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Social Determinants of Health and Population Ageing

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 July 2020) | Viewed by 31887

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Special Issue Editors

Dr. Anthony G. Tuckett

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Guest Editor

School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD 4072, Australia
Interests: population ageing; older people; citizen science; physical activity; health services research; qualitative; applied ethics

Dr. Lisa Fitzgerald

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Guest Editor

School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
Interests: Social determinants of health; qualitative longitudinal research; sexual health; HIV social research; participatory research

Dr. Allyson Mutch

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Guest Editor

School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
Interests: Social determinants of health; health inequalities; qualtiative research; HIV social research; community and primary care

Special Issue Information

Dear Colleagues,

People are living longer, with the pace of population ageing occurring much faster than has been seen previously. Worldwide, population ageing has emerged as the biggest demographic shift¹ of the early 21^st century and one of the most pressing global challenges. Older people must rely on good health and a supportive social environment if they, and society-at-large, are to prosper. Recognising this, the WHO World Report on Ageing and Health² identifies and defines “healthy ageing” as “the process of developing and maintaining the functional ability that enables well-being in older age.” Functional ability is determined by the individual’s physical, mental, and psychosocial capacities, and the physical, social, and policy environment in which they live. In short, health ageing occurs through interactions between individuals and the broader social, cultural, and historical determinants of health.

Using a life-course lens, health and well-being is shaped by particular times and places, intersections between historical events, personal biography, social and community ties, and broader structural and social determinants of health. Across a life course, these conditions can give rise to unfair and avoidable differences in health status that effectively determines healthy ageing. However, despite increasing recognition of the cumulative role that social determinants play across a life course, limited research has examined healthy ageing through this lens, with much of the current literature embedded within an individualised discourse.

This Special Issue welcomes studies and reviews on bringing together the intersections between the social determinants of health and population ageing. Research exploring these intersections includes life-course perspectives on the role of social determinants of health and the cumulative impact on the health and experiences of health inequalities for older people. Studies exploring intersections between older people and the social determinants of health (e.g., gender, work and job security, food supply, social relationships or social support, and income) are encouraged. Equally, examinations of ageing in place, and/or considerations of urban development (healthy physical environments, age-friendly environments, housing, and transportation) and older people, and how these may operate as interventions or policies for reducing age related health inequities, are invited. We also welcome research that considers diverse voices that extend beyond the western lens, along with those population groups of older people who experience marginalization and/or social exclusion.

This Special Issue will provide readers with up-to-date information on the social determinants of ageing, with the aim of providing a critical contribution to the expanding body of literature on healthy ageing.

¹Palmarini, N., Zinck, S., Hoover, M., Ewell, S. (2016). Outthink Aging. Explore the challenges and opportunities created by an aging society. IBM Accessibility Research. Accessed 10^th July, 2017 from https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=RSM12348USEN

²WHO. (2015). World report on ageing and health. Geneva, Switzerland: World Health Organization. Retrieved from http:// www.who.int/ageing/publications/world-report-2015/en/

Dr. Anthony G. Tuckett
Dr. Lisa Fitzgerald
Dr. Allyson Mutch
Guest Editors

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Keywords

Social determinants of health
Health inequity
Population ageing
Older people
Urban development
Physical environment
Aged-friendly environment
Gender
Work
Food supply
Social relationship
Social support
Income

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Published Papers (8 papers)

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Research

14 pages, 348 KiB

Open AccessArticle

Sex Differences in the Association between Living Environmental Factors and Nutritional Status in Community-Dwelling Elderly Koreans

by Dong Eun Kim, Hee-Sook Lim, Hyejin Ahn, Young Sun Kim and Yoo Kyoung Park

Int. J. Environ. Res. Public Health 2020, 17(17), 6034; https://doi.org/10.3390/ijerph17176034 - 19 Aug 2020

Cited by 7 | Viewed by 2636

Abstract

The association between nutritional status and living environment among 703 community-dwelling participants (268 men and 435 women) aged 65 years and older was assessed. In this cross-sectional survey study, living environmental factors, health-related factors, and nutrition (the Nutrition Quotient for the Elderly scores; NQ-E) were assessed. NQ-E scores were significantly higher in men than women, as were diversity and behavior factor scores (diversity: men, 50.2 ± 16.1; women, 44.1 ± 17.5; behavior: men, 59.3 ± 16.9; women, 54.1 ± 16.6). Participants living with a spouse and engaging in frequent sports activities had significantly higher adjusted odds ratio (OR) for having a high NQ-E than those who lived alone and engaged in restful activities and hobbies (men: adjusted OR for high NQ-E = 8.99; 95% confidence interval (CI): 1.35–59.56; women: adjusted OR for high NQ-E = 5.62; 95%CI: 2.36–13.38). We confirmed that women’s nutritional status, unlike men’s, was better when proper nutrition education was provided and when food security was guaranteed. For all participants, social activities and networks were important for maintaining good nutritional status and a healthy life. We suggest that different nutritional management strategies are needed for elderly people depending on sex. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

10 pages, 509 KiB

Open AccessArticle

Psychosocial Determinants of Quality of Life and Active Aging. A Structural Equation Model

by Laura Ponce de León, Jean Pierre Lévy Mangin and Soledad Ballesteros

Int. J. Environ. Res. Public Health 2020, 17(17), 6023; https://doi.org/10.3390/ijerph17176023 - 19 Aug 2020

Cited by 22 | Viewed by 5383

Abstract

Population aging is the 21st century’s predominant demographic event. The old-age dependency ratio is projected to rise sharply in the next decades. Variables of health-related quality of life can be useful in designing interventions for promoting active aging to prevent dependency and save governments’ budgets. This study aims to find a model capable of explaining how psychosocial variables are related to improved quality of life during active aging, and if this relationship varies with age. Structural equation modelling (SEM) was used to examine the relationships among the availability of social resources, memory, depression, and perception of quality of life from three community senior centers in Madrid (Spain) in a sample of 128 older adult volunteers. The results suggest a psychosocial model where the availability of social support improves quality of life and explicit memory, reduces depression in active older adults, and where there are two main elements for understanding quality of life: perception of health and satisfaction. Importantly, age does not modify the interactions between variables, suggesting that their behavior is constant across aging. We concluded that the availability of social resources, understood not only as the people we interact with daily but also other family members, close friends, or institutions that could help in case of an emergency, allows people to avoid isolation and loneliness, increasing satisfaction and well-being in older adults. Professionals and policymakers should promote well-being by incorporating psychosocial variables related to personal satisfaction in the existential project, not only health, functional activity, or a friendly environment. Older adults need to feel that they are not alone, and in this sense, the availability of social resources is key. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

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13 pages, 1591 KiB

Open AccessArticle

Body Mass Index Trajectory–Specific Changes in Economic Circumstances: A Person-Oriented Approach Among Midlife and Ageing Finns

by Jatta Salmela, Tea Lallukka, Elina Mauramo, Ossi Rahkonen and Noora Kanerva

Int. J. Environ. Res. Public Health 2020, 17(10), 3668; https://doi.org/10.3390/ijerph17103668 - 22 May 2020

Cited by 5 | Viewed by 3334

Abstract

Economic disadvantage is related to a higher risk of adulthood obesity, but few studies have considered whether changes in economic circumstances depend on a person’s body mass index (BMI) trajectory. We identified latent BMI trajectories among midlife and ageing Finns and captured individual-level changes in economic circumstances within the BMI trajectories utilizing sequence analysis. We used the Helsinki Health Study cohort data of initially 40–60-year-old Finnish municipal employees, with four survey questionnaire phases (2000–2017). Each survey included identical questions on height and weight, and on economic circumstances incorporating household income and current economic difficulties. Based on computed BMI, we identified participants’ (n = 7105; 82% women) BMI trajectories over the follow-up using group-based trajectory modeling. Four BMI trajectories were identified: stable healthy weight (34% of the participants), stable overweight (42%), overweight to class I obesity (20%), and stable class II obesity (5%). Lower household income level and having economic difficulties became more common and persistent when moving from lower- to higher-level BMI trajectories. Differences in household income widened over the follow-up between the trajectory groups, whereas economic difficulties decreased equally in all trajectory groups over time. Our study provides novel information on the dynamic interplay between long-term BMI changes and economic circumstances. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

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13 pages, 807 KiB

Open AccessArticle

Relationship between Individual Social Capital and Functional Ability among Older People in Anhui Province, China

by Zhongliang Bai, Zijing Wang, Tiantai Shao, Xia Qin and Zhi Hu

Int. J. Environ. Res. Public Health 2020, 17(8), 2775; https://doi.org/10.3390/ijerph17082775 - 17 Apr 2020

Cited by 21 | Viewed by 3272

Abstract

This study aimed to explore the relationship between individual social capital and functional ability, with a focus on whether there is an interactive relationship that exists among social capital related to functional ability among older people in Anhui province, China. We conducted a cross-sectional study with a multi-stage stratified cluster random sampling method from July to September 2017. Data were collected through questionnaire including demographic characteristics, individual social capital status, and functional capability status. Binary logistic regression analysis model and classification and regression tree model (CART) were utilized. Overall, this study included 1810 elderly people, 43% of whom had functional disability. After the adjustment, subjects with lower social participation (AOR = 1.60; 95% CI: 1.26–2.03) and lower social connection (AOR = 1.74; 95% CI: 1.34–2.25) had an increased risk of functional disability. However, social support (AOR = 0.73; 95% CI: 0.57–0.94) was inversely related to functional ability. We also observed interactive relationship of social capital associated with functional ability, which indicated that special attention and efforts should be paid to older adults with less educational attainment, with multimorbidity, with advanced age, and with lower level of social participation, cohesion for the purpose of maintaining sound functional ability. Our findings may be of salient relevance for devising more targeted and effective interventions to prevent the onset of functional limitations among community-dwelling older adults. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

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15 pages, 357 KiB

Open AccessArticle

Relevance of Gender and Social Support in Self-Rated Health and Life Satisfaction in Elderly Spanish People

by M. Pilar Matud, M. Concepción García and Demelza Fortes

Int. J. Environ. Res. Public Health 2019, 16(15), 2725; https://doi.org/10.3390/ijerph16152725 - 31 Jul 2019

Cited by 34 | Viewed by 4318

Abstract

Background: Gender and social support are important social determinants of health, but the relevance of such variables in older people’s health has raised less scholarly attention than in younger age groups. This study examines the relevance of gender and social support in the self-rated health and life satisfaction of elderly Spanish people. A cross-sectional study with a sample of 702 men and 754 women aged between 60 and 94 years was conducted. All participants were evaluated through questionnaires that assess gender role traits, social support, and life satisfaction. Results: Men scored higher than women in masculine/instrumental trait and in life satisfaction whereas women scored higher than men in feminine/expressive trait. Results from multiple regression analyses indicated that women and men presenting higher social support had better self-rated health and higher life satisfaction. High scores in masculine/instrumental trait also proved to be an important predictor of men’s and women’s high life satisfaction and of women’s better self-rated health, whereas the high feminine/expressive trait predicted better self-rated health in the men group. A high educational level was associated in the women’s group with better self-rated health and higher life satisfaction. Conclusions: We conclude that gender and social support are important social determinants of health among older people. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

13 pages, 552 KiB

Open AccessArticle

To Meet, to Matter, and to Have Fun: The Development, Implementation, and Evaluation of an Intervention to Fulfil the Social Needs of Older People

by Tina ten Bruggencate, Katrien G. Luijkx and Janienke Sturm

Int. J. Environ. Res. Public Health 2019, 16(13), 2307; https://doi.org/10.3390/ijerph16132307 - 28 Jun 2019

Cited by 9 | Viewed by 4698

Abstract

Interventions for older people are often not evaluated and, if evaluated, are not proven successful. Based on a systematic literature review and two qualitative studies about the social needs of older people, an intervention has been developed, implemented, and evaluated. Important social needs that emerged from these studies are connectedness, meaningfulness, and independence. Samsam, the developed intervention, aims to fulfil these needs. Samsam is a place where older (native Dutch speaking) people teach the Dutch language to expats, refugees, and immigrants. Two group interviews and one interview with a total of seven older participants were held to find out what the experiences are with this intervention to fulfil the social needs of older people. After analysis, three themes emerged: (1) The general experience of Samsam, (2) connectedness, and (3) meaningfulness and status. Results indicate that the volunteers are content with the conditions of the intervention, although it is sometimes hard work. The older participants indicated that helping other people and contributing to society is important for them. The intervention also has a strong social and fun element which contributes to their feeling of connectedness. The intervention fulfils various social needs, such as connectedness, meaningfulness, and status. When participating in Samsam, participants feel connected to each other, to the students, and to society. The older participants want to have meaningful lives and use their skills and talents. Samsam offers possibilities for them to do so. We further found that participants have some common characteristics such as an openness to others and to other cultures. An openness towards others and to society helps older people to connect. Most interventions focus on stimulating contact between older people, primarily on their need for affection. We conclude that meaningfulness and status are important social needs. Successful interventions for older people should focus more on fulfilling these needs—for example, by engaging in purposeful activities. It becomes easier to connect when a person feels useful. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

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10 pages, 797 KiB

Open AccessArticle

Food Insecurity and Geriatric Hospitalization

by Rachel S. Bergmans, Briana Mezuk and Kara Zivin

Int. J. Environ. Res. Public Health 2019, 16(13), 2294; https://doi.org/10.3390/ijerph16132294 - 28 Jun 2019

Cited by 6 | Viewed by 3613

Abstract

Food insecurity (FI) has been associated with hospitalization, although the pathways underlying this relationship are poorly understood, in part due to the potential for a bidirectional relationship. This study aimed to determine associations of FI with concurrent and future hospitalization among older adults; mediation by depression and; whether hospitalization increased risk of FI. Participants came from the 2012 and 2014 waves of the Health and Retirement Study (HRS; n = 13,664). HRS is a prospective cohort representative of U.S. adults over the age of 50. Primary analyses included those who were not hospitalized in 2012 (n = 11,776). Not having enough money to buy necessary food or eating less than desired defined food insecurity. The Composite International Diagnostic Interview Short Form provided depression symptomology. Logistic and linear regression examined concurrent and longitudinal associations of FI in 2012 and 2014 with hospitalization in 2014. Path analysis tested mediation of FI with hospitalization frequency by depression symptomology. Finally, logistic regression examined whether hospitalization in 2012 was longitudinally associated with FI in 2014. FI was not associated with future hospitalization (odds ratio (OR) = 1.1; 95% confidence interval (CI) = 0.9–1.4), however; FI was associated with concurrent hospitalization status (OR = 1.4; 95% CI = 1.1–1.8). Depression symptomology explained 17.4% (95% CI = 2.8–32.0%) the association of FI with concurrent hospitalization frequency. Additionally, hospitalization was associated with becoming food insecure (OR = 1.5; 95% CI = 1.2–2.0). Findings may inform best practices for hospital discharge among older adults. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

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14 pages, 620 KiB

Open AccessArticle

Multi-Morbid Health Profiles and Specialty Healthcare Service Use: A Moderating Role of Poverty

by Ilan Kwon, Oejin Shin, Sojung Park and Goeun Kwon

Int. J. Environ. Res. Public Health 2019, 16(11), 1956; https://doi.org/10.3390/ijerph16111956 - 1 Jun 2019

Cited by 3 | Viewed by 3413

Abstract

Increasing life expectancy in the USA makes a better understanding of the heterogeneous healthcare needs of the aging population imperative. Many aging studies have discovered multimorbid health problems focusing mainly on various physical health conditions, but not on combined mental or behavioral health problems. There is also a paucity of studies with older adults who use professional healthcare services caring for their mental and substance-related conditions. This study aims to enhance the knowledge of older peoples’ complex healthcare needs involving physical, mental, and behavioral conditions; examine the relationship between multi-morbid health profiles and specialty healthcare service utilization; and investigate its association to poverty. The study data were derived from the National Survey on Drug Use and Health (NSDUH) in 2013 (n = 6296 respondents aged 50 years and older). To identify overall health conditions, nine indicators, including physical, mental, and substance/alcohol, were included. Healthcare service utilization was measured with four mutually exclusive categories: No treatment, mental health treatment only, substance use treatment only, and both. We identified four health profiles: Healthy (82%), having physical health problems (6%), physical and mental health problems (4%), and behavioral problems (8%). Older people’s health profiles were differentially associated with healthcare use. Those living in poverty with both physical and mental health problems or substance/alcohol health problems were less likely to receive mental health and substance use treatments than those with more financial resources. Implications for geriatric healthcare practices and policy are discussed. Full article

(This article belongs to the Special Issue Social Determinants of Health and Population Ageing)

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