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This chapter considers how expanded longevity should impact the law’s response to aging and the needs of older adults. Countries have long responded to old age by creating social welfare policies that use chronological age to target interventions at older adults. This chapter argues that, as life expectancy increases, the use of such age-based criteria will become more problematic: Chronological age will be an increasingly poor predictor of need, and age-based criteria will increasingly result in inequitable distribution of resources. Accordingly, it argues that polities should respond to enhanced longevity not merely by recalibrating age-based criteria to ensure efficient allocation of resources but by reducing reliance of age-based criteria. It concludes by considering whether vulnerability can serve as an alternative targeting mechanism.
Local politics are dominated by older residents, who vote and participate at rates very disproportionate to their share of the population. At the same time, local government has been assigned responsibility for functions featuring inherent generational divides: most pointedly, public education, but also infrastructure development and land use regulation. This combination raises concerns about democratic distortion and local government’s continued ability to invest in the future. If predictions of substantially longer lifespans come true, these concerns about the local political economy will only be heightened. This chapter identifies this tension and reviews how local governments currently manage age-based political conflict. It then describes the limitations of these mechanisms and offers a schematic for the strategies that local governments will have to adopt as they navigate the fault lines of age moving forward: by better aligning the preferences of older and younger residents, by equalizing patterns of political participation, or by reassigning functions that implicate age away from the local level.
This chapter considers questions of immigration institutional design in light of lessons learned from how Caribbean home-care aides currently work and travel. The growth in paid home care has been largely staffed by migrant labor – with some care workers operating outside of the scope of their visas. While these workers may technically be noncompliant, the author argues that most of these workers are in fact “good types,” who would have been favorably screened ex-ante for elder-care visas. The chapter proposes that we urgently devise a system that permits temporary entry of elder-care workers. If migrant care workers are permitted long-term temporary visas in which they can work in the US for a few months per year over several years, they have every incentive to comply.
Climate change will impact many facets of aging in America – from housing and long-term care to the financing of retirement. Adaptation policy should be reformed in response, including a greater emphasis on managed retreat and the creation of a streamlined long-term support program for displaced older people. Older Americans might change the law directly through litigation, bringing novel cases rooted in the unique harms they face.
With more Americans expected to live longer than ever, law and longevity will intersect across a wide range of disciplines—from education and immigration to criminal justice and civil rights. This introduction surveys the role law will play in the 100-year life, spotlighting debates about its promises and pitfalls. Opening with a discussion of crosscutting themes that animate the book, it concludes with an overview of each section and contribution.
This chapter reflects on the future of family law in an era of longer lives. Our analysis leads us to conclude that the 100-year life is indeed likely to have an impact on the nature, scope, and definition of family law, but that families will continue to function as the primary setting for intimacy and for caregiving and caretaking, whatever form those families take. Further, the importance to both individual and social welfare of family support throughout life points to a need for reform of current family law doctrine. The impact of longer life on doctrines regulating the relationship of parents and minor children is likely to be modest, but doctrinal and policy reforms will be needed to support individuals in following their preferences for intimacy and security in old age -- as will reforms to the minimal role of the state in promoting security for individuals in different family forms and of differing socioeconomic status. We suggest general goals for law reform and offer specific proposals.
This chapter considers the status of a constitutional “right to grow old” under the US Constitution. Understood as a “positive” right – ensuring a certain minimum quality of life to people as they face the challenges of aging – such a right may seem unavailing given the austerity in respect to such rights that many lawyers associate with the US constitutional tradition. This chapter shows this view to be premature, at least. Unlike the kinds of positive rights overtly rejected in prior cases, such as rights to certain forms of social welfare or to racial equality, a right to grow old contemplates social support for all of us, and not simply for a politically disfavored class. Moreover, many of the conventional objections to positive rights, grounded in the difficulty of disciplining them, can be overcome or mitigated through strategies that have proven effective in many courts around the world: proportionality review, polycentric constitutionalism, a “minimum core” approach, progressive realization, and remedial flexibility.
In the mid-twentieth century, income and wealth inequality was declining, leading to an era of comparative economic equality and a large middle class. But since the early 1980s, income and wealth inequality has been on the rise. The 100-year life describes how increasing life expectancy could transform the course of individual lives in detail – but how does this trend intersect with our age of inequality? And what does it mean for law and policymaking more generally? The dark side of rising life expectancy is that it is unequally shared. The first part of this chapter briefly discusses how age and inequality are connected – that is, that not everyone shares in rising life expectancy equally and that those who are living longer share many common attributes. The second part considers the possible impact of the skew in rising life expectancy on representative government. Inequality skews politics to favor the wealthy; inequality by age will likely do the same. The fundamental problem is that power is held unequally in most societies. The third part, on age and institutional design, outlines some ways in which political structures might be crafted to account for age-related differences.
Law and the 100-Year Life addresses the growing trend of Americans living longer and healthier lives, with many reaching the age of 100. An aging nation presents new challenges for society, which must be reimagined to accommodate longer and more varied careers, multiple marriages, and defining moments of education. This volume explores the possibility of a 'third demographic dividend', a new period of productivity following middle age, and the potential for law and policy to support or divide aging citizens. Leading scholars across various fields come together to explore topics related to aging, such as health law and trusts and estates, as well as less obvious but equally important areas like housing, criminal justice, and education. This title is also available as Open Access on Cambridge Core.
Electronic medical record (EMR) systems in primary care present an opportunity to address frailty, a significant health concern for older adults. Researchers in the UK used Read codes to develop a 36-factor electronic frailty index (eFI), which produces frailty scores for patients in primary care settings.
Aim:
We aimed to translate the 36-factor eFI to a Canadian context.
Methods:
We used manual and automatic mapping to develop a coding set based on standardized terminologies used in Canada to reflect the 36 factors of the eFI. Manual mapping was completed independently by two coders, followed by group consensus among the research team. Automatic mapping was completed using Apelon TermWorks. We then used EMR data from the British Columbia Canadian Primary Care Sentinel Surveillance Network. We searched structured data fields related to diagnoses and reasons for patient visits to develop a list of free text terms associated with any of the 36 factors.
Results and conclusions:
A total of 3768 terms were identified; 3021 were codes. A total of 747 free text terms were identified from 527,521 reviewed data entries. Of the 36 frailty factors, 24 were captured mostly by codes; 7 mostly by free text; and 4 approximately equally by codes and free text. Three key findings emerged from this study: (1) It is difficult to capture frailty using only standardized terminologies currently used in Canada and a combination of standardized codes and free text terms better captures the complexity of frailty; (2) EMRs in primary care can be better optimized; (3) Output from this study allows for the development of a frailty screening algorithm that could be implemented in primary care settings to improve individual and system level outcomes related to frailty.
More than a million foreigners reportedly reside in South Korea now, with unskilled migrant workers accounting for a majority. Although the country's reliance on imported foreign labor is likely to continue unabated, the country prides itself as an ethnically homogenous society and insists on almost zero-immigration policy. However, this paper shows that Korean society is rapidly becoming a multicultural society and this process is inevitable and irreversible. In support of this argument, the paper examines various social factors that are contributing to the making of a multiethnic Korea, including the continuing influx of migrant workers, rapid aging of the population, low fertility rate, and shortage of brides. The paper also assesses the applicability of various theories and trends of migration to the Korean context. The Korean case suggests a need for a paradigm shift in understanding multiculturalism. This is because the dominant perspectives and theories on multiculturalism have been western-centric, based on western experience and focusing on racial differences and tensions. Multiculturalism in Korea as well as in its neighboring countries like China, Japan, and Taiwan is fundamentally different, as it involves people of similar physical appearances and historical cultural bonds, and it entails ethnic rather than racial differences.
Bilingualism delays the onset of dementia symptoms and contributes to cognitive reserve. However, the neural basis of this mechanism remains elusive. The few studies that have investigated neural mechanisms of cognitive reserve and bilingualism have focused on Alzheimer’s disease. This study investigated the neural basis of cognitive reserve among persons with frontotemporal dementia (FTD) using regional brain volumes. Sixty-eight persons with FTD (42 bilinguals and 26 monolinguals) were included. After propensity score matching for age, sex, education, FTD subtype and clinical severity, there were 26 bilinguals and 26 monolinguals. The results showed that bilinguals had reduced thalamic volume compared to monolinguals despite having similar cognitive performance. The results indicate that bilinguals were able to tolerate more severe atrophy compared to monolinguals while maintaining comparable cognitive abilities. Our study therefore suggests that bilingualism contributes to cognitive reserve in persons with FTD.
This study aimed to refine the content of a new patient-reported outcome (PRO) measure via cognitive interviewing techniques to assess the unique presentation of depressive symptoms in older adults with cancer (OACs).
Methods
OACs (≥ 70years) with a history of a depressive disorder were administered a draft measure of the Older Adults with Cancer – Depression (OAC-D) Scale, then participated in a semi-structured cognitive interview to provide feedback on the appropriateness, comprehensibility, and overall acceptability of measure. Interviews were audio-recorded and transcribed, and qualitative methods guided revision of scale content and structure.
Results
OACs (N = 10) with a range of cancer diagnoses completed cognitive interviews. Participants felt that the draft measure took a reasonable amount of time to answer and was easily understandable. They favored having item prompts and response anchors repeated with each item for ease of completion, and they helped identify phrasing and wording of key terms consistent with the authors’ intended constructs. From this feedback, a revised version of the OAC-D was created.
Significance of results
The OAC-D Scale is the first PRO developed specifically for use with OACs. The use of expert and patient input and rigorous cognitive interviewing methods provides a conceptually accurate means of assessing the unique symptom experience of OACs with depression.
We conducted a detailed linguistic analysis of Oral Proficiency Interviews (OPIs) from older Spanish-English bilinguals (n = 28) to determine which cognitive, linguistic, and demographic factors predict proficiency. In the dominant language, older age was associated with lower proficiency scores, but aging effects were not significant after accounting for cognitive functioning scores. In the nondominant language, bilinguals with larger vocabulary scores, fewer speech errors, and higher education levels obtained higher proficiency scores. Multiple linguistic submeasures from the OPIs were highly correlated across languages (e.g., fast speakers spoke fast in both languages), but these same measures exhibited significant language dominance effects (e.g., bilinguals spoke faster in the dominant than in the nondominant language). These results suggest it is critical to control for cognitive functioning when examining aging effects on language production, reveal powerful individual differences that affect how people talk regardless of language, and validate the use of the OPI to measure bilingual proficiency.
Elder abuse (EA) often remains hidden, and many victims do not interact with formal systems. Concerned persons (CPs) are family, friends, and neighbours who play an essential role in supporting EA victims.
Objective
The aim of this study was to understand CPs’ role and help-seeking experiences.
Methods
Nineteen self-identified CPs shared their experience of being involved in an EA case via an interview and/or survey, with responses analysed qualitatively.
Findings
CPs were primarily the victims’ female relatives, often related to the perpetrator, and had sought help from a wide range of formal and informal sources, facing many barriers in protecting victims from harm. Challenges commonly related to formal services and EA perpetrators. Through knowing about the abuse and/or seeking help, participants experienced negative impacts, particularly psychological ones.
Discussion
Findings suggest that CPs can play a key role in supporting EA victims but require further support and recognition from services to fulfil this role.
Home care aims to reduce harmful effects of poor health and increase well-being.
Objective
We studied whether receiving formal or informal home care was associated with changes in satisfaction with life (SwL).
Methods
The study includes people aged 70+ who participated in the Canadian Longitudinal Study on Aging (CLSA) at baseline and three-year follow-up. Linear regression models adjusted for individual factors were used to examine the relationship between home care and changes in SwL at two time points.
Results
Receiving home care was associated with declining SwL. The association was different for formal and informal care, and to some extent, for men and women. Changes in health mainly explained the association of SwL with formal but not informal care.
Discussion
The connection between home care and declining SwL suggests that some people’s needs are not met, especially by informal care, which negatively affects life satisfaction. This finding deserves more attention when planning home-based care.
Japan is shrinking. Current projections indicate a population decrease of around one quarter by mid-century. Depopulation is potentially good news, providing opportunities for reconfiguring living conditions and alleviating human-environmental pressures. Nevertheless, ageing and depopulation have outcomes that require adjustment. One of these is spatial inequalities, which have been accelerating since the 1990s. Japan is the Asia-Pacific’s pioneer ageing and shrinking society. In East Asia both China and South Korea are ageing and expected to begin shrinking soon. Even high immigration Anglophone countries such as New Zealand are experiencing post-growth demographic processes at subnational level. Japan’s significance is in how adaptive responses there inform prospects for others as they experience their own post-growth pathways. This article presents case studies of Sado Island in Japan and New Zealand’s South Island in a comparative qualitative analysis of rural agency under population decline. Overall, I contend there is potential for benefitting from demographic shrinkage - what I term a ‘depopulation dividend’ - and for rural regions in the Asia-Pacific to progress towards a sustainable post-growth economy and society.
The ability to understand and speak more than one language (i.e., bilingualism) may provide benefits to preserving social cognition against normal age-related deteriorations. This study examined how variations in bilingual language experience influence theory-of-mind (ToM) understanding in late adulthood. One hundred and five cognitively healthy older adults (Mage = 66.23 years, range = 56–79) and 80 young adults (Mage = 22.03 years, range = 19–30), who were bilingual speakers, completed a ToM task battery, a self-report questionnaire on their language background, and a battery of general cognition assessments. We found an overall age-related decline in ToM, where older adults made more errors in inferring others’ mental states compared with young adults. Importantly, an earlier L2 age of acquisition (L2AoA) predicted better ToM performance among older adults, over and above the effects of age, education, and general cognition. The results suggest that early bilingual acquisition may enhance social cognitive processes during development and contribute to intact ToM abilities in older adult bilinguals.
Cumulative exposure to anticholinergic and sedative medications has been associated with worsening physical function in older adults. We evaluated the feasibility of measuring physical function using wearable devices and explored the impact of reducing the anticholinergic and sedative medication burden in a pilot study of community-dwelling adults aged 60 years and older. Evaluations included the 10-meter walk test (10MWT), the Short Physical Performance Battery (SPPB), and the mini-BESTest. Two participants/month were recruited in one clinic in 2022. The five participants had a median age of 67, a median DBI of 1.7, and four were female. The feasibility analysis showed that the 10MWT and SPPB tests were completed on 12/12, and the mini-BESTest on 11/12. An exploratory analysis showed clinically meaningful improvements in gait speed (mean +0.18 m/s) and SPPB (mean +2.2 points). We showed the feasibility of measuring physical function by wearable devices during deprescribing of anticholinergic and sedative medications.
Independence in everyday functioning has been associated with successful aging and declines in functioning may be indicative of pathological cognitive decline. Social determinants of health, like economic status and access to health care, a]lso play a role in everyday functioning. Understanding these factors are of particular importance for older Black adults who have had long-standing disparate access to care, education, and treatments. The current study aimed to evaluate social determinants of health, more specifically social engagement, as moderators of the association between cognition and everyday functioning.
Method:
A sample of 930 older Black adults from Rush University: The Memory and Aging Project, African American Clinical Core, and Minority Adult Research Study were used. Participants completed a battery of neuropsychological testing as well as questionnaires about their everyday functioning and social behaviors. Hierarchical linear regressions were utilized to determine to what extent social factors moderated the relationship between cognition and everyday functioning.
Results:
Late life social activity reduced the effect of global cognition on everyday functioning and was independently associated with everyday functioning. Social network size was associated with increased impairment.
Conclusion:
Results from the current study provide novel information regarding the role of social interaction on cognition in an older Black adult sample. Future interventions may benefit from an emphasis on increasing social engagement.