-sourced. This study harnesses a 1.1-billion-word media database comprising the British National Corpus and Corpus of Contemporary American English-with genres including spoken/television, fiction, magazines, newspapers-to provide a comprehensive view of ageism in the United Kingdom and United States. The US and UK were chosen as they are home to the largest media conglomerates with tremendous power to shape public opinion. The most commonly used synonym of older adults was identified, and its most frequently used descriptors were analyzed for valence. Such computational linguistics techniques represent a new advance in studying aging narratives. The key finding is consistent, though no less alarming: Negative descriptions of older adults outnumber positive ones by six times. Negative descriptions tend to be physical, while positive ones tend to be behavioral. Magazines contain the highest levels of ageism, followed by the spoken genre, newspapers, and fiction. Findings underscore the need to increase public awareness of ageism and lay the groundwork to design targeted societal campaigns to tackle ageism-one of our generation's most pernicious threats.

Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions-a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the "number of days from previous non-elective admission", which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission-a key predictor in other models-since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation-an "art" that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

Role-Based Framing of Older Adults Linked to Decreased Ageism Over 210 Years: Evidence From a 600-Million-Word Historical Corpus

BACKGROUND AND OBJECTIVES

Older adults are exhibiting greater diversity in their aging trajectories. This has led to movements by the World Health Organization and AARP to reframe aging. We compare role-based framing and age-based framing of older adults over 210 years-a time span beyond the reach of traditional methods-and elucidate their respective sentiments and narratives.

RESEARCH DESIGN AND METHODS

We combined the Corpus of Historical American English with the Corpus of Contemporary American English to create a 600-million-word-dataset-the largest historical corpus of American English with over 150,000 texts collected from newspapers, magazines, fiction and non-fiction. We compiled the top descriptors of age-based terms (e.g., senior citizen) and role-based terms (e.g., grandparent) and rated them for stereotypic valence (negative to positive) over 21 decades.

RESULTS

Age-based framing evidenced a significantly higher increase in negativity (15%) compared to role-based framing (4%). We found a significant interaction effect between framing (age-based vs. role-based) and stereotypic content across two centuries (1800s and 1900s). The percentage of positive topics associated with role-based framing increased from 71% in the 1800s to 89% in the 1900s, with narratives of affection and wisdom becoming more prevalent. Conversely, the percentage of positive topics for age-based framing decreased from 82% to 38% over time, with narratives of burden, illness and death growing more prevalent.

DISCUSSION AND IMPLICATIONS

We argue for a more role-centric approach when framing aging such that age ceases to be the chief determinant in how older adults are viewed in society.

Societal perceptions of caregivers linked to culture across 20 countries: Evidence from a 10-billion-word database

Caregivers play an indispensable role in society. In 2017, 41 million family caregivers in the United States provided approximately 34 billion hours of care to their aging parents, spouses, partners and friends. The estimated economic value of their unpaid contributions amounted to $470 billion. Despite their invaluable contributions, caregivers often operate in a reality of inadequate social support. Little is known about the factors linked to the societal perceptions of caregivers, and our study seeks to contribute by filling this gap. Importantly, whether society honors or stigmatizes caregivers is critical as it could impact caregiving decisions and either exacerbate or ameliorate caregiver burden. We leveraged an online media database of 10 billion words collated from over 28 million articles, across 20 countries, to analyze societal perceptions of caregivers. Of the 20 countries, 18 evidenced neutral to positive perceptions of caregivers. Bangladesh and Ghana had the most positive perceptions, while Sri Lanka and Tanzania had the most negative perceptions. Aging demographics and culture (individualism, masculinity and uncertainty avoidance) were significantly associated with perceptions of caregivers. Findings suggest that positive perceptions of caregivers can be better cultivated when caring is lauded as a virtuous act that aids in reducing the care deficit. This study is among the first to analyze the societal perceptions of caregivers globally, and lays the groundwork to design culturally sensitive interventions that increase society's appreciation for caregivers.

Culture Linked to Increasing Ageism during Covid-19: Evidence from a 10-billion-word Corpus across 20 Countries

OBJECTIVES

Older adults experience higher risks of getting severely ill from COVID-19, resulting in widespread narratives of frailty and vulnerability. We test: (1) Whether global aging narratives have become more negative from before to during the pandemic (Oct'19 to May'20) across 20 countries; (2) Model pandemic (incidence and mortality), and cultural factors associated with the trajectory of aging narratives.

METHODS

We leveraged a 10-billion-word online-media corpus, consisting of 28 million newspaper and magazine articles across 20 countries, to identify nine common synonyms of 'older adults' and compiled their most frequently-used descriptors (collocates) from Oct'19 to May'20-culminating in 11,504 collocates that were rated to create a Cumulative-Aging-Narrative-Score-(CANS) per month. Widely used cultural dimension scores were taken from Hofstede, and pandemic variables, from the Oxford COVID-19 Government Response Tracker.

RESULTS

Aging narratives became more negative as the pandemic worsened across 20 countries. Globally, scores were trending neutral from Oct'19 to Feb'20, and plummeted in Mar'20, reflecting COVID-19's severity. Pre-pandemic (Oct'19), UK evidenced the most negative aging narratives; peak-pandemic (May'20), South Africa took on the dubious honor. Across the 8-month period, Philippines experienced the steepest trend towards negativity in aging narratives. Ageism, during the pandemic, was ironically, not predicted by COVID-19's incidence and mortality rates, but by cultural variables: Individualism, Masculinity, Uncertainty Avoidance, and Long-term Orientation.

DISCUSSION

The strategy to reverse this trajectory lay in the same phenomenon that promoted it: A sustained global campaign-though, it should be culturally nuanced and customized to a country's context.

Aging Narratives over 210 years (1810-2019)

Objectives

The World Health Organization launched a recent global campaign to combat ageism, citing its ubiquity and insidious threat to health. The historical context that promoted this pernicious threat is understudied, and such studies lay the critical foundation for designing societal-level campaigns to combat it. We analyzed the trend and content of aging narratives over 210 years across multiple genres—newspaper, magazines, fiction, nonfiction books—and modeled the predictors of the observed trend.

Method

A 600-million-word dataset was created from the Corpus of Historical American English and the Corpus of Contemporary American English to form the largest structured historical corpus with over 150,000 texts from multiple genres. Computational linguistics and statistical techniques were applied to study the trend, content, and predictors of aging narratives.

Results

Aging narratives have become more negative, in a linear fashion (p = .003), over 210 years. There are distinct shifts: From uplifting narratives of heroism and kinship in the 1800s to darker tones of illness, death, and burden in the 1900s across newspapers, magazines, and nonfiction books. Fiction defied this trend by portraying older adults positively through romantic courtship and war heroism. Significant predictors of ageism over 210 years are the medicalization of aging, loss of status, warmth, competence, and social ostracism.

Discussion

Though it is unrealistic to reverse the course of ageism, its declining trajectory can be ameliorated. Our unprecedented study lay the groundwork for a societal-level campaign to tackle ageism. The need to act is more pressing given the Covid-19 pandemic where older adults are constantly portrayed as vulnerable.

Ageism linked to culture, not demographics: Evidence from an 8-billion-word corpus across 20 countries

Objectives

Ageism has increased over 200 years and costs the U.S. health care system $63 billion a year. While scholars agree on the consequences of ageism, there are disagreements on whether it is related to the demographics of aging, or society’s cultural values. We test both hypotheses across 20 countries.

Method

To circumvent the sampling limitations of survey studies, we used an 8-billion-word corpus, identified 3 synonyms with the highest prevalence—aged, elderly, old people—and compiled the top 300 words (collocates) that were used most frequently with these synonyms for each of the 20 countries. The resulting 6,000 collocates were rated on an ageism scale by 2 raters to create an ageism score per country. Cultural dimension scores—Power Distance, Individualism, Masculinity, Uncertainty Avoidance, and Long-term Orientation—were taken from Hofstede, and demographics—size and speed of population aging—came from the World Development Indicators.

Results

Of the 20 countries, UK topped the ageism table, while Sri Lanka had the lowest ageism score. Multiple regression models showed that higher levels of masculinity and long-term orientation are associated with ageism, controlling for other cultural dimensions, demographics (size and speed of aging), and economics (GDP-per-capita).

Discussion

Our findings blunt the deterministic nature of ageism at the societal level. Demographics is only one side of the ageism coin, and the cultural side is equally, if not more important. This study lays the groundwork to tackle societal ageism—one of our generation’s most pernicious threats.

Big Data, Decision Models, and Public Health

Unlike most daily decisions, medical decision making often has substantial consequences and trade-offs. Recently, big data analytics techniques such as statistical analysis, data mining, machine learning and deep learning can be applied to construct innovative decision models. With complex decision making, it can be difficult to comprehend and compare the benefits and risks of all available options to make a decision. For these reasons, this Special Issue focuses on the use of big data analytics and forms of public health decision making based on the decision model, spanning from theory to practice. A total of 64 submissions were carefully blind peer reviewed by at least two referees and, finally, 23 papers were selected for this Special Issue.

Self-Acceptance and Interdependence Promote Longevity: Evidence From a 20-year Prospective Cohort Study

We explored psychosocial pathways to longevity, specifically, the association between psychological well-being and mortality in a 20-year prospective cohort study of 7626 participants. As hypothesized, high self-acceptance and interdependence were associated with decreased mortality risk, controlling for other psychological components (purpose, positive relations, growth, mastery) and potential confounders: personality, depression, self-rated health, smoking status, body mass index (BMI), illness, and demographics. Self-acceptance decreased mortality risk by 19% and added three years of life. Longevity expectation fully mediated the relationship between self-acceptance and mortality. Interdependence decreased mortality risk by 17% and added two years of life. Serenity towards death fully mediated the relationship between interdependence and mortality. This is the first known study to investigate self-acceptance, interdependence, and serenity toward death as promoters of longevity, and distilled the relative contributions of these factors, controlling for covariates-all of which were measured over multiple time points. Theoretically, this study suggests that components of well-being may make meaningful contributions to longevity, and practically recommend that self-acceptance and interdependence could be added to interventions to promote aging health.