The economic status of older people's households in urban and rural settings in Peru, Mexico and China: a 10/66 INDEP study cross-sectional survey

Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study

Background

While there is evidence about stablished risk factors (e.g., raised blood pressure) and higher mortality risk in older population, less has been explored about other functional parameters like the Timed Up and Go test and the Gait Speed in older people at low- and middle-income countries. We aimed to study these mobility tests as predictors of mortality in a population of older people in Peru.

Methods

Population-based prospective cohort study (2013–2020). Random sampling of people aged 60+ years in a community of Lima, Peru. Geriatricians conducted all clinical evaluations and laboratory tests were conducted in the local hospital. Participants were sought in the national vital registration system, and we collated cause (ICD-10) and date of death. We conducted a nested forward multivariate Cox proportional hazard model to identify all potential predictors of all-cause, communicable and non-communicable diseases mortality.

Results

At baseline, there were 501 older people (mean age 70.6 and 62.8% were women), complete follow-up information was available from 427 people. Mean follow-up time was 46.5 months (SD = 25.3). In multivariate models, the Timed Up and Go test was associated with higher risk of all-cause mortality (HR = 1.05; 95% CI: 1.02–1.09). For cause-specific mortality, history of heart disease (HR = 2.25; 95% CI: 1.07–4.76) and age in years (HR = 1.05; 95% CI: 1.01–1.09) were predictors of non-communicable diseases mortality.

Conclusions

In addition to established risk factors for mortality in older population, the Timed Up and Go test, a functional parameter, raised as a relevant predictor of all-cause mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02749-6.

Inequalities in Older age and Primary Health Care Utilization in Low- and Middle-Income Countries: A Systematic Review

The objective of this research was to systematically review and synthesize quantitative studies that assessed the association between socioeconomic inequalities and primary health care (PHC) utilization among older people living in low- and middle- income countries (LMICs). Six databases were searched, including Embase, Medline, Psych Info, Global Health, Latin American and Caribbean Health Sciences Literature (LILACS), and China National Knowledge Infrastructure, CNKI, to identify eligible studies. A narrative synthesis approach was used for evidence synthesis. A total of 20 eligible cross-sectional studies were included in this systematic review. The indicators of socioeconomic status (SES) identified included income level, education, employment/occupation, and health insurance. Most studies reported that higher income, higher educational levels and enrollment in health insurance plans were associated with increased PHC utilization. Several studies suggested that people who were unemployed and economically inactive in older age or who had worked in formal sectors were more likely to use PHC. Our findings suggest a pro-rich phenomenon of PHC utilization in older people living in LMICs, with results varying by indicators of SES and study settings.

Health and economic correlates of autonomy among older people in Peru, Mexico and China: The 10/66 INDEP study

Background: While autonomy is highlighted as central to older people’s wellbeing, there has been little empirical research to inform a measurement approach, support construct validity, or establish its determinants. We aimed to study the health and economic correlates of self-perceived autonomy among community-dwelling older people in Peru, Mexico and China, using a hypothesis-driven approach. Methods: Cross-sectional household surveys in urban and rural catchment areas in each country, comprising household, informant, and older person interviews, to elicit household income and older residents’ autonomy, unmet needs, and quality of life. Households, all with older residents, were selected from previous waves of the 10/66 Dementia Research Group’s comprehensive surveys of ageing and health. Results: Among 937 older respondents in 754 households, diminished autonomy was associated with older age, marital status, lower education, and lower household income. Physical, cognitive and mental morbidities, functional impairment and dependence were strongly and independently associated with diminished autonomy, explaining the effect of age. Controlling for these variables, an older person’s current total income was inversely associated with diminished autonomy (Count Ratio per fifth of total income 0.86, 95% CI 0.81-0.91). Autonomy was positively correlated with wellbeing and life satisfaction, supporting construct validity. Counter to hypotheses, less autonomy was associated with fewer unmet needs in rural sites. Conclusions: The effects of income insecurity, disability and dependence upon autonomy should be tested prospectively to confirm causal direction. Social pensions, and measures to support the rights of frail and dependent older people may be effective policy instruments for promoting autonomy. While the negative impact of diminished autonomy upon older people’s welfare is supported, the association in rural sites between more autonomy and more unmet needs should be further investigated; efforts to promote autonomy may need careful cultural nuancing, to support rather than subvert traditional family care systems.

A cohort study of the effects of older adult care dependence upon household economic functioning, in Peru, Mexico and China

Background

While links between disability and poverty are well established, there have been few longitudinal studies to clarify direction of causality, particularly among older adults in low and middle income countries. We aimed to study the effect of care dependence among older adult residents on the economic functioning of their households, in catchment area survey sites in Peru, Mexico and China.

Methods

Households were classified from the evolution of the needs for care of older residents, over two previous community surveys, as ‘incident care’, ‘chronic care’ or ‘no care’, and followed up three years later to ascertain economic outcomes (household income, consumption, economic strain, satisfaction with economic circumstances, healthcare expenditure and residents giving up work or education to care).

Results

Household income did not differ between household groups. However, income from paid work (Pooled Count Ratio pCR 0.88, 95% CI 0.78–1.00) and government transfers (pCR 0.80, 95% CI 0.69–0.93) were lower in care households. Consumption was 12% lower in chronic care households (pCR 0.88, 95% CI 0.77–0.99). Household healthcare expenditure was higher (pCR 1.55, 95% CI 1.26–1.90), and catastrophic healthcare spending more common (pRR 1.64, 95% CI 1.64–2.22) in care households.

Conclusions

While endogeneity cannot be confidently excluded as an explanation for the findings, this study indicates that older people’s needs for care have a discernable impact on household economics, controlling for baseline indicators of long-term economic status. Although living, typically, in multigenerational family units, older people have not featured prominently in global health and development agendas. Population ageing will rapidly increase the number of households where older people live, and their societal significance. Building sustainable long-term care systems for the future will require some combination of improved income security in old age; incentivisation of informal care through compensation for direct and opportunity costs; and development of community care services to support, and, where necessary, supplement or substitute the central role of informal caregivers.

A journey without maps-Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru

PURPOSE OF THE STUDY

Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability.

DESIGN & METHODS

We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person.

RESULTS

Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a 'journey without maps'. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched.

IMPLICATIONS

Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation.