As populations age, societies must take into account the nuanced needs of different groups. This is the research domain of Cynthia Chen, who joined the Walter H. Shorenstein Asia-Pacific Research Center as visiting scholar with the Asia Health Policy Program during the 2022 winter and spring quarters. An Assistant Professor at the National University of Singapore (NUS), Chen’s current research focuses on the well-being of older adults, healthcare financing, and the economics of aging. 

Drawing on support from Singapore’s Ministry of Health, Ministry of Education, the U.S. National Institutes of Aging, and the Thai Health Promotion Foundation among others, Chen explores how demographic, economic and social changes affect the burden of care, financing needs, and optimal resource allocation in the future. 

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In a recent talk at APARC, Chen presented findings on gender and socioeconomic differences in aging, exploring the ways in which such society-level characteristics can have major positive and negative effects on the health and well-being of older persons. 

According to Chen, these effects are interconnected with factors including access to effective health care, support systems that enhance function and restrict dependency, and programs assuring financial security and opportunities for older persons to effectively engage in society. “We must move beyond the archaic old-age dependency ratios and metrics, such as GDP, which neglect many of the critical factors that influence societal function,” Chen argued.

Finding Better Metrics for Aging

Gender and socioeconomic differences affect a country's ability to support its older adult population. Specifically, the longevity risk associated with females' longer life expectancy entails different needs between genders in old age. Chen aims to quantify gender differences in the aging experience of Organization for Economic Co-operation and Development (OECD) countries and compare differences in projections of disability and chronic diseases among future cohorts of older adults, including disparities by educational attainment.

In order to gain a more nuanced perspective on aging data, Chen drew data from The Aging Society Index, composed of established and available social and economic measures. The Index provides a quantitative estimate of the degree to which a society is successfully adapting to demographic transformation.

Much of Chen’s time is spent focusing on how to address gender-specific needs when developing policies and programs for aging societies. Chen cites The Network on an Aging Society, which defines a successfully aging society as “one which provides for the general well-being of older adults, is cohesive with minimal tension between generations and major subgroups, productive with opportunities for engagement both within and outside the workforce, and is equitable and secure.” Such society-level characteristics are necessary to understand the difference between successful and unsuccessful policies. 

Chen identifies systemic gender differences across critical domains of successful social aging that favor males. Thus, Chen argues, for many wealth or income-based measures, such as security, equity and productivity, males experience an advantage, which suggests room for improving women’s standing in paid work, job opportunities, and retirement income. One aspect where women do have an advantage is life expectancy. However, they tend to live longer in poorer health, reflected in a lower well-being score. 

Likewise, the gender disparity in cohesion is significantly driven by differences in co-residence rates, which is attributable to women outliving their spouses. These findings suggest that gender-specific needs should be considered when engineering policies and programs for aging societies. 

Varying Rates of Functional Disabilities 

Gender is not the only society-level characteristic that Chen investigates in her resarch on aging. In a recent study, published in Asian Development Review, Chen and her co-authors, including AHPP Director and FSI Senior Fellow Karen Eggleston, shed light on the dynamic evolution of the health and functional disparities of the future elderly.

In order to understand the differences in aging and its relationship with functional disabilities across multiple societies, Chen looked at data from Korea and Singapore. While the two nations have a similar pace of aging, they differ in the rate of increase in functional disability and chronic diseases. This may be due to many factors, including diet, lifestyle, and cultural differences, Chen suggests. Most notably, older adults with high educational attainment are projected to have a lower prevalence of functional disability and chronic diseases, and consistent across gender in both Korea and Singapore. 

The study employs a new model to compare projections of functional status and disability among future cohorts of older adults, including disparities in disability prevalence by educational attainment. These changes will have important implications for social protection systems, including the financing and delivery of long-term care and health care. The study highlights potential differences in the aging experience by gender and education in each country to inform social and healthcare policy and provides a common platform for international comparison to identify and compare challenges across countries.

Studying aging and effective medical care in late adulthood, especially with an eye for society-level characteristics, is an urgent task. Chen’s research complements the existing literature on life-protection activities, further underscoring the importance of investment in healthy aging and control of chronic disease so that the future elderly may receive appropriate care.