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Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (6 April 2023) | Viewed by 19642

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Special Issue Editors

Prof. Dr. Aviad Tur-Sinai

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Guest Editor

Department of Health Systems Management, The Max Stern Yezreel Valley College, 1930600 Jezreel Valley, ‎Israel
Interests: financing health expenses among older adults; retirement patterns; older adults’ financial quality of life
Special Issues, Collections and Topics in MDPI journals

Dr. Giovanni Lamura

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Guest Editor

IRCCS INRCA—National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, 60124 Ancona, Italy
Interests: international research on family and long-term care; migrant care work; interdisciplinary research on ageing
Special Issues, Collections and Topics in MDPI journals

Dr. Alexandra Lopes

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Guest Editor

Department of Sociology, University of Porto, 4099-002 Porto, Portugal
Interests: ageing and LTC; person-centered care; ageism; ageing and human rights

Special Issue Information

Dear Colleagues,

This Special Issue, Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective, seeks theoretical and empirical papers that deal with long-term care challenges at the local, national, and international level and possible strategies for addressing them. Submissions may investigate policy issues with regard to the role played by public and private (including profit and non-profit) stakeholders in this field and also analyze how dynamics and interactions may be changing to take into account the impact of the COVID-19 pandemic. Papers may also consider how worldwide phenomena like rising life expectancy and population aging might challenge societal arrangements and healthcare systems throughout the developed world. Longevity is one of the greatest achievements attained in the recent past due to scientific, social, and technological progress, and papers focusing on the analysis of longevity patterns and their relationships with health, social, and long-term care aspects are welcome. We particularly encourage authors to submit comparative papers and articles from low- and middle-income countries.

Among the topics that this Special Issue is willing to host are especially (albeit not exclusively) the following:

Longevity and long-term care needs
Informal care
Formal care
Migrant care work
Forgone interventions
Labor challenges in the health, social, and/or long-term care market
Health, social and/or long-term care inequalities among older adults and their families
Public vs. private (profit or non-profit) care service provision
Policy interventions and financing of health, social, and/or long-term care services
Costs of health, social, and long-term care services
Financial burden of care
Medical costs (e.g., for medication, treatments) and other economic components of care provision
Occupational hazards of care professions and the impacts of the pandemic on workers’ wellbeing
Prevention of infection spread in nursing homes
The role of technology in LTC and in the development of assisted environments
Quality of care
The impact of stereotypes and ageism in the management of COVID-19 in LTC facilities

Prof. Dr. Aviad Tur-Sinai
Dr. Giovanni Lamura
Dr. Alexandra Lopes
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

informal care
formal care
long-term care needs
migrant care work
health inequalities
quality of care
longevity
ageism
financing of health
medical costs

Published Papers (10 papers)

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Research

20 pages, 442 KiB

Open AccessArticle

What’s Your Pension Story? Women’s Perspectives during the COVID-19 Pandemic on Their Old-Age Pension Status, Past and Present

by Anat Herbst-Debby

Int. J. Environ. Res. Public Health 2023, 20(10), 5912; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20105912 - 22 May 2023

Viewed by 1347

Abstract

This study examines the present and retrospective views of mothers who are nearing or are at retirement age regarding their economic status, pension planning, and perceptions of state pension policy. The paper addresses gaps in the literature on the cross-intersections of employment history, vulnerable economic retirement status, and marital and parental status, thereby adopting a life course perspective. Based on in-depth interviews of thirty-one mothers (ages 59–72) during the COVID-19 pandemic, the findings revealed five themes—economic abuse: an unequal distribution of pension funds following divorce; regrets over past choices; COVID-19 and pensions; the state’s responsibility for old-age economic security; and knowledge is important, and I can help others. The study concludes that the majority of women at these ages perceive their current economic situation as a product of insufficient familiarity with pension plans, while voicing opinions about the state’s irresponsibility regarding people of retirement age. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

17 pages, 634 KiB

Open AccessArticle

Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China

by Changyong Yang, Jianyuan Huang and Jiahao Yu

Int. J. Environ. Res. Public Health 2023, 20(4), 3459; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043459 - 16 Feb 2023

Cited by 1 | Viewed by 1550

Abstract

Background: Long-term care (LTC) services help the elderly maintain their functional ability and live with dignity. In China, the establishment of an equitable LTC system is a primary focus of the current public health reform. This paper assesses levels of equality in resources for and utilization of LTC services between urban and rural areas and economic regions in China. Methods: We use social services data from the China Civil Affairs Statistical Yearbooks. Gini coefficients against elderly population size are calculated for the number of institutions, beds, and workers, and the concentration index (CI) against per capita disposable income is calculated for the number of disabled residents per 1000 elderly people and the number of rehabilitation and nursing services per resident. Results: The Gini coefficients against the elderly population in urban areas indicate relatively good equality. In rural areas, the Gini coefficients have increased rapidly from relatively low values since 2015. The CI values in both urban and rural areas are positive, indicating that utilization is concentrated in the richer population. In rural areas, the CI values for rehabilitation and nursing have remained above 0.50 for the last three years, implying high levels of income-related inequality. The negative CI values for rehabilitation and nursing services in urban areas in the Central economic region and rural areas in the Western region imply a concentration of resource utilization toward poorer groups. The Eastern region shows relatively high internal inequality. Conclusion: Inequalities exist between urban and rural areas in the utilization of LTC services, despite similar numbers of institution and bed resources. Resource distribution and healthcare service utilization are more equal in urban areas, creating a low level of equilibrium. This urban-rural split is a source of risk for both formal and informal LTC. The Eastern region has the largest number of resources, the highest level of utilization, and the greatest internal variation. In the future, the Chinese government should enhance support for the utilization of services for the elderly with LTC needs. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

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10 pages, 328 KiB

Open AccessArticle

Depression and Medicine Use among Older Adults during the COVID-19 Pandemic: The Role of Psychosocial Resources and COVID-19 Perceived Susceptibility

by Lee Greenblatt-Kimron, Shiri Shinan-Altman, Mordechai Alperin and Inbar Levkovich

Int. J. Environ. Res. Public Health 2023, 20(4), 3398; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043398 - 15 Feb 2023

Cited by 2 | Viewed by 1052

Abstract

A relationship was found between the COVID-19 pandemic and depression among older adults and between depressed mood and increased use of antidepressant medication among older adults during the pandemic. With the aim of broadening the understanding of these relationships, the study examined whether COVID-19 perceived susceptibility mediates the relationship between psychosocial resources (optimism and perceived social support) and depressive symptoms and medication use. Participants included 383 older adults (M = 71.75, SD = 6.77) reporting on socio-demographics, health characteristics, depression, optimism, social support, and COVID-19 perceived susceptibility. Medication use was retrieved from participants medical files. Lower optimism, lower social support, and higher COVID-19 perceived susceptibility were associated with greater depression, related with higher medication use. The findings emphasize the buffering effect of psychosocial resources on the adverse effects of depression affecting older adults during the COVID-19 pandemic, and consequently, the increased use of medication in this population. Practitioners should focus interventions on enhancing optimism and expanding social support among older adults. Moreover, interventions focused on alleviating depression among older adults should aim at improving perceptions of perceived susceptibility in the older population. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

12 pages, 580 KiB

Open AccessArticle

Long-Term Care and the State-Family Nexus in Italy and Japan—The Welfare State, Care Policy and Family Caregivers

by Rie Miyazaki

Int. J. Environ. Res. Public Health 2023, 20(3), 2027; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20032027 - 22 Jan 2023

Cited by 2 | Viewed by 1663

Abstract

This study aims to identify the state–family nexus in long-term care (LTC) provision for older adults in Italy and Japan which have been considered to be a familialistic welfare state and the most ageing societies in the world. Based on the more developed theoretical approach of the familialism–defamilialization continuum of care, represented by Saraceno (2016), the public policy systems as well as the LTC provision and the work–LTC reconciliation of family caregivers in particular, were compared between Italy and Japan. While both countries have lower level of institutional care, and particularly high proportions of family caregivers with relatively heavy care burdens, the share of cash-based and home care as well as the age range and family relationship of family caregivers significantly differ. Focusing on the peculiarities of LTC that the state–(market)–family cannot always be clearly separated, this study identified that the size of public expenditure, i.e., the role of the state does not immediately lead to a defamililization of care. This can contribute to the policy making for care provision and work–LTC reconciliation in several countries that will become super-aging societies in the coming decades. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

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15 pages, 696 KiB

Open AccessArticle

Social Innovation in Home-Based Eldercare: Strengths and Shortcomings of Integrating Migrant Care Workers into Long-Term Care in Tuscany

by Marlene Seiffarth and Giulia Aureli

Int. J. Environ. Res. Public Health 2022, 19(17), 10602; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191710602 - 25 Aug 2022

Cited by 2 | Viewed by 1547

Abstract

Italy is one of the main receiving countries of migrant care workers in Europe. Its migrant-in-the-family model has developed since the 1990s, and, today, home-based eldercare is unimaginable without the work of the almost one million care workers employed in private households, of whom over 75% are migrants. Despite forming one of the most important pillars of eldercare provision in the country, the employment of migrant care workers is not addressed in national policy. However, regional policymaking is far from inactive in the face of growing gaps in care as regions and municipalities play a crucial role in regulating, organising, and providing eldercare. With a focus on comprehensive solutions, cross-sector collaborations, and interactive learning processes, social innovation becomes an important element in reforming eldercare in the context of institutional inertia, fragmentation, and permanent austerity. In what ways are regions using social innovation to respond to challenges in eldercare provision and integrate migrant care workers? This study is based on interviews with experts from the region of Tuscany, which is running the project Pronto Badante (emergency care worker). The results suggest several advantages of local interventions breaking with the institutional silo mentality, as well as ongoing challenges regarding the impact and sustainability of these interventions. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

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29 pages, 471 KiB

Open AccessArticle

The Impact of COVID-19 on the Health and Experience of the Carers of Older Family Members Living with Dementia: An Italian–Hungarian Comparative Study

by László Árpád Kostyál, Zsuzsa Széman, Virág Erzsébet Almási, Paolo Fabbietti, Sabrina Quattrini, Marco Socci and Cristina Gagliardi

Int. J. Environ. Res. Public Health 2022, 19(9), 5329; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19095329 - 27 Apr 2022

Cited by 4 | Viewed by 1855

Abstract

This quantitative study (n = 370) compares the pandemic-related experiences of the family carers of older people living with dementia during the first wave of the pandemic, in two countries with different care regimes: Italy (Mediterranean) and Hungary (Eastern European). It aims at answering the following research questions: (1) How did the pandemic affect the subjective health of carers, and what were their experiences with care-related worries and workload? (2) What factors significantly predicted negative changes in these experiences? (3) What were carers’ main difficulties during the first pandemic wave? Results have shown that carers in both samples reported a worsening in mental health (Italy/Hungary: M = 2.25/2.55, SD = 0.93/0.99), and Italian carers also in general health (M = 2.54, SD = 0.98) (on a scale of 1 to 5, with values under “3” representing deterioration). Carers in both samples experienced high worry levels (Italy/Hungary: M = 4.2/3.7, SD = 0.93/0.89) and feeling overwhelmed with care tasks (M = 3.2/3.7, SD = 1.3/1.3) (on a scale of 1 to 5, higher values representing higher worry/work overload). In regression models, all of the above negative experiences were predicted by a combination of factors. Two of these factors stood out in importance due to being a predictor of more than one type of negative experience: a decline in the carer–care receiver relationship, predicting work overload, as well as general and mental health deterioration and being the child of the care receiver, predicting both high worry and subjective work overload. The top five encountered problems were the unavailability of medical and social care, difficulties with shopping (medicine included), restricted freedom, isolation, and anxiety. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

25 pages, 453 KiB

Open AccessArticle

Role and Characteristics of Personal Care Assistants of Frail Older People with Functional Limitations Ageing in Place in Italy

by Maria Gabriella Melchiorre, Sabrina Quattrini, Giovanni Lamura and Marco Socci

Int. J. Environ. Res. Public Health 2022, 19(7), 3969; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19073969 - 26 Mar 2022

Cited by 4 | Viewed by 1890

Abstract

When older people become frail with functional limitations, and age alone in place, caring support is fundamental for performing daily living activities. The present study aimed to explore the current role and characteristics of privately hired Personal Care Assistants (PCAs) of older people in Italy, in light of the decreasing care availability of the family and the low provision of public services. In the study “Inclusive ageing in place” (IN-AGE), 120 qualitative interviews were carried out in 2019, involving frail older people living at home in three Italian regions: Lombardy, Marche, and Calabria. A content analysis was conducted, in addition to some simple quantifications of statements. Results showed the support of PCAs in 27 cases, mainly when health issues of seniors were referred. In addition, informal and irregular employment contracts were reported. Moreover, a comparison between PCA and Domestic Home Help (DHH, 44 cases), highlighted how they even more provide very similar functions (i.e., home and personal care). The role of PCA emerged as crucial in Italy, especially in the South. Thus, to boost up home services seems necessary for allowing ageing in place, also by integrating PCAs in formal public Long-Term Care (LTC), and by providing incentive systems for regular hiring. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

17 pages, 1034 KiB

Open AccessArticle

Cessation of Care for Frail Older Adults: Physical, Psychological and Economic Outcomes for Family Carers

by Aviad Tur-Sinai, Dafna Halperin, Nissim Ben David, Ariela Lowenstein and Ruth Katz

Int. J. Environ. Res. Public Health 2022, 19(6), 3570; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063570 - 17 Mar 2022

Cited by 4 | Viewed by 1654

Abstract

Global population aging and increased longevity are making family care a nearly universal experience. Caregiving is a dynamic process that varies over time and in intensity but often takes a physical and emotional toll on carers and may inflict financial costs by attenuating their labor market participation. The study explores the implications of the ‘cessation of care’ of frail elders by adult (middle-aged and older) kin by comparing two ethnic groups in Israel with respect to their health and their psychological and economic life. Using secondary data analyses based on SHARE-Israel data for persons aged 50+, it is found that subjective health assessment and financial capability are significantly higher among those who stop providing care than among those who continue to do so, while carers report a downturn in life satisfaction after they stop giving care. Those who continue are younger than the others, and their labor force participation rate is higher. Significant implications of cessation of care for all three areas studied—psychological, health, and economic—are found as well: the subjective rating of health and financial capability improve whereas life satisfaction decreases. Furthermore, a cessation of care moderates the relation between individuals’ age and their self-rated health, which is better among those who continue to provide care. These results emphasize and deepen our understanding of the cessation-of-care phase as a key component of the process of care for frail older adults by family members. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

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15 pages, 817 KiB

Open AccessArticle

International Comparison of Social Support Policies on Long-Term Care in Workplaces in Aging Societies

by Koji Kanda, Hirofumi Sakurazawa and Takahiko Yoshida

Int. J. Environ. Res. Public Health 2022, 19(6), 3284; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063284 - 10 Mar 2022

Cited by 3 | Viewed by 2344

Abstract

A decrease in the working-age population in aging societies causes a shortage of employees in workplaces due to long-term care (LTC) leave for family and relatives as well as longer working hours or overwork among those remaining in the workplace. We collected and analyzed literature and guidelines regarding social-support policies on LTC in workplaces in seven countries (Canada, France, Germany, Japan, Sweden, the UK, and the USA) to propose an effective way of occupational health support for those in need. Our analysis indicated the existence of a system that incorporates the public-assistance mechanism of providing unused paid leave to those in need. Additionally, recipients of informal care provided by employees tended to expand to non-family members under the current occupational health system. On the other hand, the health management of employees as informal caregivers remained neglected. Likewise, salary compensation and financial support for LTC-related leave need to be improved. In order to monitor and evaluate the progress and achievement of current legal occupational health systems and programs related to the social support of LTC among employees, the available national and/or state-based quantitative data should be comparable at the international level. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

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14 pages, 1791 KiB

Open AccessArticle

Italian Adolescent Young Caregivers of Grandparents: Difficulties Experienced and Support Needed in Intergenerational Caregiving—Qualitative Findings from a European Union Funded Project

by Barbara D’Amen, Marco Socci, Mirko Di Rosa, Giulia Casu, Licia Boccaletti, Elizabeth Hanson and Sara Santini

Int. J. Environ. Res. Public Health 2022, 19(1), 103; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19010103 - 23 Dec 2021

Cited by 4 | Viewed by 3108

Abstract

The article aims to describe the experiences of 87 Italian adolescent young caregivers (AYCs) of grandparents (GrPs), with reference to the caregiving stress appraisal model (CSA) that provides a theoretical lens to explore the difficulties encountered and support needed in their caring role. Qualitative data were drawn from an online survey conducted within an EU Horizon 2020 funded project. An inductive thematic analysis was carried out, and the findings were critically interpreted within the conceptual framework of the CSA model. The analysis highlighted three categories of difficulties: material, communication and emotional/psychological. The most common material difficulty was the physical strain associated with moving “uncooperative” disabled older adults. The types of support needed concerned both emotional and material support. The study provides a deeper understanding of the under-studied experiences of AYCs of GrPs. Based on these findings, policies and support measures targeted at AYCs of GrPs should include early needs detection, emotional support and training on intergenerational caring in order to mitigate the stress drivers. Moreover, the study advances the conceptualisation of the CSA model by considering the above-mentioned aspects related to intergenerational caregiving. Full article

(This article belongs to the Special Issue Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective)

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Tackling Long-Term Care Needs in Ageing Societies in (Post) Pandemic Times: Multidisciplinary Research Approaches in an International Perspective

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