Teddy Andrews Jaihind Jothikaran

The increased life expectancy and increasing prevalence of chronic diseases and disabilities among older adults have substantially increased the demand for paid care over the last decade (Sterling ...

Background: With the rapid agiing of populations globally, the demand for long-term care (LTC) services for older people is growing exponentially. However, policy responses across the region have varied significantly. Purpose: This scoping review aims to map and describe available policies that address LTC within the Asia-Pacific Aged Care Hub (APACH) countries, specifically examining governance, implementation, and strategic challenges in this area. Methodology/Approach: This scoping review followed the framework as outlined by Arksey and O’Malley (2005). A comprehensive literature search was conducted on five electronic databases, including PubMed, Scopus, CINAHL, and Web of Science. Grey literature was identified through Google Scholar, government and public health websites. A two-stage screening process was undertaken by two reviewers independently, which was followed by data extraction and synthesis. Findings: We identified 310 articles, of which 85 were included for full review. The studies revealed that there are health policies in place in all the APACH countries. The two prevalent LTC models are residential care and community-based care. The policy documents have a common focus on LTC for older adults with emphasis on infrastructure, governance and funding, and capacity building. Effective operationalization of the existing policies has been challenged by current structural and capacity issues. Although the aged care policies have included monitoring and evaluation frameworks, comprehensive assessments of policy impact remain limited. Conclusions: Though there are policies for LTC, the review highlights significant gaps in the implementation of these policies across the APACH countries. There is a pressing need for robust regulatory frameworks and interagency collaboration to provide sustainable LTC approaches. Practical Implications: Although APACH countries have adopted several approaches to LTC, it is critical to strengthen policies and initiatives regarding regulatory frameworks, health and social care integration, quality standards, and cultural adaptability to improve LTC administration and management.

Background: Adolescent suicidality and associated behaviours are an alarming global public health concern. Understanding its underlying causes and trajectories necessitates the urgent development of targeted prevention strategies. Psychological autopsy (PA) methods provide an in-depth understanding of the complex risk factors leading to suicide in this vulnerable population. Objective: This scoping review aims to explore and synthesise the major risk elements contributing to adolescent suicide and to propose a synthesis of the trajectories leading to adolescent suicide. Methods: A methodological search was carried out to find psychological autopsy studies centered on adolescent subjects. The selection criteria were fulfilled by 15 papers, which were scrutinized with the help of a thematic synthesis method and extracted the main themes to create an overview of the scope and character of the risk factors found. Results: Four major themes emerged: (1) Individual risk factors, including psychiatric disorders, substance use, and previous self-harm; (2) Familial factors, such as parental mental illness, abuse, neglect, and family dysfunction; (3) Life events, including academic failure, interpersonal conflicts, and childhood trauma and (4) Environmental risk factors, such as access to lethal means, media influence, and lack of mental health support. The findings highlight the complex interplay of psychological, social, and contextual variables in adolescent suicide. Conclusion: Psychological autopsy studies offer valuable insights into the risk factors for adolescent suicide. A multidimensional approach addressing individual vulnerabilities, family dynamics, and broader social environments is essential for effective prevention efforts. Further research is needed to strengthen the evidence base and guide policy and intervention development.

Background: Access to healthcare among the aging population in the WHO Southeast Asia (WHO-SEARO) encounters several challenges, resulting in unmet healthcare needs in this region. These challenges are associated with adverse health outcomes, including the growing prevalence of multimorbidity (also referred to as multiple long-term conditions), and heightened economic and systemic burdens on healthcare infrastructures. Method: This study aimed to identify factors influencing healthcare access among older individuals in the WHO-SEARO, adopting a Scoping review methodology based on the Arksey and O’Malley Framework (2005) and the Levesque conceptual framework for access to healthcare. Results: Multiple databases, including Scopus, PubMed, Web of Science, and CINAHL, were screened, resulting in the identification and analysis of 39 articles. The findings highlight significant progress in healthcare access among older adults in WHO-SEARO. However, inadequate health information, heightened economic dependency and treatment cost, limited accessibility and social support, often impede optimal healthcare utilization among older adults. Conclusion: Sustained and improved healthcare access for older adults demands prioritising proactive policies, targeted aged care incentives and, decentralized programs targeting older adults across different socio-demographic milieus.

Background: Decline of intergenerational co‐residence, risk of functional and emotional deprivations in old age, and the diminishing capacity of families to care in‐person for their older parents have intensified the demand for formal care provisions among left‐behind older adults in migrant households of Kerala. While several attempts have been made to quantify the accessibility and utilisation of geriatric care, there is a dearth of evidence on the realities of alternative care in Kerala. The present study aims to explore the perception of older adults (65+) and service providers (government and non‐governmental) on the systemic enablers and barriers of alternative care in migrant households of Kerala. Materials and Methods: A qualitative approach using IDIs were employed among 20 left‐behind older adults (65+) and 8 service providers across three districts of Kerala (Pathanamthitta, Thrissur and Kannur), using purpose sampling, and thematic analysis was followed using a deductive approach. Results: Analysis using the Rainbow Model of Integrated Care revealed that the high cost of care at a micro level limits access and utilisation, while the inactivity of day care homes and their failure to upgrade as resource centres challenge the alternative care at a meso level of operation. The absence of need assessments, top‐down implementation, inappropriate fund allocation, lack of measures to sustain the programme and rigid eligibility norms for inclusion pose challenges in the care avenues, while pain and palliative care community‐based associations and doorstep delivery of essential services facilitate seamless delivery of alternative care. Conclusion: Alternative care efforts should integrate regional, state and central levels of planning, concrete implementation guidelines, participation of older adults in planning and implementation, and efforts to upgrade day care homes into regional resource centres, along with systematic monitoring and evaluation and multi‐stakeholder governance to realise alternative care for older adults. Patient and/or Public Contribution: Informal discussions with community‐dwelling older adults and service providers helped in refining research questions and in‐depth interview guides to explore their lived experiences. Participants shared insights on their care experiences, which informed data collection and interpretation. Research findings were reviewed within a subgroup of older adults and service providers to ensure contextual accuracy in reporting the practical enablers and barriers of alternative care as perceived by the stakeholders.

The convergence of youth migration and the nuclearization of families has altered conventional living arrangements in India, indicating a sharp rise in the number of families in which older adults live alone due to the outmigration of their adult children. This study aims to explore the perceptions of left-behind older adults regarding long-distance care practices by their adult children and to describe the practical and functional care deficits that lead to vulnerability and unmet mental health care in migrant households. Twenty older adults above 65 years of age living alone or with a spouse for at least one year due to the out-migration of their adult children were selected purposively. The analysis revealed that distance from migrant children makes older adults feel anxious, miss their family togetherness, and experience increased loneliness and care gaps in later years, contributing to a multifaceted causality of vulnerability while aging alone. Narratives of distance care are often shaped by the bidirectional flow of care across generations through virtual and in-person means, where emotional and functional deprivations continue to challenge the quality of informal distant care among left-behind older adults. Mental health promotion among community-dwelling older adults is crucial for sustaining their functional capacity, thereby delaying psychological morbidities during aging.