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ObjectivesThis study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤).MethodsUtilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members’ age (i.e. ≤ 64 years vs. 65 years≤) between 2004–2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age.ResultsHouseholds with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need.ConclusionsHouseholds with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts, though the health consequences of this unmet need could not be determined.

Shamsul Azhar Shah,1 Nazarudin Safian,1 Saharuddin Ahmad,2 Siti Rohani Nurumal,1 Zulkefley Mohammad,1 Juliana Mansor,1 Wan Abdul Hannan Wan Ibadullah,1 Yugo Shobugawa,3 Megumi Rosenberg4 1Department of Community Health, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia; 2Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia; 3Department of Active Aging, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 4Centre for Health Development, World Health Organization, Kobe, JapanCorrespondence: Shamsul Azhar ShahDepartment of Community Health, Faculty of Medicine, National University of Malaysia, Cheras, Kuala Lumpur, 56000, MalaysiaTel +60 3-9145 8787Fax +60 3-91456670Email drsham@ppukm.ukm.edu.myPurpose: Older people often have chronic diseases which require a continuity of care over the long term. Countries undergoing population aging need to ensure that older people are receiving the care they need. This study assesses the prevalence of, reasons for, and factors associated with unmet healthcare needs among older people individuals in Malaysia.Patients and Methods: This cross-sectional study used data collected during 2018– 2020 from 1204 older adults aged 60 and older selected from Selangor state, Malaysia. A comprehensive face-to-face interview based on the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire was administered to gain information on unmet healthcare needs, socioeconomic factors, health-related factors, and measures of function (activities of daily living, depression, visual impairment, hearing impairment, memory impairment, and walking impairment). Multivariate logistic regression was used to analyze factors associated with their unmet healthcare needs.Results: Overall, the percentage of older people respondents with unmet healthcare needs is 6.6%. The most reported reasons for forgoing or delaying healthcare were lack of knowledge about healthcare and financial barriers to care. The inability to travel alone (adjusted odds ratio [aOR] 2.51), being overweight (aOR 1.88), and having self-reported depression (aOR 2.23) were each associated with a higher likelihood of having unmet healthcare needs in their daily life.Conclusion: The prevalence of unmet healthcare needs among older people in this part of Malaysia is lower than that reported in some other countries. However, it is possible to further reduce unmet healthcare needs by improving people’s knowledge and attitudes about appropriate healthcare utilization, strengthening financial protection measures and providing support to people at high risk of having unmet healthcare needs.Keywords: healthcare needs, old age, Malaysia

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60 + years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

To measure progress towards universal health coverage (UHC) in the context of ageing, it is necessary to develop suitable monitoring frameworks. The global UHC monitoring framework is focused on priorities for younger populations and does not adequately address issues relevant to ageing populations.This study aims to propose a framework to measure UHC in a way that is relevant to health systems responding to population ageing.Based on a search strategy focusing on measures of UHC in relation to older people's care, we searched electronic databases and screened the records to qualitatively analyse the data. We also conducted 2 rounds of expert panel consultations to discuss the findings and examine the feasibility of the recommended indicators using the case of the Islamic Republic of Iran as an example.We identified main themes and classified core indicators under each theme. Besides 25 indicators for quality of care, there were 22 indicators for financial protection. Ten indicators were retrieved measuring coverage and access to long-term care. Some indicators were excluded owing to limited data availability or absence of related programmes and some alternate indicators were proposed.We identified several indicators which could be used to measure progress toward UHC in the context of population ageing. However, not all of these indicators are feasible in context of low- and middle-income countries. This study could offer useful general guidance on how to define the exact set of measures in a specific country context.قياس التغطية الصحية الشاملة لضمان استمرار تقديم الرعاية للمسنين: استعراض استكشافي مع الآثار المترتبة المحددة على السياق الإيراني.سیده صدیقه حسینی جبلی، عزيز رزابور، ميجومي روزنبرج، مازیار مرادی لاکه.لقياس التقدم المُحرز نحو التغطية الصحية الشاملة في سياق الشيخوخة، من الضروري وضع أُطُر رصد مناسبة. ويركز الإطار العالمي لرصد التغطية الصحية الشاملة على أولويات الفئات السكانية الأصغر سنًا ولا يتناول على نحو كافٍ القضايا ذات الصلة بالسكان المسنين.هدفت هذه الدراسة إلى اقتراح إطار لقياس التغطية الصحية الشاملة على نحو يتناسب مع النُظُم الصحية التي تستجيب لشيخوخة السكان.بناءً على استراتيجية بحثية تركز على تدابير التغطية الصحية الشاملة فيما يتعلق برعاية المسنين، بحثنا في قواعد البيانات الإلكترونية وفحصنا السجلات لتحليل البيانات تحليلاً نوعيًا. كما أجرينا جولتين من المشاورات مع فريق الخبراء لمناقشة النتائج ودراسة جدوى المؤشرات المُوصى بها باستخدام حالة جمهورية إيران الإسلامية كمثال.حددنا الموضوعات الرئيسية وصنفنا المؤشرات الأساسية تحت كل موضوع. وإلى جانب 25 مؤشرًا لجودة الرعاية، كان هناك 22 مؤشرًا للحماية المالية. وتم استرجاع 10 مؤشرات لقياس التغطية والحصول على الرعاية الطويلة الأجل. وتم استبعاد بعض المؤشرات بسبب محدودية البيانات المتاحة أو عدم وجود البرامج ذات الصلة بالموضوع، وتم اقتراح بعض المؤشرات البديلة.حددنا عدة مؤشرات يمكن استخدامها في قياس التقدم المُحرز نحو التغطية الصحية الشاملة في سياق شيخوخة السكان. غير أن هذه المؤشرات ليست كلها قابلة للتحقيق في سياق البلدان المنخفضة والمتوسطة الدخل. ويمكن أن تقدم هذه الدراسة إرشادات عامة مفيدة بشأن كيفية تحديد المجموعة الصحيحة من التدابير في سياق قُطري محدد.Évaluation de la couverture sanitaire universelle pour assurer des soins continus aux personnes âgées : une étude exploratoire avec des implications spécifiques pour le contexte iranien.Pour mesurer les progrès réalisés sur la voie de la couverture sanitaire universelle dans le contexte du vieillissement, il est nécessaire de mettre au point des cadres de suivi appropriés. Le cadre mondial de suivi de la couverture sanitaire universelle se concentre sur les priorités des populations plus jeunes et n’aborde pas de manière adéquate les problèmes relatifs aux populations vieillissantes.La présente étude vise à proposer un cadre pour évaluer la couverture sanitaire universelle d'une manière qui soit pertinente pour les systèmes de santé répondant au vieillissement de la population.Sur la base d'une stratégie de recherche axée sur les mesures de la couverture sanitaire universelle en relation avec les soins aux personnes âgées, nous avons effectué des recherches dans des bases de données électroniques et passé en revue les registres pour analyser qualitativement les données. Nous avons également mené deux cycles de consultations avec un groupe d'experts afin de discuter des résultats et d'examiner la faisabilité des indicateurs recommandés en utilisant le cas de la République islamique d'Iran comme exemple.Nous avons identifié des thèmes principaux et avons classé les indicateurs de base sous chaque thème. Outre les 25 indicateurs pour la qualité des soins, il y avait 22 indicateurs pour la protection financière. Dix indicateurs ont été récupérés pour évaluer la couverture sanitaire universelle et l'accès aux soins de longue durée. Certains indicateurs ont été exclus du fait de la disponibilité limitée des données ou de l'absence de programmes connexes, et d'autres indicateurs ont été proposés.Nous avons identifié plusieurs indicateurs qui peuvent être utilisés pour mesurer les progrès vers la couverture sanitaire universelle dans le contexte du vieillissement de la population. Cependant, ces indicateurs ne sont pas tous réalisables dans le contexte des pays à revenu faible ou intermédiaire. La présente étude pourrait offrir des orientations générales utiles sur la façon de définir l’ensemble exact de mesures dans le contexte spécifique d’un pays.

Background Globally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan. Methods All patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission. Results Two hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03). Conclusions These findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

There is currently no global review of the conceptual literature on the equity of healthcare coverage (including access) for older people. It is important to understand the factors affecting access to health and social care for this group, so that policy and service actions can be taken to reduce potential inequities.\ud \ud \ud \ud A scoping review of published and grey literature was conducted with the aim of summarising how health and social care service access and coverage for older people has been conceptualised. PubMed, MEDLINE, PsycINFO, CINAHL, Web of Science, SciELO, LILACS, BIREME and Global Index Medicus were searched. Selection of sources and data charting were conducted independently by two reviewers.\ud \ud \ud \ud The database searches retrieved 10 517 citations; 32 relevant articles were identified for inclusion from a global evidence base. Data were summarised and a meta-framework and model produced listing concepts specific to equitable health and social care service coverage relating to older people. The meta-framework identified the following relevant factors: acceptability, affordability, appropriateness, availability and resources, awareness, capacity for decision-making, need, personal social and cultural circumstances, physical accessibility.\ud \ud \ud \ud This scoping review is relevant to the development and specification of policy for older people. It conceptualises those factors, such as acceptability and affordability, that affect an older person’s ability and capacity to access integrated, person-centred health and social care services in a meaningful way. These factors should be taken into account when seeking to determine whether equity in service use or access is being achieved for older people.

Frailty is a common clinical syndrome in older adults associated with an increased risk for poor health outcomes including disability, hospitalisation and mortality.[1][1] The global burden of frailty is increasing with the worldwide trend of population ageing.[2][2] Based on a recent meta-analysis

Global population aging is the result of successes in public health, enabling longer life expectancy in many countries. The Asia Pacific region is aging more rapidly than many other parts of the world. The implications will be profound for every sector of society, requiring policy makers to reframe their thinking about the design of health and social systems to enable older populations to thrive. With increasing demand for more and different kinds of services, an imperative is shifting resources toward primary care for the prevention and comprehensive care of people with chronic conditions, and establishing linkages with community support. Major innovations are underway that accelerate progress in attaining universal health coverage for older populations. The renewed commitments under the Sustainable Development Goals to achieve universal health coverage offer a unique opportunity to invest in the foundations of the health system of the future.