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Special Issue "Key Issues in Current Health Research: Ageing–Health–Equity"

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

Deadline for manuscript submissions: closed (31 December 2017)

Special Issue Editors

Guest Editor
Prof. Dr. Ingrid Darmann-Finck

Institute for Public Health and Nursing Research (IPP), University of Bremen, Germany
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Guest Editor
Prof. Dr. Heinz Rothgang

SOCIUM – Research Center on Inequality and Social Policy University of Bremen, Germany
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Guest Editor
Prof. Dr. Hajo Zeeb

Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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Special Issue Information

Dear Colleagues,

The Special Issue will bring together selected papers presented at the Conference "Key Issues in Current Health Research: Ageing–Health–Equity", in Bremen, 29–30 June, 2017, as well as other papers fitting the themes of this Special Issue.

Demographic change and the evolving demands on healthcare systems, especially the provision of healthcare and nursing care for a growing number of older people, are among the greatest social challenges of the next decades. The pursuit of health equity in ageing societies raises several questions: On the one hand, there are persisting health inequities related to a social gradient in health. On the other hand, as resources are limited, social challenges to healthcare and the healthcare system will always entail questions of distributive justice.

With the conference on Ageing, Health and Equity, the High Profile Research Area Health Sciences of the University of Bremen has established a forum for discussing these key challenges of healthcare in ageing societies. A common focus is on disparities in healthcare and equity requirements.

The conference focuses on four main topics that shall be reflected in the Special Issue:

  • Health–equity–health inequalities: This may comprise questions concerning concept for reducing health inequalities, international comparisons of health inequalities and analyses of the persistence of health inequalities.
  • Qualification requirements and training of healthcare professionals: The focus is on the analysis and international comparison of concepts and programmes to meet the growing demand for skilled workers for ageing populations.
  • Prevention–Healthy Ageing: Including determinants of healthy ageing, access to health services, evaluation of preventive interventions that may reinforce inequalities.
  • Ageing and Diversity: Requirements for health services: This includes questions of participatory approaches as well as the analysis of access barriers for specific groups of people such as the growing group of elderly migrants.

The four topics are linked by their common perspective on health equity issues.  The conference aims to analyze current developments, as well as possible solutions and action strategies. Papers are invited that focus on research obstacles, and how to overcome them, as well as new methodological concepts, technological developments and innovative solutions. Papers not related to the conference but fitting the scope are also welcome.

Prof. Dr. Hajo Zeeb
Prof. Dr. Heinz Rothgang
Prof. Dr. Ingrid Darmann-Finck
Guest editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Health Inequalities
  • Health Equity
  • Healthy Ageing
  • Ageing and Diversity
  • Distributive Justice
  • Health Disparities
  • Qualification requirements of healthcare professionals
  • Prevention
  • Access to Health Services
  • Diversity-sensitive health care provision

Published Papers (11 papers)

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Editorial

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Open AccessEditorial Ageing, Health and Equity—Broad Perspectives Are Needed to Understand and Tackle Health Challenges of Ageing Societies
Int. J. Environ. Res. Public Health 2018, 15(3), 457; https://doi.org/10.3390/ijerph15030457
Received: 26 February 2018 / Revised: 26 February 2018 / Accepted: 1 March 2018 / Published: 6 March 2018
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Abstract
Demographic change and the evolving demands on healthcare systems, especially in the provision of healthcare and long-term care for a growing number of older people, are among the greatest social challenges of the next decades.[...] Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)

Research

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Open AccessArticle Shared Housing Arrangements in Germany—An Equitable Alternative to Long Term Care Services beyond Homes and Institutions?
Int. J. Environ. Res. Public Health 2018, 15(2), 342; https://doi.org/10.3390/ijerph15020342
Received: 12 December 2017 / Revised: 14 January 2018 / Accepted: 19 January 2018 / Published: 14 February 2018
Cited by 1 | PDF Full-text (304 KB) | HTML Full-text | XML Full-text
Abstract
Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models
[...] Read more.
Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models that provide more choice and flexibility to beneficiaries. One such model is ‘shared housing arrangements’ (“ambulant betreute Wohngemeinschaften”), where a small group of people rent private rooms, while sharing a common space, domestic support, and nursing care. Using interview and secondary data, this study examines the potential for such arrangements to provide an equitable alternative to care that is accessible to a larger population of beneficiaries than presently seen in Germany. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
Open AccessFeature PaperArticle Incidence Rates of and Mortality after Hip Fracture among German Nursing Home Residents
Int. J. Environ. Res. Public Health 2018, 15(2), 289; https://doi.org/10.3390/ijerph15020289
Received: 25 December 2017 / Revised: 1 February 2018 / Accepted: 4 February 2018 / Published: 7 February 2018
Cited by 1 | PDF Full-text (622 KB) | HTML Full-text | XML Full-text
Abstract
Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR) of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly
[...] Read more.
Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR) of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly admitted to German nursing homes between 2010 and 2014 were used to calculate age-, sex-, care-need- and time after admission-specific IR. To determine mortality, the Kaplan-Meier-method was applied. Using Cox regression, we studied mortality and estimated time-dependent hazard ratios (HRs). For this purpose, to each person with a hip fracture, one resident without a hip fracture was matched by sex, age and care-need using risk-set sampling. 75% were women (mean age: 84.0 years). During 168,588 person-years (PY), 8537 residents with at least one hip fracture were observed. The IR for women and men were 52.9 and 42.5/1000 PY. For both sexes, IR increased with rising age and decreased with increasing care-level. IR were highest in the first months after admission and subsequently declined afterwards. The impact of hip fractures on mortality was time-dependent. Mortality of residents with hip fracture was highest in the first two months after fracture compared to those without (HR): 2.82; 95% CI 2.57–3.11) and after six months, no differences were found (HR: 1.10; 95% CI 0.98–1.22) Further research should always include analyses stratified by sex, age and time period after admission. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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Open AccessArticle Class and Health Inequality in Later Life: Patterns, Mechanisms and Implications for Policy
Int. J. Environ. Res. Public Health 2017, 14(12), 1533; https://doi.org/10.3390/ijerph14121533
Received: 14 November 2017 / Revised: 3 December 2017 / Accepted: 4 December 2017 / Published: 8 December 2017
Cited by 3 | PDF Full-text (2553 KB) | HTML Full-text | XML Full-text
Abstract
The growth of the post-retirement population, which has occurred as a result of rapid growth in life expectancy coupled with the ageing of the baby boomer cohort, has led to significant concern. This concern, however, typically neglects the heterogeneity of later life experiences
[...] Read more.
The growth of the post-retirement population, which has occurred as a result of rapid growth in life expectancy coupled with the ageing of the baby boomer cohort, has led to significant concern. This concern, however, typically neglects the heterogeneity of later life experiences and how these are patterned by inequalities that reflect how process of social stratification continue to operate into later life. This paper draws on a programme of work, based on analysis of the English Longitudinal Study of Ageing, to empirically examine questions of inequality in later life. It begins by illustrating the patterning of health inequality. It then investigates the importance of later life contexts and events in shaping inequality through and after the retirement process. In doing so it examines the extent to which later life continues to reflect stable social structures that shape inequalities and, consequently, health and wellbeing in later life. The paper then illustrates how the effects of socioeconomic position on health in later life can be theorised as a product of class processes, borrowing in part from Bourdieu. Other dimensions of inequality, such as gender, ethnicity, area and sexuality, are not discussed here. The paper concludes with a discussion of the need for a close focus on inequalities in later life in research, policy and practice. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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Open AccessArticle Contextual Exploration of a New Family Caregiver Support Concept for Geriatric Settings Using a Participatory Health Research Strategy
Int. J. Environ. Res. Public Health 2017, 14(12), 1467; https://doi.org/10.3390/ijerph14121467
Received: 29 September 2017 / Revised: 17 November 2017 / Accepted: 23 November 2017 / Published: 28 November 2017
Cited by 1 | PDF Full-text (1552 KB) | HTML Full-text | XML Full-text
Abstract
Family caregivers are the backbone of the long-term care support system within the home environment. Comprehensive caregiver support programs require collaboration and coordination within the system. A new public health concept, Vade Mecum, aims to harmonize and professionalize family caregiver support initiatives in
[...] Read more.
Family caregivers are the backbone of the long-term care support system within the home environment. Comprehensive caregiver support programs require collaboration and coordination within the system. A new public health concept, Vade Mecum, aims to harmonize and professionalize family caregiver support initiatives in geriatric care settings in the Euregion Maas-Rhine. Exploration of the new concept recently started in Germany to gain in-depth insight into current support and the needs of the geriatric care team and family caregivers. Within the context of an exploratory qualitative study, a participatory health research (PHR) strategy was applied to make optimal use of experience and knowledge from the system. Care professionals, engaged as co-researchers, were responsible for decisions about the research question, data collection methods and procedures of engaging family caregivers. A research team representing all professions within the geriatric department was formed. Research objectives were formulated and an appropriate mix of qualitative data collection methods consisting of interviews, focus groups and story-telling was chosen. Needs and expectations of the new concept, and practical solutions for involving family caregivers were discussed. A PHR strategy resulted in initiating a qualitative study in a geriatric care setting carried out by care professionals from the department. Knowledge was generated in a co-creative manner, and co-researchers were empowered. A comprehensive understanding of the system serves as a starting point for advancement of the new family caregiver concept. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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Open AccessFeature PaperArticle Cross-Cultural Adaptation of the Social Vulnerability Index for Use in the Dutch Context
Int. J. Environ. Res. Public Health 2017, 14(11), 1387; https://doi.org/10.3390/ijerph14111387
Received: 5 September 2017 / Revised: 30 October 2017 / Accepted: 10 November 2017 / Published: 14 November 2017
Cited by 3 | PDF Full-text (285 KB) | HTML Full-text | XML Full-text
Abstract
Being able to identify socially frail older adults is essential for designing interventions and policy and for the prediction of health outcomes, both on the level of individual older adults and of the population. The aim of the present study was to adapt
[...] Read more.
Being able to identify socially frail older adults is essential for designing interventions and policy and for the prediction of health outcomes, both on the level of individual older adults and of the population. The aim of the present study was to adapt the Social Vulnerability Index (SVI) to the Dutch language and culture for those purposes. A systematic cross-cultural adaptation of the initial Social Vulnerability Index was performed following five steps: initial translation, synthesis of translations, back translation, a Delphi procedure, and a test for face validity and feasibility. The main result of this study is a face-valid 32 item Dutch version of the Social Vulnerability Index (SVI-D) that is feasible in health care and social care settings. The SVI-D is a useful index to measure social frailty in Dutch-language countries and offers a broad, holistic quantification of older people’s social circumstances related to the risk of adverse health outcomes. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
Open AccessFeature PaperArticle Changes in Sports Participation across Transition to Retirement: Modification by Migration Background and Acculturation Status
Int. J. Environ. Res. Public Health 2017, 14(11), 1356; https://doi.org/10.3390/ijerph14111356
Received: 23 September 2017 / Revised: 27 October 2017 / Accepted: 30 October 2017 / Published: 8 November 2017
Cited by 1 | PDF Full-text (1466 KB) | HTML Full-text | XML Full-text
Abstract
While total physical activity decreases over the life course, sports and leisure-time physical activity (LTPA) have shown to increase after transition to retirement. This paper aimed to investigate whether this change in sports participation differs (1) between non-migrant persons (NMP) versus persons with
[...] Read more.
While total physical activity decreases over the life course, sports and leisure-time physical activity (LTPA) have shown to increase after transition to retirement. This paper aimed to investigate whether this change in sports participation differs (1) between non-migrant persons (NMP) versus persons with a migrant background (PMB), and (2) by acculturation status. Data was drawn from 16 waves of the German Socio-Economic Panel Study (SOEP) including 2664 NMP and 569 PMB. PMB were grouped according to acculturation status (integrated, assimilated, marginalised, separated), assessed regarding three dimensions (language, social interaction and identification). We applied multilevel logistic regression models, adjusting for sex, retirement age, socioeconomic status, health status and body mass index. Our results show that (1) transition to retirement led to an increase in the sports participation of NMP during the first 5 years and the subsequent 5 years after retirement. Changes in sports participation were modified by migration status: In PMB sports participation increased to a lesser extent than in NMP. (2) While sports participation of integrated PMB was not significantly different from NMP in the preretirement phase, sports participation among integrated PMB increased less after retirement compared with NMP. Marginalized and assimilated PMB did not show consistent sports participation patterns before retirement, but seemingly increased their sports participation less than NMP over the retirement transition. Separated PMB had particularly low levels of sports participation. Considering that LTPA is a key factor for healthy ageing, the increasing gap in levels of sports participation after transition to retirement indicates the need for interventions targeting physical activity of the older migrant population. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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Open AccessFeature PaperArticle Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans
Int. J. Environ. Res. Public Health 2017, 14(10), 1224; https://doi.org/10.3390/ijerph14101224
Received: 31 August 2017 / Revised: 22 September 2017 / Accepted: 2 October 2017 / Published: 14 October 2017
Cited by 2 | PDF Full-text (498 KB) | HTML Full-text | XML Full-text
Abstract
In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal
[...] Read more.
In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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Open AccessFeature PaperArticle The Role of the Social Network in Access to Psychosocial Services for Migrant Elderly—A Qualitative Study
Int. J. Environ. Res. Public Health 2017, 14(10), 1215; https://doi.org/10.3390/ijerph14101215
Received: 31 August 2017 / Revised: 27 September 2017 / Accepted: 5 October 2017 / Published: 11 October 2017
Cited by 1 | PDF Full-text (264 KB) | HTML Full-text | XML Full-text
Abstract
Abstract: Background: Despite high prevalence of mental problems among elderly migrants in The Netherlands, the use of psychosocial care services by this group is low. Scientific evidence points at the crucial role of social support for mental health and the use of
[...] Read more.
Abstract: Background: Despite high prevalence of mental problems among elderly migrants in The Netherlands, the use of psychosocial care services by this group is low. Scientific evidence points at the crucial role of social support for mental health and the use of psychosocial services. We therefore explored the role of social networks in the access to psychosocial care among elderly migrants in The Netherlands. Methods: A qualitative study was conducted using semi-structured group interviews and individual interviews. The eight group and eleven individual interviews (respectively n = 58 and n = 11) were conducted in The Netherlands with Turkish, Moroccan, Surinamese, and Dutch elderly. The data were analysed through coding and comparing fragments and recognizing patterns. Results: Support of the social network is important to navigate to psychosocial care and is most frequently provided by children. However, the social network of elderly migrants is generally not able to meet the needs of the elderly. This is mostly due to poor mental health literacy of the social network, taboo, and stigma around mental illness and the busy lives of the social network members. Conclusions: Strategies to address help-seeking barriers should consider mental health literacy in elderly migrants as well as their social networks, and counteract taboos and stigma of mental health problems. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
Open AccessFeature PaperArticle Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany
Int. J. Environ. Res. Public Health 2017, 14(10), 1127; https://doi.org/10.3390/ijerph14101127
Received: 17 July 2017 / Revised: 18 September 2017 / Accepted: 21 September 2017 / Published: 26 September 2017
Cited by 2 | PDF Full-text (1377 KB) | HTML Full-text | XML Full-text
Abstract
Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived
[...] Read more.
Research into health inequalities in the elderly population of Germany is relatively scarce. This study examines socioeconomic inequalities in health and perceived unmet needs for healthcare and explores the dynamics of health inequalities with age among elderly people in Germany. Data were derived from the Robert Koch Institute’s cross-sectional German Health Update study. The sample was restricted to participants aged 50–85 years (n = 11,811). Socioeconomic status (SES) was measured based on education, (former) occupation, and income. Odds ratios and prevalence differences were estimated using logistic regression and linear probability models, respectively. Our results show that self-reported health problems were more prevalent among men and women with lower SES. The extent of SES-related health inequalities decreased at older ages, predominantly among men. Although the prevalence of perceived unmet needs for healthcare was low overall, low SES was associated with higher perceptions of unmet needs in both sexes and for several kinds of health services. In conclusion, socioeconomic inequalities in health exist in a late working age and early retirement but may narrow at older ages, particularly among men. Socially disadvantaged elderly people perceive greater barriers to accessing healthcare services than those who are better off. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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Review

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Open AccessReview Methods for Involving Older People in Health Research—A Review of the Literature
Int. J. Environ. Res. Public Health 2017, 14(12), 1476; https://doi.org/10.3390/ijerph14121476
Received: 30 September 2017 / Revised: 17 November 2017 / Accepted: 23 November 2017 / Published: 29 November 2017
Cited by 1 | PDF Full-text (1249 KB) | HTML Full-text | XML Full-text
Abstract
Demographic change has increased the need for research on healthcare for older people. Recently there has been a growing awareness that research might benefit from actively involving patients and the public in study design and conduct. Besides empowering patients and democratizing research, involvement
[...] Read more.
Demographic change has increased the need for research on healthcare for older people. Recently there has been a growing awareness that research might benefit from actively involving patients and the public in study design and conduct. Besides empowering patients and democratizing research, involvement enhances the quality of research and the development of equitable healthcare solutions. Little is known about how to involve older people. This review aims to support scientists intending to involve older people in health research by systematically identifying and describing studies involving older people and analyzing associated facilitators and challenges. Old people were operationalized as people living with old-age-related conditions. We conducted a systematic search in PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane library for the period 2007 to July 2017 and also manually searched reference lists of the nine retrieved articles and other relevant sources. While involvement of older people in research is feasible, specific challenges related to this group need be taken into account. Strategies to enhance effective involvement comprise a thoughtful choice of location, use of visualization and accessible communication, building good relationships and flexible approaches. Further research is needed on the involvement of people in care homes or with vision, hearing or mobility limitations. Full article
(This article belongs to the Special Issue Key Issues in Current Health Research: Ageing–Health–Equity)
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