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This paper explores how dignity is articulated and pursued by care workers in two currently prominent policy initiatives seeking to reform Danish care services for older people. Based on ethnographic case studies of 'reablement' practices and the use of 'welfare technologies', the paper shows how these attempts to create dignified care services transform interactions between care recipients and care workers. The analysis is inspired by a socio-material perspective on dignity as 'crafted' and 'co-laboured' in daily practices, in an interplay between multiple human and non-human actors. In the cases studied, dignity is articulated as closely related to older people's increasing autonomy and independence of formal care, and is pursued through enhancing care recipients' self-care ability, and through technological automation of care tasks. However, these articulations and pursuits of dignity do not stand alone. When everyday care practices are closely examined, dignity is also pursued by care workers as increased co-operation and equality between care workers and care recipients, as de-objectification, and as promotion of enjoyment and quality of life. In these practices, care is ambivalently positioned as both a potential threat to dignity, and as a prerequisite to achieving it. The paper concludes by discussing the risks of policy agendas pursuing a narrow understanding of dignity as simply independence of care. [ABSTRACT FROM AUTHOR]

Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event. Frailty is most frequently assessed in the old using the Clinical Frailty Scale (CSF) which ranks frailty from 1 to 9. This assessment typically takes less than one minute and is not validated in patients with learning difficulties or those under 65 years old. The National Institute for Health and Care Excellence (NICE) developed guidelines that use "frailty" as one of the priority-setting criteria for how scarce, but potentially lifesaving, health care resources should be allocated during the COVID-19 pandemic. Similar guidelines have been developed elsewhere. This paper discusses the ethical implications of such rationing and argues that this is an unproven and ethically problematic form of health care rationing. It specifically discusses: (1) how the frailty ascription becomes a self-fulfilling prophecy, (2) the problematic use of "frailty" in COVID-19 "triage," (3) the circularity of the link between age and frailty, (4) indirect discrimination because of the use of a seemingly neutral criterion in health care rationing, and (5) the difficult link between comorbidities and frailty. It is found that there was no research into the use of global frailty scores as a criterion for access to acute treatment before January 2020 and so it is concerning how readily frailty scoring has been adopted to ration access to potentially lifesaving treatments. Existing gerontological frailty scoring systems have not been developed for this purpose, and repurposing them creates significant ethical issues. [ABSTRACT FROM AUTHOR]

Using three waves of data and tracing the same refugees over time, this paper shows that some factors associated with settlement experience are different from life satisfaction. Evidence shows that although settlement experience has not improved over time, life satisfaction of both male and female refugees has. The non-linear effect of age on life satisfaction disappears over time while that of settlement experience lingers on. Discrimination affects both male and female life satisfaction but is only a concern for females and the younger cohort's settlement experience. Psychological capital did not appear to moderate the discrimination effect, but this needs to be robustly examined further. Lastly, different support for refugees over time and a targeted focus on some groups is likely to be more effective than a blanket support policy. [ABSTRACT FROM AUTHOR]

This study is designed to explore the association between dietary betaine intake and risk of all-cause and cardiovascular death in patients with coronary artery diseases (CAD). In this cohort study, 1292 patients with CAD were followed up for a median of 9·2 years. Baseline dietary betaine intake was collected using a paper-based semi-quantitative FFQ and assessed according to the US Department of Agriculture (USDA) database and the data of betaine in common foods. Cox proportional hazards regression models were used to analyse the association between dietary betaine intake and risks of all-cause and cardiovascular mortality. During the follow-up periods, 259 deaths recorded in 1292 participants, of which 167 died of CVD. Patients in the highest tertile of dietary betaine intake had a lower risk of all-cause (P = 0·007) and cardiovascular death (P < 0·001) than those in the lowest tertile after adjusting for age and sex, traditional cardiovascular risk factors and other potential confounders. After further adjusting for plasma methionine metabolites and vitamins, hazard ratio across tertiles of dietary betaine intake were 1·00, 0·84 and 0·72 for all-cause mortality (P for trend = 0·124), and 1·00, 0·77 and 0·55 for cardiovascular mortality (P for trend = 0·021). Higher dietary betaine intake was associated with a decreased risk of cardiovascular death after fully adjustment for cardiovascular risk factors, other potential confounders and plasma methionine metabolites and vitamins. However, the association between dietary betaine intake and risk of all-cause mortality was not statistically significant after further adjusting for plasma methionine metabolites and vitamins. [ABSTRACT FROM AUTHOR]

Previous research has found varied effects of informal care provision on the carer's health status. Few studies have, however, examined this relationship dynamically. This paper is the first to analyse trajectories of care among men and women in mid-life and their impact on health outcomes using a nationally representative prospective cohort study. Data from three waves of the United Kingdom (UK) National Child Development Study (N = 7,465), when the respondents were aged 46, 50 and 55, are used to derive care trajectories capturing the dynamics of care provision and its intensity. Logistic regression investigates the impact of caring between the ages of 46 and 55 on the carers' report of depression and poor health at age 55. At age 46, 9 per cent of men and 16 per cent of women provided some level of informal care; rising to 60 per cent for both genders at ages 50 and 55. Just 7 per cent of women and 4 per cent of men provided care at all observation points, with the most common trajectory being 'starting to care' at ages 50 or 55. New carers experienced a lower risk of depression at age 55, reflecting that they may not have experienced the caring role long enough to have an adverse impact on their wellbeing. The findings highlight that the majority of individuals with surviving parents experience caring at some point during mid-life, underlining the need for further longitudinal research to better understand the complex relationships between care-giving and health for different groups of cares. [ABSTRACT FROM AUTHOR]

Successful leaders are at risk of developing exaggerated pride, contempt for others, and a diminished sense of reality. The ancient Greeks feared this syndrome and called it hubris. Although certain contemporaneous leaders show signs of hubris and pose a great danger, the hubris syndrome does not yet figure in our classification systems. The purpose of this paper is to examine several aspects of its validity, including clinical description, laboratory study, and exclusion of other disorders. Firstly, a substantial body of evidence indicates that the hubris syndrome may develop after a person has held substantial power for a considerable amount of time. Thus, the syndrome differs from a personality disorder with its characteristic onset in late adolescence or early adulthood. It is proposed, therefore, that the syndrome is a non-organic personality change after gaining substantial power or achieving overwhelming success, characterized by the emergence or marked increase of pathological personality traits within the domains of dissociality and disinhibition. Within the domain of dissociality, grandiosity is an obligatory trait. Secondly, with reference to laboratory study, recent evidence suggests that machine learning algorithms have the ability to differentiate hubristic from non-hubristic speech patterns. Thirdly, the exclusion of other disorders is difficult, because individuals with the hubris syndrome do not collaborate in any investigation. Some suggestions are made to overcome this problem. In conclusion, there is sufficient reason to further examine the validity of the hubris syndrome and to consider it for inclusion in our classification systems. [ABSTRACT FROM AUTHOR]

Increasing longevity has led to a rising number of adult children who are at higher ages when they provide care for their parents. Drawing on the lifecourse approach and exchange theory, the paper addresses similarities and differences in parent care between late middle-aged and older adult children. The study uses the UK Household Longitudinal Study, restricting the analysis sample to individuals aged 50 and older with a living parent or parent-in-law. It presents multivariate models to examine differences between late middle-aged (aged 50–64) and older (aged 65+) children in being a parent carer, providing intensive care, the duration of parent care and providing selected types of help to parents. The involvement in parent care increases among women up to the end of their seventh decade of life and for men up to their eighth decade of life. At higher ages, the proportion of parent carers decreases more strongly for women than men. Older carers have shorter care-giving episodes than younger carers, but there is no significant difference in the type of care provided. Even past retirement age, parent care remains classed and gendered, with women from lower social classes having the highest likelihood of providing intensive parent care in old age. Having dependent children or living in a non-marital union depress the likelihood of caring for a parent even past retirement age. [ABSTRACT FROM AUTHOR]

Background: Evidence supports the use of group therapy for symptom reduction and improving functioning in people with psychosis. However, research guidelines highlight the importance of establishing the feasibility of interventions. Adherence is an important indicator of feasibility and an essential step in supporting the development of the evidence base for group interventions. This review aims to estimate adherence, and possible barriers and facilitators, to psychotherapeutic groups in people with psychosis. Methods: Embase, Ovid MEDLINE and PsycINFO databases were searched for cross-referencing terms related to group therapy and psychosis. Studies were assessed against inclusion criteria and methodological quality was evaluated. Data wasextracted from each paper including the average session attendance, demographic, clinical, study and therapy-related characteristics and the impact of these on adherence levels evaluated. Results: Fifty-nine original research papers were included, reporting on 52 independent studies which consisted of 66 therapy groups comprised of 2109 participants. Average adherence was 76.4% (s.d. = 17.4). Adherence was improved by receiving incentives and was higher in participants of older age. Study sample size was inversely associated with adherence levels. Study quality was variable with approximately 61.5% found to be at risk of bias. The results support the feasibility of group therapy and suggest that adherence in people with psychosis is not dissimilar to those for people experiencing common mental health difficulties. These findings, alongside efficacy evidence, support the use of group interventions in people with psychosis but also highlight the need for further high-quality research on the efficacy for these approaches. [ABSTRACT FROM AUTHOR]

This paper challenges historically preconceived notions surrounding a minor's ability to make medical decisions, arguing that federal health law should be reformed to allow minors with capacity as young as age 12 to consent to their own Centers for Diseases Control and Prevention (CDC)-approved COVID-19 vaccinations. This proposal aligns with and expands upon current exceptions to limitations on adolescent decision-making. This analysis reviews the historic and current anti-vaccination sentiment, examines legal precedence and rationale, outlines supporting ethical arguments regarding adolescent decision-making, and offers rebuttals to anticipated ethical counterarguments. [ABSTRACT FROM AUTHOR]

Many countries have implemented policies to extend working lives in response to population ageing, yet there remains little understanding of what drives paid work in later life, nor how this is changing over time. This paper utilises the 1988/89 Survey of Retirement and Retirement Plans, the 1999 British Household Panel Survey and the 2008 English Longitudinal Study of Ageing, to investigate drivers of paid work in the ten years surrounding state pension age (SPA) for women and men in, comparing cohorts born in the 1920s, 1930s and 1940s. Using optimal matching analysis with logistic and multinomial regression models, the study assesses the relative importance of lifecourse histories, socio-economic circumstances and contemporaneous factors, in determining paid work in mid- and later life. Participation in paid work in the five years preceding and beyond SPA increased markedly for men and women across cohorts, with women's lifecourses and engagement with paid work changing considerably in these periods. However, for women, a lifetime history of paid work remained a crucially important predictor of paid work in later life, and this relationship has strengthened over time. Experiencing divorce has also become an important driver of paid work around SPA for the youngest cohort. Having children later, and still having a mortgage, also independently predict labour force participation for women and men. Across all cohorts and for women and men, working at these older ages was a function of higher income and better health. These findings suggest that policies which enable people to maintain ties to paid work across the lifecourse may be more effective at encouraging later-life employment than those concerned only with postponing the retirement transition. [ABSTRACT FROM AUTHOR]

The majority of refugees are children and youth and their integration and life-course transitions are a research priority. This paper examines the timing of refugee children and youths' entrance into the labour market and family formation (marriage/common law union and parenthood). It does so by examining how admission category, knowledge of a host country's official languages, and age at arrival shape their transition to adulthood. Using data from the Canadian Longitudinal Immigration Database and Heckman selection estimation, the paper finds minimal variation in refugee children and youths' entry into the labour market compared to children of other immigrant streams. It also finds that refugee children and youth start forming families at a younger age than children of economic class immigrants, but at an older age than family class children. The analysis also shows limited effects of knowledge of official language prior to arrival while age at arrival has a robust impact on their adulthood transitions. These findings shed light on the unique patterns of life-course transition among refugee children and youth and contribute to a better conceptualization of their experiences relative to children and youth of other immigrants. [ABSTRACT FROM AUTHOR]

Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants' vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide an understanding of why people are still retiring earlier than would have been expected, despite policies that increase the retirement age. This is a qualitative study in a large public-service organisation in Sweden focusing particularly on how human resource routines aimed at middle management tend to inhibit the promotion of a prolonged working life, despite government efforts aimed at changing these actions. The results highlight three key routines (development talks, salary talks and internal recruitment) that inhibit prolonged working life. These routines seem rational and appropriate to the organisation's managers, because the demands of the job must have priority over employees' capabilities in recruitment routines. Furthermore, it could be considered economically rational to prioritise salary demands of younger employees over those of older employees, and it may appear economically rational to stop further training efforts for older employees. In general, then, it seems reasonable to managers to make decisions based on objective criteria like age. Nevertheless, our results suggest that these routines may need to be redesigned in order to support a prolonged working life and to avoid a discrepancy between accepted prolonged working-life policies and the actions of organisational actors. The study further reveals how intra-organisational institutions (e.g. taken-for-granted mind-sets and norms) embedded in human resource routines may promote or inhibit prolonged working life, suggesting a need for change in those institutions. [ABSTRACT FROM AUTHOR]

Inefficient health service utilisation puts pressure on health systems and may cause such negative individual consequences as over-medicalisation or exacerbation of health problems. While previous research has considered the key relevance of health literacy (HL) for efficient use of health services, the results of that research have been somewhat inconclusive. Possible reasons for diverging results of prior research may be grounded in different measurement concepts of HL and the disregarding of age-specific effects. This paper analyses the association between individuals' HL typology based on a two-dimensional concept and indicators of health service utilisation measured by registered data covering the number of doctor visits and medication costs. Our results confirm a significant interaction effect between age and HL typology. The age-related increase in health service utilisation is strongest for individuals with the combination of high subjective HL but low health-related knowledge, while the smallest increase is for individuals with the constellation of high subjective HL combined with high health-related knowledge. Individuals with specific constellations of HL (that is, individuals with high subjective HL but low health-related knowledge) are associated with reduced service utilisation in younger ages but higher service utilisation in later stages of life, compared to other groups. These results are likely to be attributed to a higher external health-related locus of control and more traditional paternalistic role expectations in such groups. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses articles in the issue on topics including gendered impacts of extended working life, older women workers having relatively poor economic outcomes, and working career after an absence due to illness.

Research shows that older people tend to not only be underrepresented on television (TV), but also to be represented within a number of fixed types. These correspond to cultural myths about ageing, which emphasise vulnerability and decline but also increasingly stress the individual's responsibility for successful ageing. This paper analyses the representation of older people on Flemish public TV, using qualitative content analysis to identify patterns of representation in a sample of 44 programmes broadcast in 2019 and 2020, including the first months of the COVID-19 pandemic. To complement our own analysis, we also interviewed eight experts on ageing. Our research shows that representations of older people on Flemish public TV tend to gravitate towards two types related to different age groups: vulnerable and passive old-old people (over 80 years old), particularly those in nursing homes who feature prominently in reporting on the COVID-19 pandemic; and dynamic and active young-old people (65–80 years old), connected to the ideals of successful ageing. The two predominant types correspond to cultural myths about ageing and are also connected to recurrent themes: sexual intimacy, loneliness and death. Our research highlights the need for a more diverse representation, reflecting the variety of individual life conditions and the functional age of older people. [ABSTRACT FROM AUTHOR]

The aim of this paper is to study the role of the distribution of income by age group on the existence of speculative bubbles. A crucial question is whether this distribution may promote a bubble associated to a larger level of capital, that is a productive bubble. We address these issues in an overlapping generations model where agents live three periods and productive investment done in the first period of life is an illiquid investment whose return occurs in the following two periods. A bubble is a liquid speculative investment that facilitates intertemporal consumption smoothing. We show that the distribution of income by age group determines both the existence and the effect of bubbles on aggregate production. We also show that fiscal policy, by changing the distribution of income, may facilitate or prevent the existence of bubbles and may also modify the effect that bubbles have on aggregate production. [ABSTRACT FROM AUTHOR]

This article engages with the legal regulation of end-of-existence decisionmaking for novel beings, specifically assisted nonexistence for such entities. The author explains the concept of a legal model for assisted death by reference to the substantive features of legal regimes in three jurisdictions in which assisted suicide or euthanasia is lawful. He considers how these models might fit novel beings who may require or prefer assistance to end their own existence by reference to the constituent features—abstract legal ingredients—that models for assisted death share. The author argues that extant models may block some novel beings' access to end-of-existence assistance or fail to track what matters to them. He then examines the merits of adopting a universal model for assisted nonexistence, that is, a legal framework whose substantive features capture the end-of-existence concerns of both human and novel beings. Consideration of a unified legal framework may illuminate the discussion of assisted nonexistence for humans and novel beings. However, the paper proposes that whereas novel beings may have similar interests to humans, they may be relevantly different also. The prima facie case for adopting a one regime to rule us all approach to assisted nonexistence may be defeated by reasons for divergent regulation. [ABSTRACT FROM AUTHOR]

In recent years, there has been an increasing interest in researching ageing ethnic minority populations in the West. However, older people from such minority communities have received comparatively little attention in wide-ranging discussions on appropriate research methodologies. By a process of critically reflecting on our experiences of undertaking fieldwork for our Economic and Social Research Council New Dynamics of Ageing study of ‘Families and Caring in South Asian Communities', this paper maps out the key methodological and ethical challenges we faced and, in the process, highlights the importance of developing socially appropriate research methodologies and ethical frameworks for research with such populations. With a reflexive approach, we specifically explore the significance of gender, age, time and space to the fieldwork processes and the ‘field’ relationships formed at various stages of the research process. In particular, we explore three key emergent issues which conflicted with our formal research protocols and presented particular challenges for us and our older Pakistani Muslim participants: (a) structuring of time in daily life; (b) gendered use of public and private spaces; and (c) orality of informal social contexts and relationships. Using illustrations from our fieldwork which reveal the particular significance of these issues to our fieldwork experiences and performativities of public/private identities, we highlight important tensions between formalised ethical and methodological dimensions of conducting funded research and the realities of being in ‘the field’. We conclude the paper by emphasising the need to explore further not only the ways in which researchers can adopt more socially and culturally sensitive data collection processes and methodologies at the micro level of their interactions with research participants, but also contextualising the particular challenges experienced by researchers and their participants in terms of the wider research frameworks and agendas as well as the broader social contexts within which they live and work. [ABSTRACT FROM PUBLISHER]

The decision to start a new career might seem an unusual one to make in later life. However, England has seen a steady rise in numbers of workers undertaking an apprenticeship in their fifties and sixties, through a government-funded policy initiative opening up training to adults at all stages of the lifecourse. At the same time, in most Western contexts, the amalgamation of ‘older’ and ‘apprentice’ presents a challenge to normative understandings of the ‘right age’ to undertake vocational training. What is it like to make a new start as an older worker? This paper draws on new qualitative research conducted in England with older apprentices, exploring how they found the experience and management of training ‘out of step’. Inspired by Elizabeth Freeman's temporalities approach, our findings reveal how powerful norms of age-normativity routinely structure understandings, experiences and identities of older-age training for both organisations and apprentices. While these norms demand careful negotiation by both apprentices and trainers, if managed successfully older workers gain significant benefits from their training. These findings have resonance not only for England, but for other international contexts considering expanding vocational training into older age. The paper concludes that if adult training schemes are to succeed, some fundamental changes may need to be made to understandings of age and ageing within contemporary workplaces. [ABSTRACT FROM AUTHOR]

In recent years, various pro-natalist policies have been adopted in Singapore and other high-income Asian countries with low fertility, aiming at raising fertility rates. Previous studies were mainly focused on the impact or outcome of the policies. This paper, however, aims to identify the most influential groups in determining Singapore's total fertility rate (TFR) and evaluate the targeting of pro-natalist measures adopted by the government. We first reveal the changing age-parity-and-marital-status composition of women at childbearing age, and further conduct an elasticity analysis to assess the roles of different subgroups of women in changing the TFR. Our results show that compared to other groups, the 20–29-year-old single women and the married childless women aged 30–34 (‘married’ throughout this paper includes women who are or have been married) are more influential in determining the TFR and should be the potential pro-natalist target groups. However, Singapore's pro-natalist policies are more in favour of third and higher-order births. Such mismatch indicates that, if more efforts are devoted to facilitating marriage and first births in these potential groups, the TFR may be increased effectively. In order to achieve a long-term and significant fertility reversal, it calls for a long-term and integrated policy package. [ABSTRACT FROM PUBLISHER]

What governs labour force participation in later life and why is it so different across countries? Health and labour force participation in older ages are not strongly linked, but we observe a large variation across countries in old-age labour force participation. This points to the important role of country-specific regulations governing pension receipt and old-age labour force participation. In addition to the statutory eligibility age for a pension, such country-specific regulations include: earnings tests that limit the amount of earnings when pension benefits are received; the amount of benefit deductions for early retirement; the availability of part-time pensions before normal retirement; special regulations that permit early retirement for certain population groups; and either subsidies or extra costs for employers if they keep older employees in their labour force. This paper asks two questions: Can we link a relatively low labour force participation at ages 60–64 to country-specific regulations that make early retirement attractive? and Can we link a relatively high labour force participation at ages 65–74 to country-specific regulations that make late retirement attractive? To answer these questions, we compared the experiences in a set of developed countries around the world in order to understand better the impact of country-specific rules and laws on work and retirement behaviour at older ages and, by consequence, on the financial sustainability of pension systems. [ABSTRACT FROM AUTHOR]

Whether encouraging successful ageing or labelling one as a stereotypical senior citizen, messages surrounding ageing pervade the daily lives of older adults. However, as a social status, age remains primarily in the background of older adults' conversations, only being drawn into the focus when one is identified as older. This paper draws on interviews with members and staff of an Osher Lifelong Learning Institute (OLLI) in the southeastern United States of America in order to examine the ways that they discuss age and ageing. These older adults' ageing talk often focused on navigating away from negative ideas about age and avoiding labels deemed pejorative. Humour was occasionally used in identifying age, which carried potential for reinforcing as well as subverting ageism. Yet, members highlighted positive value in being older, particularly as demonstrated through participation in age-segregated education. Overall, these findings reflect the conflicting influences of deeply embedded ageist beliefs and personal desires to age successfully among this group of white, upper-middle-class, educated older adults. Ultimately, OLLI served as a protective environment for these privileged individuals, shielding the self from stereotypes otherwise present in ageing talk. [ABSTRACT FROM AUTHOR]

High sodium (Na) diet is one of the leading behavioural risks of disease identified in the Singapore Burden of Disease Study. We aim to estimate the cost attributable to a high Na diet in Singapore in 2019 from a societal perspective by employing a prevalence-based approach in cost-of-illness studies. We extracted national-level healthcare data and population attributable fractions by sex and age. Costs included direct and indirect costs from inpatient treatment and productivity losses. In 2019, the annual societal cost attributable to a high Na diet was conservatively estimated to be USA$262 million (95 % uncertainty interval (UI) 218, 359 million). At least USA$67·8 million (95 % UI 48·4, 120 million) and USA$194 million (95 % UI 153, 274 million) could be saved on healthcare and indirect costs, respectively, if the daily Na intake of Singaporeans was reduced to an average of 3 g. Overall, males had higher costs compared with females at USA$221 million (95 % UI 174, 312 million) and USA$41·1 million (95 % UI 33·5, 61·7 million), respectively. Productivity loss from foregone wages due to premature mortality had the largest cost at USA$191 million (95 % UI 150, 271 million). CVD had the largest healthcare expenditure at USA$61·4 million (95 % UI 41·6, 113 million), driven by ischaemic heart disease at USA$41·0 million (95 % UI 21·4, 88·9 million). Our study found that reducing Na intake could reduce future healthcare expenditures and productivity losses. This result is vital for policy evaluation in a rapidly ageing society like Singapore, where the burden of diseases associated with high Na diet is expected to increase. [ABSTRACT FROM AUTHOR]

It is generally accepted that oceanic plate subduction has occurred along the eastern margin of Asia since about 500 Ma ago. Therefore, the Japanese Islands have a >500 Ma history of oceanic plate subduction in their geological records. In this paper, the accretionary history of the Japanese Islands is divided into six main stages based on the mode and nature of tectonic events and the temporal gaps in the development of accretionary processes. In the first stage, oceanic plate subduction and accretion started along the margin of Gondwana. After detachment of the North and South China blocks in Devonian time, accretionary complexes developed along island arcs offshore of the South and North China blocks. After the formation of back arc basins such as the Japan Sea, accretionary processes occurred only along the limited convergent margin, e.g. Nankai Trough. Detrital zircons of sandstones revealed the accretionary history of Japan. An evaluation of a comprehensive dataset on detrital zircon populations shows that the observed temporal gaps in the development of the Japanese accretionary complexes were closely related to the intensity of igneous activity in their provenance regions. Age distributions of detrital zircons in the accretionary complexes of Japan change before and after the Middle Triassic period, when the collision of the South and North China blocks occurred. [ABSTRACT FROM AUTHOR]

The article presents the discussion on measurements conducted at the department of human nutrition at the Agricultural University in Wageningen the Netherlands. Topics include performing large series of anthropometric measurements of people from all ages enrolled in different projects on body composition; and ethnic-specific criteria needed for specifying the levels of fatness and associated cardiometabolic health indicators.

There is limited research on the living arrangements of older adults with disabilities, especially research that combines household composition and housing characteristics. This paper addresses that gap with two complementary sets of logistic regression models: first, estimating the odds of disability by household composition and housing type and, second, estimating the odds of disability by living arrangement within gender and age sub-groups. Data come from the 2012 American Community Survey (N = 504,371 respondents aged 65 and older), which includes six measures of disability: cognitive, ambulatory, independent living, self-care, vision and hearing. Living alone, with children or with others was associated with higher odds of any disability, compared with living with a spouse only. Compared to those living in a single-family home, living in a mobile home or other temporary structure, or large apartment building was associated with higher odds of disability. Having a disability was associated with lower rates of living with a spouse only, alone, in a single-family home or in a small or mid-sized apartment building and higher rates of all other living arrangements. Sub-group analyses revealed differences in the relationship between living arrangements and disability by gender and age group. This information provides a baseline from which to observe trends in living arrangements and disability for older adults in the United States of America. [ABSTRACT FROM AUTHOR]

Background: In adults, the solitary lateral cystic neck mass remains a diagnostic challenge with little solid material to target for cytology and few clues on imaging modalities to suggest underlying malignancy. Method: This study was a retrospective review of patients presenting with a lateral cystic neck mass to a tertiary academic head and neck centre over a 10-year period. Results: A total of 25 of 157 cystic lesions were subsequently malignant on paraffin section histopathology, with the youngest patient being 42 years. In the age cohort over 40 years, 30 per cent of males and 10 per cent of females were diagnosed with malignancy. The ipsilateral palatine tonsil was the most common primary site (50 per cent). A total of 85 per cent of cases demonstrated integrated human papillomavirus infection. Age, male sex and alcohol were significant risk factors on univariate analysis. Ultrasound-guided fine needle aspiration cytology and magnetic resonance imaging represented the most accurate pre-open biopsy tests. Conclusion: The authors of this study advocate for a risk-stratified, evidence-based workup in patients with solitary lateral cystic neck mass in order to optimise timely diagnosis. [ABSTRACT FROM AUTHOR]

The development of social gerontology has led to the emergence of its own terminology and conceptual armoury. 'Ageism' has been a key concept in articulating the mission of gerontology and was deliberately intended to act as an equivalent to the concepts of racism and sexism. As a term, it has established itself as a lodestone for thinking about the de-valued and residualised social status of older people in contemporary society. Given this background, ageism has often been used to describe an overarching ideology that operates in society to the detriment of older people and which in large part explains their economic, social and cultural marginality. This paper critiques this approach and suggests an alternative based upon the idea of the social imaginary of the fourth age. It argues that not only is the idea of ageism too totalising and contradictory but that it fails to address key aspects of the corporeality of old age. Adopting the idea of a social imaginary offers a more nuanced theoretical approach to the tensions that are present in later life without reducing them to a single external cause or explanation. In so doing, this leaves the term free to serve, in a purely descriptive manner, as a marker of prejudice. [ABSTRACT FROM AUTHOR]

Drawing on the revived literature on the subjective dimension of ageing, this paper investigates whether people aged 65+, usually defined as old, do actually feel old and which events they associate with feeling old. Logistic models are used on unique data from the 2013 survey called 'I Do Not Want to Be Inactive', conducted on individuals aged 65–74 in Italy (N = 828). It is found that a large proportion of respondents do not feel old at all. The analyses show that women are more likely than men to feel old and to think that society considers them old. While men feel old mainly when they retire, women associate this feeling with loneliness, loss of independence and death of loved ones. Higher-educated people are less likely to associate feeling old with loneliness and boredom than their lower-educated counterparts. The findings have important implications for the conceptualisation of ageing. Most people who are old according to the standard threshold of 65 do not consider reaching this age as a distinctive marker of old age in their lifecourse. This suggests that absolute thresholds for setting the start of old age are questionable. Feeling old seems to be mainly influenced by events, such as retirement and death of loved ones, hinting to the importance of the social construction of ageing in addition to its biological dimension. Researchers and policy makers are encouraged to give more attention to layperson views on ageing. [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyse how the nature of retirement is related to post-retirement life conditions among early retirees. As to the nature of retirement, we make use of the concepts of push, pull and jump to describe why individuals retire early. Push is analysed as an outcome of poor health and firings, pull as a mechanical (reflective) response to economic and symbolic signals of the welfare state, while jump is described as a reflexive process; jumpers strive for new experiences (a new life project) and/or social gains (to be more together with grandchildren). Post-retirement life conditions are analysed in a four-dimensional citizenship perspective: (a) economic, (b) social and (c) political citizenship, as well as the feeling of having (d) 'equal social worth' vis-à-vis fellow citizens. Results show that role transitions are strongly affected by the nature of retirement. Jumpers largely seem to be shielded from low levels of citizenship in old age. Those pushed out of the labour market indeed run a rather high risk of lacking citizenship, epitomised as loss of economic and social citizenship as well as a low sense of having equal social worth vis-á-vis fellow citizens. No conclusive results were found for older workers subject to pull. Pullers made up a rather small proportion of total sample. [ABSTRACT FROM AUTHOR]

As a response to the ageing population, the United Kingdom (UK) government, like many others, has increased the State Pension Age. This has involved equalising women's State Pension Age with men's, raising it from 60 to 65, with further increases already underway. It has been argued that a key issue with how this change has been implemented is the lack of notice the government gave to the women affected, impacting on their ability to plan for retirement. So far, there has been very little research exploring inequalities in awareness of these developments and, in particular, considering whether women of particular socio-economic backgrounds are less likely to know about the changes. This has implications for potentially further widening inequalities in old age. In this paper we analyse data from the English Longitudinal Study of Ageing. We consider the role of cognitive ability in mediating the relationship between socio-economic background and awareness, given recent debates on deficiencies in financial literacy. We find that socio-economic inequalities exist, especially with respect to labour force status, occupation and education. We also find that cognitive ability, especially numeracy, mediates a sizeable proportion of the relationship. These findings have important implications in terms of implementing future policy changes and awareness campaigns to help mitigate the possibility that they will further entrench inequalities in older age. [ABSTRACT FROM AUTHOR]

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC. [ABSTRACT FROM AUTHOR]

This paper examines associations between early and mid-lifecourse events with economic activity in later life. These lifecourse trajectories are in turn examined for their impact on the pathways of men and women to retirement, including whether these pathways are perceived by individuals as been chosen or imposed. Data are from the three waves (2005, 2008 and 2011) of the French version of the Gender and Generations survey and comprise a sub-sample of 2,016 respondents in the birth cohort 1941–1960 who participated in all three waves. The analysis is undertaken within a gender perspective and in the context of the (de)standardisation of the lifecourse. The results show that mid-life and later-life work history, job category, employment sector and economic activity are influenced by early lifecourse events for both men and for women. Different pathways to retirement are observed according to institutional factors that determine access to pension rights. Women whose family formation occurred early, together with women who had an absence of family events (partnership or childlessness), were much more likely to be economically active in later life than men with the same characteristics. The results suggest that institutionalised (standardised) lifecourse patterns exist simultaneously with individualised (destandardised) patterns. [ABSTRACT FROM AUTHOR]

Objective: To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms. Methods: A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate. Results: Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour. Conclusion: An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population. [ABSTRACT FROM AUTHOR]

The WHO encourages national diet survey (NDS) implementation to obtain relevant data to inform policies addressing all forms of malnutrition, which remains a pressing issue throughout Europe. This paper provides an up-to-date review on energy, macro- and selected micronutrient intakes in children across WHO Europe using the latest available NDS intakes. It assesses these against WHO recommended nutrient intakes (RNI) to highlight vulnerable groups and areas of concern. Dietary survey information was gathered by Internet searches, contacting survey authors and nutrition experts. Survey characteristics, energy and nutrient intakes were extracted and weighted means calculated and presented by region. Child energy and nutrient intakes were extracted from twenty-one NDS across a third (n 18) of the fifty-three WHO Europe countries. Of these, 38 % (n 6) reported intakes by socio-economic group, but by various indicators. Energy and macronutrients, where boys and older children had higher intakes, were more widely reported than micronutrients. Most countries met under half of the WHO RNI for nutrients reported in their NDS. Micronutrient attainment was higher than macronutrients, but worst in girls and older children. Only a third, mainly Western, WHO European member states provided published data on child nutrient intakes. Gaps in provision mean that dietary inadequacies may go unidentified, preventing evidence-based policy formation. WHO RNI attainment was poor, particularly in girls and older children. Inconsistent age groups, dietary methodologies, nutrient composition databases and under-reporting hinder inter-country comparisons. Future efforts should encourage countries to conduct NDS in a standardised format by age and sociodemographic variables. [ABSTRACT FROM AUTHOR]

This paper examines immigrant poverty at an older age in Sweden with an emphasis on late-in-life immigrants. We analyse tax data for the entire Swedish-born and non-Swedish-born population. The poverty status of a household is assessed using two criteria. First, the disposable income of the household in which the person lived in 2007 must be below 60 per cent of the median equivalent income in Sweden as a whole. Second, to be classified as 'twice poor' a household's net assets must be below SEK 10,000. The results indicate that three out of four Swedish-born older persons were not classified as poor by either of the criteria, and only 1 per cent by both criteria. In contrast, among older persons born in low-income countries almost three out of four were classified as poor according to one of the criteria and not fewer than one in three according to both. Results of estimating logistic models indicate that the risk of being considered poor according to both criteria is strongly positively related to one's age at immigration. Our results indicate that it is crucial that migrants, particularly those who arrive after age 40, be better integrated into the Swedish labour market. To alleviate poverty among those migrants who are already of older age, increased transfers are probably the only possible alternative. [ABSTRACT FROM AUTHOR]

Similar to their younger counterparts, older adults (age 60+) are increasingly turning to online dating sites to find potential romantic and sexual partners. In this paper, we draw upon qualitative data from a thematic analysis of 320 randomly selected online dating profiles posted by Canadian heterosexual older adults who self-identified as Asian, Black, Caucasian or Native American. In particular, we examined how the older adults' self-presentations varied according to race/ethnicity, age and gender, and how the language they used to describe themselves and their preferred potential partners reflected and reinforced idealised images of ageing. Our analysis identified five primary ways in which the older adults portrayed themselves. They depicted themselves as active and busy with cultural/artistic, social and adventurous activities; and also as physically healthy and intellectually engaged. Third, they emphasised the ways in which they were productive through work and volunteer activities. Fourth, they accentuated their positive approach to life, identifying themselves as happy, fun-loving and humorous individuals. Finally, they highlighted their personable characteristics, portraying themselves as trustworthy and caring. We discuss our findings with a particular focus on gender differences, drawing on literature on masculinity and femininity, and also look at capital and power relations by considering the online dating setting as a field in the Bourdieusian sense. [ABSTRACT FROM AUTHOR]

Numerous health benefits are attributed to the n -3 long-chain PUFA (n -3 LCPUFA); EPA and DHA. A systematic literature review was conducted to investigate factors, other than diet, that are associated with the n -3 LCPUFA levels. The inclusion criteria were papers written in English, carried out in adult non-pregnant humans, n -3 LCPUFA measured in blood or tissue, data from cross-sectional studies, or baseline data from intervention studies. The search revealed 5076 unique articles of which seventy were included in the qualitative synthesis. Three main groups of factors potentially associated with n -3 LCPUFA levels were identified: (1) unmodifiable factors (sex, genetics, age), (2) modifiable factors (body size, physical activity, alcohol, smoking) and (3) bioavailability factors (chemically bound form of supplements, krill oil v. fish oil, and conversion of plant-derived α -linolenic acid (ALA) to n -3 LCPUFA). Results showed that factors positively associated with n -3 LCPUFA levels were age, female sex (women younger than 50 years), wine consumption and the TAG form. Factors negatively associated with n -3 LCPUFA levels were genetics, BMI (if erythrocyte EPA and DHA levels are <5·6 %) and smoking. The evidence for girth, physical activity and krill oil v. fish oil associated with n -3 LCPUFA levels is inconclusive. There is also evidence that higher ALA consumption leads to increased levels of EPA but not DHA. In conclusion, sex, age, BMI, alcohol consumption, smoking and the form of n -3 LCPUFA are all factors that need to be taken into account in n -3 LCPUFA research. [ABSTRACT FROM AUTHOR]

Faced with demographic ageing, European policy makers since the mid-1990s have taken a turn from fostering early retirement to promoting longer working life by reducing early exit incentives and facilitating work continuation. However, it remains open whether these reforms are yet reflected in the retirement plans and preferences of future pensioners’ cohorts. Using most recent data on desired retirement ages from the fifth wave of the European Social Survey (2010/11 wave), this paper empirically investigates how far current policy reforms are in line with the retirement age preferences of older workers aged 45 and over. Results show that older workers approaching retirement ages still intend to retire before the politically envisioned age of 65, and in many cases also before nationally defined standard retirement ages. Despite visible progress in implementing active ageing measures, the challenge of motivating older workers to continue working until or even beyond retirement ages thus remains. At the same time, there are regime-specific problem groups that face difficulties in adjusting to the active ageing paradigm of longer working life. Especially in countries with little employment support, those with unstable work careers, employment interruptions and few financial resources are at a high risk of being crowded out from late career employment and thus from the possibility of ensuring a decent standard of living in old age. [ABSTRACT FROM PUBLISHER]

Objective: Cochlear implant is the standard treatment of choice for children and adults with severe to profound sensorineural hearing loss. The main objective of this study was to assess the knowledge, attitude and practices regarding cochlear implant among doctors other than otolaryngologists in a tertiary care academic institution. Method: A 24-item knowledge, attitude and practices questionnaire was developed based on an extensive literature review and expert opinion and was administered to 100 non-otolaryngologists in a tertiary care academic institution to be completed in about 15 minutes. The data obtained was analysed to assess knowledge, attitude and practices regarding cochlear implant in this group. Results: The results showed that awareness regarding the option of cochlear implants for elderly and unilateral deafness was deficient. Surgeons and doctors in higher specialties did better when it came to practice related to cochlear implant. The age and experience of doctors also improved knowledge and practice with regards to cochlear implant. Conclusion: Improving awareness about cochlear implants and their benefits among non-otolaryngology colleagues can ensure that more people who could potentially benefit from cochlear implants will receive appropriate counselling and referral. [ABSTRACT FROM AUTHOR]