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The purpose of the study is to assess the quality of life (QOL) of older adults and explore factors associated with it.

A cross-sectional study was conducted in a remote community in Nepal. A total of 671 older adults aged 60 years were enrolled in the study. QOL was measured by WHOQOL-OLD questionnaire. Data were analyzed using multiple logistic regression.

Most participants were female (53.0%), illiterate (70.6%), married (64.2%) and living with family (59.3%). Among participants, 82.4% had fair QOL, and the autonomy domain received the lowest score (average = 10.98). After adjusting the model, the elderly aged <70 years had 11.07 times better QOL (aOR = 11.070; 95% CI = 2.546–48.123), elderly with high sufficient income had 2.73 times better QOL (aOR = 2.738; 95% CI = 1.183–6.337) and elderly free from depression had 9.45 times better QOL (aOR = 9.452; 95% CI = 3.466–25.773) compared to their counterparts. The elderly receiving social support had 9.97 times better QOL than those who did not (aOR = 9.976; 95% CI = 3.152–31.574), and those able to afford healthcare services had 4.69 times better QOL than those who could not afford it (aOR = 4.694; 95% CI = 1.046–21.063).

The five predictors – age, income sufficiency, depression, social support and healthcare service affordability – were found to significantly affect QOL. This study suggests special care strategies for vulnerable older adults addressing the issues that affect geriatric depression. This article provides relevant information to the government to consider increment of income, encourage family and community for social support and make health services affordable for older adults.

The COVID-19 pandemic poses a great challenge for older people both in terms of the severity of the disease and the negative consequences of social distancing. Assumptions about negative effects on the lives of the elderly, affecting dimensions of successful aging (such as the preservation of social relationships), have thus far been hypothetical and have lacked empirical evidence. The aim of this paper is to shed empirical light on the effects of COVID-19 on the everyday life of older people against the background of the concept of successful aging.

Data of a standardized, representative telephone survey with residents of Lower Austria, a county of Austria, were used for this secondary analysis. The sample included 521 persons of 60 years of age and older. For this paper, contingency analyses (χ² coefficients, z-tests using Bonferroni correction) and unidimensional correlational analyses were calculated.

The empirical data show that successful aging along the three dimensions of successful aging is a challenge in the time of the COVID-19 pandemic – leaving the elderly caught between two fronts.

The present work focusses on a unique moment in time, describing the changes to the lives of Austrian elderly because of the social distancing measures imposed to protect against the spread of COVID-19. These changes are discussed in the theoretical framework of successful aging.

This article analyses community care services (CCS) in terms of availability, awareness, accessibility, and acceptance (the Four A’s approach), untangles the deep-seated factors underlying the CCS and provides some short-term, medium-term, and long-term recommendations.

A literature review was conducted, including relevant government reports, consultation papers, Legislative Council papers and articles from academic journals from 1980 to the present.

The Four A’s approach shows that applicants to both centre-based services and home-based services endure lengthy waiting times because of the limited number of CCS. Furthermore, the awareness of day respite services is approximately 50 percent, which lags behind other CCS. Accessibility is contingent on a cross-district day respite service system and a lack of consistency between the quota and the proportion of older adults in the districts. Finally, the level of service provided by CCS is unsatisfactory due to inflexible service provision. Reviewing the brief history of long-term care services (LTC) reveals the deep-seated factors at the core of their heavy reliance on the subvention model, in contrast to the adoption of the ‘mixed economy of care’ by residential care services (RCS). An imbalance in budget allocation to RCS and CCS is also revealed.

Although the principle of ‘ageing in place’ was introduced in 1977, the institutionalisation rate (6.8 percent) of older adults remains unexpectedly high in Hong Kong, even surpassing its Asian counterparts, whereas the usage rate of CCS hovers around 0.8 percent. Thus, how to implement policy concerning LTC services for older adults must be re-evaluated.

The purpose of this paper is to study the factors affecting COVID-19 mortality.

An empirical model is developed in which the mortality rate per million is the dependent variable, and life expectancy at birth, physician density, education, obesity, proportion of population over the age of 65, urbanization (population density) and per capita income are explanatory variables. Crosscountry data from 184 countries are used to estimate the quantile regression that is employed.

The estimated results suggest that obesity, the proportion of the population over the age of 65 and urbanization have a positive and statistically significant effect on COVID-19 mortality. Not surprisingly, per capita income has a negative and statistically significant effect on COVID-19 death rate.

The study is based on the COVID-19 mortality data from June 2020, which have constantly being changed. What data reveal today may be different after two or three months. Despite this limitation, it is expected that this study will serve as the basis for future research in this area.

Since the findings suggest that obesity, population over the age of 65 and density are the primary factors affecting COVID-19 death, the policy-makers should pay particular attention to these factors.

To the authors’ knowledge, this is first attempt to estimate the factors affecting the COVID-19 mortality rate. Its novelty also lies in the use of quantile regressions, which is more efficient in estimating empirical models with heterogeneous data.

The aim of this paper is to contribute to a greater understanding of non-profit organization (NPO) management control systems (MCS) and accountability in organizations providing support service for capacity constrained service users. Specifically, the paper examines the role of MCS and accountability in supporting mission realization in NPOs providing services to people with intellectual disabilities and reflects on this in the context of the COVID-19 pandemic.

The research comprised a case study of four NPOs providing services to people with intellectual disabilities in Ireland conducted prior to the global COVID-19 pandemic. The study probed management's perceptions of stakeholders and examined the manner in which the design and use of MCS and accountability processes supported mission realization.

Service users were regarded as the least powerful stakeholder and consequently the least attended to in terms of MCS and accountability processes. The absence of relational and dialogical accountability with service users is not only central to maintaining this power asymmetry but also poses a threat to mission realization. These deficits can be addressed through the integration and monitoring of internal advocacy activities into MCS and accountability processes, which, on reflection, may also mitigate some of the negative consequences for service users of isolation from external support networks in times of crisis.

This research has opened up an area for enquiry – internal advocacy – heretofore not addressed in the management accounting literature, opening up a novel vein for future research. Such research could further examine the role of internal advocacy, drawing from and adding to the research in other support service domains. A number of objectives and questions might be considered: (1) probing the level of management recognition of the role of direct engagement in advocacy activities in supporting service user agency; (2) identifying with service users and management the nature and attributes of effective advocacy activities and practices; (3) questioning how such advocacy activities and practices might be reflected in MCS; (4) identifying what service user stakeholders regard as effective accountability to them in relation to their needs and objectives; and (5) assessing the impact on service user experience and on NPO mission realization of internal advocacy activities and the monitoring and review thereof through MCS. These suggestions for future research draw attention to aspects of support service delivery that have the potential to be profoundly influential on service outcomes.

A performance management model reflecting the identified need to incorporate internal advocacy mechanisms into organizational management control systems is proposed in an effort to increase accountability of NPOs to their core mission stakeholder – service users. This model may be of value to NPO management as they move from a medical-model of care to a rights-based model for service delivery in care settings.

The paper reflects the importance of listening to the voice of vulnerable service users in NPO care settings and proposes a mechanism for embedding internal advocacy in formal management control systems and accountability processes.

In proposing an “agency” supportive relational and dialogical accountability logic for such organizations, underpinned by “internal advocacy”, this research provides theoretical and practical insights for accountability processes and the design of MCS. The findings contribute empirically, not just to the NPO management and MCS literature but also to understanding the relational interaction of service users with service organizations, and what this means in supporting service user objectives and realization of organizational mission.

To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care.

The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care.

The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes.

The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.

The purpose of this paper is to provide contrasting narratives of what the future of Asia Pacific tourism may look like, and to identify how current policy interventions and recommendations made for coronavirus disease 2019 (COVID-19) recovery shape the system's trajectory.

Drawing on a set of four possible futures emerging from COVID-19, tourism policy responses are analysed and a link to their potential contribution to the Sustainable Development Goals is made.

A system goal is presented for each scenario, and what this means for the tourism system. Existing policies indicate that tourism is moving towards a “Discipline” future, although evidence for all four trajectories could be identified. Whilst the “Transform” scenario is most aligned with a sustainable future, the findings highlight that sustainability outcomes are possible in the other scenarios as well, if risks are managed adequately.

The limitation is that the core structure of the four futures was not specifically developed for tourism. However, given that tourism is firmly embedded in national and global economies, this limitation is not material.

This paper supports decision-makers to develop adaptability in the face of great uncertainty and complexity. Risks and opportunities associated with each of the four tourism futures are identified, and examples are provided how sustainability outcomes can be maximised in each.

Sustainability is a safe and necessary strategy regardless of the trajectory to any of the four scenarios. The long-term health of the tourism system and anyone involved in it depends on significant progress along the Sustainable Development Goals.

This paper explores pathways for system change and how different COVID-19 policy approaches contribute to shaping the system's trajectory. It highlights the risks associated with certain trajectories, and also identifies how short-term recovery priorities might undermine long-term sustainability.

The purpose of this study is to investigate the inbound and outbound medical tourism in the UK to determine if the UK can be considered as a net exporter of health services as well as the impact of the 2007 global economic crisis, diaspora populations and the number of UK expats on medical tourism figures.

Using microdata drawn from the International Passenger Survey (2000-2016), the authors estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. The authors also analyse the main destinations of UK residents, the country of origin of overseas residents and the particular case of British expats.

The results show the upward trend of inbound and outbound patients, the strong seasonality in outbound patients, and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, Hungary and India are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, France, Gibraltar and the United Arab Emirates are the main countries providing inbound health patients. However, the processes of migration explain full or partly the inbound and outbound flows found for some countries.

This study offers a critical insight into inbound and outbound medical flows, demonstrating both the scope for and limitations to market development in this area.

The aim of this paper is to argue for the values of familial caring and relationships in addition to the provision of social media technology during the COVID-19 pandemic in Hong Kong.

The discussion of this paper has adopted an inter-disciplinary approach by integrating health care system and psychological analysis, based on cultural philosophical argument through the hermeneutic approach of classical texts and critical analysis.

The COVID-19 pandemic has exposed the dilemma between the public health measures for COVID-19 and sustaining elderly social psychological health through familial connection. From a Confucian perspective, the practice of filial piety (xiao, 孝), which demands taking care of parents, is essential for one’s moral formation, and for one’s becoming a virtuous (ren, 仁) person. The necessity of taking care of elderly parents by adult children is not something that can be explained in terms of consequentialism. Indeed, the rising trend of instrumental rationality seems to weaken rather than strengthen the sense of filial obligation. In the face of the COVID-19 pandemic which tends to separate connections between family members, the author argues that we should emphasize the values of familial caring and relationship because it enhances the elderly’s characteristic of resilience.

This paper shows that while social media technology has mitigated the negative effect of social distancing, such online relationships should never replace the bodily connections between the elderly and their family members from a Confucian perspective.

The purpose of this paper is to evaluate health effects and determine the factors associated with health effects from smartphone and tablet use among the elderly in Thailand.

This study was a cross-sectional descriptive study. The participants comprised 490 elderly people. A self-administered questionnaire was used for data collection via the Healthy e-Elderly People Assessment mobile application in the Android operating system by Google which consists of five parts of a questionnaire. The variables were analyzed using SPSS such as frequency, percentage, mean and binary logistic regression.

Altogether, the participants were 223 males and 267 females; mean age=64.9±5.4. The average time spent using a mobile device was 2.8±1.9 h/day. Participants recorded that after use of either device, 59.0 percent experienced eye pain, 52.7 percent experienced dim eyes, 30.2 percent experienced tiredness, and 28.0 percent experienced moodiness. Socially, 26.8 percent recorded changes in social interaction. Periods of time using devices, time consumed in device usage (hours/day), the type of application, and the difference in times of use, place of usage and time spent in rest breaks from smartphone or tablet usage were significantly associated with health effects (p<0.05).

The elderly users may be at risk of several health effects from smartphone and tablet use. The potential gap in knowledge conceals some of the risk factors for the current health effects. Practical intervention to reduce health effects from the use of smartphones and tablets should be considered.