1. Introduction

Population aging is an important phenomenon among the major medical and sociodemographic issues facing the world today. Over the past 50 years, the number of elderly people in Japan has increased fourfold, from 5.7% in 1960 to 23.1% in 2010 [1]. The fastest pace of change in the world is happening right now. In France, the proportion of the French population that is older has tripled in the last century. Over the next 25 years, the number of Americans age 65 and older is expected to double. By 2030, approximately 72 million Americans, or nearly one in five, will be 65 or older. Currently, the fastest-growing age group in the U.S. population is those 85 and older.

One in five older Americans experience daily situations when restricted income does not allow for the flexibility to meet additional or unexpected medical bills. In times of ill health, approximately 6 million senior citizens in the United States, who are either living in poverty or on the cusp of it, depend on the Medicare program to cover the costs associated with their medical care. Universal Medicare coverage assures they have access to the U.S. healthcare system and gives them with financial security to prevent financial calamity when they become ill [2]. However, gaps in Medicare benefit coverage and covered payment obligations can lead to a substantial financial burden.

Notwithstanding the overall progress made in the financial well-being of senior citizens over the past three decades, a significant portion of older adults in the United States still face difficulties in meeting their basic living costs due to limited or modest financial resources [3]. A significant portion, amounting to 41%, of the 31 million elderly Americans residing in communities across the nation, are facing financial hardships with incomes that fall short of double the Federal Poverty Level (FPL). Moreover, a staggering one-fifth of this population is either living in poverty or on the brink of it [4].

As the elderly age, the incidence of various diseases will also increase. Early studies have shown, the following conditions had rates of "deficient" care: angina (46%) dyspnea with exertion (78%), hypertension (26%), hearing impairment (61%), and depression (81%) [5]. In recent years, many people have questioned the US medical system for caring for the elderly. Now the elderly are the largest group of healthcare consumers in the United States, and the number of elderly people may increase by more than 30% in the next 30 years [6,7]. If there are risk loopholes in medical care and elderly care, it will be a very big hidden danger in the future. This article mainly discusses the loopholes in social care for the elderly when the elderly lack the ability to take care of themselves and proposes possible solutions.

First, many hospitals and nursing homes are short of medical staff. Nursing care workers are a very difficult job, and they will face high requirements and high pressure. Sometimes faced with difficult to manage the behavioral and psychological symptoms of dementia patients, patients will have invisible pressure and a sense of powerlessness. But if there is a shortage of personnel in this work, it is difficult for the elderly to get high-quality services. Research has revealed that a substantial proportion, roughly 33%, of the workforce engaged in providing care for the elderly, felt that their moral standards were excessively rigorous. Furthermore, 20% of these caregivers admitted to suppressing their ethical concerns to maintain their employment, a phenomenon that has been linked to the psychological burden of moral distress [8,9].

2. Policy approaches to improve the independence and caregiving abilities of older people

2.1. Declining fertility rates exacerbate population aging challenges

First, the government should enact some policies to increase the fertility rate. Fertility rates have been falling around the world over the past century, and the world is heading towards a low-fertility future. Over the past 70 years, the global total fertility rate has fallen by more than 50%, from approximately 5 children per woman in 1950 to 2.2 children in 2021. The start of Stage 2 of the demographic transition in Europe during the 18th century is credited for sparking the extraordinary increase in the human population. Birth rates were still high at the period, but the industrial revolution's effects on primary healthcare, security, affluence, and urbanization caused death rates to begin to drop. The number of births in the United States in 2023 fell to the lowest level in more than 40 years, continuing the trend of fewer children in the United States in the past 20 years. Preliminary data released by the National Center for Health Statistics on Thursday showed that the total number of births last year fell 2% to 3.59 million, the lowest level since 1979, when about 3.4 million babies were born in the United States. Brady Hamilton, the main author of the report and a demographer at the National Center for Health Statistics, said that the fertility rate of women of childbearing age in the United States is at its lowest level since the center began compiling statistics. Strong interdependence between parents and adult children in terms of time flows and financial support is typically found in research. The majority of research on resource transfers between generations finds evidence of reciprocal and altruistic motivations. According to the altruistic perspective, each generation helps its own according to need: adult children give care and social support to parents who are in poor health, while parents give money to adult children who have the fewest financial resources [10]. Due to the decline in birth rates, the number of elderly people in each family is disproportionate to the number of young people who support them. For example, if a family has one child, when two children from two families marry, it means that they will bear the responsibility of supporting at least four elderly people. At the same time, they also need to take care of their own children and deal with work problems, which creates huge pressure. Therefore, to improve the quality of life of the elderly in their later years, the government can enact policies to encourage childbirth and increase the number of young people in the country. In order to increase the fertility rate, the government should optimize the fertility policy and fertility environment and encourage families to have more children. In addition to opening the three-child policy, tax incentives, childcare leave and other measures can also be taken to increase the fertility rate and alleviate the aging problem. As shown in Table 1, the global total fertility rate has declined dramatically over the past few decades, from 4.08 children per woman in 1975 to 2.32 in 2021. This trend is particularly pronounced in more developed regions, where the total fertility rate has fallen below the replacement level of 2.1 children per woman. Implementing effective policies to boost fertility rates is crucial for addressing the challenges posed by population aging [11].

Table 1. Trends in total fertility rate 1975–2021 [11].

2.2. Integrating medical care and elderly care: a comprehensive approach to senior well-being

Promote the idea of integrating nursing and medical care. A new form of aged care called medical care and nursing care combines contemporary medical treatment with principles of old care. In order to fulfill the goal of offering scientific care services for the elderly, it primarily integrates medical and aged care resources. It is more crucial to provide medical care, chronic disease management, physical exercise, health examinations, hospice care, and other medical and health services to the elderly in their later years in order to improve their quality of life, in addition to life care, mental and psychological services, and cultural entertainment and other life guarantees. The proposed medical care and elderly care model can efficiently combine the resources now available for both medical and elderly care. This is a brand-new approach to senior care that blends medical and senior care services. In order to set itself apart from traditional elderly care services that only attend to the basic needs of the elderly, the "medical care and elderly care" elderly care model places a greater emphasis on the health and medical services of the elderly after reexamining the relationship between the content of elderly care services. The "medical care and elderly care" model of senior care includes five components: management mechanism, service topic, service object, service content, and service method. With fewer medical treatments offered, the majority of senior care facilities primarily offer basic life care services. For instance, nearly 40% of Beijing's senior care facilities lack both internal medical rooms and collaboration with neighboring medical facilities. The number of aged care beds per person in China is now lower than both the average of 5% to 7% in industrialized nations and the level of 2% to 3% in developing nations. Although there should be a shortage of elderly care beds in theory, between 50% and 60% of beds in elderly care facilities are not in use. In Hefei, for instance, private senior flats often have 50% of empty beds, whereas aged care facilities have bed occupancy rates of over 95% or even 100%. Figure 1 illustrates the distribution of hospital beds by bed type during the COVID-19 pandemic, highlighting the importance of optimizing healthcare resource allocation. Integrating medical care with elderly care can help alleviate the strain on healthcare systems by providing more comprehensive and targeted care for older adults, ultimately reducing the need for hospital admissions and freeing up critical care beds for those who need them most [12]. The importance of integrating nursing and medical care can significantly raise and enhance people's overall health as well as the health of society. In addition to helping patients complete their rehabilitation tasks more quickly, it can also effectively lower medical insurance costs, conserve medical resources, and quicken the advancement of medical technology—all of which contribute to the timely, accurate, and scientific provision of healthcare services to the general public. Second, "combining medical care with nursing care" enhances traditional medical diagnosis and treatment models, integrates nursing and medicine, and achieves more systematic and complete health management to raise quality of life and individual health. Effective intervention can help patients feel better and manage their symptoms, which in turn allows them to exercise more, manage stress better, and become more resilient to physical and mental exhaustion. All of these things contribute to better disease prevention, lower medical costs, and less use of medical resources.

Figure 1. Distribution of hospital beds by bed type: O2/ICU beds dedicated/occupied [12].

3. Conclusion

This study explores strategies to improve elderly care policies and enhance the independence and caregiving abilities of older adults amidst global population aging. It analyzes the main challenges faced by the elderly, including inadequate healthcare coverage, financial burdens, and nursing staff shortages. To address these issues, two key policy recommendations are proposed: increasing fertility rates through government policies and promoting the integration of nursing and medical care through the "medical care and elderly care" model.

These findings have significant implications for tackling the challenges of population aging. As the elderly become the largest group of healthcare consumers, with their population potentially increasing by more than 30% in the next 30 years, the proposed policy recommendations contribute to improving the elderly care system, enhancing quality of life, and providing references for sustainable healthcare development. The innovative concept of "medical care and elderly care" emphasizes the importance of integrating medical and nursing services to optimize resource allocation and improve elderly health.

However, the analysis has certain limitations. It lacks in-depth discussions on specific implementation aspects, such as effectively increasing fertility rates and promoting the "medical care and elderly care" model. Additionally, it does not sufficiently explore strategies to attract and retain nursing talents and improve their working environment. Furthermore, elderly care issues involve multiple dimensions beyond just medical and policy perspectives, which may not fully reflect the complexity of the problem.

Future research should focus on exploring effective ways to increase fertility rates and promote the "medical care and elderly care" model by drawing on experiences from different countries and regions. It should also strengthen research on developing the nursing workforce and explore incentive mechanisms to improve their working conditions and career prospects. Adopting an interdisciplinary perspective to consider the cultural, social, and psychological factors influencing elderly care is crucial for proposing comprehensive strategies. As global population aging intensifies, further research on elderly care policies is vital for addressing future challenges and achieving sustainable social development.