nep-age New Economics Papers
on Economics of Ageing
Issue of 2017‒11‒26
nineteen papers chosen by
Claudia Villosio
LABORatorio R. Revelli

  1. The Rising Longevity Gap by Lifetime Earnings: Distributional Implications for the Pension System By Haan, Peter; Kemptner, Daniel; Lüthen, Holger
  2. The Behaviors of Elderly Travelers in Turkey: Adana Case By Ebru Özgür Güler; Huseyin Guler; Ceren Boruban
  3. Property Tax Deferral: A Proposal to Help Massachusetts Seniors By Alicia H. Munnell; Anek Belbase; Wenliang Hou; Abigail Walters
  4. Contribution of increased life expectancy to economic growth: evidence from CEE countries By Gindrute Kasnauskiene; Karol Michnevich
  5. The Effect of the Affordable Care Act on the Labor Supply, Savings, and Social Security of Older Americans By Eric French
  6. Access to long-term care after a wealth shock: evidence from the housing bubble and burst By Costa-Font, Joan; Frank, Richard; Swartz, Katherine
  7. Elderly Labor and Unemployment By Watanabe, Minoru; Yasuoka, Masaya
  8. Older Americans Would Work Longer If Jobs Were Flexible By John Ameriks; Joseph S. Briggs; Andrew Caplin; Minjoon Lee; Matthew D. Shapiro; Christopher Tonetti
  9. Inequality in an OLG Economy with Heterogeneous Cohorts and Pension Systems By Marcin Waniek; Krzysztof Makarski; Joanna Tyrowicz; Marcin Bielecki
  10. Dodged a Bullet? “Rothification” Likely to Reduce Retirement Saving By Alicia H. Munnell; Gal Wettstein
  11. Lifestyle and dietary factors associating with dementia status in the community-dwelling elderly aged 65 years and older in a suburban town of Tokyo By Chisako YAMAMOTO
  12. Shareholding Networks for Care in Rural Thailand: Experiences of Older Persons and Their Family Members By Supaporn Voraroon
  13. Tablas de mortalidad = Life tables By -
  14. Forced Migration and Mortality By Bauer, Thomas K.; Giesecke, Matthias; Janisch, Laura
  15. Forecasting Mortality: Some Recent Developments By Taku Yamamoto; Hiroaki Chigira
  16. Lifespans of the European elite, 800–1800 By Cummins, Neil
  17. ‘Replacement Care’ for working carers? A longitudinal study in England, 2013–15 By Pickard, Linda; Brimblecombe, Nicola; King, Derek; Knapp, Martin
  18. Lifespan dispersion in times of life expectancy fluctuation: the case of Central and Eastern Europe By Jose Manuel Aburto Flores; Alyson A. van Raalte
  19. Older Thai peoples? perceptions and experiences of major depression By duangkaew kleebthong

  1. By: Haan, Peter (DIW Berlin); Kemptner, Daniel (DIW Berlin); Lüthen, Holger (DIW Berlin)
    Abstract: This study uses German social security records to provide novel evidence about the heterogeneity in life expectancy by lifetime earnings and, additionally, documents the distributional implications of this earnings-related heterogeneity. We find a strong association between lifetime earnings and life expectancy at age 65 and show that the longevity gap is increasing across cohorts. For West German men born 1926–28, the longevity gap between top and bottom decile amounts to about 4 years (about 30%). This gap increases to 7 years (almost 50%) for cohorts 1947–49. We extend our analysis to the household context and show that lifetime earnings are also related to the life expectancy of the spouse. The heterogeneity in life expectancy has sizable and relevant distributional consequences for the pension system: when accounting for heterogeneous life expectancy, we find that the German pension system is regressive despite a strong contributory link. We show that the internal rate of return of the pension system increases with lifetime earnings. Finally, we document an increase of the regressive structure across cohorts, which is consistent with the increasing longevity gap.
    Keywords: mortality, lifetime inequality, pensions, redistribution
    JEL: H55 I14 J11
    Date: 2017–10
  2. By: Ebru Özgür Güler (Cukurova University); Huseyin Guler (Cukurova University); Ceren Boruban (Cukurova University)
    Abstract: According to the definition of the United Nations, a population is called ?old? if the proportion of elderly population is between 8% and 10%, and ?very old? if it exceeds 10%. In Turkey, the proportion of 65 years and older people is 7.7% in 2013, and it is expected that this proportion reaches 10.2% in 2023 according to the population projections. This study is designed to investigate elderly travelers in Adana, which has an old population now, and will have a very old population in the future.We investigate the demographic backgrounds of the respondents, the general information about the elderly traveler behaviors and the attributes in considering elderly travelers? destination selection. We also examine the barriers on traveling and issues related to quality of staff and service. In order to do this, a survey is conducted on 100 old people living in Adana, Turkey. A mixed survey which has four sections is composed based on Shoemaker (2000), You et al. (2000a and 2000b), Gray et al. (2001), Kim et al. (2003), Pearce et al. (2005), Carneiro (2013), Ward (2014). Respondents are asked to answer demographic questions in section A, travel behaviors in section B, vacation route choice in section C, and travel barriers in section D. Factor analysis is conducted to identify underlying factors. The resulting factors are used to test the effect of demographic variables on travel barriers and issues related to quality of staff and service.
    Keywords: Elderly travelers, Traveler behaviors, Traveler barriers
    JEL: L83 M31 C38
    Date: 2017–10
  3. By: Alicia H. Munnell; Anek Belbase; Wenliang Hou; Abigail Walters
    Abstract: Massachusetts citizens, like those in other states, face the prospect of inadequate retirement income. Social Security will provide less relative to pre-retirement earnings; 401(k) balances are generally meager; and half the private sector workforce does not have an employer-sponsored retirement plan. At the same time, the number of years spent in retirement has increased dramatically; health care costs are high and rapidly rising; and interest rates are at historic lows. In addition to these nationwide challenges, Massachusetts’ older residents face extraordinarily high housing costs and, as a result, rank among the most disadvantaged in terms of the gap between their required and actual resources. The three big levers to improve the retirement income situation are: 1) encourage people to work longer; 2) provide coverage for employees who do not have a retirement savings plan at work; and 3) enable older households to tap their home equity. States can assist on all three fronts to help individuals use their own resources to support themselves in retirement. They can publicize the advantage to individuals of staying in the labor force and to companies of hiring and retaining older workers. They can institute programs that require employers without a retirement plan to automatically enroll their workers in an Individual Retirement Account. And they can offer a program of property tax deferral that will enable homeowners to use some of their home equity to augment inadequate retirement income. This brief focuses on the third option, exploring one possible approach to property tax deferral that uses Massachusetts as an example. The discussion proceeds as follows. The first section describes the nation’s retirement income challenge and the particular problem created by Massachusetts’ high housing costs. The second section describes the major existing programs for homeowners’ relief in Massachusetts: two that cost the taxpayer and one that allows low-income homeowners to help themselves through limited property tax deferral. The third section describes a proposal for a new statewide program of property tax deferral that would be open to all homeowners. The fourth section addresses likely utilization and startup costs before the program becomes self-financing. The final section concludes that a comprehensive property tax deferral program offers enough promise to at least be tried as a pilot.
    Date: 2017–11
  4. By: Gindrute Kasnauskiene (Vilnius university); Karol Michnevich (Vilnius university)
    Abstract: Population ageing in a backdrop of growing average life expectancy can be seen in many advanced economies, but the rapid pace of these demographic changes in Central and Eastern Europe (CEE) makes it a pressing matter for the region. We investigate these two phenomenon and compare results with prior research to determine their separate and combined effect on output growth in a panel regression model using Eurostat data for the period 1996 to 2013. Our findings point to both life expectancy and population ageing exerting a statistically significant, overlapping effect on real output. The conclusions of our research demonstrate the utility of augmenting macroeconomic models with a demographics-sensitive component.
    Keywords: demographics, life expectancy, population ageing, economic growth, CEE countries
    JEL: E10 J10 J11
    Date: 2017–10
  5. By: Eric French (University College London)
    Abstract: This paper assesses the effect of the Affordable Care Act (ACA) on the labor supply of Americans ages 50 and older. Using data from the Health and Retirement Study and the Medical Expenditure Panel Survey, we estimate a dynamic programming model of retirement that accounts for both saving and uncertain medical expenses. Importantly, we model the two key channels by which health insurance rates are predicted to change: the Medicaid expansion and the subsidized private exchanges.
    Date: 2017
  6. By: Costa-Font, Joan; Frank, Richard; Swartz, Katherine
    Abstract: Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study (1996-2010), we exploit the exogenous variation in the form of wealth shocks resulting from the value of housing assets, to examine the effect of wealth on use of home health, unpaid help and nursing home care by older adults. We find a significant increase in the use of paid home health care and unpaid informal care but no effect on nursing home care access. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. The findings suggest that a wealth shock exerts a positive and significant effect on the uptake of home health and some effect on unpaid care but no significant effect on nursing home care.
    JEL: N0
    Date: 2017–09
  7. By: Watanabe, Minoru; Yasuoka, Masaya
    Abstract: Economically developed countries are confronting the aging of society. Especially, their respective shares of elderly people among the total population in Japan are highest in the world. Moreover, the labor participation rates of older people in Japan are higher than in other OECD countries. Several reasons underlie the increased labor participation of older people in Japan. One reason is the subsidy for the labor supply of elderly people. This paper presents an examination of how this subsidization of the labor supply of elderly people affects the labor participation of young and elderly people and unemployment. As a result, in a temporary equilibrium, an increase in the subsidy raises the employment rate of elderly people. However, in a steady state in a closed economy, this subsidy has little effect on the employment rate of elderly people.
    Keywords: Elderly labor, Subsidy, Unemployment
    JEL: J21
    Date: 2017–11–13
  8. By: John Ameriks; Joseph S. Briggs; Andrew Caplin; Minjoon Lee; Matthew D. Shapiro; Christopher Tonetti
    Abstract: Older Americans, even those who are long retired, have strong willingness to work, especially in jobs with flexible schedules. For many, labor force participation near or after normal retirement age is limited more by a lack of acceptable job opportunities or low expectations about finding them than by unwillingness to work longer. This paper establishes these findings using an approach to identification based on strategic survey questions (SSQs) purpose-designed to complement behavioral data. These findings suggest that demand-side factors are important in explaining late-in-life labor market behavior and may be the most appropriate target for policy aimed at promoting working longer.
    JEL: E24 J22 J26
    Date: 2017–11
  9. By: Marcin Waniek (University of Warsaw); Krzysztof Makarski (Warsaw School of Economics and Narodowy Bank Polski); Joanna Tyrowicz (National Bank of Poland); Marcin Bielecki (University of Warsaw and Narodowy Bank Polski)
    Abstract: In this paper, we analyze the consumption and wealth inequality in an OLG model with obligatory pension systems. We model both policy relevant pension systems (a defined benefit system -- DB -- and a transition from a DB to a defined contribution system, DC). Our framework features within cohort heterogeneity of endowments (individual productivities) and heterogeneity of preferences (preference for leisure and time preference). We introduce two widely used policy instruments: a contribution cap and a minimum pension. We show four main results. First, longevity increases substantially aggregate consumption inequality and wealth inequality alike in both pension systems. Second, the effect of a pension system reform works to reinforce the consumption inequality and reduce the wealth inequality. Third, the contribution cap has negligible effect on inequality, but the role for minimum pension benefit guarantee is more pronounced. In fact, the reduction in inequality due to minimum pension benefit guarantee cuts by half the increase of inequality due to the pension system reform and this reduction is achieved with virtually no effect on capital accumulation. Fourth the minimum pension benefit guarantee addresses mostly the inequality which stem from differentiated endowments and not those that stem from differentiated preferences.
    Date: 2017
  10. By: Alicia H. Munnell; Gal Wettstein
    Abstract: As part of its tax reform effort, the Congress was considering a proposal to require that employee contributions to 401(k)s above $2,400 go to a Roth – rather than a traditional – account. While this change is not currently in either the House or Senate bill, the debate over the tax plan is continuing. And opposition to other provisions – such as curtailing deductions for state and local taxes – could lead lawmakers to reconsider the 401(k) changes in order to help offset the overall cost of the tax-cut package. “Rothification” would help finance proposed tax cuts because it would increase government revenues over the next 10 years – the budget window for evaluating the impact of tax reform – and reduce revenues by a comparable amount thereafter. The increase occurs in the short term because money going to Roths is taxed up front, while taxation of money contributed to traditional plans does not occur until retirement. This effect on the budget is the sole reason that Rothification has been under consideration. The question is whether a shift to Roth accounts should be viewed as merely a budget gimmick or as a change that could affect how much people save for retirement. That subject is the focus of this brief. The discussion proceeds as follows. The first section describes the differences between Roth and traditional accounts. The second section discusses how switching to Roth accounts would affect the federal budget. The third section explores how the change may affect saving by different types of individuals. The final section concludes that Rothification is likely to lead to less saving by low- and moderate-earners who cannot afford to pay the taxes up-front. Among higher earners, savings may well remain unchanged, or even increase. Importantly, this budget-driven exercise is a diversion from real reform that would enhance retirement saving, such as mandatory auto-enrollment in 401(k)s, mandatory auto-escalation in the default contribution rate, automatic draw-down provisions, and an expansion of coverage to the half of private sector workers without a workplace retirement plan.
    Date: 2017–11
  11. By: Chisako YAMAMOTO (Shonan University of Medical Sciences)
    Abstract: Objectives: Dementia is a priority health issue worldwide and becoming the most expensive disease of the 21st century. The World Health Organization has unanimously adopted a global plan of action on the public health response to dementia 2017-2025 at the 70th World Health Assembly in May 2017. One of the targets included in the plan is risk reduction. An unhealthy lifestyle and diet are likely to cause many diseases. This study aims to clarify lifestyle and dietary factors associating with dementia status in the community-dwelling elderly aged 65 years and older in a suburban town of Tokyo and to clarify gender differences in health behavior. Methods: Self-administered questionnaires were mailed to 2,069 elderly people in February 2004 and 1,538 were returned by addressees or proxies (response rate 74.3%). Institutionalized ones were excluded. Analysis subjects were comprised of 52 people with dementia (PWD), 173 people with probable dementia (PPD) and 1,211 cognitively intact people (CIP). Average age(sd) was 74.03(6.55) in men and 75.56(7.27) in women. Descriptive statistics, a chi-square, Kruskal-Wallis, Mann-Whitney U and Bonferroni?s multiple comparison tests were performed in men and women, respectively. Significance was set at 0.05 (0.0167 after Bonferroni correction). Lifestyle items included daytime lying hours, sleeping hours, walking/exercise, outing, pet caring, hobbies, smoking, alcohol consumption, cooking and breakfast. Diet items included meat/poultry, soy products, eggs, oily fish, dairy products, fruits, (cooked) vegetables, fried food and miso soup/soup. Results: The Kruskal-Wallis and Mann-Whitney U tests revealed significant differences in most lifestyle items except smoking in men and women. Breakfast was significant only in women. As for diet items, only fruits and fried food were significant in men: CIP>PPD and/or PWD. Women showed significant differences in every diet items: mostly CIP>PPD and CIP>PWD and only fruits showed PPD>PWD. Conclusion: Though significant differences in lifestyle were weaker in men, CIP showed healthier lifestyle. In women CIP showed better health behavior both in lifestyle and diet. Exercise, social and mental activities like outing and hobbies, moderate alcohol consumption and food items above are recommended to prevent or delay the onset of dementia by Alzheimer?s Society. This study, along with Japanese women?s better lifestyle, has the same implications associating with dementia risk reduction. It also suggests that Japanese diet ?Washoku? (a UNESCO Intangible Cultural Heritage) which is nutritionally well-balanced contributes to better health status as Japanese women enjoy the longest longevity in the world.
    Keywords: dementia, the community-dwelling elderly aged 65 years and older, lifestyle, diet, factors associating with dementia status, risk reduction, health behavior.
    JEL: I18
    Date: 2017–10
  12. By: Supaporn Voraroon (PhD.Student nursing at Mid Sweden University)
    Abstract: Most members of the older population in Thailand live in rural areas whiletheir children live in cities. With the joint family system separated, elderlyThai persons often have to care for themselves, and opportunities for them toget involved in community care remain limited. In response, the aim of thisstudy was to describe older persons? and their family members? experienceswith shareholding networks for the care of older people in rural Thailand.Paired interviews with five older persons and five of their family memberswere conducted, and collected data were subjected to content analysis, whichyielded results organized around two themes: older persons? outsider statusand disregard for older persons? individuality. Whereas the theme of outsiderstatus describes shortcomings in health care encounters, the theme of disregardfor individuality describes the lack of engagement of authorities and caregiversin older persons? care. In that sense, the concept of participationemerged as a framework for understanding interviewees? experiences. Givenfindings from local authorities, older individuals and their family membersshould engage in dialogue in order to support healthcare based on shared understanding.
    Keywords: Community Healthcare, Content Analysis, Older Persons, Participation
    JEL: I19 I18 I10
    Date: 2017–10
  13. By: -
    Abstract: El Observatorio Demográfico 2017, dedicado a la mortalidad, permite realizar un análisis de los diferenciales por sexo y edad de los países de América Latina entre 1950 y 2020. Las tablas presentadas se han obtenido mediante la interpolación de las tablas de mortalidad implícitas en las estimaciones y proyecciones de población elaboradas por el CELADE-División de Población de la CEPAL, conjuntamente o en consulta con los institutos nacionales de estadística, en su revisión de 2017. Como es habitual, se incluye un capítulo analítico en el que se presentan los diferenciales de la mortalidad por sexo y edad en países seleccionados, lo que permite identificar el panorama regional y algunas particularidades de la región durante este período. La información correspondiente a las estimaciones y proyecciones de la población nacional, urbana, rural y económicamente activa está disponible en formato de hojas de cálculo en el sitio web del CELADE-División de Población de la CEPAL (
    Date: 2017–11
  14. By: Bauer, Thomas K. (RWI); Giesecke, Matthias (RWI); Janisch, Laura (RWI)
    Abstract: We examine the long-run effects of forced migration from Eastern Europe into post-war Germany. Existing evidence suggests that displaced individuals are worse off economically, facing a considerably lower income and a higher unemployment risk than comparable natives even twenty years after being expelled. We extend this literature by investigating the relative performance of forced migrants across the entire life cycle. Using social security records that document the exact date of death and a proxy for pre-retirement lifetime earnings, we estimate a significantly and considerably higher mortality risk among forced migrants compared to native West-Germans. The adverse displacement effect persists throughout the earnings distribution except for the top quintile. Although forced migrants are generally worse off regarding mortality outcomes, those with successful labor market histories seem to overcome the long-lasting negative consequences of flight and expulsion.
    Keywords: forced migration, differential mortality, lifetime earnings, economic history
    JEL: I12 J61 O15 R23
    Date: 2017–10
  15. By: Taku Yamamoto (Hitotsubashi University); Hiroaki Chigira (Tohoku University)
    Abstract: Forecasting mortality has been a vital issue in demography and actuarial science. It also has profound implications for pension plan and long-term economic forecasts of the nation. In the present paper we examine various forecasting methods for mortality in the framework of cointegrated time series analysis. The Lee-Carter (LC) method has been regarded as the benchmark for forecasting mortality. However, its forecasting accuracy has been known to be particularly poor for short-term forecasts, while it is well for long-term forecasts. Recently, a new methods called the multivariate time series variance component (MTV) method has been proposed which explicitly satisfies cointegration restrictions of the series. It overcomes weak points of the LC method. In the present paper we propose two new methods. The first one is the modified MTV (mMTV) method which modifies the MTV method in order to get more accurate forecast of the trend component of the method. The second is the all-component Lee-Carter (LCA) method which generalizes the Lee-Carter method, by using all principal components, in order to improve short-term forecasts of the LC method. However, it may be noted that the LCA method does not satisfy cointegration restrictions. We analytically compare forecasting accuracy of the proposed methods with the Lee-Carter method and the MTV method in the framework of cointegrated time series. We further compare them in a Monte Carlo experiment and in an empirical application of forecasting mortality for Japanese male. It is shown that the mMTV method is generally the most accurate in the Monte Carlo experiment and in Japanese data. The MTV method works almost as well. However, since the drift estimator is inefficient, it is slightly less accurate than the mMTV method in some occasions. The forecast accuracy of the LCA method is reasonably high and can be equivalent to the mMTV method in some occasions, but is generally inferior to the MTV method and the mMTV method. As expected, the LC method is the worst among methods examined in the present study. The mMTV method is recommended for practical use.
    Keywords: Time Series ModelsForecasting MethodsCointegrated ProcessMortality.
    JEL: C01 C32 C53
    Date: 2017–10
  16. By: Cummins, Neil
    Abstract: I analyze the adult age at death of 115,650 European nobles from 800 to 1800. Longevity began increasing long before 1800 and the Industrial Revolution, with marked increases around 1400 and again around 1650. Declines in violent deaths from battle contributed to some of this increase, but the majority must reflect other changes in individual behavior. There are historic spatial contours to European elite mortality; Northwest Europe achieved greater adult lifespans than the rest of Europe even by 1000 ad.
    JEL: N0
    Date: 2017–06–12
  17. By: Pickard, Linda; Brimblecombe, Nicola; King, Derek; Knapp, Martin
    Abstract: In the context of rising need for long-term care, reconciling unpaid care and carers’ employment is becoming an important social issue. In England, there is increasing policy emphasis on paid services for the person cared for, sometimes known as ‘replacement care’, to support working carers. Previous research has found an association between ‘replacement care’ and carers’ employment. However, more information is needed on potential causal connections between services and carers’ employment. This mixed methods study draws on new longitudinal data to examine service receipt and carers’ employment in England. Data were collected from carers who were employed in the public sector, using self-completion questionnaires in 2013 and 2015, and qualitative interviews were conducted with a sub-sample of respondents to the 2015 questionnaire. We find that, where the person cared for did not receive at least one ‘key service’ (home care, personal assistant, day care, meals, short-term breaks), the carer was subsequently more likely to leave employment because of caring, suggesting that the absence of services contributed to the carer leaving work. In the interviews, carers identified specific ways in which services helped them to remain in employment. We conclude that, if a policy objective is to reduce the number of carers leaving employment because of caring, there needs to be greater access to publicly-funded services for disabled and older people who are looked after by unpaid carers.
    Keywords: unpaid care; employment; paid services; replacement care; England
    JEL: R14 J01
    Date: 2017–08–16
  18. By: Jose Manuel Aburto Flores (Max Planck Institute for Demographic Research, Rostock, Germany); Alyson A. van Raalte (Max Planck Institute for Demographic Research, Rostock, Germany)
    Abstract: Central and Eastern Europe have experienced considerable instability in mortality since the 1960s. Long periods of stagnating life expectancy were followed by rapid increases in life expectancy and in some cases even more rapid declines before more recent periods of improvement. These trends have been well documented but to date, no study has comprehensively explored trends in lifespan variation. We improve such analyses by incorporating life disparity as a health indicator alongside life expectancy. We analyzed how lifespan variation has changed since the 1960s for 12 countries from the region and determined the ages which have contributed the most to the observed variability in age at death. Furthermore, we quantified the effect of mortality related to alcohol consumption on life disparity since 1994. Our results showed that life disparity was high and strongly fluctuating over the time period. Life expectancy and life disparity moved independently from one another, particularly during periods of life expectancy stagnation. Fluctuations in mortality were, to a large extent, directly or partially attributable to changes in alcohol consumption. These trends run counter to the common patterns observed in most developed countries and contribute to the life expectancy-disparity discussion by showing that expansion/compression levels do not necessarily mean lower/higher life expectancy or mortality deterioration/improvements.
    Keywords: Belarus, Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Russian Federation, Slovakia, Slovenia, Ukraine, age at death, alcoholism, causes of death, differential mortality, inequality, life expectancy
    JEL: J1 Z0
    Date: 2017–11
  19. By: duangkaew kleebthong (Mid Sweden University)
    Abstract: AbstractBackground: Depressive disorders are common mental health problems and may be disabling among the general older population. Although older people have significant symptoms of depression, the symptoms are likely to be underreported. The condition often co-exist along with somatic ill and has often been unrecognized. The aim of the study was to explore and understand the perceptions and experiences of older Thai people diagnosed with major depressive disorder.Methods: A qualitative inductive research design was used and latent content analysis was utilized. The data were collected through face-to-face, in-depth interviews. Fourteen older people diagnosed with major depressive disorder were selected for participant using purposive sampling. Findings: Older Thai peoples? perceptions and experiences of depression were abstracted into two themes. First theme was leading a life in detachment, which included three subthemes: living with meaninglessness, holding distress with one?s self, and feeling judged by surrounded people. The second theme was inconvenience of approaching mental health treatment, which included two subthemes: sensing an unapproachable health care services, and lacking knowledge about clinical depression.Conclusion: Older Thai peoples? perceptions and experiences of major depression were affected with high level suspected existential loneliness that might even be worse in a collect oriented society as in the Thai context. Further, it seem hard to approach the mental health care. The central reason for this is interpreted as lack of mental health literacy, and in this case knowledge on depression. Future studies should focus on relatives? experiences of living with an older family member that suffered from major depression, and on the state of mental health literacy in the rural Thai population.
    Keywords: Keyword: major depression, qualitative latent content analysis, rural, Thai
    Date: 2017–10

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