Older workforce management through active aging frameworks: case studies of challenges and implications in Thailand and China

BackgroundChina has entered a stage of moderate aging, characterized by a “90-7-3” eldercare pattern: 90% of the older adults opt for home-based care, 7% utilize community-based care, and 3% reside in institutional care facilities. With the rapid development of the digital economy, innovative solutions such as smart eldercare devices and telemedicine have emerged, offering new possibilities to enhance the efficiency and quality of eldercare services. However, while benefiting from digital technologies, the older adults generally face challenges posed by the “digital divide,” making digital literacy a critical factor constraining the digital transformation of eldercare services.MethodsThis study utilizes data from the 2020 China Longitudinal Aging Social Survey (CLASS 2020) to examine the impact of digital literacy on older adults’ utilization of community-based home care services (CHCS). Factor analysis was employed to measure digital literacy levels, while probit regression and Heckman’s two-stage model were applied for empirical analysis.ConclusionOur empirical analysis yields three key findings: (1) A significant negative relationship is found between digital literacy and the utilization of CHCS. This indicates that, on average, higher digital literacy is associated with a lower propensity to use CHCS. (2) Dimension-specific analysis reveals divergent impacts: Digital application literacy was positively associated with service utilization. However, device operation literacy, information acquisition literacy, and digital social literacy all exhibited significant negative correlations with service use. (3) Mechanism analysis indicates that digital literacy reduces older adults’ reliance on CHCS through multiple pathways, including increased alternative consumption expenditures, strengthened social and family support, and improved self-efficacy.DiscussionThe findings suggest that improved digital literacy may reduce older adults’ utilization of CHCS, providing important implications for optimizing the elderly care system in the digital era. While promoting digital literacy among older populations, policymakers should establish integrated online-offline service delivery models to achieve precise matching between seniors’ needs and care provision.

Digital back-feeding is a bottom-up process by which younger generations teach or assist older generations in digital access, usage, and literacy. This study aims to examine how two means of digital back-feeding—proxy back-feeding and learning back-feeding—might be differently impacted by older adults’ perceptions of smartphone use, as well as their impact on older adults’ digital literacy. A cross-sectional questionnaire survey ( n = 433) was conducted in mainland China. Our findings revealed that perceived usefulness and perceived risk of smartphone use were positively associated with older adults’ engagement with both proxy back-feeding and learning back-feeding. Perceived ease of use was found to be negatively associated with older adults’ engagement in proxy back-feeding. In addition, older adults’ digital literacy was found to be negatively associated with proxy back-feeding, but positively associated with learning back-feeding. Results suggest that digital back-feeding is a complicated process that may influence older adults’ digital literacy through different routes, which deserves further investigation to bridge digital divide intergenerationally.

The concept of healthy or successful ageing dates back to the 1960s, where its goal is more realistic in today's ageing society as a result of effective interventions to control and reduce disability and health risks. The aim of this paper is to outline the importance of defining ageing, the semantics and indicators used, and to identify common challenges for health professionals' understanding and application of a healthy ageing approach in their everyday clinical practice. This discursive paper demonstrates how realistic ageing indicators are for highlighting the variation and impact of challenges associated with ageing. It examines the proportion of older adults requiring aged-care services and allocation of resources, focusing on health maintenance and secondary ageing prevention. Indicators of ageing commonly used in clinical healthcare settings are reviewed, and their appropriateness for determining functional and intrinsic capacity of older adults. Other indicators are introduced, i.e., the Healthy Life Expectancy (HLE), Disability Free Life Expectancy (DFLE), the Human Development Index (HDI), and the Active Ageing Index (AAI), for enhancing and promoting a healthy ageing model of healthcare. Healthy ageing models of health and social care are also considered. Outlining evidence on healthy ageing may facilitate health professionals to address realistic challenges regarding age-related health and social care provision, using a personalised approach for every older adult as opposed to cutting off chronological age parameters. Increasing health professionals' focus on healthy ageing will maintain good health in at least 80% of the ageing population for longer. No patient or public contribution.

This study developed system dynamic modeling (SDM) based on the International Classification of Functioning, Disability and Health (ICF) framework to simulate and identify key leverage points for enhancing social participation among older adults with noncommunicable diseases (NCDs), aiming to offer a robust theoretical foundation for designing effective interventions. Utilizing a system dynamics modeling, we simulated intervention strategies to augment social participation among older NCDs patients. Initial insights from in-depth interviews with 31 older individuals informed the construction of a causal loop diagram, elucidating the multifactorial relationships and feedback mechanisms among pertinent variables. Data from 500 patients were analyzed using correlation analysis, an independent weighting approach, and multiple regression to identify key variables, determine their equation coefficients, and construct a stock flow diagram for the model. The model then simulated social participation trends over 16 months under varying intervention intensities. The results showed significant improvements in mobility function, functional ability, pain management, and social support, resulting in increases of 54.9%, 32.4%, 28.7%, and 25.0%, respectively, at a 10% intervention level. When intervention intensity was escalated to 20%, the impact became even more pronounced, with mobility function leading the way at a 127.5% increase, followed by pain management (63.6%) and functional ability (62.8%), and social support (48.7%). Self-care and emotional functions showed minimal improvement in social participation, with increases of less than 3% and 5%, respectively. Improving social participation in older NCDs adults requires understanding complex system dynamics. This study highlights mobility function, functional ability, pain management, and social support as key leverage points, stressing the need for targeted interventions based on individual assessments.

Introduction: While existing reflections on participatory action research (PAR) emphasize the benefits experienced by participants in such studies, they often fail to critically interrogate the PAR process. This gap underscores the significance of process-oriented papers that illuminate the dynamics, supports, and hurdles of PAR, crucial for aligning scholarly endeavors with its fundamental principles of equitable participation, social transformation, and reflexivity. This paper aimed to bridge these gaps by presenting insights from both older adults with age-related vision loss (ARVL) and university researchers, shedding light on their application of PAR principles during the initial stages of a project focused on identifying research priorities. Methods: The foundational PAR study, forming the basis of this paper, involved eight older adults aged 65 and above with ARVL. Additionally, three university researchers participated, including a faculty member and two students (one pursuing a PhD and the other an MSc). The PAR process encompassed three half-day meetings, dedicated to investigating how environmental factors (physical, social, cultural, political, and institutional) influence the engagement of older adults with ARVL in their daily activities. Following completion of the three half-day meetings, the university co-researchers conducted individual interviews with each older adult, as well as a collective reflexive exercise involving the university co-researchers, to delve into their personal journey through the PAR process, encompassing achievements, challenges, and encountered tensions. Results: The study’s outcomes were distilled into three central thematic domains: (1) attentiveness to power differentials; (2) realization of personal and social transformation; and (3) a steadfast commitment to reflexivity. Discussion: This paper endeavors to fill a void within the existing PAR landscape by providing process-oriented insights that spotlight the intricacies of the PAR journey, inclusive of encountered challenges. By candidly acknowledging these challenges, future scholars will be better equipped to harness PAR in a manner that is truly aligned with its core principles.

BackgroundDepression and anxiety are the emotional problems most frequently experienced by older adults. These mental health challenges can influence an individual's ability at finding, evaluating, and applying electronic health information to health problems. Thus, we aimed to examine associations of digital health literacy (DHL) with education, depression, and anxiety among older adults in Slovakia.MethodsA cross-sectional study was conducted among 101 adults aged 55 years and over (40.6% from 60 to 64 years, 85.1% of women, 54.5% with secondary education). DHL, depressive symptoms, and anxiety level were measured using the self-reported eHealth Literacy Scale (eHEALS), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder scale (GAD-7), respectively. Multiple linear regressions were performed to explore the role of education and mental health characteristics in DHL controlling for age and sex.ResultsThe vast majority of sample (92.1%) used the internet within the last 3 months and 67.3% used it to search for health-related information. The mean eHealth literacy score achieved 29.82 ± 6.78. Higher DHL was significantly associated with higher education (β = 0.31, p < 0.01) and it remained significant (β = 0.34, p < 0.001) after adding the mental health characteristics. Higher DHL was significantly associated with lower depressive symptomatology (β=-0.37, p < 0.01) and higher anxiety level (β = 0.33, p < 0.05). The final model explained 13.2% of the variance in DHL.ConclusionsPreliminary findings suggest that those seeking to decrease the DHL disparities among older adults may benefit from tailoring interventions towards those with lower education. Furthermore, the study underscores the need for integrated interventions, such as mental health support combined with digital literacy education, to enhance health outcomes among aging population. Further research is needed to uncover the relationship between higher anxiety level and higher DHL. [VEGA 1/0097/24].Key messages• Emotional problems seem to be significant contributors to digital health literacy of older adults.• Mental health support should be incorporated into the digital literacy intervention programs for older adults.

The need for digital literacy in aging populations is increasing in the digitalizing society. Digital literacy involves the identification, evaluation, and communication of information through various digital devices or relevant programs. The aims of this study were to develop an Everyday Digital Literacy Questionnaire (EDLQ), a digital literacy assessment scale, and subsequently evaluate its psychometric properties using a population of community-dwelling older adults in South Korea. The EDLQ was developed using an instrument development design. A nationwide survey was conducted, and the study included 1016 community-dwelling older adults (age ≥60 years). To evaluate the psychometric properties, the participants were randomly divided into 2 groups (n=508 each), and the internal consistency (Cronbach α and McDonald ω), structural validity (exploratory factor analysis and confirmatory factor analysis), hypothesis-testing construct validity using the eHealth Literacy Scale (eHEALS), and measurement invariance were analyzed. Among the initial 30 items of the EDLQ, 22 items with a 3-factor solution had a total explained variance of 77%. The domains included "information and communication" (9 items), "content creation and management" (4 items), and "safety and security" (9 items). Confirmatory factor analysis was conducted with this 3-factor solution (χ2206=345.1; normed χ2206=1.7; comparative fit index=0.997; Tucker-Lewis index=0.997; root-mean-square error of approximation=0.036; standardized root-mean-square residual=0.050; composite reliability=0.903-0.959; average variance extracted=0.699-0.724; R2=0.616-0.773). Hypothesis-testing construct validity with the eHEALS revealed a strong correlation (r=0.75). Cronbach α and McDonald ω coefficients were .98 and 0.98, respectively. The fit indices for measurement invariance, including the configural, metric, and scalar invariance models, demonstrated a satisfactory fit to the data. Our findings suggest that the psychometric properties of the 22-item EDLQ are valid and reliable for assessing digital literacy among older Korean adults. In this study, we developed a digital literacy measure with strong psychometric properties that made it suitable for assessing the digital literacy of community-dwelling older adults in Korea. To broaden its applicability, however, further assessment of its feasibility for use with different languages and cultures is necessary. Moreover, more empirical research on digital literacy and related factors in older adults can facilitate the development of personalized digital health care services and educational interventions in the digital society.

Background Fear of falling is a prevalent concern among older adults and is associated with physical inactivity, reduced independence, and decreased quality of life. Although various factors contribute to the fear of falling, limited evidence exists regarding the relationship between body mass index status, balance impairment, and fear of falling, particularly in rural populations. Objective This study aimed to examine the association between body mass index, balance impairment, and fear of falling among community-dwelling older adults in a rural area. Methods A cross-sectional study was conducted among 439 older adults aged 60 years and above residing in rural Thailand. In the initial phase, a list of older adults was obtained from primary care center records, and simple random sampling was employed to select participants according to the inclusion criteria. Data were collected on demographic characteristics, body mass index, balanced performance (measured using the Berg Balance Scale and the Timed Up and Go test), and fear of falling (assessed using the Short Falls Efficacy Scale-International). Multiple linear regression analysis was conducted to determine the factors significantly associated with fear of falling. Results The results showed that 56.7%, 18.5%, and 24.8% of the elderly had low, moderate, and high fear of falling, respectively. Multiple regression analysis revealed that balance performance, as measured by the Berg Balance Scale, was the only significant predictor of fear of falling (β = –0.298, p &lt; 0.001), whereas the Timed Up and Go test and body mass index were not significantly associated. Conclusion Balance impairment is a key determinant of fear of falling among older adults in rural areas. Interventions to improve balance may be effective in reducing fear of falling and preventing functional decline in this population.

Dementia knowledge is essential for early detection, care planning, and reducing stigma. Disparities persist among immigrant and minority populations, especially among older Asian Americans. Grounded in the digital health literacy model, this study examined how immigration and social factors, digital literacy, and dementia-related variables would be associated with dementia knowledge. Data were drawn from a survey with 507 Asian Americans aged 50 and older (M = 64.42, SD = 9.68) in central Florida. Hierarchical regression analyses estimated the impact of sequential blocks of independent variables on dementia knowledge: (1) background characteristics (age, gender, education, financial status, chronic conditions), (2) immigration-related factors (limited English proficiency [LEP], length of U.S. residence), (3) social factors (marital status, social network, activity participation), (4) digital literacy, health-information seeking behavior, and confidence in health information, and (5) dementia-related factors (having a family/friend with dementia, concerns about dementia, concerns about caregiving, dementia planning). Digital literacy emerged as a major independent predictor of dementia knowledge (β = .22, p &amp;lt; .001). Being married, having a family member/friend with dementia, and perceived importance of dementia planning as well as female gender and shorter US residence were also significant knowledge promoters. LEP was negatively associated with dementia knowledge, but its effect diminished when digital literacy was included. Findings suggest the critical role of digital literacy in reducing dementia knowledge disparities. Interventions enhancing digital and eHealth literacy, particularly among older adults with LEP, can improve access to dementia-related information. Future efforts should develop culturally tailored digital resources to bridge knowledge gaps.

Abstract: When the Canadian record on disability policy-making is reviewed a deja vu discourse is clearly evident. Assessing disability policy reform over recent decades evokes a strong sense that we have been here before in terms of the problems identified and the promises made. From interviews with disability community leaders and documentary analysis, five explanations for this frustrating pace of reform over the last 25 years are examined. These are public attitudes and the lack of information; the relative powerlessness of the disability community; the constraints of economic thinking and public finances; federal-provincial jurisdictional issues; and the absence of robust accountability mechanisms for disability policy within Canada's welfare state. Drawing on Foucault's concept of governmentality, the article argues that governance arrangements and discursive techniques, and not only programs and benefits, need to be the focus of advocacy and scrutiny by the disability movement and by scholars in disability studies. ********** A quarter century ago, a major Canadian study on policies and programs for people with disabilities was aptly entitled A Hit-and-Miss Affair (Brown, 1977). Prepared for the Canadian Council on Social Development, the inquiry sought to discover what was happening in services and programs for people with physical disabilities across the country. Looking at the total policy system, Brown found that the network of policies for Canadians with disabilities was not functioning effectively. Gaps in service provision, late referrals and inadequate follow-up programs, insufficient linkages among social programs, and incomplete information systems were among the barriers. Brown concluded her study with two strong impressions: first was that there is a lively awareness of the many deficiencies in policies for disabled people in Canada together with a desire for constructive change. The second was a strong sense of frustration that the need to change is not being given an adequate priority at the level where decisions must be made (Brown, 1977: 548). A growing awareness of the need for change coupled with a strong frustration with inadequate policy action meant that addressing the needs and rights of Canadians with disabilities was a hit-and-miss affair. This description of the policy setting, I will argue, remains a fair portrayal of Canadian disability programs and services, especially so from the perspective of groups of, and for persons with disabilities. Why has there been relatively slow movement on the disability agenda in Canada in recent decades? To explore this question, the paper examines reports and observations by various disability community groups and parliamentary committees that critique the Canadian government's disability policy record since the early 1980s, spanning the International Year of Disabled Persons of 1981 to the current context in the early 2000s. (1) The slow pace of reform is evident by what I call the deja vu discourse on disability reform and the disability issues circle. Traditionally, disability studies as a field of inquiry included relatively little analysis of public sector governance and related policy processes. Canadian social science was a clear example of this custom that, happily, is changing with major contributions to problematizing the way people with disabilities and their experiences have been studied or ignored (Bickenbach, 1993; Enns, 1999; Titchkosky, 2000 and 2003; Cameron and Valentine, 2001). A key premise of this article is that matters of governance and public policy are major determinants of the sluggish pace of reform. The paper therefore identifies several interrelated factors for why we are still a long way from meeting disability policy commitments on the Canadian government's agenda. Foucault's concepts of bio-politics and governmentality are used to inform the analysis and interpretation of this state of affairs. …

BackgroundDespite rising internet use in Canada, older adults continue to face significant barriers in adopting and using digital technologies. Digital literacy among older adults extends beyond technical proficiency, encompassing adaptation to new technologies, overcoming age-related limitations, and addressing socioeconomic disparities. Limited digital skills hinder social participation, access to essential services, and engagement with eHealth technologies, exacerbating disparities in health outcomes.ObjectiveThis scoping review aimed to identify key barriers to digital literacy among older adults, synthesizing evidence from existing literature to provide a comprehensive understanding of the challenges older adults face in adopting and utilizing digital technologies.MethodsA systematic search was conducted across the Ovid MEDLINE, PubMed, Web of Science, and EBSCOhost databases to identify studies published in the past 10 years that examined digital literacy barriers among older adults. Data extraction captured population characteristics, study context, research methods, and outcomes, which were thematically analyzed to identify overarching categories and themes.ResultsA total of 22 studies met the inclusion criteria. Most studies used a qualitative design (n=16, 72.72%), with the remaining studies comprising 3 quantitative studies (13.63%) and 3 reviews (13.63%). Seven primary barriers to digital literacy among older adults were identified: (1) health barriers, (2) support networks, (3) convenience and ease of use, (4) knowledge and information, (5) perception barriers, (6) resource barriers, and (7) barriers for special populations. Within these themes, 18 associated categories provided a more detailed understanding of the challenges older adults face in adopting and using digital technologies.ConclusionsThese findings demonstrate that digital literacy challenges among older adults are shaped by interacting individual, social, and contextual factors rather than isolated skill deficits. Barriers often co-occur, with health-related limitations, access to support, technology design, and resource constraints jointly influencing digital engagement. This review highlights the need for integrated and inclusive digital literacy strategies that address compounded barriers and reflect the diverse circumstances of older adults. Future research should focus on establishing consistent definitions of digital literacy, evaluating the long-term impact of digital inclusion initiatives, and addressing the needs of subpopulations experiencing heightened or intersecting barriers.

Association between sensory impairments and restricted social participation in older adults: A cross-sectional study

PurposeThis study aims to document the participation of intra-household decision-making activities by older adults in India.Design/methodology/approachThis study has used a nationally representative sample of 21,662 older adults (aged 60 and above) from the Longitudinal Ageing Study of India data of 2017–2018. Intra-household decision-making participation is measured based on decision-making activities that includes marriage of daughter/son, buying and selling of property, giving a gift to the family, education of family member and arrangement of social/religious events. This paper used bivariate analysis and binary logistic regression model to examine the factors associated with the participation of older adults in the intra-household decision-making activities.FindingsThe result has shown that older persons’ participation declined with increased age. This study has also found a difference in the participation of intra-households decision-making activities between male and female, rural and urban older adults, poor and rich older adults. Older adults with good health status who maintain social engagement and a good lifestyle are more likely to participate in the household’s decision-making activities.Practical implicationsOlder adults with better economic and social status are more likely to participate in intra-household decision-making activities that make their life happier than the counterpart. Therefore, emphasis should be given to those vulnerable older adults who do not have any social and economic security in the society.Originality/valueThere are limited studies available on intra-household decision-making participation by older adults. This paper documents the intra-household decision-making participation by older adults in India with a nationally representative large sample.

PurposeMore and more older adults begin to use the mobile internet to obtain information. However, the quality of information obtained through mobile internet by older adults is hard to be guaranteed. The purpose of this paper is to study the role of family support when older adults obtain information from mobile internet.Design/methodology/approachThis study conducted a survey of 263 older adults who owned mobile internet devices such as smartphones or tablet PCs. The theory hypotheses are tested using partial least squares techniques.FindingsFor older adults, family support is the influencing factor of mobile internet literacy improvement. Family emotional support has stronger impacts on the improvement both of mobile internet skill literacy and of mobile internet information literacy than family cognitive support has. Furthermore, the improvement of both mobile internet skill literacy and of mobile internet information literacy hs positive impacts on the quality improvement of obtained information by older adults.Practical implicationsThis paper gives advice on how family members can support older adults during their obtaining information from mobile internet to improve their mobile internet literacy and quality of obtained information.Originality/valueThis study examines the factors that influence mobile internet literacy and quality of obtained information among older adults from the perspective of family support in the Chinese mobile internet context. The research results enrich the internet literacy theory and the information quality theory.

Internet use is increasing every year, most of the reason is finding information (80.1%). Along with this, misinformation is circulating, including health information, so digital literacy is needed, especially for teenagers or Generation Z who are technology savvy. This activity aims to increase teenagers' digital literacy and help them search for appropriate health information through search engines. This Community Service is carried out using the Participatory Action Research (PAR) method with direct face-to-face presentation of material and practice on the given topic. Participants were 43 high school/equivalent level students aged 15-19 years. Most participants were 16 years old (46.51%) and female (88.37%). The average knowledge of participants regarding appropriate health information in the pre-test was 60.21, and the post-test was 88.65. A total of 40 out of 43 participants experienced an increase in scores (93.02%) after lectures and practice. This activity concluded that participants' knowledge and skills increased regarding using search engines to manage appropriate health information.