Journal of Aging & Social Policy

Can ChatGPT Provide Useful Guidance to Assess the Current State of and Future Priorities for Aging Research in the Social Sciences?
Wieczorek M, Kliegel M, Beard J, Guillemin F, Avendano M and Maurer J
The multifaceted implications of global population aging require regular assessments of the current state of aging-related social science research and the identification of potential future research priorities in this important area. Given the multi-, inter-, and transdisciplinary nature of this field, such assessments typically require the involvement of experts from diverse backgrounds to ensure a comprehensive picture and to synthesize understudied and newly emerging topics into a future research agenda. We explored to what extent ChatGPT (version GPT-4, OpenAI) might be a useful tool for synthesizing the current state of research and identifying promising future research areas, which could feed into expert panel discussions for priority setting. ChatGPT proposed a long list of topics and specific research questions that are useful in summarizing current views on research priorities across diverse sources. To illustrate, the top five priorities for future aging research identified by ChatGPT were digital integration, climate change and older populations, mental health and aging, aging in diverse contexts, and post-pandemic aging. In conclusion, ChatGPT may be a useful tool for identifying research agenda priorities across organizations present in the web, but the lack of transparency requires that experts critically evaluate the values and views underlying selected priorities.
The Connection of Place, Routine Activity, and Financial Exploitation of Older Adults in a Large Retirement Community
Brancale JN, Blomberg TG and Beaver KM
Financial exploitation of older adults is a rapidly growing social problem, and research in this area has largely focused on individual-level risk factors with the role of the community not considered. Given the rapid expansion of retirement communities across the United States, these areas may be emerging as hotspots for financial exploitation. This study presented officially reported administrative trend data on reported cases of financial exploitation and analyzed focus group and interview data collected from 80 residents of a large retirement community to assess the self-reported role of the community on older adults' financial exploitation experiences and perceptions of risk. Study participants overwhelmingly expressed that they were targeted for financial exploitation immediately and repeatedly after moving into the retirement community and much more frequently than they had experienced before moving. Participants believed they were seen as vulnerable targets and adequate protection measures were not implemented by the retirement community's management. Retirement community managers and local criminal justice officials should recognize that residents of retirement communities may be at risk for financial exploitation and implement prevention and response strategies.
Relationship Between Primary Caregiving Type and a Peaceful End-Of-Life Experience Among Older Adults in China
Gong X, Wang X, Qi X and Wu B
Few studies have compared pain management provided by informal and formal caregivers of older adults in China at the end of life. This study aims to address this gap by investigating the association between formal and informal care and painfulness at the end of life among older adults in China. Specifically, the study focuses on the influence of various types of informal care. Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted from 2002 to 2018, which is the largest nationally representative study of older adults in China, with a sample size of 21,849 deceased participants. Results from multiple logistic regressions suggest that informal care is associated with a more painful end-of-life experience compared to formal care, with care provided by adult children being a more favorable option within informal care. These findings underscore the urgent need to prioritize education on death and dying, improve the formal care system, and enhance professionalism within informal care.
The Different Aspects of the Housing Quality of Older Adults: Which Criteria Should Be Prioritized?
Sendi R, Filipovič Hrast M, Šeme A and Kerbler B
Various studies have identified that older adults' assessment of their housing quality differs from that deemed as good-quality housing by housing professionals. This has prompted the need to advance academic discourse beyond simply reporting high levels of satisfaction in older adult's housing surveys. This study attempts to achieve this by using empirical data gathered through a mixed quantitative and qualitative research approach conducted with older adults in Slovenia. While the quantitative survey revealed generally high levels of satisfaction, the qualitative face-to-face interviews revealed numerous deficiencies, irrespective of whether older adults tended to express satisfaction with their dwellings. Therefore, our findings suggest that attributes such as ownership, period of residence, and neighborhood relations are far more important in determining housing satisfaction. Thus, we conclude that policies and programs for modifying housing for older adults must be based on a deeper understanding of their specific needs. During the policy formulation process and the implementation of specific housing improvement programs, emphasis should be placed on the social-historical aspects related to the lifestyle of each specific older adult.
Telehealth Challenges, Opportunities, and Policy Recommendations for Rural Older Adults Living with HIV in the United States
O'Neil AM, Quinn KG, Algiers OH, John SA, Hirshfield S, Kallies KJ, Petroll AE and Walsh JL
Over one million people in the United States (U.S.) are living with HIV. People living with HIV in the rural South experience delayed HIV treatment and increased mortality risks. Access challenges and HIV stigma exacerbate care disengagement for rural people living with HIV (PLH). This study examines the applicability and feasibility of telehealth to provide HIV care for older adults in the rural U.S. South. Semi-structured interviews were conducted with 27 key informants with expertise in HIV care and community engagement in high rural HIV burden states. Results indicate that telehealth challenges exist for older rural PLH to receive HIV care, such as lack of internet access and low technology literacy. Phone calls can be a simple and effective telehealth option for older rural PLH, as they align with their care preferences, mitigate care barriers, and show promise increasing care engagement. When warranted, complex telehealth options for older rural PLH require tailored approaches, such as portable medical instruments allowing real-time data sharing during home visits or tablet distribution from the clinic. Findings suggest that policy makers and providers support the reimbursement and use of audio-only telehealth services, expand broadband infrastructure and affordability in rural areas, and implement tailored telehealth interventions.
Elder Caregiving Frequency, Labor Force Participation, and Work
Forden J
Unpaid eldercare provided by family comes with costs to caregivers, including the limitations eldercare responsibilities may place on labor force participation and work hours. This study examines the relationship between the frequency of unpaid eldercare and work behavior for previously full-time workers using multivariate regression and 2011-2018 American Time Use Survey data. High-frequency eldercare provision is associated with a decreased probability of being in the labor force for both men and women, and 5.5 fewer weekly hours worked for men ages 25-49, conditional on working full time 2-5 months prior. Policymakers should consider the relationship between work and unpaid caregiving for high-frequency caregivers in addressing growing care demand.
Factors Affecting Managers' Technology Adoption Decisions in Long-Term Care Homes: A Canadian Exploratory Study Post-COVID-19 Pandemic
Cruise D, Jaana M, Sinden D and Garcia L
Health information technologies (HIT) provide opportunities to support staff as well as residents and their families in long-term care (LTC) homes. Yet, LTC homes lag behind other healthcare organizations in HIT adoption, and little is known about the factors that inform and shape LTC home managers' decisions. We conducted an exploratory Delphi study with a panel of 19 Canadian LTC managers who were surveyed through three iterative rounds (brainstorming, narrowing down, and ranking) to solicit their input on the key factors that influence HIT adoption decisions. An authoritative list of 25 factors, described and ranked in importance, was produced. The top five identified factors were (in order of importance): availability of funding, impact on workload and efficiency, value proposition, ease of use, and impact on residents' outcomes. The findings of this research may inform policies and interventions that provide training and workshop opportunities for managers in LTC and increase the awareness of the advocacy and leadership role that managers can play in advancing technology adoption in support of older adults' care. The results can also be used to support funding from LTC home governing bodies, which is tied to the technology adoption portfolio, to institutionalize the commitment to technological transformation in LTC.
Health Effect of Elderly Family Planning Subsidy on Older Chinese with Only One Child
Lu P, Kong D, Shelley M and Li C
The decades-long one-child policy in China has led to a growing number of older individuals with only one child. The Elderly Family Planning Subsidy (EFPS) policy was introduced to provide extra financial support to this group and was expanded nationwide in 2012. This study investigated the relationship between EFPS use and health among EFPS-eligible older Chinese using data from the China Health and Retirement Longitudinal Study. A total of 1,981 respondents were eligible for EFPS (i.e. aged 60 and above, had only one child, or were rural residents with two daughters). Respondents self-reported if they received EFPS in 2011, 2013, and 2015 and were followed up to 2018. Propensity score matching was used to match EFPS non-users with users based on their probability of using EFPS. Among the EFPS-eligible respondents, 256 (12.92%) used the benefit. Analysis revealed no significant differences between EFPS users and non-users with respect to mortality and other health outcomes (i.e. self-reported health, cognition, activities of daily living, chronic diseases, and depressive symptoms). Findings do not provide evidence that EFPS improved the short-term health of older Chinese with only one child.
Whether Pension Program Stimulates the Consumption of Addictive Products: Evidence from China's New Rural Pension Scheme
Li X, Wang Y, Xuan Z and Zhao Q
Much attention has been paid to evaluating the policy effects of pension programs, but few studies have focused on possible inefficiencies stemming from their implementation. Drawing on a quasi-natural experiment associated with the adoption of China's New Rural Pension Scheme (NRPS), this study explores the impact of the NRPS on food consumption among rural residents. A difference-in-differences (DID) analysis is performed using panel data from the 2009 and 2013 National Rural Fixed Observation survey. Results show that participation in the NRPS improves residents' dietary quality by increasing the consumption of recommended foods and decreasing the consumption of non-recommended foods. However, the results also show that the NRPS is associated with increased consumption of addictive and unhealthy products, especially in households with lower average levels of education, poorer self-reported health, and older adults over age 60. Findings suggest that when examining the possible health effects of new pension policies, it is essential to account for potential increases in the intake of unhealthy and addictive products, such as cigarettes and alcohol.
Aging Well? Exploring Self-Reported Quality of Life in the Older Austrian Population Based on Repeated Cross-Sectional Data
Felsinger R, Mayer S, Haidinger G and Simon J
Increase in life expectancy around the world puts aging societies with all their challenges on the Global Public Health agenda. In Austria, additional years of life gained are not spent in good health, as healthy life expectancy is far below the European average. Using repeated cross-sectional data from three waves of the Austrian Health Interview Survey (2006, 2014 and 2019), including a total of 10,056 participants aged 65 years and above, this study examined the change in self-reported quality-of-life (QoL) over time and explored associated factors. QoL, estimated by domain scores of the WHOQOL-BREF questionnaire, increased over time but decreased with age in all survey waves. Observed mean scores were significantly higher in males than in females in all QoL domains except the social domain but sex differences disappeared in most domains in the multivariable regression analyses. Instead, factors associated with significantly higher QoL scores included younger age, higher socioeconomic status, living in Western Austria and having no chronic conditions. Statistically significant observed sex differences in QoL in the older-aged Austrian population disappeared when adjusting for income and education. Strategies and measures to increase financial capabilities may have a significant impact on QoL and well-being in this age group.
Inequalities in Unmet Needs for Healthcare Services Among Middle-Aged and Older Adults in China
Wang Y, Wang X and Ye X
Unmet needs for healthcare services are widely recognized as an indicator of inequalities in healthcare access and utilization. This study estimated inequalities in unmet needs for healthcare services as well as their contributing factors and reasons among middle-aged and older adults in China. Results indicated that 30.47% and 5.69% of the middle-aged and older population in China reported unmet needs for outpatient and inpatient services, respectively. Mostly pro-poor inequalities concerned unmet needs for both rural and urban residents. The coverage of public health insurance and individuals' health status contributed most to the inequalities in the unmet needs identified. The most prevalent reason for unmet needs was affordability, especially for poor or rural respondents. Despite the rapid development of universal healthcare, unmet needs for healthcare services still existed and remained high among people living in rural areas and with low incomes in China. Policy interventions should focus on improving the public health insurance system and targeting financial barriers to obtaining care, particularly vulnerable populations in China.
What is the Relationship Between Older People's Housing Characteristics and Their Care Needs?
Brimblecombe N, Stevens M, Rajagopalan J, Hu B, Cartagena Farias J and Pharoah D
Housing conditions and quality are well-established structural or social determinants of health. Poor quality housing also has the potential to affect care needs, but there is much less research on the topic, particularly on nonspecialist housing. Based on analysis of in-depth interviews with 44 people aged 65 and older living in England, their unpaid carers ( = 22), or as a carer-care recipient dyad ( = 6), (total  = 72), this study sought to explore the perceived relationship between people's housing conditions and characteristics and their care needs. Findings indicate three key themes within this relationship: condition of home (cold and damp; state of repair; cleanliness and clutter); space and design (space, access); and legal relationship with the home (ability to carry out remedial work; precarity). There was variation in how and whether housing affected care needs by housing tenure, financial resources, and the type and level of care need. Care needs can increase requirement for warmer, less damp homes and be a barrier to improving homes. In turn, housing has a role to play in preventing the occurrence or worsening of care needs. Improving housing through policy and practice actions could reduce care needs and improve the lives of older people now and in the future.
Conundrums in Implementing Consumer Direction in Home-Based Care: Perspectives of Older Adults and Family Members in China
Zhang J, Wang JS, Chan WK, Chen Y and Lan D
Consumer-directed care (CDC) for older people enables clients to arrange personalized services and improves their well-being. However, little is known about clients' preferences for policies in collectivist cultures. We investigate the views of older clients and family members about policies that promote consumer direction in a collectivist cultural setting - Guangzhou, China. Using semi-structured interviews, we recruited older persons and their family members ( = 24) in 2021. Inductive thematic analysis was employed. Two themes emerged. The first theme, the need for flexibility in utilizing benefits, includes the need for: 1) flexibility in selecting care workers; 2) autonomy in choosing budget management agents; 3) flexibility in selecting care-related goods; and 4) adequate and equitable benefits. The second theme, the need for professional support, contains the need for: 1) information and support; and 2) individualized training for care workers. Similar to those in individualistic cultures, people in collectivist environments desire autonomy and choice in service arrangements. However, the welfare and preferences of family members, rather than clients, may be prioritized by family members when making care decisions. Adapting CDC to collectivist cultures requires navigating between client preferences and family preferences.
Perceived Housing Problems and Depressive Symptoms Among Middle-Aged and Older Americans
Lu P, Kong D and Shelley M
Housing insecurity has been shown to be associated with worse mental health. However, previous studies mostly examined one aspect of housing insecurity (e.g., affordability), and few focused on older adults. This study examined the relationship between perceived housing problems and depressive symptoms among middle-aged and older Americans. Data from the Health and Retirement Study between 2006 and 2018 were used. A total of 7,119 respondents (aged 50+ at baseline in 2006) were followed up every 4 years. Respondents self-reported the status, severity, and duration of their housing problems. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression Scale. Mixed-effect models examined the association between perceived housing problems and depressive symptoms. Results show about 5%-7% of respondents had housing problems during every study visit and 5.73% of them experienced persistent housing problems over 12 years. Having housing problems was associated with a higher risk of depressive symptoms (incidence risk ratio = 1.29, 95% CI = 1.23, 1.36). A dose-response relationship was observed in the severity and duration of housing problems, with a greater increase of depressive symptoms risk among those experiencing more severe or prolonged housing problems. The dose-response pattern highlighted the importance of early intervention and persistent assistance to those experiencing housing problems.
'They Don't Want to Label It': Insights from Communities Not Enrolled in the Network of Age-Friendly States and Communities
Gleason SR, Oh P, Coyle C and Somerville C
More than 800 municipalities and 11 states and territories in the United States have joined the Network of Age-Friendly States and Communities (NAFSC); however, to our knowledge, no studies have examined the many communities that have not joined. The present study explored the factors that inhibit communities from joining the NAFSC. Data were drawn from semi-structured interviews conducted with 12 community leaders in Massachusetts and Maine. Results indicated variation in perceptions and attitudes, with some participants seeing benefits to joining but encountering barriers to doing so, while others did not see sufficient benefit to joining to make the effort worthwhile. Key themes included lack of human and financial capacity, concerns over aspects of the NAFSC model, and desire to maintain local control over the process and components of age-friendly efforts. Participants voiced a need for funding and technical assistance in order to expand their age-friendly work.
Racial and Ethnic Disparities in the Effects of COVID-19 on Employment Disruption and Financial Precarity
Carpenter R, Carr DC, Cao QK and Sonnega A
Previous research shows that minoritized (i.e. Black and Hispanic) older workers are more likely to work in jobs subject to employment disruptions and negative economic outcomes, including job and wage loss. Of the studies that have examined the pandemic-related employment and financial outcomes of minoritized older workers, few studies have accounted for the role that pre-COVID-19 financial precarity (i.e. ongoing financial strain) might play in post-COVID-19 financial precarity. Using data from the Health and Retirement Study, we evaluate the racial/ethnic differences in post-COVID-19 employment disruption and financial precarities among workers 51 years and older ( = 708 to 2,812 respondents depending on the outcome measure). Ordinary Least Squares regression and moderation analyses show that older Black and Hispanic workers were more likely to experience post-COVID-19 employment disruption and associated financial precarities (e.g. missed rent/mortgage payment). Furthermore, the consequences of preexisting financial precarity differed by race/ethnicity. Non-Hispanic white older workers without pre-COVID-19 financial precarity were uniquely protected from post-COVID-19 financial precarity, whereas Black and Hispanic older workers were more likely to experience post-COVID-19 financial precarity even in the absence of pre-COVID-19 precarity. Findings suggest that multi-level policies and interventions need to address structural inequity contributing to minoritized older workers' financial vulnerability during crises.
Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index
Huan T, Intrator O, Kind AJ, Hartronft S and Kinosian B
Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.
The Impact of Age-Based COVID-19 Pandemic Regulations on Older People in Turkey: A Capability Approach
Con Wright G and Özdemir Ocaklı B
Older adults all around the world encountered numerous challenges during the COVID-19 pandemic. Some of these challenges were pertinent to biological factors, like the risk of infection, while others resulted from social factors, like ageism and government regulations. Employing a capability approach, this study examined how age-based pandemic regulations that were imposed in Turkey affected the freedom and social environment of older adults. We used Bachhi's What is the Problem Represented to Be? (WPR) approach to analyze the memorandums issued by the central government between March 11, 2020, and June 30, 2021. Our analysis revealed that the problem is represented in these memorandums as older people's increased vulnerability to health risks, which resulted in violations of their mobility and health capabilities, as well as (mis)recognition of diversity within the older population. These findings provide vital insight into how age-based pandemic regulations define the problem based exclusively on chronological age, thereby creating circumstances that compromise older people's capabilities beyond simply maintaining health. Thus, we recommend that policymakers pay closer attention to both the intended and unintended consequences of any proposed regulations, and account for individuals' rather than merely their
Does Social Support Alleviate the Caregiving Burden of Adult Children? Evidence from Chinese Long-Term Care Insurance Pilot Program
Li S, Zhang L and Fang Y
In China, and many other developed nations, public long-term care insurance (LTCI) is a commonly adopted approach to meet long-term care needs, but its impact on the burden of family caregivers remains uncertain. This study investigated whether a parent having LTCI alleviates the caregiver burden for the adult child caregiver. Data derived from the 2011, 2013, and 2018 China Health and Retirement Longitudinal Study ( = 4595 adult child caregivers). Guided by the stress-appraisal model, Difference-in-Difference (DID) methods were used to investigate the spillover effects of LTCI on caregiver stressors and burden. The results show that having public LTCI in place in a location is associated with reduced caregiver burden among adult child caregivers through its effects on secondary stressors (wealth, health, and sleep problems) and hours of caregiving. Findings suggest that the LTCI is an effective form of social support for aiding family caregivers and alleviating their burden.
Mass Media Exposure Moderates the Association of Education and Wealth with Enrollment in Health Insurance Among Older Adults Aged 60 Years and Older in India
Barman P, Karmakar R, Roy A and Dakua M
Mass media exposure (MME) plays an important role in changing health-related behavior or decision-making. This study aimed to examine the association of MME with enrollment in health insurance and its moderating effect on the associations of education and wealth with enrollment in health insurance among older adults in India. The data of 29,935 older adults aged 60 years and older from the first wave (baseline) of the Longitudinal Ageing Study in India (LASI-2017/18) were utilized. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and Fairlie decomposition were used. The findings revealed that 18.3% of older adults had MME and enrollment in health insurance in India. Older adults with MME were 1.42 times more likely to be enrolled in health insurance than those with no MME, and years of schooling increased the probability of enrolling in health insurance compared to those who did not have formal schooling. With increasing monthly per capita expenditure (MPCE), the probability of enrolling in health insurance is lower than the poorest. Further, MME moderates the effects of education and MPCE on enrollment in health insurance and increases the likelihood of enrollment in health insurance. The study's findings imply strategic communication plans to encourage health insurance enrollment in India should take into account the usage of these communication channels.
Live-In Migrant Care Workers as Part of the Long-Term Care Workforce in Taiwan, Singapore, and Austria: Implications for Home-Based Dementia Care
Chiu HC and Yen CM
The demand for home-based eldercare, especially for those with dementia, has been growing as societies age; in this context, the acute shortage of local care labor has resulted in the use of migrant workers in many countries. Taiwan, Singapore, and Austria, all emphasizing the family's responsibility for eldercare, have long histories of recruiting migrant workers for home-based eldercare. However, cases of mistreatment of migrant caregivers and care recipients have aroused public concern regarding migrant workers' care capabilities and working conditions. Migrant caregivers have also reported that their lack of care skills and sufficient rest hamper their work with care recipients who have dementia. This commentary provides a critical review of the laws and policies pertaining to live-in migrant care workers' care capabilities and working conditions; the effects of such legal frameworks; and recent changes in Taiwan, Singapore, and Austria. This article enhances our cross-country understanding of the advantages and disadvantages of using foreign labor for eldercare in private homes. Governments should enact legislation that supports live-in migrant care workers' care capabilities and welfare, thereby also improving the well-being of care recipients and their families.