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Aging: Healthcare, Inequalities, Challenges and Trends

A special issue of Sustainability (ISSN 2071-1050). This special issue belongs to the section "Sustainability in Geographic Science".

Deadline for manuscript submissions: closed (6 December 2019) | Viewed by 39657

Special Issue Editor

Special Issue Information

One of the most important trends of the 21st century is the aging of populations, all the way from the local to the global scale. In nation after nation, the proportion of the population which is 60 years or older is now or will soon be greater than the proportion of the population under 15 for the first time. Population aging is, however, not a uniform process, geographically, socially or economically. This uneven process raises a multitude of questions for countries, including: Can age-friendly communities be created? What are the challenges in creating housing and care across the continuum of housing and care needs? Will the trend towards driverless cars increase mobility opportunities for older people or reduce them as driverless cars challenge public transport and taxi systems? How will an older population in the suburbs adapt to the challenges of aging in communities designed for families with children? How will governments support rural older populations where the absolute numbers of older people is small, but as a percentage of the total population, they are dominant? Health geographers, gerontologists, public policy researchers, and other social and health scientists who are carrying out research on aging are invited to submit their manuscripts on any aspects of aging of the population and the implications for healthcare, social systems, transportation, housing, etc. Research at any geographic scale and from any country or region will be considered for publication subject to peer review.

Prof. Mark Rosenberg
Guest Editor

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Keywords

  • population aging
  • healthcare
  • social systems
  • public policy

Published Papers (10 papers)

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Research

13 pages, 243 KiB  
Article
Social-Demographic Correlates of the Mental Health Conditions among the Chinese Elderly
by Wenjuan Du, Jiayi Zhou, Jianjian Liu, Xuhao Yang, Hanxu Wang, Meikun He, Zongfu Mao and Xiaojun Liu
Sustainability 2019, 11(24), 7114; https://0-doi-org.brum.beds.ac.uk/10.3390/su11247114 - 12 Dec 2019
Cited by 7 | Viewed by 2405
Abstract
Studies on psychological problems among the elderly were mainly conducted in developed countries, which may not fit China under the context of the dramatic changes of social environment. This study aims to assess the status and social-demographic determinants of the mental health among [...] Read more.
Studies on psychological problems among the elderly were mainly conducted in developed countries, which may not fit China under the context of the dramatic changes of social environment. This study aims to assess the status and social-demographic determinants of the mental health among the Chinese elderly. The Chinese version of the Symptom Checklist-90-R (SCL-90-R) was used to measure participants’ mental health. A logistic model was established to identify the main socio-demographic factors associated with the overall detection rate of SCL-90-R. The overall positive detection rate of SCL-90-R was 23.6%, and the four symptoms with the highest positive detection rate were somatization (39.5%), obsessive-compulsive disorder (28.1%), other poor mental health symptoms (mainly sleep and diet problems) (25.7%), and depression (25.1%). The results showed those aged 75–79 (OR = 0.640, 95% CI 0.452 to 0.905) and 80 or above (OR = 0.430, 95% CI 0.302 to 0.613), those received 0 (OR = 0.224, 95% CI 0.162 to 0.310) or 1–5 years of education (OR = 0.591, 95% CI 0.449 to 0.776), those were living with spouse only (OR = 0.817, 95% CI 0.563 to 0.997) and with multiple generations (OR = 0.689, 95% CI 0.472 to 0.950), those holding a non-agricultural household registration (OR = 0.727, 95% CI 0.537 to 0.984), and those with an better higher household income were less likely to be positive in overall mental health symptoms. Mental health was shown to be better among those with more advanced ages (≥75), lower levels of schooling (≤5), normal body mass index, higher household incomes, and those who are married and live with their spouse or multiple generations, and those who came from city and currently live in the county. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
14 pages, 2055 KiB  
Article
Spatial Access to Medical Services in the Underdeveloped Region of Northwestern China: A Case Study in Lanzhou City
by Wantong Xu, Fuguang Zhang, Biao Zeng, Taibao Yang and Hui Wang
Sustainability 2019, 11(23), 6786; https://0-doi-org.brum.beds.ac.uk/10.3390/su11236786 - 29 Nov 2019
Cited by 5 | Viewed by 2464
Abstract
Research on the spatial access to medical services has become a hot topic in recent years. The representative provincial capital in the underdeveloped region of northwestern China, Lanzhou, was selected for the research area. In this paper, methods such as the two-step floating [...] Read more.
Research on the spatial access to medical services has become a hot topic in recent years. The representative provincial capital in the underdeveloped region of northwestern China, Lanzhou, was selected for the research area. In this paper, methods such as the two-step floating catchment area and ArcGIS network analysis are used to analyze the geographic spatial accessibility of medical services and differences of spatial access between urban and rural areas in Lanzhou city. The results show that 1. Areas in General and below grade of accessibility account for most of Lanzhou city. Therefore, the spatial accessibility of whole Lanzhou city is comparatively unsatisfactory. It shows a tendency of the north region to be worse than south region, and areas in parts of the main districts, parts of HG, and other tiny minority show Great grade of accessibility, and most of other areas distribute in poorer grade of accessibility, especially the surrounding mountainous region. 2. There are obvious differences in accessibility between urban and rural regions, mainly reflected in that residents and areas are basically districted in the Great and Good grade in the urban region, while almost 75% of the population and 35% of the areas are distributed in the Great and Good grade, and nearly 25% of the residents and 65% of the areas are still in the unsatisfactory accessibility grade in the rural region. According to the results, the researchers put forward corresponding suggestions to improve the current situation, which are roughly as follows: The construction of hospitals and primary health care should be strengthened in the rural region, especially the construction of township health centers and health stations. High-class hospitals are needed in Honggu district, Yongdeng county, Yuzhong county, and Gaolan county, while the medical capacity and facility grade of existing hospitals should be improved to satisfy the demand of local residents. Meanwhile, rural areas should strengthen the construction of road networks. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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19 pages, 2045 KiB  
Article
Characterizing Stakeholders of Aging-in-Place through Social Network Analysis: A Study of Nanjing, China
by Shenghua Zhou, S. Thomas Ng, Dezhi Li, Jiankun Zhang, Jie Fan and Yifan Yang
Sustainability 2019, 11(23), 6722; https://0-doi-org.brum.beds.ac.uk/10.3390/su11236722 - 27 Nov 2019
Cited by 5 | Viewed by 2778
Abstract
China currently has an elderly population of 249 million with over 97% of them ending up aging in place. Although various regional pilot programs have been conducted, a sustainable aging-in-place system has not been established to effectively and efficiently provide aging services in [...] Read more.
China currently has an elderly population of 249 million with over 97% of them ending up aging in place. Although various regional pilot programs have been conducted, a sustainable aging-in-place system has not been established to effectively and efficiently provide aging services in many cities of China. The characteristics of stakeholder networks in the aging-in-place systems have not attracted great attention from researchers. This research applies social network analysis to characterize the interactions of stakeholders in aging-in-place systems to facilitate cooperation and coordination amongst them. Using Nanjing as a case study, 23 stakeholders in Nanjing’s aging-in-place system are identified, such as the Aging Affairs Committee, Aging-in-Place Service Association, and aging-in-place service centers; and then the relationship networks of these stakeholders in terms of communication, supervision, and trust are developed and analyzed. The results show that the aging-in-place system suffers from certain defects, including the loose connection of government departments, redundant information channels, low trustworthiness of certain aging-in-place service centers, poor credibility of third-party training and assessment institutions, and excess power of the industry association. To tackle these issues, a wide spectrum of actionable measures applicable to Nanjing’s conditions, as well as high-level policy implications for other cities of China, are proposed for augmenting the communication, supervision, and trust among stakeholder groups. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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13 pages, 649 KiB  
Article
Impact of Population and Workforce Aging on Economic Growth: Case Study of Taiwan
by Wen-Hsin Huang, Yen-Ju Lin and Hsien-Feng Lee
Sustainability 2019, 11(22), 6301; https://0-doi-org.brum.beds.ac.uk/10.3390/su11226301 - 09 Nov 2019
Cited by 27 | Viewed by 8150
Abstract
Taiwan’s population is aging at a fast pace, and its aged society is expected to transition into a hyper-aged society within eight years. Population aging has been a matter of international concern; however, there remain differing views about its economic impact. Thus, this [...] Read more.
Taiwan’s population is aging at a fast pace, and its aged society is expected to transition into a hyper-aged society within eight years. Population aging has been a matter of international concern; however, there remain differing views about its economic impact. Thus, this study aims to examine the impact of population and workforce aging on Taiwan using quarterly data from 1981–2017. The empirical results demonstrate that an aging workforce has a significantly positive impact on the rate of economic growth. However, the old-age dependency ratio has a significantly negative effect on economic growth. The empirical findings indicate that human capital is essential for total factor productivity (TFP) growth and that workforce and population aging mainly impact productivity through TFP. Accounting for policy factors, increasing the supply of the eldercare workforce and foreign manpower contribute toward countering the negative impact of an aging population on national economic growth. Policies on retirement, pension systems, health care, and human capital accumulation that target the aged population are discussed, accompanied by policy suggestions. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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20 pages, 2896 KiB  
Article
Spatial Differences in China’s Population Aging and Influencing Factors: The Perspectives of Spatial Dependence and Spatial Heterogeneity
by Yuanyuan Wu, Yuxiang Song and Tingting Yu
Sustainability 2019, 11(21), 5959; https://0-doi-org.brum.beds.ac.uk/10.3390/su11215959 - 25 Oct 2019
Cited by 28 | Viewed by 4141
Abstract
Since China became an aging society in 2000, the regional inequality of population aging has been highlighted, and the phenomenon of “aging before getting rich” has gradually become a core issue in China’s coordinated socioeconomic development. This paper aims to comprehensively assess the [...] Read more.
Since China became an aging society in 2000, the regional inequality of population aging has been highlighted, and the phenomenon of “aging before getting rich” has gradually become a core issue in China’s coordinated socioeconomic development. This paper aims to comprehensively assess the spatial differences and driving forces of China’s population aging through two-stage nested Theil decomposition, ESDA, and spatial econometric models. Empirical results show that spatial differences in population aging were evident at different spatial scales, and the distribution gradually decreased from east to west, showing a positive spatial correlation of similar value aggregation. Moreover, China’s population aging was determined by the demographic, socioeconomic, and natural environment, and there are different leading factors in different regions. The demographic aspects played a decisive role and had a direct influence, while the socioeconomic and natural environment indirectly affected population aging through demographic factors and became the root cause of regional differences in population aging. These findings provide an empirical basis for establishing a cooperative mechanism and formulating a targeted response to the problem of population aging in various regions in China. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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16 pages, 598 KiB  
Article
Workforce Ageing and Labour Productivity in Europe
by Iñigo Calvo-Sotomayor, Jon Paul Laka and Ricardo Aguado
Sustainability 2019, 11(20), 5851; https://0-doi-org.brum.beds.ac.uk/10.3390/su11205851 - 22 Oct 2019
Cited by 20 | Viewed by 5439
Abstract
This article analyses the influence of workforce ageing on labour productivity in Europe. This question is relevant because of the impact it may have on economic activity, social security systems sustainability and the wellbeing of the population. The method applied is a quantitative [...] Read more.
This article analyses the influence of workforce ageing on labour productivity in Europe. This question is relevant because of the impact it may have on economic activity, social security systems sustainability and the wellbeing of the population. The method applied is a quantitative contrast using the panel data technique for 24 countries in the period 1983–2014. This research is framed in the open conversation in the literature on the possible impact of ageing on productivity and takes as reference the seminal work of James Feyrer and the contrast model developed by Shekhar Aiyar, Christian Ebeke, and Xiaobo Shao. The results obtained show how a 1% increase in the workforce between the ages of 55 and 64 is related to a decrease of the annual increase in productivity between −0.106% and −0.479%. The main contribution of the article is to provide, as far as the authors are aware, the first evidence of this negative relationship for the period 1983–2014, in addition to suggesting that the influence of ageing on productivity may be reduced by the evolution of the economies in question toward capital and/or knowledge-intensive sectors. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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18 pages, 725 KiB  
Article
The Impact of Rural Labor Migration on Elderly Health from the Perspective of Gender Structure: A Case Study in Western China
by Sha Cao, Dingde Xu, Yi Liu and Shaoquan Liu
Sustainability 2019, 11(20), 5763; https://0-doi-org.brum.beds.ac.uk/10.3390/su11205763 - 17 Oct 2019
Cited by 5 | Viewed by 2472
Abstract
Aging and rural labor migration have become two major demographic features in China. Using data of 400 rural households in Sichuan, China in 2015, this study constructs an ordered probit model containing instrumental variables to analyze the effect of rural labor migration on [...] Read more.
Aging and rural labor migration have become two major demographic features in China. Using data of 400 rural households in Sichuan, China in 2015, this study constructs an ordered probit model containing instrumental variables to analyze the effect of rural labor migration on the health of the elderly in the family, from the perspective of the gender structure of migrant labor. The results indicate that the overall impact of labor migration on the elderly’s health is positive, and labor migration in the family has different effects on the health of the elderly by gender. Specifically, the results indicate the following: (1) the joint migration of both male and female labor or the migration of only male labor in a household can have a positive impact; (2) if only female labor migrates, the impact is negative; and (3) although the effect is negative, the migration of only female labor has a more prominent impact on the elderly’s self-rated health, whereas the migration of only male labor has a more significant effect on the elderly’s activities of daily living. Our findings suggest that the differential influence of labor migration by gender on rural elderly health should be considered to ensure the welfare of the elderly. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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10 pages, 956 KiB  
Article
Social Capital and Self-Rated Health among Older Adults Living in Urban China: A Mediation Model
by Nan Lu and Jingyue Zhang
Sustainability 2019, 11(20), 5566; https://0-doi-org.brum.beds.ac.uk/10.3390/su11205566 - 10 Oct 2019
Cited by 15 | Viewed by 2509
Abstract
Social capital and healthy aging are both crucial for social sustainability in China. The present study tested the role of structural social capital in self-rated health among older urban Chinese adults and the influence of cognitive social capital on this relationship. A sample [...] Read more.
Social capital and healthy aging are both crucial for social sustainability in China. The present study tested the role of structural social capital in self-rated health among older urban Chinese adults and the influence of cognitive social capital on this relationship. A sample of 456 older adults aged 60 or older in Suzhou, China, were recruited and completed the survey in 2015. Structural equation modeling was used to test the proposed model. Cognitive social capital had larger effects on self-rated health than structural social capital. The relationship between structural social capital and self-rated health was fully mediated by cognitive social capital, when sociodemographic characteristics, socioeconomic status, physical health conditions, and living arrangements were controlled. The culturally sensitive latent construct of community-based social capital proved to be a valid instrument in urban Chinese contexts. Structural social capital likely indirectly affects self-rated health through cognitive social capital. Policy and intervention implications are discussed. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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13 pages, 706 KiB  
Article
Projection of Long-Term Care Costs in China, 2020–2050: Based on the Bayesian Quantile Regression Method
by Xiaocang Xu and Linhong Chen
Sustainability 2019, 11(13), 3530; https://0-doi-org.brum.beds.ac.uk/10.3390/su11133530 - 27 Jun 2019
Cited by 78 | Viewed by 6298
Abstract
The aging population in China highlights the significance of elderly long-term care (LTC) services. The number of people aged 65 and above increased from 96 million in 2003 to 150 million in 2016, some of whom were disabled due to chronic diseases or [...] Read more.
The aging population in China highlights the significance of elderly long-term care (LTC) services. The number of people aged 65 and above increased from 96 million in 2003 to 150 million in 2016, some of whom were disabled due to chronic diseases or the natural effects of aging on bodily functions. Therefore, the measurement of future LTC costs is of crucial value. Following the basic framework but using different empirical methods from those presented in previous literature, this paper attempts to use the Bayesian quantile regression (BQR) method, which has many advantages over traditional linear regression. Another innovation consists of setting and measuring the high, middle, and low levels of LTC cost prediction for each disability state among the elderly in 2020–2050. Our projections suggest that by 2020, LTC costs will increase to median values of 39.46, 8.98, and 20.25 billion dollars for mild, moderate, and severe disabilities, respectively; these numbers will reach 141.7, 32.28, and 72.78 billion dollars by 2050. The median level of daily life care for mild, moderate, and severe disabilities will increase to 26.23, 6.36, and 27 billion dollars. Our results showed that future LTC cost increases will be enormous, and therefore, the establishment of a reasonable individual-social-government payment mechanism is necessary for the LTC system. The future design of an LTCI system must take into account a variety of factors, including the future elderly population, different care conditions, the financial burden of the government, etc., in order to maintain the sustainable development of the LTC system. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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9 pages, 227 KiB  
Article
Are Area-Level Crimes Associated with Older Adults’ Physical Activity and Sedentary Behavior?
by Chien-Yu Lin, Jong-Hwan Park, Ming-Chun Hsueh, Ting-Fu Lai and Yung Liao
Sustainability 2019, 11(9), 2454; https://0-doi-org.brum.beds.ac.uk/10.3390/su11092454 - 26 Apr 2019
Cited by 6 | Viewed by 2395
Abstract
There is limited evidence for the associations of area-level crime with older adults’ physical activity and sedentary behavior, especially in Asia. This study explored the association of area-level crime with older adults’ active and sedentary behavior. A telephone-based survey of Taiwanese seniors was [...] Read more.
There is limited evidence for the associations of area-level crime with older adults’ physical activity and sedentary behavior, especially in Asia. This study explored the association of area-level crime with older adults’ active and sedentary behavior. A telephone-based survey of Taiwanese seniors was conducted in September–November of 2017. Data related to sociodemographic factors, residential neighborhood (objectively recorded area-level crime incidence), and time spent in physical activity and sedentary behavior, were obtained from 1068 older adults. Adjusted binary logistic regression was analyzed. Fully adjusted analyses showed older adults living in neighborhoods with a higher incidence of drug crime (odds ratio, OR = 0.71, 95% confidence interval, CI = 0.52–0.96), car theft (OR = 0.70, 95% CI 0.51–0.95), and locomotive theft (OR = 0.69, 95% CI 0.51–0.94) were found to be less likely to achieve the recommendation on physical activity. In addition, those living in neighborhoods with a higher incidence of theft (OR = 1.93, 95% CI 1.05–3.55), drug crime (OR = 1.93, 95% CI 1.05–3.55), breaking and entering (OR = 2.04, 95% CI 1.11–3.76), and rape (OR = 2.20, 95% CI 1.20–4.06) were more likely to have more sedentary time. There were sex differences in the association of area-level crime incidence with physical activity and sedentary behavior. These findings suggest that crime prevention should be considered when designing physical activity and sedentary behavior interventions for older adults. Full article
(This article belongs to the Special Issue Aging: Healthcare, Inequalities, Challenges and Trends)
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