Population Aging, Health Investment and Economic Growth: Based on a Cross-Country Panel Data Analysis

Personal and Organizational Factors as Predictors of Life Satisfaction Among Older Adults in Long-Term Care Settings

BACKGROUND AND AIMS

Resident satisfaction is a critical indicator of the quality of care in long-term care facilities (LTCFs). Yet, the relative importance quality of care factors in predicting resident satisfaction remains unclear for guiding resident support initiatives. This study aims to identify the relative contribution of personal and facility care service factors as predictors of satisfaction LTCF residents.

METHODS

This cross-sectional study enrolled a convenience sample of 399 older adult residents from LTCFs in Shanghai, Nanjing, and Changsha, China, from June to December 2023. The inclusion criteria were age 65 or older, fluency in speaking and reading simplified Chinese Mandarin, having resided in long-term care facilities for at least one month, and cognitive competence to comprehend the questionnaires. Hierarchical multiple regressions were utilized to examine self-report survey data on ten resident personal variables, and seven care facility service domains were examined for their relative contribution to resident care satisfaction. Moreover, the analysis included the interaction between personal factors and care service attributes.

RESULTS

The combined personal and care service factors explained 26.1% of the variance in overall resident satisfaction. Personal factors that predicted resident satisfaction included age, level of independence, and length of stay (ΔR2 = 0.11). Of the care facility factors, the significant predictors of higher resident satisfaction were spending time (β = 0.60, p < 0.01, ΔR2 = 0.09) and environment domains (β = 0.62, p < 0.01, ΔR2 = 0.03). Age moderated the relationship between the spending time domain and overall satisfaction, with a positive effect for residents aged 70-79 compared to those aged 60-69 (β = -1.26, p < 0.05).

CONCLUSIONS

This study provides evidence to suggest the importance of personal and care facility characteristics to LTFC resident satisfaction. Based on these findings, improved resident satisfaction is likely with LTCF care services that provide tailored care plans using resident characteristics.

Predictive models for delay in medical decision-making among older patients with acute ischemic stroke: a comparative study using logistic regression analysis and lightGBM algorithm

OBJECTIVE

To explore the factors affecting delayed medical decision-making in older patients with acute ischemic stroke (AIS) using logistic regression analysis and the Light Gradient Boosting Machine (LightGBM) algorithm, and compare the two predictive models.

METHODS

A cross-sectional study was conducted among 309 older patients aged ≥ 60 who underwent AIS. Demographic characteristics, stroke onset characteristics, previous stroke knowledge level, health literacy, and social network were recorded. These data were separately inputted into logistic regression analysis and the LightGBM algorithm to build the predictive models for delay in medical decision-making among older patients with AIS. Five parameters of Accuracy, Recall, F1 Score, AUC and Precision were compared between the two models.

RESULTS

The medical decision-making delay rate in older patients with AIS was 74.76%. The factors affecting medical decision-making delay, identified through logistic regression and LightGBM algorithm, were as follows: stroke severity, stroke recognition, previous stroke knowledge, health literacy, social network (common factors), mode of onset (logistic regression model only), and reaction from others (LightGBM algorithm only). The LightGBM model demonstrated the more superior performance, achieving the higher AUC of 0.909.

CONCLUSIONS

This study used advanced LightGBM algorithm to enable early identification of delay in medical decision-making groups in the older patients with AIS. The identified influencing factors can provide critical insights for the development of early prevention and intervention strategies to reduce delay in medical decisions-making among older patients with AIS and promote patients' health. The LightGBM algorithm is the optimal model for predicting the delay in medical decision-making among older patients with AIS.

A global perspective on the governance-health nexus

BACKGROUND

This study raises two key arguments: First, government health expenditure (GHE) and per capita out-of-pocket expenditures on healthcare (OPEH) are sensitive to contemporary good governance practices, giving policy importance to the exogeneity of healthcare determinants, i.e., governance for health rather than health governance. Second, it is the income level of countries that reflects the volatility of the governance spillovers on the subject.

METHODS

The present study constructs a composite governance index (CGI) and employs a set of panel data for 144 countries over the period from 2002 to 2020. To allow comparability and extract specific policy implications, the countries are classified as full, high-, middle-, and low-income panels. Meanwhile to delve into the short- and long-run effects of CGI on GHE and OPEH, the study employs the cross-sectionally augmented autoregressive distributed lags (CS-ARDL) model. Further, to establish a causal link between the variables, it uses the Dumitrescu-Hurlin panel causality technique.

RESULTS

The results indicate that CGI is significantly cointegrated with GHE and OPEH in all recipient panels. It indicates that while CGI has significantly positive impacts on GHE and OPEH, its effects vary according to the income level of the underlying economies. The findings support the idea of governance for health and show that CGI drives the stabilization and enhancement of GHE and OPEH in the long run. Furthermore, the findings reveal that economic growth, the age dependency ratio, and tax revenue have positive effects, while the crude death rate and the child mortality rate exert negative impacts on the subject. Finally, the results highlight a unidirectional causality running from CGI to GHE and OPEH, while no feedback response is evident.

CONCLUSIONS

Although an increase in GHE and OPEH is associated with the improvement of the population's healthcare, the results suggest the recognition of the importance and institutionalization of good governance to streamline this improvement through effective channelization, outreach, and social environment development for extensive health inclusion.

Implementation of the World Health Organization Age-Friendly Principles: A Case Study from Portugal

Demographic ageing has emphasized the need to adapt current healthcare systems to the comorbidity profile of older adults. In 2004, the World Health Organization (WHO) developed the Age-Friendly Principles, but the approach to their implementation in the health systems still remains uncertain. This article intends to address this gap by assessing how the Principles are perceived and implemented in the Portuguese National Health Service (NHS), where this topic has recently been placed on the political agenda. A questionnaire survey was administered to primary care directors and hospital administrators, covering a total of 173 health units. Findings show that most respondents are unaware of the WHO Principles (71%) and do not identify the current organizational structure of care as a problem for the provision of care (80%). However, the implementation of the WHO Principles is lower than desired, especially regarding professional training and the management system (50% and 28% of the criteria are implemented, respectively). These criteria defined by the WHO are implemented in a reduced number of health units, as opposed to the physical environment where implementation is more widespread (64%). Accordingly, further dissemination and implementation support in the national territory are needed in order to improve the health outcomes of older adults and increase the performance of health units.

Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study

BACKGROUND

Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood.

OBJECTIVE

This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases.

METHODS

We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ≥45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use.

RESULTS

Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2% to 12.3%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95% CI 0.33-0.84, P=.007), depression (HR 0.80, 95% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases.

CONCLUSIONS

This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention.

How do the older adults in nursing homes live with dignity? A protocol for a meta-synthesis of qualitative research

INTRODUCTION

As the population continuous to age and family sizes decrease, residing in nursing homes has emerged as a crucial option for older adults' care. Ensuring a dignified life for older adults in nursing homes is critical for enhancing their overall quality of life. The primary objective of this study is to synthesise the evidence of qualitative research on the feelings and experiences of dignity among older adults living in nursing homes. This will enable a better understanding of the factors influencing the perception of dignity and its preservation, ultimately assisting older adults in achieving a more comfortable and fulfilling experience in nursing homes.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses will guide this meta-synthesis. We conducted an initial search on 1 June 2022, for studies published between the inception of each database and 2022, using the population exposure-outcome nomenclature. We searched the Embase, Web of Science, CINAHL, Cochrane Library and PubMed databases for relevant studies. For data synthesis, we will employ the Ritchie and Spencer framework, and the Supporting the Use of Research Evidence Framework will be used for data analysis. To minimise the risk of bias, we will critically appraise the selected studies using the Qualitative Assessment and Review Instrument.

ETHICS AND DISSEMINATION

This review does not involve human participants and, therefore, does not necessitate ethical approval. We plan to disseminate the protocol and findings through relevant channels, including publication in pertinent journals, presentations at conferences and symposia, and engagement with local and international health stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42022343983.

CONCLUSION

This study aims to offer comprehensive evidence to guide nursing staff in providing dignity-focused interventions for older adult residents in nursing homes.

Home-Based Exergame Program to Improve Physical Function, Fall Efficacy, Depression and Quality of Life in Community-Dwelling Older Adults: A Randomized Controlled Trial

This study aimed to investigate the effects of home-based exergame programs on physical function, fall efficacy, depression, and health-related quality of life in community-dwelling older adults. Fifty-seven participants aged 75 years or older were divided into control and experimental groups. The experimental group received a home-based exergame program that included balance and lower-extremity muscle strength for 8 weeks. The participants exercised at home for 50 min three times a week and were monitored through a video-conference application. Both groups received online education on musculoskeletal health once a week, whereas the control group did not exercise. Physical function was assessed using the one-leg standing test (OLST), Berg balance scale (BBS), functional reaching test (FRT), timed up-and-go test (TUGT), and five-times sit-to-stand (FTSTS). Fall efficacy was assessed using the modified falls efficacy scale (MFES). Depression was assessed using the geriatric depression scale (GDS). Health-related quality of life was assessed using a 36-item short-form health survey (SF-36). The experimental group showed an overall improvement in OLST, BBS, FRT, TUGT, and FTSTS (p < 0.05). MFES was significantly increased in the experimental group after the intervention (p < 0.05). The GDS significantly decreased in the experimental group after the intervention (p < 0.05). In SF-36, role limitations due to physical health, general health, and fatigue (energy and fatigue) items improved in the experimental group after intervention (p < 0.05). An 8-week home-based exergame program improved physical function, fall efficacy, depression, and health-related quality of life in older adults. The study was registered on ClinicalTrials.gov (NCT05802537).

Regional impact of aging population on economic development in China: Evidence from panel threshold regression (PTR)

The aging population is a common problem faced by most countries in the world. This study uses 18 years (from 2002 to 2019) of panel data from 31 regions in China (excluding Hong Kong, Macao, and Taiwan Province), and establishes a panel threshold regression model to study the non-linear impact of the aging population on economic development. It is different from traditional research in that this paper divides 31 regions in China into three regions: Eastern, Central, and Western according to the classification standard of the National Bureau of Statistics of China and compares the different impacts of the aging population on economic development in the three regions. Although this study finds that the aging population promotes the economy of China's eastern, central, and western regions, different threshold variables have dramatically different influences. When the sum of export and import is the threshold variable, the impact of the aging population on the eastern and the central region of China is significantly larger than that of the western region of China. However, when the unemployment rate is the threshold variable, the impact of the aging population on the western region of China is dramatically higher than the other regions' impact. Thus, one of the contributions of this study is that if the local government wants to increase the positive impact of the aging population on the per capita GDP of China, the local governments of different regions should advocate more policies that align with their economic situation rather than always emulating policies from other regions.

The health consequences of civil wars: evidence from Afghanistan

This study examines the effects of long-run civil wars on healthcare, which is an important component of human capital development and their causality nexus in Afghanistan using the MVAR (modified vector autoregressive) approach and the Granger non-causality model covering data period 2002Q3-2020Q4. The primary results support a significant long-run relationship between variables, while the results of the MVAR model indicate the per capita cost of war, per capita GDP, and age dependency ratio have significantly positive impacts on per capita health expenditures, whereas child mortality rate and crude death rate have negative impacts. The results of the Granger non-causality approach demonstrate that there is a statistically significant bidirectional causality nexus between per capita health expenditure, per capita cost of war, per capita GDP, child mortality rate, crude death rate, and age dependency ratio, while it also supports the existence of strong and significant interconnectivity and multidimensionality between per capita cost of war and per capita health expenditure, with a significantly strong feedback response from the control variables. Important policy implications sourced from the key findings are also discussed.

Asian ageing: The relationship between the elderly population and economic growth in the Asian context

The elderly population and economic growth have been a contentious topic among researchers. Regardless of the economic growth rate, the population and its growth have a stimulating influence on economic development. This study aims to explore the relationship between the elderly population and economic growth in 15 Asian countries, based on secondary data gathered from the WDI (World Development Indicators) from 1961 to 2021. This research contributes to filling the empirical gap, capturing the Granger causality concerning the relationship between the elderly population and economic growth in the Asian context in a single study. The empirical findings highlighted a one-way Granger causality from economic growth to the elderly population for India, Japan, Malaysia, and Singapore while vice versa for Bangladesh, China, and Pakistan. Furthermore, for Nepal, there is a two-way Granger causality, while there is no Granger causality for remaining countries. To the best of the authors' knowledge, this study has been the first to investigate the relationship between the elderly population and economic growth for Asian nations, using a lengthy data series and a Granger causality test. The main findings will assist the governments, policymakers, and foreign investors in effective decision-making in this regard.

Promoting the Integration of Elderly Healthcare and Elderly Nursing: Evidence from the Chinese Government

The increase of the aging population in China and the rise of the concept of healthy aging have accelerated the transformation and upgrading of the traditional elderly nursing pattern. Nevertheless, there is a critical limitation existing in the current situation of China's elderly care, i.e., the medical institutions do not support elderly nursing and the elderly nursing institutions do not facilitate access to medical care. To eliminate the adverse impact of this issue, twelve ministries and commissions of the Chinese government have jointly issued a document, i.e., the Several Opinions on Further Promoting the Development of Combining the Healthcare with the Elderly care (SOFPDCHE), to provide guidance from the government level for further promoting the integration of elderly healthcare and elderly nursing. Under this background, this paper constructs a healthcare-nursing information collaboration network (HnICN) based on the SOFPDCHE, proposing three novel strategies to explore the different roles and collaboration relationships of relevant government departments and public organizations in this integration process, i.e., the node identification strategy (NIS), the local adjacency subgroup strategy (LASS), and the information collaboration effect measurement strategy (ICEMS). Furthermore, this paper retrieves 484 valid policy documents related to "the integration of elderly healthcare and elderly nursing" as data samples on the official websites of 12 sponsored ministries and commissions, and finally confirms 22 government departments and public organizations as the network nodes based on these obtained documents, such as the National Health Commission of the People's Republic of China (NHC), the Ministry of Industry and Information Technology of the People's Republic of China (MIIT), and the National Working Commission on Aging (NWCA). In terms of the collaboration effect, the results of all node-pairs in the HnICN are significantly different, where the collaboration effect between the NHC and MIIT is best and that between the NATCM and MIIT is second best, which are 84.572% and 20.275%, respectively. This study provides the quantifiable results of the information collaboration degree between different government agencies and forms the optimization scheme for the current collaboration status based on these results, which play a positive role in integrating elderly healthcare and elderly nursing and eventually achieving healthy aging.

How Population Aging Affects Industrial Structure Upgrading: Evidence from China

The question of how to proactively respond to population aging has become a major global issue. As a country with the largest elderly population in the world, China suffers a stronger shock from population aging, which makes it more urgent to transform its industrial and economic development model. Concretely, in the context of the new macroeconomic environment that has undergone profound changes, the shock of population aging makes the traditional industrial structure upgrading model (driven by large-scale factor inputs, imitation innovation and low-cost technological progress, and strong external demand) more unsustainable, and China has an urgent need to transform it to a more sustainable one. Only with an in-depth analysis of the influence mechanism of population aging on the upgrading of industrial structure can we better promote industrial structure upgrading under the impact of population aging. Therefore, six MSVAR models were constructed from each environmental perspective based on data from 1987 to 2021. The probabilities of regime transition figures show that the influencing mechanisms have a clear two-regime feature from any view; specifically, the omnidirectional environmental transition occurs in 2019. A further impulse-response analysis shows that, comparatively speaking, under the new environment regime the acceleration of population aging (1) aggravates the labor shortage, thus narrowing the industrial structure upgrading ranges; (2) has a negative, rather than positive, impact on the capital stock, but leads to a cumulative increase in industrial structure upgrading; (3) forces weaker technological progress, but further leads to a stronger impact on the industrial structure upgrading; (4) forces greater consumption upgrading, which further weakens industrial structure upgrading; (5) narrows rather than expands the upgrading of investment and industrial structures; and (6) narrows the upgrading of export and industrial structures. Therefore, we should collaboratively promote industrial structure upgrading from the supply side relying heavily on independent innovation and talent, and the demand side relying heavily on the upgrading of domestic consumption and exports.

Health expenditures, environmental quality, and economic development: State-of-the-art review and findings in the context of COP26

There are numerous factors that affect human health. Among others, environmental degradation, bad governance, and extensive economic growth are regarded as more destructive for health-related issues. To explore the nexus of the said factors and extend the scholarly literature, the current study aims to analyze the influence of greenhouse gas (GHG) emissions, governance indicators, and gross domestic product (GDP) on human health expenditures-captured by domestic health expenditures and capital health expenditures. Specifically, this study contrasted variables including regulatory quality (RQ), rule of law (RL), GDP, GHG emissions, and human capital (HC) with that of human health expenditure. Covering the period from 1996 to 2020, this study uses time series specifications in the case of China, which is one of the largest pollution-emitting economies across the globe. The empirical results found that the long-run equilibrium relationship exists between the variables. For the long-run coefficients, this study utilizes the fully modified ordinary least square, dynamic ordinary least square, and canonical cointegration regression, suggesting that economic development and RQ are adversely affecting human health expenditure. However, GHG emissions, RQ, and HC significantly improve human health by increasing health expenditure in China. Based on the empirical results, policies are suggested regarding human health improvement, improved governance quality, and environmental sustainability. The study discusses the empirical conclusions and implications as per COP26 declarations.

The Impact of Health Investment on Industrial Structure: “Spillover” or “Crowding Out”?—Evidence From Emerging Market Countries

Using national dynamic panel data from 21 emerging markets between 1999 and 2020 and bidirectional fixed effect and threshold regression methods, this paper evaluated the impact of health investment on industrial structure upgrading from two aspects of economic output and economic structure. The results showed that: (1) public health investment and private health investment have a crowding out effect on the added value of primary and secondary industries, and the crowding out effect of public health investment is greater than that of private health investment; (2) Public health investment and private health investment have a spillover effect on the added value of the tertiary industry, and the spillover effect of public health investment is greater than that of private health investment; (3) Both public and private health investment contribute to the transfer of the labor force to the tertiary industry, and tests showed the baseline regression results were robust and reliable; (4) The relationship between health investment and industrial structure upgrading was non-linear. As per capital GDP increases, the inhibition effect of public health investment on industrial structure upgrading gradually weakens whilst the promotion effect of private health investment on industrial structure upgrading gradually increases. The results of this study clarify how health investment affects industrial structure, and offers new guidance for health investment policy formulation in emerging market countries.

Hip Lift Transfer Assistive System for Reducing Burden on Caregiver's Waist

In Japan, the aging population is expected to increase the number of elderly people in the future. The purpose of this study was to develop a hip lift transfer assistive system to improve the QOL of elderly living and to prevent back pain for caregivers. We extracted the impediment factor and the necessary scene for the assistance, decided on the transfer process from the wheelchair in the toilet, and considered the reduction method of the burden based on the quantitative evaluation of the caregiver's lumbar burden and developed the device. Then we proposed the algorithm of the system by grasping the behavior and lumbar burden characteristics at the time of using the hip lift transfer assistive system by the developed device in which the proposed support algorithm of standing seating assistance operation is implemented in the actual use environment. Through the assistive movement evaluation experiment and the actual operation in the toilet, we have verified that the use of this device can reduce the caregivers' lumbar burden below the standard value (3400 N) and have proved the effectiveness of the proposed transfer assistive system.