How Much Money Is Enough? Poverty and Health in Older People

The impact of place attachment on well-being for older people in high-density urban environment: a qualitative study

Aging in place has become a popular social policy worldwide. This paper argues that well-being is an important outcome of aging in place, upon which older people develop autonomy and environmental proactivity. The temporal dimension of aging in place highlights development of place attachment, which includes place identity and place dependence. The study explores how older people, who live inhigh-density urban environments, make sense of well-being and place attachment by articulating their daily lives. Community dwelling older people aged 65 and above, who came from neighborhoods with high aging population and residential density but high and low median household incomes, were invited for focus group discussions. Multifaceted meanings of well-being include various dimensions that cover individual-collective and material-spiritual (psychological) construct. Meanings of place attachment include values of, bonding ties to, and memories about places. Three pathways are identified linking place attachment and multifaceted well-being. The study finds that social welfare and material richness are not the only determinants of well-being. Fulfillment of higher psychological needs, such as positive evaluation of life and self-actualization, should be emphasized by which older people can make the most of their life in old age.

Long-term care needs and the risk of household poverty across Europe: a comparative secondary data study

PURPOSE

Population ageing and rising poverty are two of the most pressing issues today, even in Western European nations, growing as a result of the recent global economic crisis and the COVID-19 containment measures. This study explores the relationship between long-term care (LTC) needs and risk of poverty at household level in eight European countries, representing the different European care regimes.

METHODS

The main international databases were scoured for study variables, categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. We initially identified 104 variables regarding 8 different countries (Austria, Finland, Germany, the Netherlands, Italy, Spain, Poland, Romania). Statistical analyses were conducted as described hereafter: analysis of the Pearson's Bivariate Correlation between the dependent variable and all other variables; a Multivariable Linear Regression Model between the Poverty Index (dependent variable) and the covariates identified in the preceding step; a check for geographical clustering effects and a reduced Multivariable Linear Regression Model for each identified European cluster.

RESULTS

The variables that addressed the risk of poverty pertained to the area of policy intervention and service provision. Rising private out-of-pocket health expenditures and proportion of "poor" couples with at least one child are two factors that contributed significantly to poverty increasing. Moreover, rising private out-of-pocket health expenditures for covering LTC needs (even in presence of public financial contribution to the family) is the main contributor to household poverty increasing in presence of ADL disability.

CONCLUSION

The results reveal the existence of a clear correlation between the need for LTC and the risk of poverty in households across Europe. These results highlight the central relevance of LTC policies, which are often still treated as marginal and sectoral, for the future sustainability of integrated care strategies.

The Impact of Long-Term Care Needs on the Socioeconomic Deprivation of Older People and Their Families: Results from Mixed-Methods Scoping Review

BACKGROUND

Long-term care (LTC), poverty, and socioeconomic deprivation are globally significant social issues. Ongoing population aging trends and the recent social and health emergencies caused by the COVID-19 pandemic crisis have highlighted the need for macro-level LTC and welfare system sustainability strategies.

AIMS

This scoping review (ScR) explores the relationship between LTC needs, the health status of older people, and the risk of socioeconomic deprivation for their households.

METHODS

The methodology considers different relevant sources: (a) the guidelines for ScR proposed by Lockwood et al.; (b) the recommendations of Munn et al.; (c) the PRISMA guideline for scoping reviews; and (d) the Joanna Briggs Institute (JBI) checklist. Sixty-three papers are included in the mixed-methods analysis.

RESULTS

The findings reveal the existence of a debate that seeks to understand the different characteristics of the relationship between the investigated issues. Relevant gaps in the literature are identified in terms of the concepts and approaches of the studies analyzed.

CONCLUSIONS

The results indicate that the reciprocal relationship between LTC needs, supply, and the risk of socioeconomic deprivation is understudied. Future studies should focus on the causal relationship between the two phenomena and identify any internal factors that may be involved.

The impact of long-term care needs on the socio-economic deprivation of older people and their families: A scoping review protocol

Major global problems such as population ageing, long-term care and the socio-economic burden of chronically ill older people and their families are urgent issues. Research in this field contributes to the growing international literature on health-related quality-of-life instruments, but little is known about the links between the related variables. Thus, the scoping review this protocol refers to plans to examine the socio-economic consequences of older people’s poor health on their economic conditions and their families. In particular, the main aims are: a) to map the main concepts that characterize the body of the reference literature; b) to identify conceptual gaps or unexplored research areas to be addressed; c) to illuminate the difficulties that affect a large number of families with older members to care for, with particular attention to the concept of socio-economic deprivation, which includes material living conditions as well as social aspects (e.g. in the form of loneliness experienced as a consequence of health disorders). This protocol paper fulfils the purpose of clarifying the planned methodological phases, including the sub-phases, and listing the techniques used. A three-step approach is being applied, consisting of: pre-planning phase, protocol phase, and conduction and reporting phase. The preliminary stages of the protocol design are part of a dedicated project within the Open Science Framework platform and included in a Research Square preprint. This proposed project will contribute to multidisciplinary research on the connections between ill health and poverty, and could support critical reflections on the current evidence and guide future policies to alleviate this double burden.

Multi-Dimensional Comparison of the Impact Mechanism of the Self-Rated Health Status of Urban and Rural Residents in Chinese Social Environments

Self-rated health status (SRHS) reflects individuals' social environment, and the difference between urban and rural areas in China further highlights the impact of social environment on health. This paper aimed to systematically analyze and compare the impact mechanism of the SRHS of urban and rural residents from multiple dimensions, i.e., time, space, and scale. Drawing on data from the Chinese General Social Survey (CGSS) and China Statistical Yearbook, we used spatial, cross, and HLM analyses. Results indicate that: (1) From 2010 to 2017, the overall SRHS level of Chinese residents gradually declined; the gradient pattern of east, middle, and west became more marked, and the health level in rural areas generally fell behind that of urban areas. (2) The focus of SRHS moved toward mental health, and people's perceptions of the social environment gradually became a key factor affecting health. (3) In the long term, the gradient allocation of medical service resources could narrow the gap between urban and rural areas to comprehensively improve regional health levels.

Does the longitudinal association between neighbourhood cohesion and mental health differ by ethnicity? Results from the UK Household Longitudinal Survey

PURPOSE

While the association between neighbourhood cohesion and mental health has been widely studied in the general population, the effects of neighbourhood cohesion across ethnic groups are not well understood. Ethnicity is often left out of study design, many studies do not consider effect modification by ethnicity, or they rely on overly simplistic ethnic categories.

METHODS

Data from the UK household longitudinal study were used to investigate whether changes in neighbourhood cohesion are independently associated with changes in mental health (measured using the GHQ) over 9 years (2009-2018), and whether the association differed across 17 ethnic groups. The study used a fixed-effect modeling approach that includes within-person estimators that allow each participant to act as their own control.

RESULTS

Compared to British White, the following ethnic groups all saw a similar improvement in GHQ (- 0.76, 95% CI - 0.83 to - 0.70) for each point increase in neighbourhood cohesion: Irish, any other White, White and Asian mixed, Chinese, Caribbean, African, any other Black, Arab, and others. Some ethnic groups saw stronger improvements in mental for each point increase in neighbourhood cohesion, including White and Black Caribbean mixed, any other mixed, Indian, Pakistani, any other Asian, with the strongest effect seen in Bangladeshi participants (- 2.52. 95% CI - 3.48 to - 1.56).

CONCLUSION

Our study highlights the importance of ethnocultural data in research examining neighbourhood effects on mental health. Future research should evaluate policies to improve neighbourhood cohesion for ethnic minorities to address ethnic mental health disparities.

Evaluation of a poverty-focused educational program and simulation for pharmacists

BACKGROUND AND PURPOSE

Limited literature explores the impact that poverty-focused educational simulations can have on practicing clinicians. This study used a poverty simulation, specifically created to resemble the lives of Medicare patients, to sensitize practicing pharmacists to the situations faced by people living in poverty. The study evaluated how a poverty-focused educational program impacted practicing pharmacists' actual knowledge gain, intention to assist patients with limited income, and satisfaction with the educational program.

EDUCATIONAL ACTIVITY AND SETTING

A quasi-experimental one-group pre-/posttest design of practicing pharmacists was utilized. The intervention was a live continuing educational (CE) program at a pharmacy alumni event and a pharmacy convention. The CE program was delivered in person and included a Medicare poverty simulation and a 75-min didactic lecture. Pre- and posttests were used to assess outcomes. The primary outcome was change in knowledge as measured by test scores. Secondary outcomes included intention to assist future low-income patients and participant satisfaction with the educational program.

FINDINGS

Eighty-nine pharmacists participated in the educational program. Participants' mean knowledge increased from 2.76 (SD = 0.97) to 3.61 (SD = 1.21) (P < .001) out of 5. The majority (88.3%) agreed they were interested in assisting patients with limited income in the future. Most participants strongly agreed that the program was satisfactory and contributed to their learning.

SUMMARY

This is the first identifiable study that incorporated a poverty simulation into an educational program for practicing pharmacists. The study may help inform the development of future educational programs for practicing pharmacists.

The Interplay between Public Health, Well-Being and Population Aging in Europe: An Advanced Structural Equation Modelling and Gaussian Network Approach

Given the COVID-19 pandemic crisis that has deeply affected the health and well-being of people worldwide, the main objective of this paper was to explore the existing relationship between health, welfare, and population aging until the pandemic burst, on the basis of two distinctive groups of European Union (EU) countries, namely, the old and the new member states. The methodological endeavor was based on two advanced econometric techniques, namely, structural equation modelling and network analysis through Gaussian graphical models, applied for each group of EU countries, analyzed during the period of 1995-2017. The main results revealed significant differentiation among the new and old EU countries as follows: public health support was found to have a positive impact on healthy aging and well-being of older people, on other social determinants, and on people's perceived good and very good health; overall, significant influences were revealed in terms of the aging dimensions. The main implications of our findings relate to other researchers as a baseline comparison with the existing situation before the COVID-19 pandemic outbreak, but also to policymakers that have to rethink the public health allocations, both in old and new EU member states, in order to endorse the aging credentials, underpinning a successful and healthy integration of the elderly within all life dimensions.

Design of a Personal Mobility Device for Elderly Users

The ageing society has resulted in imbalances in the population age ratio. The ratio of working-age people was less than that of elderly people resulting in a shortage of elderly caregivers and increased healthcare costs. Although the lifestyle the elderly remains the same, their physical abilities are reduced, requiring them to rely on special equipment when traveling in order to gain more control and safety. Therefore, the Elderly Personal Mobility Device (EPMD) is developed using Internet of Things (IoT) technology to reduce the burden of caregivers, provide freedom and safety for elderly travelers, assess air pollution risks, and alert the occurrence of emergency events. The EPMD is designed in terms of structure, electrical equipment, and sensor systems. First, the shapes, sizes, and thicknesses of the carbon steel used for construction of the EPMD structure are calculated by using SolidWorks software. Next, the electric equipment is carefully selected to meet the requirements of actual use. Finally, the sensor system is designed to monitor the EPMD status and air quality using IoT devices to create a data interface and big data for elderly health service development, as well as an air quality map with distributed measuring stations and a charging station detection system for future use.

Predictors of malnutrition among older adults aged above 65 years in eastern Ethiopia: neglected public health concern

BACKGROUND

A nutritional problem, especially under nutrition is one of the common public health problems in older population causing greater mortality and economic loss in developing countries. However, evidences on the risk factors for increased nutritional risk among older population is not well stated in Ethiopia. This study aimed to assess the nutritional status and predictors of malnutrition among older adults (> = 65 years) in Eastern Ethiopia.

METHODS

A community-based analytical survey was conducted among randomly selected 592 older people aged above 65 years of age in Harari region. Subjects were selected using multistage sampling pretested Full Mini Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score < 17), at risk of malnutrition (MNA score of 17 to 23.5) and otherwise normal. Validated geriatric depression scale short form (15 items) was employed to screen for depression. Data were presented using statistical tables, frequency, percentage, and graphs. Ordinary logistic regression was employed to identify predictors of malnutrition and plum method was used to generate odds ratio. The level of statistical significance was declared at P-value less than 5%. Chi-square test, crude and adjusted odds ratio with 95% confidence was reported.

RESULTS

A total of 592 respondents (93.4%) were interviewed. About 306 (51.7%) and 93 (15.7%) were found to be at risk of malnutrition and malnourished respectively. The predicted log odds of being malnourished was higher among those from rural residents (AOR = 2.08: 1.25-3.45), not on working (AOR = 1.31: 95% CI: 0.87-1.95) and did not have health insurance (AOR = 1.58; 95% CI; 0.97-2.58). Those with chronic pain (AOR = 1.70; 95% CI: 1.15-2.51), previous hospitalization (AOR = 1.59: 95% CI: 1.27-2.38) and not able to cover their personal expense (AOR =1.61: 95% CI: 1.12-2.30) were predictors of malnutrition. The relationship between previous hospitalizations with malnutrition among older adults people is moderated significantly by the presence of chronic pain (β = 0.113, p = 0.015).

CONCLUSIONS

Malnutrition among old age is a public health concern that needs attention. Economical vulnerability, residence, depression, presence of chronic disease, and hospitalization were important risk factors for malnutrition among old age.