Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

A comprehensive overview of barriers and strategies for AI implementation in healthcare: Mixed-method design

Implementation of artificial intelligence systems for healthcare is challenging. Understanding the barriers and implementation strategies can impact their adoption and allows for better anticipation and planning. This study's objective was to create a detailed inventory of barriers to and strategies for AI implementation in healthcare to support advancements in methods and implementation processes in healthcare. A sequential explanatory mixed method design was used. Firstly, scoping reviews and systematic literature reviews were identified using PubMed. Selected studies included empirical cases of AI implementation and use in clinical practice. As the reviews were deemed insufficient to fulfil the aim of the study, data collection shifted to the primary studies included in those reviews. The primary studies were screened by title and abstract, and thereafter read in full text. Then, data on barriers to and strategies for AI implementation were extracted from the included articles, thematically coded by inductive analysis, and summarized. Subsequently, a direct qualitative content analysis of 69 interviews with healthcare leaders and healthcare professionals confirmed and added results from the literature review. Thirty-eight empirical cases from the six identified scoping and literature reviews met the inclusion and exclusion criteria. Barriers to and strategies for AI implementation were grouped under three phases of implementation (planning, implementing, and sustaining the use) and were categorized into eleven concepts; Leadership, Buy-in, Change management, Engagement, Workflow, Finance and human resources, Legal, Training, Data, Evaluation and monitoring, Maintenance. Ethics emerged as a twelfth concept through qualitative analysis of the interviews. This study illustrates the inherent challenges and useful strategies in implementing AI in healthcare practice. Future research should explore various aspects of leadership, collaboration and contracts among key stakeholders, legal strategies surrounding clinicians' liability, solutions to ethical dilemmas, infrastructure for efficient integration of AI in workflows, and define decision points in the implementation process.

Leveraging Artificial Intelligence for Expediting Implementation Efforts

Expedited implementation of evidence into practice and policymaking is critical to ensure the delivery of effective care and improve health-care outcomes. Implementation science deals with the designing of methods and strategies for increasing and facilitating the uptake of evidence into practice and policymaking. Nevertheless, the process of designing and selecting methods and strategies for implementing evidence is complicated because of the complexity of health-care settings where implementation is desired. Artificial intelligence (AI) has revolutionized a range of fields, including genomics, education, drug trials, research, and health care. This commentary discusses how AI can be leveraged to expedite implementation science efforts for transforming health-care practice. Four key aspects of AI use in implementation science are highlighted: (a) AI for implementation planning (e.g., needs assessment, predictive analytics, and data management), (b) AI for developing implementation tools and guidelines, (c) AI for designing and applying implementation strategies, and (d) AI for monitoring and evaluating implementation outcomes. Use of AI along the implementation continuum from planning to delivery and evaluation can enable more precise and accurate implementation of evidence into practice.

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.

A Review of the Role of Artificial Intelligence in Healthcare

Artificial intelligence (AI) applications have transformed healthcare. This study is based on a general literature review uncovering the role of AI in healthcare and focuses on the following key aspects: (i) medical imaging and diagnostics, (ii) virtual patient care, (iii) medical research and drug discovery, (iv) patient engagement and compliance, (v) rehabilitation, and (vi) other administrative applications. The impact of AI is observed in detecting clinical conditions in medical imaging and diagnostic services, controlling the outbreak of coronavirus disease 2019 (COVID-19) with early diagnosis, providing virtual patient care using AI-powered tools, managing electronic health records, augmenting patient engagement and compliance with the treatment plan, reducing the administrative workload of healthcare professionals (HCPs), discovering new drugs and vaccines, spotting medical prescription errors, extensive data storage and analysis, and technology-assisted rehabilitation. Nevertheless, this science pitch meets several technical, ethical, and social challenges, including privacy, safety, the right to decide and try, costs, information and consent, access, and efficacy, while integrating AI into healthcare. The governance of AI applications is crucial for patient safety and accountability and for raising HCPs' belief in enhancing acceptance and boosting significant health consequences. Effective governance is a prerequisite to precisely address regulatory, ethical, and trust issues while advancing the acceptance and implementation of AI. Since COVID-19 hit the global health system, the concept of AI has created a revolution in healthcare, and such an uprising could be another step forward to meet future healthcare needs.

Data Science Implementation Trends in Nursing Practice: A Review of the 2021 Literature

OBJECTIVES

The goal of this work was to provide a review of the implementation of data science-driven applications focused on structural or outcome-related nurse-sensitive indicators in the literature in 2021. By conducting this review, we aim to inform readers of trends in the nursing indicators being addressed, the patient populations and settings of focus, and lessons and challenges identified during the implementation of these tools.

METHODS

We conducted a rigorous descriptive review of the literature to identify relevant research published in 2021. We extracted data on model development, implementation-related strategies and measures, lessons learned, and challenges and stakeholder involvement. We also assessed whether reports of data science application implementations currently follow the guidelines of the Developmental and Exploratory Clinical Investigations of DEcision support systems driven by AI (DECIDE-AI) framework.

RESULTS

Of 4,943 articles found in PubMed (NLM) and CINAHL (EBSCOhost), 11 were included in the final review and data extraction. Systems leveraging data science were developed for adult patient populations and were primarily deployed in hospital settings. The clinical domains targeted included mortality/deterioration, utilization/resource allocation, and hospital-acquired infections/COVID-19. The composition of development teams and types of stakeholders involved varied. Research teams more frequently reported on implementation methods than implementation results. Most studies provided lessons learned that could help inform future implementations of data science systems in health care.

CONCLUSION

In 2021, very few studies report on the implementation of data science-driven applications focused on structural- or outcome-related nurse-sensitive indicators. This gap in the sharing of implementation strategies needs to be addressed in order for these systems to be successfully adopted in health care settings.

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.

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.

Artificial Intelligence Applications in Health Care Practice: A Scoping Review (Preprint)

Background

Artificial intelligence (AI) is often heralded as a potential disruptor that will transform the practice of medicine. The amount of data collected and available in health care, coupled with advances in computational power, has contributed to advances in AI and an exponential growth of publications. However, the development of AI applications does not guarantee their adoption into routine practice. There is a risk that despite the resources invested, benefits for patients, staff, and society will not be realized if AI implementation is not better understood.

Objective

The aim of this study was to explore how the implementation of AI in health care practice has been described and researched in the literature by answering 3 questions: What are the characteristics of research on implementation of AI in practice? What types and applications of AI systems are described? What characteristics of the implementation process for AI systems are discernible?

Methods

A scoping review was conducted of MEDLINE (PubMed), Scopus, Web of Science, CINAHL, and PsycINFO databases to identify empirical studies of AI implementation in health care since 2011, in addition to snowball sampling of selected reference lists. Using Rayyan software, we screened titles and abstracts and selected full-text articles. Data from the included articles were charted and summarized.

Results

Of the 9218 records retrieved, 45 (0.49%) articles were included. The articles cover diverse clinical settings and disciplines; most (32/45, 71%) were published recently, were from high-income countries (33/45, 73%), and were intended for care providers (25/45, 56%). AI systems are predominantly intended for clinical care, particularly clinical care pertaining to patient-provider encounters. More than half (24/45, 53%) possess no action autonomy but rather support human decision-making. The focus of most research was on establishing the effectiveness of interventions (16/45, 35%) or related to technical and computational aspects of AI systems (11/45, 24%). Focus on the specifics of implementation processes does not yet seem to be a priority in research, and the use of frameworks to guide implementation is rare.

Conclusions

Our current empirical knowledge derives from implementations of AI systems with low action autonomy and approaches common to implementations of other types of information systems. To develop a specific and empirically based implementation framework, further research is needed on the more disruptive types of AI systems being implemented in routine care and on aspects unique to AI implementation in health care, such as building trust, addressing transparency issues, developing explainable and interpretable solutions, and addressing ethical concerns around privacy and data protection.

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.

Diversity of COVID-19 News Media Coverage across 17 Countries: The Influence of Cultural Values, Government Stringency and Pandemic Severity

The 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 one of the first known studies to operationalize news media diversity and examine its association with cultural values during the pandemic. We tracked the global diversity of COVID-19 coverage in a news media database of 12 billion words, collated from 28 million articles over 7000 news websites, across 8 months. Media diversity was measured weekly by the number of unique descriptors of 10 target terms of the pandemic (e.g., COVID-19, coronavirus) and normalized by the corpus size for the respective countries per week. Government Stringency was taken from the Oxford COVID-19 Government Response Tracker and cultural scores were taken from Hofstede's Cultural Values global database. Results showed that Media Diversity Rate increased 6.7 times over 8 months, from the baseline period (October-December 2019) to during the pandemic (January-May 2020). Mixed effects modelling revealed that higher COVID-19 prevalence rates and governmental stringency predicted this increase. Interestingly, collectivist cultures are linked to more diverse media coverage during COVID-19. It is possible that news outlets in collectivist societies are motivated to present a diverse array of topics given the impact of COVID-19 on every segment of society. Of broader significance, we provided a framework to design targeted public health communications that are culturally nuanced.

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.

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 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.