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[This corrects the article DOI: 10.1371/journal.pone.0345858.].

\"Our climate crisis is resulting in more frequent and more intense extreme weather events. The US population is aging (by 2034, the US will have more people over 65 than under 18). Older adults often have challenges in preparing for and responding to a disaster (limited mobility, cognitive challenges, financial and housing instability) that the disaster management and health-care communities are not prepared to address, in spite of the evidence that older adults are disproportionately affected by natural disasters. There is very little written about the intersection of these trends. It is precisely this challenge - understanding how the many dimensions of vulnerability intersect with and compound climate impacts on older adults - that is at the heart of this book. Danielle argues that we cannot achieve true resilience until communities adopt interventions that work to meet the needs of their oldest. The book explores how older adults experience climate-related risk, why resilience interventions look different when designed with the needs of older adults in mind, and how to integrate age-friendly resilience into community planning and disaster preparedness efforts. The author draws from her experience in hazard planning and leading the livable communities program at AARP to make a strong case for prioritizing the needs of our most vulnerable citizens. She provides practical steps and some examples of what is being done at all levels of government and by NGOs. While there are examples sprinkled throughout the book, the chapter on models takes a more in depth look at New York State; Portland, Oregon and Multnomah County; and New Orleans\"-- Provided by publisher.

[This corrects the article DOI: 10.1371/journal.pone.0320309.].

Abstract There are relatively few explorations of later life in the peer reviewed gerontological literature that holistically embrace the duality of potential and decline. This is in striking contrast to a growing body of non-scholarly literature, frequently authored by elders, displaying deep interest in the phenomenon of elderhood, i.e. the holistic, lived experience of later life. We conducted a narrative review with the aim of describing the state of the science with regard to the bio-psycho-social-spiritual experience of elderhood. Following a search of multiple databases for English language, peer reviewed articles published from 2000-2017, we identified 24 articles in the disciplines of gerontology, anthropology, psychology, the humanities, and spirituality studies, reflecting elderhood in Eastern and Western cultures. While the articles offered no shared operational definition of elderhood, nor applied any unifying conceptual or theoretical structures, several common themes emerged. These included the description of elderhood as both inward facing (inner development) and outward facing (social contributions of elders). Numerous articles also recognized that ageism socially mediates the experience of elderhood, resulting in a failure of social systems and structures to recognize or provide opportunities for lifelong growth in later years, including a lack of mentors and role models for individuals transitioning into elderhood. This review demonstrates that there is a compelling need for the discipline of gerontology to strengthen our understanding of the phenomenon of elderhood by leading on the development and implementation of theoretically driven empirical research into the subject of the holistic, lived experience of later life.

FragestellungDie Kritische Gerontologie blieb in der deutschsprachigen Alternsforschung lange ungehört und wurde nur zögerlich in den Diskurs aufgenommen. Der Beitrag zeichnet zunächst die Entwicklung der Ansätze nach, die sich heute unter dem Label des „Denkraums“ einer Kritischen Gerontologie versammeln. Anschließend wird der Kritikbegriff der Kritischen Gerontologie erläutert, um zu klären, was das Kritische an der Kritischen Gerontologie ist, und welche sozialtheoretischen Überlegungen den jeweiligen Richtungen zugrunde liegen.ErgebnisseEs wird argumentiert, dass die einzelnen Ansätze sich trotz ihrer geteilten Orientierung an der Emanzipation und Autonomie älterer und alter Menschen erheblich in ihrem Kritikverständnis und ihrer Auffassung über den Status wissenschaftlicher Theorien unterscheiden. Damit bleibt weiterhin diffus, was die spezifische Perspektive der Kritischen Gerontologie in Abgrenzung zu anderen sozialgerontologischen Ansätzen ist.SchlussfolgerungenEs werden vier Kriterien formuliert, die eine Kritische Gerontologie erfüllen sollte.

People are living longer, not only in wealthy countries but in developing nations. Western experts have long conceived of aging as a universal predicament--one that supposedly provokes the same welfare concerns in every context. In the twenty-first century, we must embrace a new approach that prioritizes local agendas and values. In this history of how gerontologists, doctors, social scientists, and activists came to define the issue of global aging, Sivaramakrishnan shows that the United Nations, private NGOs, and transnational philanthropic foundations embraced programs that reflected prevailing Western ideas about modernization. The dominant paradigm often assumed that, because large-scale growth of an aging population happened first in the West, developing societies will experience the issues of aging in the same ways and on the same terms as their Western counterparts. Focusing on South Asia and Africa, As the World Ages shows how regional voices have begun to question this one-size-fits-all model and have argued instead for an approach that responds to local needs and concerns.-- Provided by publisher

The Comprehensive Care for Joint Replacement (CJR) model, a bundled Medicare payment for lower extremity joint replacement (LEJR), was initially randomized across metropolitan statistical areas (MSAs) in the United States when it was first implemented in April 2016. Hospitals in randomized MSAs were required to participate in the bundled payment while those in other MSAs could not participate. This randomization process offers a unique opportunity to study the broad impact of this alternative payment model. This dissertation assessed the CJR model’s unintended impacts, i.e., spillover effects, on LEJR patients in California covered outside of the traditional Medicare program and how these spillover effects varied based on patient and hospital characteristics. The three studies in this dissertation used quasi-experimental research designs, including event study, difference-in-differences (DID), and triple differences (DDD) models. These models, frequently used in applied microeconomics, compare changes between treated and control groups over time and aim to attribute differential changes to the specific policy or program being examined, in this case, CJR. In this dissertation, these models were used to estimate and compare changes in discharge-related outcomes in hospitals in treated and control MSAs before versus after the CJR implementation. Main outcomes were hospital length of stay and home discharge rates as these were the key anticipated areas for Medicare cost savings from LEJR. The three studies analyzed 312,914 hospitalizations for hip and knee joint replacement in California between January 2014 and December 2017 from the California Patient Discharge Dataset. All LEJR patients admitted to the treated or control hospitals were included in the study regardless of primary payer since my interested was largely in the spillover effect of the program to patients covered outside the traditional Medicare program. The total number of hospitals included in the study was 287 after excluding 37 hospitals participating in the Bundled Payment for Care Initiative (BPCI) initiatives, a voluntary Medicare’s bundled payment program for LEJR treatment. Among them, 142 were in the treated MSAs and 145 were in control MSAs. The first study, chapter 2, examined whether inpatient length of stay and rates of discharge home of LEJR patients covered outside the traditional Medicare program in California changed after policy implementation. The second study, chapter 3, examined if the spillover effects found in chapter 2 were differential based on patient race and ethnicity focusing primarily on Hispanic patients, who constitute a large share of the population in California, to non-Hispanic White patients within treatment and control MSAs. The third study, chapter 4, examined if both direct and spillover effects of the CJR payment model varied based on hospital ownership type - nonprofit, for-profit or government-owned – to shed light on where CJR had the biggest impact. Together these studies demonstrated that the CJR model was associated with a significant decrease in inpatient length of stay and an increase in home discharge rates among both Medicare Advantage and non-Medicare patients in treated hospitals, even though their care was not directly subject to the newly implemented traditional Medicare payment model. Across all patient groups, Hispanic patients were more affected by the program, experiencing a larger increase in home discharge rates compared to their non-Hispanic White counterparts. Additionally, patients in nonprofit and for-profit hospitals experienced a significant decrease in length of stay following the program while patients in government-owned hospitals experienced an increase. This dissertation shows the CJR model affected health care services utilization of untargeted patients and the effects were differential based on patient race/ethnicity and hospital ownership type. Evaluating the program based on traditional Medicare beneficiaries alone or averaging its effects does not capture the comprehensive and nuanced impacts of the program across patients or hospitals.