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Background: The aging population has led to a growing health expenditure burden. According to the National Bureau of Statistics of China, the old-age dependency ratio rose from 10.7% in 2003 to 17.8% in 2019, and health expenditure increased from 658.410 billion yuan in 2003 to 5812.191 billion yuan in 2019 in China. Methods: This paper utilizes the quantile regression method to discuss the influencing factors of health expenditure in urban China based on the China Household Finance Survey (CHFS), especially dependency burden. Moreover, its regional heterogeneity is also compared. Results: The old-age dependency ratio, age, family size, self-rated health status, and income significantly impact the health expenditure of urban families in the quantile regression of the national sample. Dependency burden and other variables on urban household health expenditure have great regional heterogeneity. The relationship between urban health expenditure and residential areas in western China is more stable than that in eastern and central China. Discussion: Government should improve the healthcare system suitable for the older adult population as soon as possible. The government of western China should pay more attention to the introduction of professional medical talents and the configuration of precision medical equipment to improve the health system in western China.

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BACKGROUND: A randomized, controlled, phase 3b study (ALPINE) evaluated efficacy and safety of a 2-month formulation of aripiprazole lauroxil (AL) using a 1-day initiation regimen in patients hospitalized for an acute exacerbation of schizophrenia. Paliperidone palmitate (PP) was used as an active control. Exploratory endpoint assessments included severity of illness, positive and negative symptoms, quality of life, caregiver burden, and satisfaction with medication. METHODS: Adults were randomly assigned to AL 1064 mg q8wk or PP 156 mg q4wk as inpatients, discharged after 2 weeks, and followed through week 25. Exploratory efficacy measures included the 3 original PANSS subscales, Clinical Global Impression-Severity (CGI-S) subscale, and caregiver Burden Assessment Scale. Exploratory patient-reported outcomes (PROs) included the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) and the Medication Satisfaction Questionnaire. Within-group changes from baseline through week 25 were analyzed for AL and PP separately. PROs were summarized based on observed data. RESULTS: Of 200 patients randomized (AL, n = 99; PP, n = 101), 99 completed the study (AL, n = 56; PP, n = 43). For AL, PANSS subscale and CGI-S scores improved from baseline through week 25 (mean [SE] change from baseline at week 25: Positive, -7.5 [0.70]; Negative, -3.9 [0.46]; General, -11.8 [0.83]; CGI-S, -1.3 [0.12]). Caregiver burden also improved (mean [SD] changes from baseline at week 9: -8.4 [10.15]; week 25: -8.9 [12.36]). Most AL patients were somewhat/very satisfied with treatment at each timepoint (70.8%-74.7%); mean Q-LES-Q-SF total scores were stable in the outpatient period. For PP, results were similar: PANSS Positive, -7.3 (0.67); Negative, -3.6 (0.69); General, -10.9 (1.22); CGI-S, -1.4 (0.16); caregiver burden, week 9: -8.8 (11.89) and week 25: -9.2 (14.55); satisfaction with treatment, 64.7%-69.3%; and stable Q-LES-Q-SF scores. CONCLUSIONS: ALPINE patients initiating the 2-month AL formulation using the 1-day initiation regimen as inpatients and continuing outpatient care experienced schizophrenia symptom improvement, sustained patient satisfaction with medication, stable quality of life, and reduced caregiver burden. A similar benefit pattern was observed for PP. These results support the feasibility of starting either long-acting injectable in the hospital and transitioning to outpatient treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03345979 [trial registration date: 15/11/2017].

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INTRODUCTION: There is a growing body of research that addresses caregivers for people living with dementia. However, there is limited research looking at the perceptions of caregivers in specific daily tasks. To address this gap, this study investigated the assistance caregivers provided and the difficulty they faced when completing daily tasks for people with dementia and, additionally, how these experiences might relate to their perceived burden. METHODS: Sixty-two caregivers for people living with dementia completed the study. Data were collected, through a survey, on the level of assistance caregivers provided, and the difficulties they experienced. The Zarit Burden Scale was used to measure the level of perceived burden. Descriptive statistics and Spearman's correlation coefficient were used to report the results and the relationship between the perceived burden, the level of assistance provided, and the difficulty experienced. RESULTS: The activities of daily living that caregivers provided the most assistance for was dressing and showering. Most instrumental activities of daily living required maximal to total assistance. Overall, the caregivers did not experience a high level of difficulty with assisting with these daily tasks in comparison to the level of assistance provided. The caregiver burden was associated significantly with the difficulties experienced in dressing, toileting, and showering (rho = 0.30-0.75), most instrumental activities of daily living (rho = 0.29-0.47), but not with the level of assistance provided. CONCLUSION: Caregivers are assisting in many daily tasks. Their level of difficulty is relatively low in comparison to the level of assistance they provide. Significant correlations were found between the difficulties experienced and the burden scale. There is a need for occupational therapists to address the specific daily tasks and the concerns experienced by caregivers and to provide them with adequate support to improve the quality of care for people with dementia.

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INTRODUCTION: Patients with moderate-severe cerebral palsy require the support of their caregivers to carry out the activities of daily living (ADLs). OBJECTIVES: To describe the comorbidities, need for care in children with cerebral palsy and to analyse the influence of the degree of motor involvement, nutritional status and other neurological disorders. METHODS: Cross-sectional and observational study. Patients with cerebral palsy degrees III-IV-V according to the Gross Motor Function Classification System (GMFCS) have been studied. A record of comorbidities has been made and body composition has been studied using anthropometry and bioimpedance. In addition, a caregiver burden survey on ADLs has been carried out (10 items on the different actions: hygiene, clothing, transfers, sleeping and feeding). Which variables have the greatest influence on the perception of difficulty in performing ADLs have been studied. RESULTS: A total of 69 patients (50.7% women, mean age 10.46 ± 0.4 years) were analysed, with GMFCS grades: grade III 36.2% (N=25), grade IV 29.0% (N=20), grade V 34.8% (N=24). A relationship was found between the caregiver burden score and GMFCS grade (P=0.003) and intellectual disability (P<0.001). However, regardless of the degree of GMFCS and intellectual disability, there is greater difficulty in performing ADLs in relation to lower values in weight (Z-score) (P=0.028), fat mass (kg) (P=0.035), fat mass (%) (P=0.094), body mass index (Z-score) (P=0.086). CONCLUSIONS: In addition to the degree of clinical impairment, nutritional status is a factor that influences the caregiver's difficulty in performing the ADLs in cerebral palsy patients on which we can act to improve this problem.

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BACKGROUND/AIM: Occupational therapists and health practitioners commonly provide interventions to family caregivers of people with dementia with the aim of relieving burden, depression, and disruptions in health and social support. To date, the effects of multicomponent interventions specifically targeting these four important outcomes has not been established. The aim of this study was to evaluate the effectiveness of multicomponent interventions on four outcomes for co-residing family caregivers of people with dementia. METHODS: A comprehensive database search of the literature was performed using CINAHL, MEDLINE, PubMed, PsycINFO, OTseeker, EMBASE and the Cochrane library. Randomised control trials (RCTs) that included multicomponent interventions for co-residing family caregivers addressing burden, depression, health and social support were selected. Relevant articles were critically reviewed and study results were synthesised. Meta-analysis was conducted separately. RESULTS: Twenty-two of 358 retrieved studies were selected, with 15 studies being included in the meta-analyses. The multicomponent interventions identified were comprised of a range of different individual strategies. Significant effective results were found for all four specified outcomes. CONCLUSIONS: Many types of multicomponent interventions appear beneficial on all of the four specified outcomes. The literature presents a trend that multicomponent interventions consisting of a combination of counselling, support groups, education, stress and mood management or telephone support are important strategies within an effective multicomponent intervention.

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BACKGROUND: Spatial neglect prolongs stroke survivors' recovery to independence. However, little is known about the impact of spatial neglect on caregivers of stroke survivors. OBJECTIVE: To explore the factors associated with burden and stress among informal caregivers of stroke survivors with spatial neglect. METHODS: Following the previous study of 108 stroke survivors, we reached 24 stroke survivors' caregivers, and 20 caregivers (age: M±SD=56.9±12.7 years; 12 females) completed the study. 10 survivors had symptoms of spatial neglect, and 10 did not (i.e., SN+ or SN-, respectively) at the time when discharged from inpatient rehabilitation, which was 9.3±6.2 months before the present study. Via a semi-structured telephone interview, we assessed caregivers' burden and stress qualitatively and quantitatively. RESULTS: No difference was observed across caregiver groups in cognitive function, depressive mood, or community mobility. In comparison, caregivers of the SN+ group allocated more time to care, controlling for survivors' disability (adjusted effective size d = 1.80). Their self-perceived burden and stress were more severe than the other group (adjusted d = .99). Qualitative analysis indicated caregivers of the SN+ group were more likely to describe economic stressors and undesirable changes in career and vacation planning. While 80% of participants preferred their care recipients to receive additional motor or mobility therapy, caregivers of the SN+ group were more likely to suggest additional therapy for cognitive impairment. CONCLUSIONS: This exploratory study suggests that spatial neglect may heighten caregivers' burden and stress levels. Future studies with a large sample size are required.

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The economic implications of increasing life expectancy are important concerns for governments in developed countries. The aims of this study were as follows: (i) to forecast mortality for 14 developed countries from 2010 to 2050, using the Poisson Common Factor Model; (ii) to project the effects of the forecast mortality patterns on support ratios; and (iii) to calculate labour force participation increases which could offset these effects. The forecast gains in life expectancy correlate negatively with current fertility. Pre-2050 support ratios are projected to fall most in Japan and east-central and southern Europe, and least in Sweden and Australia. A post-2050 recovery is projected for most east-central and southern European countries. The increases in labour force participation needed to counterbalance the effects of mortality improvement are greatest for Japan, Poland, and the Czech Republic, and least for the USA, Canada, Netherlands, and Sweden. The policy implications are discussed.

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PURPOSE: The purpose of this study was to describe depression, caregiving burden and the correlation of the two variables in the families of patients with amyotrophic lateral sclerosis (ALS) and to clarify factors predicting caregiving burden. METHODS: A descriptive and cross-sectional study was conducted with 139 family members who provided care to patients with ALS. The characteristics of patients and families, Korean-Beck Depression Inventory (K-BDI), Korean version of Zarit Burden Interview (K-ZBI) and Korean-Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (K-ALSFRS-R) were used as study measures. RESULTS: The mean score for K-BDI was 19.39 out of 63 suggesting sub-clinical depression and 38.2% of the family members exhibited depression. The mean score for K-ZBI was 66.03 out of 88. The predictors for K-ZBI were K-BDI, age of family member, length of time spent per day in caring, relationship to patient and K-ALSFRS-R. CONCLUSION: The results of this study suggest that levels of depression and caregiving burden are high among family members caring for patients with ALS. As depression is associated with caregiving burden, screening and emotional supports should be provided to reduce the burden of care for these family. Support programs to alleviate the care burden are also needed, considering family demographics, time per day in caring giving and K-ALSFRS-R.

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PURPOSE: The purpose of this study was to describe depression, caregiving burden and the correlation of the two variables in the families of patients with amyotrophic lateral sclerosis (ALS) and to clarify factors predicting caregiving burden. METHODS: A descriptive and cross-sectional study was conducted with 139 family members who provided care to patients with ALS. The characteristics of patients and families, Korean-Beck Depression Inventory (K-BDI), Korean version of Zarit Burden Interview (K-ZBI) and Korean-Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (K-ALSFRS-R) were used as study measures. RESULTS: The mean score for K-BDI was 19.39 out of 63 suggesting sub-clinical depression and 38.2% of the family members exhibited depression. The mean score for K-ZBI was 66.03 out of 88. The predictors for K-ZBI were K-BDI, age of family member, length of time spent per day in caring, relationship to patient and K-ALSFRS-R. CONCLUSION: The results of this study suggest that levels of depression and caregiving burden are high among family members caring for patients with ALS. As depression is associated with caregiving burden, screening and emotional supports should be provided to reduce the burden of care for these family. Support programs to alleviate the care burden are also needed, considering family demographics, time per day in caring giving and K-ALSFRS-R.

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PURPOSE: Purposes of this study were: evaluation of family burden of caring for elders who receive long term care services, and examination of differences in burden before and after the introduction of long term care service in Korea. METHODS: Data were collected by questionnaires from 416 caregivers of elders who were registered with the Long Term Care Insurance Corporation in six cities. Data were collected in September, 2010 and analyzed using descriptive statistics, paired t-test, and ANOVA with the Scheffe test, and stepwise multiple regression. RESULTS: Family burden decreased significantly after long-term care service was initiated. Subjective burden decreased from 2.93 to 2.69 (t=11.78, p<.001), and objective burden, from 3.40 to 3.10 (t=12.73, p<.001). Stepwise multiple regression analysis revealed that factors affecting subjective burden were family relations (F=13.60, p=.003), age (F=5.47, p=.019), job (F=6.98, p=.008), and education (F=4.59, p=.032), and that factors affecting objective burden were living together (F=17.66, p<.001), job (F=13.34, p=.003), monthly income (F=6.61, p=.010), and type of service (F=6.62, p=.010). CONCLUSION: The results of this first study to investigate caregiver burden after the Korean Long-term Care Insurance System was begun provide positive information for the development of strategies to decrease family burden in long term care.

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Background: Six percent of the Chilean population has a disability requiring assistance with daily-living-activities and 69 percent of these individuals are cared by direct family members. The latter are at risk of developing caregiver burden. Zarit scales are used to assess the severity of caregiver burden. Aim: To validate the original and abbreviated Zarit scales for caregiver burden. Material and methods: Two groups of interviewers applied the original and abbreviated Zarit scales, along with a single subjective indicator for burden and surveys for depression, to 32 caregivers from an outpatient clinic in Melipilla, Chile. In 22 subjects, the instruments were applied again, four months later Results: Both Zarit scales showed high correlation with the subjective indicator for burden and with depression (r =0.51 and 0.67, respectively), supporting its construct validity. The abbreviated scale had a high correlation with the original scale (r =0.92), supporting its criterion validity. It had a 100 percent sensitivity 77.7 percent, specificity 86.6 percent positive predictive value and 100 percent negative predictive value to discriminate severe caregiver burden, using the original scale as standard. Both instruments showed high internal consistency (Cronbach alpha =0.84 and 0.87, respectively), inter-observer reliability (intraclass correlation coefficient =0.81 and 0.86, respectively) and stability reliability (Kappa test-retest =0.91 and 0.93, respectively). Conclusions: Both original and abbreviated Zarit burden scales are valid to assess caregiver's burden in a Chilean context. The abreviate scale Szeged particularly useful for primary care.

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PIP: This study recommends a probabilistic scenario approach for population projections. The benefits are better information, ease of adoption, and expert opinion on the mean and range of uncertainty. The study answers whether it matters if high and low variants cover 85% or 95% of the range. An assumption of piece-wise linear random paths may underestimate the variance of the resulting population age distribution. A more realistic random path would have short-term fluctuations with some degree of autocorrelation. The expert-based probabilistic approach is applied to Austria. Official projections to 2050, account for 3 alternative migration assumptions and the usual fertility and life expectancy assumptions. Austria may have an absolute deficit of 60,000 persons after 2025. Population aging will increase from 19.7% to over 30%. The mean age of population will reach 50 years. The social implications of the alternative degrees of population aging are likely to have significant effects, such as on the pension system. The results of a test of the sensitivity of results for 85% and 95% confidence intervals and the impact on population size and old-age dependency outcomes reveal larger standard deviations and differences between fractiles with the 85% assumption of all cases lying between high and low values. Differences were larger between 85% and 90%, although not very significantly, than between 90% and 95%. When assuming short-term fluctuations, there was a greater range of uncertainty in the first 20 years than a standard linear interpolation, but long-term projections had lower standard deviations.^ieng

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PIP: "By using a model population, the composition of the future elderly population [in the Netherlands] has been simulated. Demographic forecasts and forecasts on the level of educational attainment of elderly people were used to construct this model population. As the percentage of elderly people with disabilities is expected to fall due to an increasing level of educational attainment, the number of dependent elderly people will, over the next two decades, increase much slower than the total number of elderly people." (EXCERPT)^ieng

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PIP: This study examines patterns among the elderly in China using census data. The analysis includes a description of past population changes by province and urban or rural status and future population projection scenarios with 3 variants of fertility and mortality. The author briefly discusses the socioeconomic implications of population aging. China had high fertility and mortality in 1949. The mortality rate improved during the 1950s and 1960s. Fertility declined to 2.24 in 1980. Population size expanded in the early 1950s and 1960s. A baby boom occurred in 1963-64. By 1982, the population pyramid showed the fluctuations in fertility and slow, gradual growth. In 1990, the increase in persons aged 0-4 reflected the increase in the number of reproductive age women. The proportion aged over 65 years rose from 4.41% to 5.57% during 1953-90. The total dependency ratio in 1990 was 49.83 (8.35 elderly). Old age ratios varied by region, from 6.68 in the Northwest to 8.79 in the Central South. More elderly were females and persons living in rural areas. Projections to 2050 under high, medium, and low variants indicate a range from 17.5% to 26.6% of elderly, or over 322.5 million persons, an increase from 67 million in 1990. The dependency ratio will increase. The speed of the process of population aging will increase after 2000.^ieng

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PIP: An examination of dependency among the Chinese elderly in physical, mental, social and economic areas is presented. Data were obtained from the cross-tabulations of the 1992 National Survey on the Old-Age Support System in China. A total of 20,083 respondents aged 60 years and over were included in the study. Findings showed that dependency rates differed markedly among the four functional areas. Only a very small proportion of the elderly was physically dependent or partly dependent. Within its functional area, dependency rates varied by age, sex, and urban-rural residence. Moreover, the economic needs of the elderly are the only fields that attract serious attention from the government and the society. Although economic security is the fundamental factor in the well being of the elderly, their physical, mental, and social aspects should also be considered. Mortality improvements would result in more elderly surviving to advanced ages and a potential rise in dependency rates. Therefore, China needs nationally unified strategies and policies, special government funding, and well-organized programs in order to address the needs of their elderly population.^ieng

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"Because minority populations often have greater needs for health care and fewer resources to pay for it, it is important to assess the demand for services. This paper takes an initial step in that direction by focusing upon the geographic distribution of elderly minority populations in the United States. The study is carried out at several spatial scales, and it is concluded that elderly minority populations tend to be even more segregated than their non-elderly counterparts."

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Accelerated population ageing experienced in the last few decades is an unprecedented phenomenon. Currently, this is more in the developing countries. Soon three-fourths of the elderly will be in the developing world. From 1990 to 2025, the elderly population in Asia will rise from 50 per cent of the world's elderly to 58 per cent, in Africa and Latin America from 5 to 7 per cent, but in Europe the figure will drop from 19 to 12 per cent of the world's elderly. The life span has increased in India from 32 yr in 1947 to more than 62 yr now. From the morbidity point of view, almost 50 per cent of the Indian elderly have chronic diseases and 5 per cent suffer from immobility. There are several vulnerable groups and a big disadvantaged lot are elderly females who are one of the fastest growing segments, which will increase to become 4 times the current figure, by 2025. In spite of professional disinterest in the speciality, recent trends indicate the beginning of sensitization of medical teachers, advancing speciality of psychosocial gerontology and availability of some research funds. Importance of training of health professionals and priorities in gerontological research are also under consideration. Infections still take a heavy toll of our elderly population apart from well known degenerative disorders. Limitations of a developing country further influence the morbidity pattern in various ways. Nutritional deficiencies are common and often subclinical thus escaping the desired interventions. Coronary heart disease, hypertension, mental and many other disorders in the elderly have been reported as isolated observations highlighting differences from those made in the Western countries. Socio-economically, the traditional support of extended families is rapidly undergoing erosion making the elderly further vulnerable. This causes more emotional and psychological problems while the State finds itself helpless in providing a comprehensive care to its large chunk of elderly population. It will be important to surmise and predetermine the future factors that are going to modify the diverse patterns of morbidity, disability and mortality in regional context.

PIP: The author discusses aging trends in India, with a focus on ways of dealing with the resulting dependency burden. Sections are included on various dimensions of aging, the health status of the elderly, mortality and morbidity, and psychosocial status and support for the aged.

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PIP: In India, data from the decennial censuses have been the catalyst that has led researchers to identify social policy needs and craft programs to lower overall mortality rates, infant mortality rates, and fertility rates. A new demographic phenomenon that is being exposed by the data is the increase in life expectancy that will see large numbers of individuals surviving 15-20 years beyond age 60. This increased life expectancy will lead to an increased old age dependency ratio and will require reexamination of the issue of resources to meet the needs of the elderly. These needs are social and psychological as well as physical. Research is needed to predict the initial consequences of population aging within different states. International comparisons within the Asian region will also foster identification of effective policies. Research is also needed to identify whether longevity is tied to higher educational and socioeconomic status in order to improve life expectancy among low-income groups. Another aspect that requires consideration is that most elderly women will likely survive their husbands. This means that they will be available to care for their husbands but will have to depend upon their children to care for them. The possible demographic diversity in the experience of aging among various states and classes and between the genders may be of special interest to researchers.^ieng

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PIP: There is no global population issue, because there is no global government. Overpopulation as the world's monolithic population problem is overly simplistic and may lead to extreme positions. Problems are also caused by slow population growth, as for the 25% of the world's population who live in countries with age structure imbalances. Nearly all of world population growth comes from less-developed countries. By the year 2000, inhabitants of poor countries are expected to number 5 billion, a 5-fold increase in this century. Europe's population may decline from 728 million today to 563 million by 2050. The implosion of population in developed countries and the population explosion in developing ones creates problems. Nations must address these problems. A pronatalist policy in Europe would allow women to have the 2 children they desire, rather than the 1.5 they now have. The increase in fertility would eventually alleviate the age imbalance. Trade and economic policies could encourage trade rather than aid. European countries should also shift to more generous immigration policies, such as those in the United States. This could also ease the age dependency burden and demands for labor. Crucial to all efforts, however, is increasing fertility in Europe. It is now true that countries where women have the highest status (such as Scandinavian countries) often have higher fertility rates. Policies should be based on mutual understanding and recognition of the socioeconomic realities.^ieng

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PIP: "The current aging of Quebec's population is expected to intensify in the beginning of the next century. By 2031, seniors could represent 25 percent of the total population, or nearly two million individuals. It is vital that policy-makers more fully grasp the multiple aspects of this much-feared eventuality. To this end, the aim of this study is to shed new light on one facet of the problem. Using data from the 1986 Health and Activity Limitation Survey (HALS), the authors analyze the correlation between the income and health status of Quebec seniors aged 65 and over living in private households." (EXCERPT)^ieng

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