Frontiers in public health · 2026
Older adult care policy implications derived from quality of life disparities and sociodemographic risk factors.
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Tu Yulin, He Chao, Tan Tangbiyao, Zhou Yanhong, Zhu Huakang
Аннотация
INRODUCTION: Population aging is placing increasing pressure on healthcare and social welfare systems worldwide, yet empirical evidence on whether integrated care policies for older adults reduce quality-of-life inequalities and improve well-being remains limited. This study examines the effects of such policies, together with socioeconomic, healthcare-access, and demographic factors, on the quality of life of older adults across countries.
METHODS: A balanced panel of 24 countries observed annually from 2018 to 2025 (N = 192 country-years) was assembled from World Bank (World Development Indicators, Policy Database, ASPIRE) and WHO Global Health Observatory data. Eleven countries that adopted a national integrated older adult care policy in 2021-2022 formed the treatment group, and 13 non-adopting countries formed the control group. The dependent variables were a multidimensional Quality of Life Index (QoL; health, economic security, and social participation on a 0-100 scale) and life expectancy at age 60 (LE60). A difference-in-differences (DID) framework with country and year fixed effects was complemented by event-study analysis, mechanism tests, robustness checks, propensity score matching DID (PSM-DID), and heterogeneity analysis.
RESULTS: Policy adoption was associated with a 3.842-point increase in QoL (95% CI: 2.39-5.30; p < 0.01), or 0.33 standard deviations, and a 1.126-year increase in LE60 (95% CI: 0.50-1.75; p < 0.01; 0.36 SD). Pre-policy event-study coefficients were individually and jointly insignificant (joint p = 0.91), consistent with parallel trends, whereas post-policy effects rose from 1.264 (95% CI: 0.25-2.28) in the adoption year to 3.842 (95% CI: 2.39-5.30) three years later. The policy increased universal health coverage (β = 4.126) and social protection coverage (β = 5.284) and reduced out-of-pocket health expenditure (β = -3.417). Results were robust to an alternative outcome, a lagged specification, and PSM-DID; the point estimate was larger in lower-income countries, although the subsample confidence intervals overlapped.
DISCUSSION: Under the identifying assumptions of the DID design, integrated care policies for older adults substantially improve quality of life and life expectancy at age 60, operating mainly through expanded health coverage, broader social protection, and a lower financial burden, and may help narrow welfare inequalities among older adults.
METHODS: A balanced panel of 24 countries observed annually from 2018 to 2025 (N = 192 country-years) was assembled from World Bank (World Development Indicators, Policy Database, ASPIRE) and WHO Global Health Observatory data. Eleven countries that adopted a national integrated older adult care policy in 2021-2022 formed the treatment group, and 13 non-adopting countries formed the control group. The dependent variables were a multidimensional Quality of Life Index (QoL; health, economic security, and social participation on a 0-100 scale) and life expectancy at age 60 (LE60). A difference-in-differences (DID) framework with country and year fixed effects was complemented by event-study analysis, mechanism tests, robustness checks, propensity score matching DID (PSM-DID), and heterogeneity analysis.
RESULTS: Policy adoption was associated with a 3.842-point increase in QoL (95% CI: 2.39-5.30; p < 0.01), or 0.33 standard deviations, and a 1.126-year increase in LE60 (95% CI: 0.50-1.75; p < 0.01; 0.36 SD). Pre-policy event-study coefficients were individually and jointly insignificant (joint p = 0.91), consistent with parallel trends, whereas post-policy effects rose from 1.264 (95% CI: 0.25-2.28) in the adoption year to 3.842 (95% CI: 2.39-5.30) three years later. The policy increased universal health coverage (β = 4.126) and social protection coverage (β = 5.284) and reduced out-of-pocket health expenditure (β = -3.417). Results were robust to an alternative outcome, a lagged specification, and PSM-DID; the point estimate was larger in lower-income countries, although the subsample confidence intervals overlapped.
DISCUSSION: Under the identifying assumptions of the DID design, integrated care policies for older adults substantially improve quality of life and life expectancy at age 60, operating mainly through expanded health coverage, broader social protection, and a lower financial burden, and may help narrow welfare inequalities among older adults.