Relationship between living arrangements and the psychological well‐being of older people in Hong Kong

Objectives: This study explored the relationship between three types of living arrangements, namely living alone, living with family, and living in a hostel, and the psychological well‐being of older people in Hong Kong. The impact of various sociodemographic factors on the choice of living arrangements of older people was also studied. Methods: Ninety healthy Hong Kong Chinese were recruited from four multi‐service centres and one hostel. An individual interview was conducted with each participant and the General Health Questionnaire‐12 and the Center for Epidemiological Studies Depression Scale‐10 were administered. Results: The results suggested that the psychological well‐being of older people living in hostels was better than that of older people living alone, but that the psychological well‐being of older people living with their family was not different from that of older people living alone. Conclusion: That the psychological well‐being of older people in different living arrangements is different may be explained by the differences in time for leisure, access to social services, as well as changes in their attitude towards co‐residence with children.     

Living Alone: Elderly Chinese Singaporeans

Asian societies maintain the norm that older people should live with their children. Yet some older people live alone. This is the first study to explore social isolation, strategies of coping, and preferences about living arrangements among Chinese Singaporeans aged 65+ who live alone. Data from 19 semi-structured interviews were analyzed. The elderly people who live alone either have no other alternative, or they choose it despite opportunities to live with others. Regardless of the initial reason, solo-dwellers in Singapore succeed at living alone by developing behavioral and psychological strategies that help overcome social isolation. Their main link to the “outside” world is access to medical and social services. Despite some hardships, many prefer living alone because it has become familiar and personally comfortable.     

Health care for older persons: a country profile--Lebanon

Lebanon is a small country, comparable in size to New Hampshire. It is currently estimated that 8% of the population is age 65 and older. The Lebanese population has witnessed a clear demographic transition in the past few decades. Our culture demands respect for older people and values highly the natural bonds of affection between all members of the family. The healthcare system in the country is an adaptation of the European model. Despite the large number of physicians (approximately 10,000) there is a shortage of primary care and geriatric physicians. There are 36 nursing homes in Lebanon, with a total of 6,000 beds, but most of them are understaffed, with the exception of three nursing homes that offer relatively comprehensive services including rehabilitative, preventive, and curative services. The Ain Wizen Elderly Care Centre is well recognized for the program it operates for older people, which is a good model for the region and for Lebanon in terms of services, training, and research. Demographic changes and social and economic developments in Lebanon have created new realities in the unprecedented growth of the older population. Lebanon, like other developing countries, needs to define the policies and programs that will reduce the burden of an aging population on its society and economy. There is a need to ensure the availability of health and social services for older persons and to promote older persons' continuing participation in a socially and economically productive life.     

Long-Term Care Needs in the Context of Poverty and Population Aging: the Case of Older Persons in Myanmar

Myanmar is one of the poorest and least healthy countries in Southeast Asia. As elsewhere in the region, population aging is occurring. Yet the government welfare and health systems have done little to address the long-term care (LTC) needs of the increasing number of older persons thus leaving families to cope on their own. Our study, based on the 2012 Myanmar Aging Survey, documents the LTC needs of persons aged 60 and older and how they are met within the context of the family. Nearly 40% of persons in their early 60s and 90% of those 80 and older reported at least one physical difficulty. Spouses and children constitute the mainstay of the financial and instrumental support of elderly including those with LTC needs. Nearly two-thirds of older persons reported receiving assistance with daily living activities. More than three quarters coreside with children, a living arrangement that in turn is strongly associated with receiving regular assistance in daily living. Daughters represent almost half and spouses, primarily wives, one-fourth of primary caregivers. Unmet need for care as well as inadequate care decline almost linearly with increased household wealth. Thus elderly in the poorest households are most likely to experience gaps in LTC. Given mounting concerns regarding health disparities among Myanmar’s population, this pattern of inequality clearly needs to be recognized and addressed. This needs attention now rather than later given that reduced family size and increased migration pose additional challenges for family caregiving of frail elderly in the coming decades.     

Aging in Southeast and East Asia: Issues and Policy Directions

Population aging is unique in Asia given the speed at which it is occurring and the immense social and economic changes that the region is experiencing at the same time. Compared to their Western counterparts, Asian governments have much less time to prepare for population aging. Asian countries that have traditionally relied on family-based support for older family members are worried that increased numbers of older adults may stress these family systems. At the same time, information concerning the effectiveness of formal programs for older adults is scarce. This paper reviews current research on informal support versus formal support of older adults in Southeast and East Asia, with a larger aim of assessing the current well-being of older Asians and suggesting areas of policy concern. Current research reveals that formal programs in the majority of Southeast and East Asian countries have very low coverage of today's older adults, and the figures for future generations are not that much higher. However, family support of older persons may not be deteriorating as predicted by modernization theory. Asian families continue to play a major role in supporting older members, thus policies should focus on enabling Asian families to provide this support.     

Networks of older New Yorkers with HIV: fragility, resilience, and transformation

To better understand how HIV-infected older persons receive and perceive social support, the perceptions and experiences of 34 older HIV-positive persons in New York City were explored in July and August 2005 through five focus groups. The participants' network members tended to be HIV positive and the presence of so many people with HIV in their networks tended to be serendipitous. The advantages of having a HIV-positive network include being members of a caring community that provides safety, support, mentors, and inspiration, while the disadvantage is shrinkage of the network due to illness and death. These participants demonstrated that living with HIV changes one's network because people die of HIV; new friends are made when one seeks services; and HIV-positive networks replace those lost through stigma and rejection. Social service providers and policy makers in the HIV and aging networks should expand their view of "family" and not make assumptions about the networks for older persons living with HIV. Networks expand and shrink at different times and are resilient and fragile at the same time.     

Stress among Family Caregivers of Older Persons in Singapore

It is projected that, in the 21st century, the majority of the world’s older people will be living in Asia. After Japan, Singapore is the most rapidly aging country in Asia. With an increasing life expectancy, many older persons will require health and instrumental care during later life stages. In Singapore, close to 95% of older people co-reside with family members, highlighting the importance of community support for family caregivers. Using a study of 61 principal family caregivers in Singapore, this article highlights the nature of and relationship between caregivers’ stress and gender, patients’ activities of daily living (ADL) and instrumental ADL dependency, and caregivers’ attitudes. Findings from the study suggest that female caregivers tended to be more stressed than male caregivers. Results also showed a significant inverse relationship between the level of stress experienced by caregivers and the ADL and instrumental ADL dependency of patients. Caregivers looking after patients suffering from dementia, Parkinson’s disease, and hypertension were more likely to be stressed than those caring for persons with stroke, depression, and other illnesses. This article concludes by describing some implications of this research for social worker practice and for informal as well as formal support programs for family caregivers.     

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults

ABSTRACT

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.     

Evolution of the needs of older persons

Most countries in the world experienced a major increase in life expectancy during the 20th century and a resulting aging of their populations. Further gains in life expectancy are uncertain, particularly in developed countries already characterized by a high longevity, and little is known concerning the health state of future generations of the elderly. But there is no doubt that further population aging will produce larger numbers of older persons both in developed and developing countries. As the prevalence of most chronic diseases is high in old age, population needs change rapidly in health care systems still organized essentially to provide acute care to children and young adults. Old age is heterogeneous, but a large proportion of older persons is affected by multiple chronic diseases, resulting in a wide range of needs. Health systems will have to adapt to this new situation while still providing appropriate responses to acute diseases affecting all ages. Although future needs are difficult to quantify, their nature is already apparent. Providing for these needs will require a major investment in manpower, a diversification of services delivered by health care systems, changes in the training of health professionals and extensive research to define effective treatments for elderly patients with multiple co-morbidities.     

Aging

Many issues are emerging as a consequence of the aging of modern populations. Developed as well as developing countries need to define the policies and programs that will reduce the burden of aging populations on societies and their economies, ensure the availability of health and social services for older persons, and promote their continuing participation in a socially and economically productive life. The situation is more challenging for developing countries, which must add new priorities to the scarce resources of their health and social programs when they still have to deal with the problems of their younger population. The World Health Organization is collaborating with the member states to find solutions that are adequate to their own situation. Promotion of research that will provide policymakers with data on the actual needs of their aging population is the main objective of the WHO international research program on aging.     

The social sciences and successful aging: Issues for Asia–Oceania

Aim:   This paper presents social science understandings of successful aging for a broad audience in multidisciplinary gerontology in Asia–Oceania.
Methods:   The international literature on social science aspects of successful aging is reviewed with a focus on Asia and social improvement.
Results:   New positive approaches to aging research are identifying opportunities for maintaining capacities and well-being over the life course. Successful aging, productive aging, and active aging are key concepts. Increasing life expectancy and fertility control are major social achievements that underpin population aging as the mainstream social transformation facing the world. Asia will be at the forefront of this change and the consequences will vary greatly between cultures, nations, and subgroups within them. Older people generally maintain good quality of life and the capacity to 'age well' is influenced by life-long maturation and emotional, social, and economic resources. Good health can be enhanced through positive actions such as physical activity, good nutrition, and not smoking. Mental capacities can also be improved and maintained throughout old age. In advanced old age, the 'fourth age', the focus turns to ameliorating the effects of loss and to maintaining dignity.
Conclusions:   The social sciences contribute knowledge useful for improving life experiences for older people and aging societies. Population aging is central to national economic development. Public policy and individual action concerning aging can benefit all age groups. To better inform these developments it is important to address the serious shortfall of social science research on aging in the Asia–Oceania region.     

The Power of Global Aging

The principal aim of this article is to analyse the swift expansion in the proportion of older people across the globe, and to highlight the main social and economic forces causing this. Specific areas of the globe such as North and South America, Europe, Asia and Africa will be focused on in detail before I discuss some of the key challenges and consequences of global aging for global society. The paper is underpinned by a political economy of aging perspective that highlights how globalization and global aging are key driving forces that raises critical questions about the power of the individual nation state to deal with a global problem: an aging population. Globalization as both an analytical tool and social practice throws into flux the policies and practices of individual nation states to address social, economic and political issues for older people focusing on pensions and health and social care. It highlights how research needs to move from being state centred to one of which acknowledges global forces and the impact on populational aging.     

Alter und Migration—

In the course of demographic change, the number of elderly migrants increases, and the population of elderly people in Germany becomes more varied-facts that have to be taken into account more intensely when it comes to planning services for elderly people in the future. The need for action is intensified by the fact that elderly migrants are still worse off than natives of the same age in many areas of life (e. g. income, health, etc.). At the same time, elderly migrants cannot automatically be regarded as helpless or isolated because of their solid family help networks.Meanwhile, on political and social levels, approaches have been developed to open services and institutions for the special needs of minority ethnic elders. Furthermore, offers have been established by the creation of ethnic-specific emphases that focus on the life style and the everyday life of the target group. In spite of all these efforts, the whole range of care services for the population of elderly migrants is still regarded as insufficient by experts. Therefore, especially in the fields of networking, cooperation and controlling of the people involved, information transfer, and training measures that aim at better preparing the provider of care services for elderly people are highly recommended in order to meet the increasing needs of help and care of older migrants more precisely.     

The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India

HIV stigma continues to be a barrier to physical and mental health among people living with HIV globally, especially in vulnerable populations. We examined how stigma is associated with health outcomes and quality of life among rural women living with HIV in South India (N?=?600). Interviewer-administered measures assessed multiple dimensions of stigma, as well as loneliness, social support, ART adherence, time since diagnosis, and quality of life. Internalized stigma and a lack of social support were associated with a lower quality of life, while the association between internalized stigma and adherence was mediated by the use of stigma-avoidant coping strategies, suggesting that keeping one’s diagnosis a secret may make it more difficult to take one’s medications. These findings suggest that these women constitute a vulnerable population who need additional services to optimize their health and who might benefit from peer support interventions and stigma-reduction programs for family and community members.     

Attitudes of old people towards old age homes in Hong Kong

The attitudes of older people towards old age homes (OAH) in Hong Kong and the factors which influenced their attitudes were investigated. A total of 197 non-institutionalised older subjects were interviewed with a standard questionnaire. A quarter of them admitted to having thought about going into an OAH, though most had never visited one. Half of them would consider an OAH if they lived alone with no family support, while only a few would consider it if they were living with family. If they became disabled and required help from family, a third would consider an OAH. If family support was not available, two-thirds would consider an OAH, while a few opted for social services. If advised to go into an OAH by doctors or family, about a half of the subjects would comply. On stepwise logistic regression, independent predictors of the desire for an OAH were agreeing with OAH placement if it was affordable and if one was living alone with visits from family, admitting to be happy in an OAH, and previous experience with an OAH. We concluded that older people in Hong Kong were not in favour of an OAH unless there were physical disabilities and lack of family support. They were, however, vulnerable to external pressures.     

African-American, Anglo-American, and Anglo-Canadian grade 4 children's concepts of old people and of extended family.

A cross-national study of 104 fourth grade children's concepts of old people and extended family was conducted in Canada and the United States, using the Children's Attitudes Toward the Elderly Scale (CATE), and a modified version of the Gilby and Pederson (1982) Family Concept Interview. Both Anglo-American and African-American children were included in the U.S. sample. Results indicated that Anglo-American and Anglo-Canadian children were significantly more similar in their attitudes toward the elderly and their concepts of family than African-American and Anglo-American children. In comparison with the other two cultural groups, Anglo-American children were significantly more likely to include extended family members in their concept of who is family; Anglo-Canadian children had a significantly higher level of age discrimination ability; and African-American children showed a trend toward more positive attitudes toward older people. Overall findings of negative attitudes toward old people were consistent with earlier studies. The implications of children's ageist attitudes for increasingly aging Western societies are noted, particularly given impoverished children's potential need for extrafamilial social supports.     

What do we know about older adults and HIV? A review of social and behavioral literature

The fastest growing segment of the United States HIV population is people aged 50 and older. This heterogeneous group includes people with diverse pathways into HIV positive status in later life, including aging with the disease as well as later life-acquired infections. As people with HIV live into older ages, solving problems of successful secondary prevention and ongoing treatment requires more specific knowledge of the particular aging-related contextual sociocultural, psychosocial, and personal factors salient to the situations of persons living with HIV. Greater knowledge of these factors will help solve challenges to reducing psychological burden and promoting health maintenance for people with HIV. Yet, the current literature on aging and HIV remains nascent. To assess the state of knowledge of the sociocultural and behavioral factors associated with aging with HIV, we conducted a systematic critical content review of peer-reviewed social and behavioral research on aging and HIV to answer the question, "How have older age, and social, cultural, and behavioral aspects of the intersection of HIV and age been addressed in the literature?" We searched First Search, Proquest, Psych Info, Pub Med, Wilson Select Plus, and World Cat and identified 1549 articles. We then reviewed these to select peer-reviewed articles reporting results of research on the social and behavioral aspects of living with HIV at age 50 and older. Fifty-eight publications were identified that met study inclusion criteria. While few publications reported clear age-related differences, there were significant ethnic differences in living with HIV in later life and also differences among older people when groups were defined by mode of transmission. Findings are discussed in light of constructs from gerontology which may contribute to clarifying how later life, life course stage, and psychological development intersect with, influence, and are influenced by HIV disease and long-term anti-retroviral therapy use.     

Effects of Social Exclusion on Depressive Symptoms: Elderly Chinese Living Alone in Shanghai,China

Research has identified social exclusion as one of the social determinants of health. There are risks of social exclusion in later life in recent years. However, despite the fact that China has the largest aging population in the world and reports a rapid growth in the proportion of older people living alone, research on the role of social exclusion on depression is limited. This study examined the effects of social exclusion on depressive symptoms in older Chinese who are living alone in China, based on the data from one Shanghai neighbourhood. The data used were obtained between August and October 2008 through face-to-face interviews, using a structured survey questionnaire, from a simple random sample of 228 Chinese 60 and older living alone in a Shanghai community. Depressive symptoms were measured by a 15-item Chinese version Geriatric Depression Scale. Social exclusion was represented by income adequacy, social relations, civic participation, and housing condition. Over 30% of participants reported symptoms of a mild or above mild level of depression. When controlled for the demographics and health variables in hierarchical multiple regression, social exclusion variables, represented by a lower level income adequacy, a less favourable housing condition, and feeling more lonely correlated significantly with more depressive symptoms. Contrary to previous studies on depression in the older adults in China, this study has obtained findings indicating that social exclusion variables are more important than other socio-demographic factors in the context of contemporary China. While two significant social exclusion variables (i.e. income and housing) are related to structural changes in the economic context in China, the intra-personal role of feeling lonely that ties strongly living alone and role of older adults in an increasingly competitive market economy should not be underestimated. To address depression and mental health of older Chinese who live alone, social policies and programs to reduce various forms of social exclusion should be developed. In additional to providing assistance in financial support and housing improvement, services to strengthen the social networks and social relations of these older people are essential.     

Older People as Social Pioneers

Abstract. The five papers examined reveal diverse responses among older people to social and economic change. The main themes were: the changing accommodation and care needs of older people in urban areas as customary forms of family-based support are compromised; the strength and resourcefulness of family obligations in managing support and care; and similarities and contrasts in private sector and governmental responses to needs. In Sao Paulo, Brazil, the inventiveness of families in establishing networks of support and in contriving physical aids to patients with paralysis is impressive. In the rural areas and townships of South Africa, the strength of family ties is revealed in the readiness of social-benefit recipients to support others. In Ontario, Canada, several thousand retirees have responded to the marketing of vacated housing in a collapsed mining town; and in the Basque Country,- the older residents of new supported housing have few regrets about not living with their children but worry that others see them as recipients of charity. Around the Mediterranean, increasing numbers of retirees from several northern European countries are exploring new ways of developing mutual help, of pressing the authorities and businesses for better services, and seeking a resolution between their ethos of self-responsibility and how to help those who cannot help themselves. Change is endemic, and constructive and assertive responses from older people are widely seen.     

Population aging in the Asia–Oceania region

Recently the term 'global aging', which refers to the universal trend of aging of the world population, is being widely used. First of all, I will shed some light on this trend of world population aging from the viewpoint of regional populations and their future projections.
Second, I will discuss about the determinants of population aging in the Asia and Oceania region. So far as the region is concerned, it will be divided into three groups of countries according to the level of population aging. The first group is the most advanced aged countries such as Japan, Australia, and New Zealand whose percentage of the elderly aged 65 and over is more than 10% in the year of 2000. The second group is the aging countries such as Korea, Taiwan, Singapore, and China whose percentage of the elderly is between 5 and 10%. and the third group is the remaining countries in this region whose percentage is less than 5%. The demographic aspects of each group are analyzed and the relationships between the fertility reduction and aging are also discussed in the perspectives of the demographic transition.
Third, I will discuss about the consequences of population aging in this region with special reference to Asian developing countries. In this section, I will mention the problems of dependency burden, the so-called population bonus, health expectancy, and social security systems. Fourth, some prominent characteristics concerning the living conditions and norms or attitudes of the elderly will be indicated, and I will also raise such points like family systems, living arrangements, social participation, and Ikigai (the worth of life) peculiar to Asian countries. Fifth and finally, I will touch on the topics of the issues and policies of the aging society. At present the social status of the elderly is improving in Asian countries and it is in the hope that the myth of aging will disappear in the near future.