The aging male in the 21st century

Background.?Prostate cancer incidence varies significantly among different ethnic groups. However, the report concerning the clinical outcome after radical prostatectomy (RP) in the low incidence Asian population is still limited. We aimed to compare the clinical outcome in patient treated with RP among different ethnic groups and to identify significant prognostic factors in Taiwanese patients.

Methods.?A total of 341 patients with clinical localized prostate cancer undergoing curative RP in three medical centers in Taiwan were included in this study. Ethnic group comparison was performed using the CaPSURE, SEARCH databases from United States (US) and one large European series. The Kaplan–Meier analysis and Cox proportional hazard model were used to identify significant predictors for prostate-specific antigen (PSA) recurrence.

Results.?Compared to the Caucasian white population in the US and Europe studies, the Taiwanese population have higher age at surgery and higher pre-operative PSA level. With mean and median follow-up of 39.1 months and 31.0 months (range 5–120 months), 127 men (37.2%) had PSA recurrence which was significant higher than the Western series. Significant predictors for PSA recurrence identified in the post-operative overall model were PSA level, pathological Gleason Score, pathological tumor stage and lymph node metastasis.

Conclusions.?The clinical outcome of Taiwanese male with prostate cancer post-RP appears inferior to the Western country, which is largely due to delay surgery at higher PSA level. Earlier diagnosis and treatment may improve the cancer control of RP.     

Mental health and aging in the 21st century

This article reviews pressing issues in mental health care for older adults in the 21st century. After examining current forces for change in older adults' mental health care and coverage, the authors discuss barriers to accessing mental health care resulting from the fragmentation of the United States health care system as well as the history behind the multiple and competing systems of care for older adults. The article continues with a discussion of goals for the provision of good mental health service delivery for older adults and concludes by addressing potential responses and future target areas regarding mental health care for older adults as well as a potential realistic collaboration to address mental health and aging.     

Housing for the aging population

Based on the concept of ‘aging in place,’ design of houses in the past years are explored. Design features in the built environment become barriers for aging people with functional limitations. Initially, houses were designed according to the required needs of the user with the physical limitations. Later, adaptable house design was introduced that allows the house to meet the specific needs of the user, while maintaining the appearance of the house until more obvious accessibility features are needed. Today, ‘design for all’ is recognised as a tool for ensuring physical accessibility for aging people. The holistic perspective embedded in the universal design theory should be systematically and consistently developed during the design process.     

Innovative models of aging in place: Transforming our communities for an aging population

As the proportion of the global population over 60 continues to grow, the issue of where and how elders are going to live becomes increasingly pressing. The idea or “aging in place” – in which elders remain in their own homes and communities – is becoming an increasingly popular alternative to age-segregated retirement communities. This article documents three new models of aging in place – naturally occurring retirement communities (NORC-SSPs), villages and campus-affiliated communities – and explores how they seek to provide both services and meaningful connections among members. Data from interviews and site visits reveal both promising practices as well as challenges such as how to ensure access for low and moderate-income elders, integrating elders from diverse cultural and linguistic back grounds, and building the leadership and participation of elders. By looking critically at these models, the author argues that many previously held theories and assumptions about the aging process and social capital formation must be reexamined in light of the agency of elders and the new organizational models. Ultimately the design of our communities – both physically and socially – and our approach to retirement must be restructured to support the needs of an aging population.     

Does population aging produce increasing gerontocracy?

As the population of the United States grows older, we might expect the role of the elderly to change. Among the many questions that could be asked about changes in the age stratification system, here we focus on the engagement of older persons in leadership roles. The period covered is roughly 1940 to the present, and the areas of leadership examined are representation in Congress and in professional and managerial occupations. If age-specific rates of representation remain constant over time, the proportion of leadership positions filled by older persons will increase at the same pace that the proportion of the adult population age sixty-five and over is increasing. On the other hand, if changes are occurring in the age stratification system, the role of the elderly in leadership may be either decreasing or increasing more rapidly than the population is aging. The data examined here show that over the past several decades the engagement of older persons in leadership positions has declined rapidly.     

Osteoporosis in the aging population: the male perspective

The importance of senile osteoporosis in men as a public health problem has long been underestimated. Elderly men are at substantial risk for fracture, and morbidity after osteoporotic fractures appears to be more serious and mortality more common in men than in women. Risk factors for osteoporotic fractures in men appear to be qualitatively similar to those in women, but there are quantitative differences. Low bone mineral density (BMD) is an important risk factor for fracture in men; however, further clarification of the relationship between BMD, bone geometry and fracture risk is needed before formulating definitive proposals on operational densitometric criteria for diagnosis of osteoporosis in men and the identification of men at high risk for fracture. Understanding of the mechanisms underlying senile bone loss and the pathogenesis of senile osteoporosis in men remains fragmentary with, in particular, the need for further clarification regarding the precise impact of hormonal status in elderly men on skeletal homeostasis. Recommendations on prevention and treatment of senile osteoporosis in men should focus on the minimization of known risk factors for bone loss and falls. Testosterone treatment may be useful in those men with initially low serum testosterone. As to other pharmacological treatment modalities, prospective trials specifically in elderly men, and preferably with fracture incidence as the primary clinical endpoint, are required.     

Meeting the mental health needs of the aging veteran population

The growth in the veterans population parallels the graying of America, accompanied by an increasing need for health care and mental health services from the U.S. Department of Veterans Affairs (VA) health care system. With the incidence of posttraumatic stress disorder (PTSD) rising in veterans of the wars in Iraq and Afghanistan and the already strained mental health resources in use by veterans with persistent PTSD from previous wars, the VA mental health system is and will continue to be in overload. In addition, recent research has noted an increased incidence of dementia in veterans with PTSD. The VA's long-term care facilities cannot meet their current demands, nevermind provide support for veterans with cognitive deficits who can no longer be cared for at home. It is imperative that immediate measures be taken to strengthen resources for research, manpower, and training to accommodate the future mental health needs of our aging veterans.     

How an aging society affects the economic costs of inactivity in Germany: empirical evidence and projections

Background

Aging societies represent a major challenge for health care systems all over the world. As older people tend to be more physically inactive, economic costs of inactivity are likely to increase notably. The present study aims to investigate this relationship between an aging society and economic costs of inactivity using the example of Germany.

Methods

Using data from the German Socio-Economic Panel, this study applied the comparative risk assessment method developed by the WHO to estimate the direct costs of inactivity for the period 2001–2013 differentiated by gender-specific age-groups (15–29; 30–44; 45–64; 65+). Based on population statistics predicting the aging of the German population for the years 2014–2060, this research projects the development of future costs of inactivity and potential effects of interventions promoting physical activity among the German population.

Results

The results reveal an increase in the level of physical activity during the observed period (2001–2013) which compensated the negative effect of aging and resulted in a decline of inactivity costs. The projections for the years 2014–2060 indicate a constant increase in direct per capita costs until 2060 because of an aging society. Scenarios indicating how a short-term reduction of physical inactivity impacts costs of inactivity reveal the crucial role of the oldest age-group in this context.

Conclusion

The findings indicate that the aging of the German population demands further actions and initiatives to promote physical activity, especially for the oldest age-group.

     

Economic implications of Japan's aging population: a macro-economic demographic modeling approach

This paper utilizes a macroeconomic demographic model to analyze the probable impact of population aging on various public programs in Japan. Rapid fertility decline aided by mortality decline has caused the proportion of the Japanese population aged 65 and over to increase from 4.9% in 1950 to 9.0% in 1980. A population projection based on the 1975 population census assumes a recovery of fertility from a total fertility rate (TFR) of 1.9 in 1976 to 2.16 in 1980 and a gradual decline to 2.1 by 1987, while an alternative projection assumes a continuing fertility decline to a TFR of 1.65 in 2025. According to these assumptions, in 2025 18.12% to 21.29% of the total population would be aged 65 or over and 38.66% to 43.80% of the working age population would be aged 45-64. A macroeconomic neoclassical growth model with some Keynesian features was formulated to evaluate the future impact of population aging on social security programs. Population changes are transmitted to economic variables in the model through the supply of labor, level of savings, public health care plans, and old-age pension schemes. The simulation experiments included the 2 population projections and 2 alternative production functions, 1 with the quality of labor incorporated and 1 without. The results indicated that, regardless of the population projection and production function used, the growth of the economy is likely to slow to 1 or 0% in the beginning of the next century due to decreased growth of the labor force and a change in its quality due to age-compositional variations. Public health insurance schemes and pension plans will require increasing financial resources as a result of accelerated population aging; depending on the choice of benefit levels, the proportion of national income allocated to them is expected to range from 14%-40% in the year 2010. Per capita gross national product will continue to grow despite decreased economic growth, but savings might be adversely affected if the provision of social insurance benefits continued to increase monotonically. Possible palliative measures would be to change present employment practices or to upgrade the quality of the labor force through vocational training programs for older workers.     

德国建筑游:硬邦邦的感觉非常SHARP

行走在欧洲大陆,就像在阅读一部伟大的建筑史,同时也是一部华丽的艺术史.不亲身到欧洲大陆走一走,很难想象古典主义在人类文明发源地的影响是怎样的深远;也不会知道现代主义怎样在历史发展的滔滔洪流中取代了古典主义的地位,然后又是怎样被多元化的思想覆盖.这一切都反映了各个时代的经济和政治利益、意识形态和生活方式.更好地了解他们,能够在旅途中多一个视角去观察和感受身边的世界,有助于准确地审视我们自身,进而自我改造和更新,这是促使我踏上这片土地的原动力.下面,我将带领大家前往德国去拜访那里的西方建筑.     

Comparing public attitudes toward providing for the livelihood of the elderly in two aging societies: Germany and Japan

Using an ordered logit model on representative survey data, we study attitudes about who should provide for the livelihood of the elderly in two aging societies—Germany and Japan. We find that in both countries, those with higher income are more inclined toward the private option, whereas age has the opposite effect. Part-time work status negatively (positively) affects the inclination toward a government-based pension system in Japan (Germany). Other significant influences are the pensioner status of the respondents in Japan and specific left-wing party support in the case of Germans.     

A century of mosques in France: building religious pluralism

The public debate in France has rolled out heatedly on the building of minarets, with opinion polls giving a majority of French opposed to the idea. Nevertheless, a fair number of mosques has been built throughout the past century. The French reception of mosques is therefore a complicated case. Recalling the history of French mosques and its different turns, with a focus on recent history, allows a glimpse at the visibility of Islam in the national sphere in France and its public reception. It also underlines that religious buildings, in the city, are at the intersection of different levels: questions of identity, of politics, of faith, and of integration, are all at stake.     

A distribution-sensitive examination of the gender wage gap in Germany

This paper provides a new examination of the gender pay gap for Germany based on a family of distribution-sensitive indicators. Wage distributions for men and women do not only differ by a fixed constant; differences are more complex. We show that focusing on the bottom of the wage distribution reveals a larger gender gap. Our distribution-sensitive analysis can also be used to study whether the statistical disadvantage of women in average pay might be ‘offset’ by lower inequality. Over a broad range of plausible preferences over inequality, we show however that ‘inequality-adjusted’ estimates of the gap can be up to three times higher than standard inequality-neutral measures in Eastern Germany and up to fifty percent higher in Western Germany. Using preference parameters elicited from a hypothetical risky investment question in our sample, inequality-adjusted gender gap measures turn out to be close to those upper bounds.     

A century of change in occupational segregation 1891–1991

Abstract Data from the Population Censuses for 1891 and 1991 are analysed to assess long term trends in the degree and pattern of occupational segregation. Two competing theories are addressed: that occupational segregation is linked to levels of female employment, and that occupational segregation was prompted in the nineteenth century by a concern to control sexuality and fertility behaviour. Sociologists have overlooked the impact of social factors outside the labour force on developments within the workforce.     

Place-based urban ecology: A century of park planning in Seattle

This research responds to calls from within the field of urban ecology to explicitly incorporate humanities-based research in order to achieve robust interdisciplinarity. Our research provides an example of a place-based urban ecological analysis. We use this framework to analyze over a century of park planning and development within the city of Seattle. We identify four eras of park planning that are linked by a comprehensive 100-year park plan. This case study examines how the political, cultural, and economic aspects of park planning have produced and been influenced by long-term trends and historical contingencies. This research also offers practical insights for effective contemporary urban planning, emphasizing the need for flexible and adaptive long-term plans when confronted with unpredictable events, emerging political arrangements, changing cultural priorities, and shifting fiscal climates.