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The social phenomenon of extended working age has been subject to broad scholarly and social policy interest, as part of such trends as the aging of the population, increased life expectancy, shortage of the labor force, and policy debates on pension reforms. A major question about extending working age, or working after retirement, is whether it is a matter of choice, taking control of one's later life, or is coerced, part of entering the precariat. This study provides a nuanced examination of the social processes that direct labor market participation among older workers by conducting an analysis of in-depth interviews with 42 low-income older workers in Israel. The study exposed several institutional constraints that increase their economic vulnerability, demonstrating how interrelated structural factors related to the labor market, gender, and immigration shape the precarity of the life of older workers and coerce their continuous labor market participation. We conclude by emphasizing the responsibility of governments to ensure that older workers' labor market participation truly represents their "choice and control," rather than being a matter of coercion.

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BACKGROUND: Unmet need for home and community-based services (HCBS) may disparately impact older adults from racial and ethnic minoritized groups. We examined racial and ethnic differences in unmet need for HCBS among consumers ≥65 years using publicly funded HCBS. METHODS: We analyzed the National Core Indicators-Aging and Disability survey data (2015-2019) from 21,739 community-dwelling HCBS consumers aged ≥65 years in 23 participating states. Outcome measures included self-reported unmet need in six service types (i.e., personal care, homemaker/chore, delivered meals, adult day services, transportation, and caregiver support). Racial and ethnic groups included non-Hispanic Black, Asian, non-Hispanic White, Hispanic, and multiracial groups. Logistic regression models examined associations between race and ethnicity and unmet need, adjusting for sociodemographic, health, and HCBS program (i.e., Medicaid, Older Americans Act [OAA], Program for All-Inclusive Care for the Elderly [PACE]) characteristics, and use of specific service types. RESULTS: Among 21,739 respondents, 23.3% were Black, 3.4% were Asian, 10.8% were Hispanic, 58.8% were non-Hispanic White, and 3.7% were multiracial or identified with other races/ethnicities. Asian and Black consumers had higher odds of reporting unmet need in personal care than White consumers (adjusted odds ratio [aOR], 1.45, p value < 0.01; and aOR, 1.25, p < 0.001, respectively). Asian and Black consumers had significantly higher odds of unmet need in adult day services versus White consumers (aOR, 1.94, p < 0.001 and aOR, 1.39, p < 0.001, respectively). Black consumers had higher odds of unmet need versus non-Hispanic White consumers in meal delivery and caregiver support services (aOR, 1.29; p < 0.01; and aOR 1.26, p < 0.05, respectively). Race and ethnicity were not significantly associated with experiencing unmet need for homemaker/chore or transportation services. CONCLUSIONS: Future research should identify driving forces in disparities in unmet need to develop culturally appropriate solutions.

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Older adults are more frequently wanting to age in place. Governments are seeking cost-effective and efficient methods of supporting aging populations. Older adults who want to stay in their homes for as long as possible encounter multiple barriers, including struggling to maintain their homes, inadequate levels of social and healthcare support, and the lack of financial capacity to pay for home support services. The Mobile Seniors' Wellness Network (MSWN), a multi-disciplinary and person-centered mobile health and social support intervention study was designed to investigate and support aging in place for older adults living in rural New Brunswick, Canada. Secondary analysis of case notes and exit interviews using content analysis revealed concerns with the lack of affordable and mobile care services for vulnerable rural older adults. Older adults revealed that their needs include "the little things" rather than grand gestures or sweeping policies to age in place such as assistance with grounds and home maintenance, in addition to relational and person-centered health and social care in the home. Reliance on private service delivery and volunteer organizations can increase the likelihood that older adults will experience a breakdown of social support networks tied together loosely by friends, family, and their communities. When services are unattainable aging in place becomes an unreachable goal.

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The world's population is aging with the fastest growth in the older population projected to take place in Africa. In this article, we present the challenges of the growing older population in Ethiopia, outline some key changes that are needed to address those challenges, and consider the opportunities that can come about when older adults' basic needs are met and they are supported in contributing to their communities. Older adults in Ethiopia are faced with multidimensional challenges that call for collaborative efforts from different stakeholders at local, regional, and national levels. However, some measures should be given the utmost priority: combating negative attitudes toward older people, strengthening geriatric/gerontology and social work education and research, and developing aging-specific policies and services. Although the challenges faced by older adults in Ethiopia seem like a problem of aging compounded by poverty, the root source of the problem is a poverty of policy fueled by ageism. If income support and appropriate health care was provided to older adults throughout Ethiopia, health and well-being in late life would improve, food and housing insecurity among older adults would lessen, and all Ethiopians could anticipate a dignified late life.

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OBJECTIVES: Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence. DESIGN: Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING AND PARTICIPANTS: The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility). METHODS: Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence. RESULTS: Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week. CONCLUSIONS AND IMPLICATIONS: Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.

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As population aging continues to become a major demographic trend globally, it is essential to examine the demographic shifts at the micro-level to understand the changing scenario of older populations. A lack of adequate data in India on older populations is a hindrance to the government's efforts to provide social security for them. This study uses gridded population data to analyze the spatial patterns, micro-level trends, and the share of older populations in India for 2030 and 2040. The study's findings demonstrate that India has seen a dramatic shift in population aging trends, with large intra-state variability. The micro-level analysis shows that certain districts have a higher percentage of older people. Further, the share of older populations is predicted to rise considerably over the next two decades. The results highlight the need to shift from national and state-level policies to a more localized approach. The findings provide a comprehensive analysis of population aging at the micro-level in India and highlight the need for targeted policies and programs to ensure the well-being of older populations. The results of this study can inform policymakers in their efforts to provide social security for older people and improve their quality of life.

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Policy Points Little attention to date has been directed at examining how the long-term services and supports (LTSS) environmental context affects the health and well-being of older adults with disabilities. We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences. We find the LTSS environment is highly associated with person-reported care experiences, but the direction of the relationship varies by domain; increased neighborhood social and economic deprivation are highly associated with experiencing adverse consequences due to unmet need, whereas availability and generosity of the health care and social services delivery environment are inversely associated with participation restrictions in valued activities. Policies targeting local and state-level LTSS-relevant environmental characteristics stand to improve the health and well-being of older adults with disabilities, particularly as it relates to adverse consequences due to unmet need and participation restrictions. CONTEXT: Long-term services and supports (LTSS) in the United States are characterized by their patchwork and unequal nature. The lack of generalizable person-reported information on LTSS care experiences connected to place of community residence has obscured our understanding of inequities and factors that may attenuate them. METHODS: We advance a conceptual framework of LTSS-relevant environmental domains, drawing on newly available data linkages from the 2015 National Health and Aging Trends Study to connect person-reported care experiences with public use spatial data. We assess relationships between LTSS-relevant environmental characteristic domains and person-reported care adverse consequences due to unmet need, participation restrictions, and subjective well-being for 2,411 older adults with disabilities and for key population subgroups by race, dementia, and Medicaid enrollment status. FINDINGS: We find the LTSS environment is highly associated with person-reported care experiences, but the direction of the relationship varies by domain. Measures of neighborhood social and economic deprivation (e.g., poverty, public assistance, social cohesion) are highly associated with experiencing adverse consequences due to unmet care needs. Measures of the health care and social services delivery environment (e.g., Medicaid Home and Community-Based Service Generosity, managed LTSS [MLTSS] presence, average direct care worker wage, availability of paid family leave) are inversely associated with experiencing participation restrictions in valued activities. Select measures of the built and natural environment (e.g., housing affordability) are associated with participation restrictions and lower subjective well-being. Observed relationships between measures of LTSS-relevant environmental characteristics and care experiences were generally held in directionality but were attenuated for key subpopulations. CONCLUSIONS: We present a framework and analyses describing the variable relationships between LTSS-relevant environmental factors and person-reported care experiences. LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Greater attention should be devoted to strengthening state- and community-based policies and practices that support aging in place.

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Although a new conceptualization of functional ability was proposed in the Decade of Healthy Aging, few studies attempted to understand functional ability among older adults from a holistic review. Based on the China Health and Retirement Longitudinal Study from 2011 to 2018, the study investigated the current situation of five domains of functional ability (ability to self-care, being mobile, building/maintaining relationships, contributing to society, learning, and growing), the overall functional ability score and their associated factors among older people. Compared to other functional ability domains, the ability to contribute to society and learn/grow has been largely underdeveloped. Rural respondents were 23% ~ 48% less likely to preserve the five functional ability domains than their urban peers. The findings in this study suggest that China should shift the paradigm to healthy aging by providing more opportunities for the aged to pursue their ability to contribute to society, and the ability to learn, grow and make decisions. Timely policies to maintain functional ability should target those with rural hukou, low education, and low income, especially those with poor cognition.

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Globally, the number and proportion of people aged 60 years and older is growing fast. As people age, health needs become more complex, and the health system's responsiveness to older people's needs requires evidence-informed policies. Hence, this study explores the factors affecting the health policy development process for older people in Iran. We conducted 32 interviewers with people aged 60 years and older and 21 interviews with key informants involved in policy making related to older people. Qualitative data were analyzed using thematic analysis. Actors and stakeholders, policy structure, selected health policy processes, the health care service delivery system, government financial support, and community and culture building are the most influential factors in health policy making for older people. Government policies and health priority interventions are needed to address these influential factors for older people to ensure healthy aging over the life course.

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While the continent of Africa currently has the lowest share of adults aged 60 and older in its population among all world regions, the total number of older Africans is projected to triple between 2020 and 2050. Nigeria-Africa's leading economy and most populated country-has the highest number of older people in the continent and the 19th highest across the globe, with the population of Nigerians aged 65 and older projected to nearly triple by 2050. However, the increase in older Nigerians is occurring against the backdrop of extreme poverty, unsolved development problems, socioeconomic inequality, the HIV/AIDS epidemic, and a decline in the traditional care and support of older adults. Additionally, the absence of an operational national aging policy or safety net services and programs poses a unique challenge to older Nigerians and their families. In this article, we examined social statistics and the current literature to describe aging in the Nigerian context. Our findings highlight the importance of establishing effective governmental policy interventions for the adequate care and support of older Nigerians and the training of gerontological professionals. This article will describe the demography of aging in Nigeria, significant areas of research, key scholars and publicly available data sets, public policy issues, and emerging issues affecting the health and well-being of older Nigerians.

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BACKGROUND AND OBJECTIVES: As the older adult population grows, it is important to understand the effectiveness of service delivery systems that support aging in place. Studying service delivery processes and organizational structures of Area Agencies on Aging (AAAs) is essential for future efforts to understand service delivery outcomes and innovations. RESEARCH DESIGN AND METHODS: We conducted site visits with 5 government-run California AAAs. We used a template and constant comparative analysis to analyze transcripts from site visits and focus groups with key informants. RESULTS: AAA representatives discussed how their organizational structure was related to (a) which services and programs they provided; (b) administrative cost savings and access to funding sources; (c) inter- and intra-agency coordination; and (d) visibility among clients and community partners. DISCUSSION AND IMPLICATIONS: These findings can be used to guide decisions surrounding how changes in AAA structure may affect funding, coordination, service delivery, and visibility, among other factors. Consolidating the AAA with other departments and programs facilitates coordination and shared administrative costs, yet consolidation may reduce standalone AAAs' visibility and ability to innovate. AAA structure should be tailored to fit community resources, local government organization, and the needs of older residents.

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Until the 1980s, institutional elder care was virtually unknown in China. In a few decades, China had to construct a universal social safety net and assure basic elderly care. China's government has been facing several challenges: the eroding traditional family care, the funding to assure care services for the older population, as well as the shortage of care delivery services and nursing staff. This paper examines China's Five-Year Policy Plans from 1994 to 2020. Our narrative review analysis focuses on six main topics revealed in these policies: care infrastructure, community involvement, home-based care, filial piety, active aging and elder industry. Based on this analysis, we identified several successive and often simultaneously strategic steps that China introduced to contend with the aging challenge. In Western countries, elder care policies have been shifting to the home care approach. China introduced home care as the elder care cornerstone and encouraged the revival of the filial piety tradition. Although China has a unique approach, the care policies for the aged population in China and Western countries are converging by emphasizing home-based care, informal care and healthy aging.

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Most developing nations are facing rapid population aging with limited economic and social resources. In Ghana, a National Aging Policy (NAP) was promulgated by the government in 2010 to ensure the well-being of older adults. Since its passage, the NAP has yet to be funded and implemented. In this paper we synthesize key information on policies and programs targeted at older adults in Ghana and identify the challenges that are adversely impacting their welfare, including the non-implementation of the National Aging Policy. To give the NAP needed attention and promote its implementation, a national coordinating body exclusively devoted to older adults is an essential first step. Critical next steps are offered to promote the effective implementation of the NAP and ensure the well-being of older adults in Ghana. With its current foundation of support programs for older adults, Ghana has the opportunity to be the lead nation in Sub-Saharan Africa to establish a national level office dedicated to promoting older adults' well-being and including them in the nation's development efforts.

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Although there has been an increase in awareness of the struggles experienced by caregivers, discourse on caregiving remains confined mostly to academia, policy circles or the family unit. There have been suggestions that public discourse on informal caregiving dwells overwhelmingly on the outsize toll it takes on the health of caregivers. However, few studies have examined societal narratives on caregivers-a gap our study aims to fill. We leveraged an online media database of 12 billion words collated from over 30 million articles to explore societal narratives on caregivers in six Asian countries. Computational linguistics and statistical analysis were applied to study the content of narratives on caregivers. The prevalence of societal narratives on caregivers was highest in Singapore-five times higher than Sri Lanka, which evidenced the lowest prevalence. Findings reveal that the inadequacies of institutional care as well as the need to train and empower caregivers are pressing issues that need to be prioritized on the policy agenda in Asia. Of broader significance, the diverse capabilities across Asia present opportunities for cross-country learning and capacity-building.

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Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions-a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the "number of days from previous non-elective admission", which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission-a key predictor in other models-since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation-an "art" that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

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OBJECTIVES: This study constructed an Active Aging Index (AAI) for Vietnam and compares Vietnam's AAI with those of China, Korea, Taiwan, and 28 countries in the European Union. METHODS: A survey of 1,105 people aged 55 or above in three provinces from the northern, central, and southern parts of Vietnam was conducted. Active aging was measured using the AAI; its 22 indicators were grouped into four domains: employment, social participation, independent/healthy/secure living, and enabling environments. RESULTS: Of the 32 countries reviewed, Vietnam ranked 11th. It ranked high for employment (1st) and social participation (5th) but low for independent/healthy/secure living (32nd) and enabling environments (26th). CONCLUSION: Three policy priorities were identified: maintaining a high preference-driven social and workforce participation rate among older adults; promoting medical care and healthy behaviors among older adults; and improving other poorly performing aspects of active aging, including voluntary activities, poverty risk, Internet usage, and lifelong learning.

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In this essay the current and previous editors discuss the history of the Journal of Aging & Social Policy. In reviewing the past thirty years of publishing the Journal, one can see three phases: Phase 1 took pace during the first decade (1989-1997), Phase 2 covered the next decade and a half or so (1998-2015), and Phase 3 reflects the past five years, a period of continuing growth and success (2016-Present). Despite its inevitable challenges, the Journal of Aging & Social Policy overcame each and has arrived. Today, it is a well-respected Journal that attracts excellent scholarship from around the world, that is well-cited, and that has earned the Journal a commendable impact factor. The editors are proud of that evolution. However, success is never final. The Journal will require continued effective stewardship as it looks to the next thirty years and beyond.

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Home- and community-based services (HCBS) provide support to individuals needing assistance with daily activities, like people with multiple sclerosis (MS) who often experience functional impairment. Research notes racial differences in HCBS utilization among people with MS, which may be attributed to state's relative amount of long-term service and support (LTSS) expenditures dedicated to HCBS (HCBS priority). As a first step in untangling this mechanism, we explored how HCBS priority may contribute to racial differences in service utilization. Using Medicaid claims data for a national cohort of dual eligibles with MS, we find state HCBS priority is associated with disparities in utilization-blacks and Hispanics receiving HCBS more often do so in low-priority states compared with whites. Findings indicate a need for additional research focusing on health equity to further examine effects on quality of life and health outcomes of individuals who would benefit from more generous HCBS policies, specifically determining whether minorities in low-HCBS states fare worse than those in high-priority states. Findings from the present study can help policymakers more effectively design HCBS programs for diverse individuals.

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There is no single path to becoming an Age-Friendly University (AFU). This paper shares the story of one regional, public university that became the first in its state to join the AFU global network. We discuss how early efforts at coalition building both within and outside the university facilitated the campus-wide endorsement of the AFU principles. We highlight several partnerships and programs that reflect the AFU principles and discuss how becoming an AFU helped to further strengthen university ties and is now providing a valuable framework for continued collaboration and coalition building. We share lessons from our efforts, including the challenges and benefits of being the first AFU in our state as we forge a path forward. We conclude with our plans for ensuring the growth of age-friendly practices and policies at our university, and we hope that this paper will encourage you to do the same on your campus.

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The combined effect of rising life expectancy and declining fertility has made "aging" a dominant topic on the policy agenda across Europe. With the aim of retaining older workers and facilitating longer working lives, offering retention measures, such as the possibility of phased retirement, additional leave, and/or bonuses to older workers, has become a widespread strategy among Norwegian companies to combat voluntary early retirement. However, analyses do not find any overall effect of offering such retention measures, although some single measures like additional leave and bonuses seem to have reduced early retirement among older workers in Norway. The aim of this article is to examine whether the limited effect of companies' retention measures on early retirement have been impacted by the financial crisis of 2007/08. Our hypothesis is that the effect of companies' retention measures on early retirement will be less if companies were affected by the financial crisis of 2007/08. Although most companies affected by the crisis of 2007/08 still offers retention measures, the financial hardship following the crisis may force some to priorities to cut cost and reduce staff, which may in turn lead to earlier rather than delayed retirement among their older employees. In order to investigate whether the effects of retention measures on early retirement vary between individuals in companies affected by the financial crisis of 2007/08 or not, we use data from a survey carried out among a representative sample of Norwegian companies in 2010 combined with individual register data on all employees in these companies in the period 2000-2010. Using individual fixed-effects in combination with a linear probability model we did not find that the financial crisis of 2007/08 impact on retention measures overall effects on early retirement. However, working in a company affected by the financial crisis of 2007/08 seem to reduce bonuses and extra days offs' effect on early retirement among private sector employees; although the effects were not statistically significant. Hence it indicates, as expected, that the effect of retention measures on early retirement in the private sector are vulnerable to changes in companies' performance and the overall market situation.