A two-echelon responsive health analytic model for triggering care plan revision in geriatric care management

Due to the increasing ageing population, how can caregivers effectively provide long-term care services to meet the older adults’ needs with finite resources is emerging. In addressing this issue, nursing homes are striving to adopt smart health with the internet of things and artificial intelligence to improve the efficiency and sustainability of healthcare. This study proposed a two-echelon responsive health analytic model (EHAM) to deliver appropriate healthcare services in nursing homes under the Internet of Medical Things environment. A novel care plan revision index is developed using a dual fuzzy logic approach for multidimensional health assessments, followed by care plan modification using case-based reasoning. The findings reveal that EHAM can generate patient-centred long-term care solutions of high quality to maximise the satisfaction of nursing home residents and their families. Ultimately, sustainable healthcare services can be within the communities.

The Impacts of Long-Term Care Insurance on Health Care Utilization and Expenditure: Evidence From China

Long-term care insurance (LTCI) is one of the important institutional responses to the growing care needs of the ageing population. Although previous studies have evaluated the impacts of LTCI on health care utilization and expenditure in developed countries, whether such impacts exist in developing countries is unknown. The Chinese government has initiated policy experimentation on LTCI to cope with the growing and unmet need for aged care. Employing a quasi-experiment design, this study aims to examine the policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure in China. The Propensity Score Matching with Difference-in-difference approach was used to analyse the data obtained from four waves of China Health and Retirement Longitudinal Study (CHARLS). Our findings indicated that, in the aspect of health care utilization, the introduction of LTCI significantly reduced the number of outpatient visits by 0.322 times (p<0.05), the number of hospitalizations by 0.158 times (p<0.01), and the length of inpatient stay during last year by 1.441 days (p<0.01). In the aspect of out-of-pocket health expenditure, we found that LTCI significantly reduced the inpatient out-of-pocket health expenditure during last year by 533.47 yuan (p<0.01), but it did not exhibit an impact on the outpatient out-of-pocket health expenditure during last year. LTCI also had a significantly negative impact on the total out-of-pocket health expenditure by 512.56 yuan. These results are stable in the robustness tests. Considering the evident policy treatment effect of LTCI on health care utilization and out-of-pocket health expenditure, the expansion of LTCI could help reduce the needs for health care services and contain the increases in out-of-pocket health care expenditure in China.

Pensions and the Extending Working Lives Agenda in the UK: The Impact on Women

Extending working lives (EWLs) has been a key policy response to the challenges presented by an ageing population in the United Kingdom (UK). This includes the use of pension policies to encourage working longer. However, opportunities and experiences of EWLs are not equal. While much has been written about EWLs more broadly, limited attention has been paid to connecting those EWLs policies associated with pensions and their potentially unequal impact on women. This article aims to address this gap, taking a feminist political-economy perspective to explore the structural constraints that shape EWLs and pensions. Initially it briefly introduces the EWLs agenda, before focussing on pension developments and their implications for EWLs, considering the gendered nature of these policies. Finally, it touches upon potential policy measures to mitigate the impact of these developments on women. It demonstrates how women’s existing labour market and pension disadvantages have been largely overlooked in the development of EWLs policy, perpetuating or expanded many women’s financial inequalities in later life. It highlights the need for a greater focus on gendered pension differences in developing EWLs policy to ensure women’s circumstances are not adversely impacted on.

Effects of ageing on the eyes

With ageing, significant changes occur in all structures of the eye, resulting in a variety of morphological and functional effects. This review summarises parameters that are within the normal ageing process in order to distinguish them from true disease processes. Understanding the ageing changes of the eye will help to understand some of the visual problems experienced by the ageing population.

Workforce Participation, Ageing, and Economic Welfare: New Empirical Evidence on Complex Patterns across the European Union

The ageing population has become one of the major issues, with manifold consequences upon the economic welfare and elderly living standards satisfaction. This paper grasps an in-depth assessment framework of the ageing phenomenon in connection with the labor market, with significant implications upon economic welfare, across the European Union (EU–27). We configure our research on four distinctive groups of the EU–27 countries based on the Active Ageing Index mapping, during 1995–2018, by acknowledging the different intensities of ageing implications on economic well-being from one group of countries to another. The methodological endeavor is based on Structural Equation Modelling. Empirical results highlight that the ageing dimensions and labor market productivity notably shape the socioeconomic development of EU countries, visibly distinguished across the four panels. The economic development induced remarkable positive spillover effects on the welfare of older people, under the influence of the ageing credentials and dynamic shaping factors. Our research advances the literature underpinnings on this multifaceted topic by investigation made on specific groups of the EU countries and distinctive strategies proposed for each group of countries, as effective results for improving the well-being of older people. Constant policy rethinking and adequate strategies should be a top priority for each specific group of EU countries, to further sustain the ageing phenomenon, with positive implications mostly on elderly welfare.

LRG1 as a novel therapeutic target in eye disease

Retinal and choroidal diseases are major causes of blindness and visual impairment in the developed world and on the rise due to an ageing population and diabetes epidemic. Standard of care is centred around blockade of vascular endothelial growth factor (VEGF), but despite having halved the number of patients losing sight, a high rate of patient non-response and loss of efficacy over time are key challenges. Dysregulation of vascular homoeostasis, coupled with fibrosis and inflammation, are major culprits driving sight-threatening eye diseases. Improving our knowledge of these pathological processes should inform the development of new drugs to address the current clinical challenges for patients. Leucine-rich α-2 glycoprotein 1 (LRG1) is an emerging key player in vascular dysfunction, inflammation and fibrosis. Under physiological conditions, LRG1 is constitutively expressed by the liver and granulocytes, but little is known about its normal biological function. In pathological scenarios, such as diabetic retinopathy (DR) and neovascular age-related macular degeneration (nvAMD), its expression is ectopically upregulated and it acquires a much better understood pathogenic role. Context-dependent modulation of the transforming growth-factor β (TGFβ) pathway is one of the main activities of LRG1, but additional roles have recently been emerging. This review aims to highlight the clinical and pre-clinical evidence for the pathogenic contribution of LRG1 to vascular retinopathies, as well as extrapolate from other diseases, functions which may be relevant to eye disease. Finally, we will provide a current update on the development of anti-LRG1 therapies for the treatment of nvAMD.

Preliminary evidence of differential expression of myogenic and stress factors in skeletal muscle of older adults with low muscle strength

The age-related loss of muscle strength and mass, or sarcopenia, is a growing concern in the ageing population. Yet, it is not fully understood which molecular mechanisms underlie sarcopenia. Therefore, the present study compared the protein expression profile, such as catabolic, oxidative, stress-related and myogenic pathways, between older adults with preserved (8 ♀ and 5 ♂; 71.5 ±2.6 years) and low muscle strength (6 ♀ and 5 ♂; 78.0±5.0 years). Low muscle strength was defined as chair stand test time >15 seconds and/or handgrip strength <16kg (women) or <27kg (men) according the EWGSOP2 criteria. Catabolic signaling (i.e. FOXO1/3a, MuRF1, MAFbx, LC3b, Atg5, p62) was not differentially expressed between both groups, whereas the mitochondrial marker COX-IV, but not PGC1α and citrate synthase, was lower in the low muscle strength group. Stress factors CHOP and p-ERK1/2 were higher (~1.5-fold) in older adults with low muscle strength. Surprisingly, the inflammatory marker p-p65NF-κB was ~7-fold higher in older adults with preserved muscle strength. Finally, expression of myogenic factors (i.e. Pax7, MyoD, desmin; ~2-fold) was higher in adults with low muscle strength. To conclude, whereas the increased stress factors might reflect the age-related deterioration of tissue homeostasis, e.g. due to misfolded proteins (CHOP), upregulation of myogenic markers in the low strength group might be an attempt to compensate for the gradual loss in muscle quantity and quality. These data might provide valuable insights in the processes that underlie sarcopenia.

Analysis on the Development Mode of Home Based Pension Real Estate

With the growth of the proportion of the ageing population, the problem of population ageing in China has become increasingly prominent because the implementation of family planning policy intensifies the speed of ageing development in China. The restructuring of family structure caused by social reasons, "421" and "422" have become the current family structure mode. With the vigorous development of the economy, the traditional mode and way of the traditional mode and way of providing for the aged cannot meet the spiritual and life needs of the elderly. Most of the institutions only develop the projects to provide for the aged, but not combined with the traditional way of providing for the aged in China. Based on the two-way needs of the young and the elderly, this paper combines the traditional culture with China's current national conditions and constructs the most suitable pension mode for China's traditional pension mode and Chinese people.

Exploring the Relation Between the Digital Divide and Government's Effort to Develop E-Participation

According to the digital divide theory, the provision of opportunities to broaden participation in political processes pose a challenge for governments worldwide. In this research, the authors analyze the relationship between the evolution governments' effort to develop citizen e-participation in public policy—measured through the UN's e-participation index—and that of national contexts variables identified by the digital divide theory at country level, using panel data for 178 countries over the period 2008-2016. The results confirm the strong and positive connection between EPI and economic development and technological infrastructure of the countries, ageing population associated to higher life standards, as well as a negative impact of rurality, gender, and political freedom and democracy result not influential, as well as education. Some practical implications derive from the findings, contributing to explain performance differences across different national settings and identifying current inequalities that still require public action to bridge the divide.