Medicare is an important public health insurance scheme for U.S. adults aged 65 years and over. As of 2024, an estimated 19.1 percent of the U.S. population was covered by Medicare, an increase from the previous year. As of 2023, California, Florida, and Texas had the largest number of adults aged 65 years and older. The Medicare program Medicare has two primary parts: Medicare Part A covers hospital care and Medicare Part B covers medical and preventative services. Both parts of Medicare are available to those aged 65 years and older under certain conditions. Medicare premiums are variable and depend on the enrollee’s income. Despite a majority of the Medicare enrollees being above the federal poverty line, there are still several programs in place to help cover the costs of healthcare for the elderly. Opinions on elderly care in the U.S. It is estimated that about 23 percent of Medicare enrollees are in fair/poor health. But there are lots of questions about who should pay for or help with elderly care long-term. In a recent survey of U.S. adults, about half of the respondents said that health insurance companies should pay for elderly care. However, a majority of adults also supported a long-term government sponsored health plan like Medicaid. The issue is still hotly debated and politicized in the United States.

Abstract

Purpose: The multi-country Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Innovation, Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is compiling longitudinal data on the health and well-being of adult populations, and the ageing process, through primary data collection and secondary data analysis. SAGE baseline data (Wave 0, 2002/3) was collected as part of WHO's World Health Survey http://www.who.int/healthinfo/survey/en/index.html (WHS). SAGE Wave 1 (2007/10) provides a comprehensive data set on the health and well-being of adults in six low and middle-income countries: China, Ghana, India, Mexico, Russian Federation and South Africa. Objectives: To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions Additional Objectives: To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes To develop a mechanism to link survey data to demographic surveillance site data To build linkages with other national and multi-country ageing studies To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults Methods: SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; 4) verbal autopsy questionnaire; and, 5) appendices including showcards. A VAQ was completed for deaths in the household over the last 24 months. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey. Content Household questionnaire 0000 Coversheet 0100 Sampling Information 0200 Geocoding and GPS Information 0300 Recontact Information 0350 Contact Record 0400 Household Roster 0450 Kish Tables and Household Consent 0500 Housing 0600 Household and Family Support Networks and Transfers 0700 Assets and Household Income 0800 Household Expenditures 0900 Interviewer Observations Individual questionnaire 1000 Socio-Demographic Characteristics 1500 Work History and Benefits 2000 Health State Descriptions and Vignettes 2500 Anthropometrics, Performance Tests and Biomarkers 3000 Risk Factors and Preventive Health Behaviours 4000 Chronic Conditions and Health Services Coverage 5000 Health Care Utilization 6000 Social Cohesion 7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method) 8000 Impact of Caregiving 9000 Interviewer Assessment

Geographic coverage

National coverage

Analysis unit

households and individuals

Universe

The household section of the survey covered all households in all nine provinces in South Africa. Institutionalised populations are excluded. The individual section covered all persons aged 18 years and older residing within individual households. As the focus of SAGE is older adults, a much larger sample of respondents aged 50 years and older were selected with a smaller comparative sample of respondents aged 18-49 years.

Kind of data

Sample survey data [ssd]

Sampling procedure

South Africa used a stratified multistage cluster sample design. Strata were defined by the nine provinces:(Eastern Cape, Free State, Gauteng, Kwa-Zulu Natal, Limpopo, Mpumalanga, North West, Northern Cape and Western Cape), locality (urban or rural), and predominant race group (African/Black, White, Coloured and Indian/Asian), as not all combinations of stratification variables were possible, there were 50 strata in total. The Human Science Research Council's master sample was used as the sampling frame which comprised 1000EAs. A sample of 600 EAs was selected as the primary sampling units(PSU). The number of EAs to be selected from each strata was based on proportional allocation (determined by the number of EAs in each strataspecified on the Master Sample). EAs were then selected from each strata with probability proportional to size; the measure of size being the number of individuals aged 50 years or more in the EA. In each selected EA 30 households were randomly selected from the Master Sample. A listing of the 30 selected households was conducted to classify each household into one of two mutually exclusive categories: (1) households with one or more members aged 50 years or more (defined as '50 plus households'); (2) households which did not include any members aged 50 years or more, but included residents aged 18-49 (defined as '18-49 households'). All 50 plus households were eligible for the household interview, and all 50 plus members of the household were eligible for the individual interview. Two of the remaining 18-49 households were randomly selected for the household interview. In each of these household one person aged 18-49 was eligible for the individual interview, and the individual to be included was selected using a Kish Grid.

Stages of selection Strata: Province, Predominant Race Group, Locality=50 PSU: EAs=408 surveyed SSU: Households=4020 surveyed TSU: Individual=4227 surveyed

Sampling deviation

Originally 600 EAs were drawn into the sample. However due to time and financial contraints only 396 EAs were visited.

Mode of data collection

Face-to-face [f2f] PAPI

Research instrument

The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. A Verbal Autopsy questionnaire was administered to households that had a death in the last 24 months. An Individual questionnaire was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into six of the major languages in South Africa: Afrikaans, IsiZulu, IsiXhosa, Sepedi, Setswana and Xitsonga. All SAGE generic questionnaires are available as external resources.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) structural checking of the CSPro files (4) range and consistency secondary edits in Stata

Response rate

Household Response rate=67% Cooperation rate=99%

Individual: Response rate=77% Cooperation rate=99%

Abstract

The study objectives were: (1) Describe the roles, health problems (physical and mental) and social wellbeing of older people who are directly and indirectly affected by HIV/AIDS, with special attention to the effects of the introduction of ART (2) Develop recommendations for policy and practice that can be expected to improve tthe wellbeing of older people affected by or infected with HIV/AIDS

Content Part I 000 Coversheet 100 Respondent and household characteristics 200 Health State Description 300 Chronic Conditions and Health Service Coverage 400 Health Care Utilization and Risk Factors and Behaviour 500 Health Measurements

Part II 600/700 Caregiving and ART Knowledge 800 Receiving Care

Geographic coverage

Rural Masaka district and urban Wakiso district in Uganda

Analysis unit

individuals

Kind of data

Sample survey data [ssd]

Sampling procedure

Quantitative study The sample consisted of people aged 50 years and over, selected from existing databases. Five groups were selected, each with 100 participants of whom half were living in a rural area (Masaka district) and half in a periurban area (Entebbe). The groups were as follows: (1) Have an adult child who died of HIV/AIDS (2) Have an adult child who is living with HIV and on antiretroviral therapy (ART) (3) Have no child with HIV/AIDS and are not infected with HIV (comparison group) (4) Is HIV infected and on ART for at least one year (5) Is HIV infected and not on ART

Mode of data collection

Face-to-face [f2f], PAPI

Research instrument

The structured questionnaire and health examination were derived from existing instruments of the WHO multi-country Study on Global Ageing. This ensured alignment of the instruments with international standards. The interviews were done in two visits. During the first visit, Part 1 of the questionnaire was administered. Part 2 of the structured interviews was generally done the day after the first interview. All the modules used in the questionnaires were translated into Luganda (the main local language) and was tested during the pilot study.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) range and consistency secondary edits in Stata

Response rate

In total 510 people were interviewed in the quantitative component: 256 in the rural district and 254 in the urban district The response rate was 99%.

Abstract

Objectives: To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions

Additional Objectives: To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes To develop a mechanism to link survey data to demographic surveillance site data To build linkages with other national and multi-country ageing studies To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults

Methods: SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; and, 4) appendices including showcards. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey.

Content Household questionnaire 0000 Coversheet 0100 Sampling Information 0200 Geocoding and GPS Information 0300 Recontact Information 0350 Contact Record 0400 Household Roster 0450 Kish Tables and Household Consent 0500 Housing 0600 Household and Family Support Networks and Transfers 0700 Assets and Household Income 0800 Household Expenditures 0900 Interviewer Observations

Individual questionnaire 1000 Socio-Demographic Characteristics 1500 Work History and Benefits 2000 Health State Descriptions and Vignettes 2500 Anthropometrics, Performance Tests and Biomarkers 3000 Risk Factors and Preventive Health Behaviours 4000 Chronic Conditions and Health Services Coverage 5000 Health Care Utilization 6000 Social Cohesion 7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method) 9000 Interviewer Assessment

Geographic coverage

Municipality of Shanghai

Analysis unit

households and individuals

Universe

The household section of the survey covered all households in the municipality of Shanghai. Institutionalised populations are excluded. The individual section covered all persons aged 18 years and older residing within individual households. As the focus of SAGE is older adults, a much larger sample of respondents aged 50 years and older were selected with a smaller comparative sample of respondents aged 18-49 years

Kind of data

Sample survey data [ssd]

Sampling procedure

Shanghai comprises 19 districts. These are divided into suburbs and downtowns which is based on their geographical location and socioeconomic status. The Downtowns include: Huangpu, Luwan, Zhabei, Hongkou, Jing'an, Changning, Xuhui, Putuo, Yangpu. And the Suburbs include Minhang, Pudong, Nanhui, Qingpu, Songjiang, Jiading, Baoshan, Jinshan, Fengxian, Chongming. Shanghai used a stratified multistage cluster sample design. Five districts were sampled. Strata were defined by the five districts(Luwan, Hongkoui ,Qingpu, Minhang and Nanhui). From each district 4 communities/townships were selected probability proportional to size; the measure of size being the number of households in the community/township. From each community/township 2 residential blocks/villages were selected probability proportional to size; the measure of size being the number of households in the residential blocks/villages. In each selected residential block/village 84 households were randomly selected:70 50 plus households and 14 18-49 households. All 50 plus members of the 50 plus households were eligible for the individual interview. One person aged 18-49 was eligible for the individual interview, and the individual to be included was selected using a Kish Grid.

Stages of selection Strata: District=5 PSU: Township/Community=20 surveyed SSU: Village/Neighbourhood Community=40 surveyed TSU: Households=6720 surveyed QSU: Individuals=9524 surveyed

Mode of data collection

Face-to-face [f2f] PAPI and CAPI

Research instrument

The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. An Individual questionniare was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into Chinese. All SAGE generic questionnaires are available as external resources.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) structural checking of the CSPro files (4) range and consistency secondary edits in Stata

Response rate

Household Response rate=89% Cooperation rate=99%

Individual: Response rate=97% Cooperation rate=99%

Abstract

Objectives: To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions

Additional Objectives: To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes To develop a mechanism to link survey data to demographic surveillance site data To build linkages with other national and multi-country ageing studies To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults

Methods: SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; 4) verbal autopsy questionnaire; and, 5) appendices including showcards. A VAQ was completed for deaths in the household over the last 24 months. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey.

Content Household questionnaire 0000 Coversheet 0100 Sampling Information 0200 Geocoding and GPS Information 0300 Recontact Information 0350 Contact Record 0400 Household Roster 0450 Kish Tables and Household Consent 0500 Housing 0600 Household and Family Support Networks and Transfers 0700 Assets and Household Income 0800 Household Expenditures 0900 Interviewer Observations

Individual questionnaire 1000 Socio-Demographic Characteristics 1500 Work History and Benefits 2000 Health State Descriptions and Vignettes 2500 Anthropometrics, Performance Tests and Biomarkers 3000 Risk Factors and Preventive Health Behaviours 4000 Chronic Conditions and Health Services Coverage 5000 Health Care Utilization 6000 Social Cohesion 7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method) 9000 Interviewer Assessment

Geographic coverage

National coverage

Analysis unit

households and individuals

Universe

The household section of the survey covered all households in the People's Republic of China. Two special administrative regions Hong Kong and Macau are excluded. Institutionalised populations are also excluded. The individual section covered all persons aged 18 years and older residing within individual households. As the focus of SAGE is older adults, a much larger sample of respondents aged 50 years and older were selected with a smaller comparative sample of respondents aged 18-49 years

Kind of data

Sample survey data [ssd]

Sampling procedure

The People's Republic of China(PRC) administers 22 provinces. These were grouped into Eastern, Central and Western provinces based on geographical location and economic status.PRC used a stratified multistage cluster sample design. Eight provinces were sampled. Strata were defined by the eight province(Guangdong,Hubei,Jilin,Shaanxi,Shandong,Shanghai,Yunnan,Zhejiang) and locality (urban or rural), there were 16 strata in total. One district(urban) and one county(rural) was randomly selected from each province. From each district/county 4 communities/townships were selected probability proportional to size; the measure of size being the number of households in the community/township. From each community/township 2 residential blocks/villages were selected probability proportional to size; the measure of size being the number of households in the residential blocks/villages. In each selected residential block/village 84 households were randomly selected:70 50 plus households and 14 18-49 households. All 50 plus members of the 50 plus households were eligible for the individual interview. One person aged 18-49 was eligible for the individual interview, and the individual to be included was selected using a Kish Grid.

Stages of selection Strata: Province, Locality=16 PSU: Township/Community=64 surveyed SSU: Village/Neighbourhood Community=127 surveyed TSU: Households=10278 surveyed QSU: Individuals=15050 surveyed

Mode of data collection

Face-to-face [f2f]

Research instrument

The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. An Individual questionniare was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into Chinese. All SAGE generic questionnaires are available as external resources.

Cleaning operations

Data editing took place at a number of stages including: (1) office editing and coding (2) during data entry (3) structural checking of the CSPro files (4) range and consistency secondary edits in Stata

Response rate

Household Response rate=95% Cooperation rate=99%

Individual: Response rate=93% Cooperation rate=98%