Health and ageing in low, middle and high-income countries (1)

The present paper aims to study health status of elderly, their morbid condition, perceptions about their own health and treatment seeking behaviour using data based on 60th Round of the National Sample Survey Organization and Census of India 2001. Bi-variate and multi-variate techniques were used to find out the factors affecting health condition and health care utilization of the elderly in India.
The elderly population in India as per the 2001 Census data constitute around 7.4 percent and their proportion to the total population is gradually increasing. The study showed that widows/widowers are having relatively poor health status as compared to currently married elderly. Monthly Percapita Consumer Expenditure (MPCE) is positively related to state of health. Dependency during old age has significant negative impact on the health of the elderly. Male elderly used to take more treatment as compared to their female counterparts. It may be by due to culture of silence and low status of the female elderly. Educational level, occupation and MPCE are found to be important determinant of treatment seeking behaviour.

As a result of declining birth rates, improvements in health care, and a slow down in mortality at older ages we are living in an increasingly aging world. The impact of population aging (PA) on infectious diseases, and in particular the role of antibiotic resistant pathogens, has been understudied. The elderly consume relatively large amounts of antibiotics, have higher rates of hospitalization, and many are immune-suppressed; therefore PA could have significant implications for future rates of antibiotic resistance. The objective of this paper is to analyze the impact of population structure (specifically the increasing share of the population that will be 65+) on antibiotic resistance in the US. Data on antibiotic resistance and consumption, hospitalization rates, and socioeconomic factors, stratified by age and geographic region, are available from 2008-10. Antibiotic resistance data will come from the Surveillance Network database, while antibiotic use data will come from IMS Health’s Xponent database. Hospitalization data is available from the National Inpatient Survey. Socioeconomic data is available from the US census bureau. We expect to find that, controlling for other factors, an increase in the proportion of the population above the age of 65 has had a strong and positive effect on antibiotic resistance.

Little is known about depression in older people in sub-Saharan Africa. Objectives: Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and-affected older people. Methods: In 2010, 422 participants aged 50+ were recruited into a cross- sectional study. A diagnosis of depressive episode was derived using Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE). Results: Overall, 42.4% had a depressive episode (MDE: 22.7%; BDE: 19.7%). MDE was significantly higher in HIV-affected than HIV-infected participants; the opposite was the case for BDE. Women (aOR3.04), government grant receipients(aOR0.34), and care-givers (aOR2.37) were significantly associated depression. Participants with a depressive episode were 2–3 times more likely to report poor health perceptions. Study limitations include the cross-sectional design, limited sample size and possible selection biases. Conclusions: Major depressive episodes were higher in HIV- affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.

Previous studies found that elderly females were more likely to experience memory decline than their male counterparts. Although there were some studies on gender’s issue of elderly in the Thai context, little was known about issue of memory decline. Therefore, this study focuses on gender differentials in memory decline.
The two waves (2006 and 2011) of longitudinal study from the Kanchanaburi Demographic Surveillance System (KDSS) were employed. The sample was 609 elderly aged 60 and above in 2006 who had been followed until 2011. Memory test is used by applying ten worlds list. The effect of gender on memory decline was estimated by using GEE logit model.
Results revealed that almost two-fifths of elderly faced memory decline over a period of 5 years. There were 38.9 percent of males and 40. 6 percent of female experienced memory decline. However, GEE logit model showed that there was no statistically significant difference by gender in the memory decline, even controlling for other variables.
The findings did not support previous studies. However, it suggested that both male and female elderly had an equal risk of memory decline. Thus, program intervention to prevent cognitive impairment and maintain cognitive function should focus for all elderly.

Title: Demographic Characteristics of the Elderly in Cambodia and Policy Implications
Authors: Hang Lina, National Institute of Statistics, Phnom Penh, Cambodia
Meng Kimhor, National Institute of Statistics, Phnom Penh, Cambodia
Nott Rama Rao*, International Census and Survey Consultant , Chennai,
India ( formerly with UNFPA)
Abstract: Population ageing is no longer a demographic problem confined to the advanced countries. With declining fertility and mortality many among the developing nations find themselves in the third stage of demographic transition. Cambodia is one among them. The proportion of elderly population (aged 60 and more) has increased from about 5 per cent to 6.3 per cent during 1998-2008 and it is projected to touch the 11 per cent mark in 2030.
Utilizing the Census and Survey data, the paper analyses the changing population age structure which will prove useful in monitoring and implementation of the National Strategic Development Plan which is underway. Cambodia is among the poorest countries of the world and any increase in the elderly population who are mainly dependent on the working age population gives rise to several social and economic problems.

We aim to investigate the probabilities of transition among health states for middle-aged and older adults and examine how they vary by age, sex and immigrant status. The longitudinal dimension acquired by the Survey of Health, Aging and Retirement (SHARE) allows us to investigate how successful is the immigrants’ aging with respect to natives. We hypothesize that immigrants are more likely to experience a deterioration of health during aging, that is, the probability that a foreign born living in specific countries will move from a “healthy state” to a “sick state” is higher with respect to non-immigrants, especially for older adults. The health measures included self-rated health, depression, chronic diseases and ADLs.
Preliminary results show that transition probabilities varied by age, gender and immigrant status. In almost all domains of health, the probability that older immigrants’ health status deteriorated was higher with respect to natives, even if results emphasize a large heterogeneity found among immigrants’ groups.
The analyses of the changes over time in different aspects of immigrants health status is very interesting for policy makers so that clearly defined public interventions can be adopted to improve their health and planning relevant health services.

Public health expenditure has a clear tendency of increase in Spain in recent years. Assessing its determinants is extremely important to predict future health consumption and adjust government policies to attend future demand. Population aging is among one of the most important variables that trigger health expenditures. Deeper analysis is needed to understand which is the share of health costs growth attributable to population aging, regarding other factors like technological change or budget level allocated to health expenditures. We use a hospital cost survey to analyze the age profile of public expenditures on hospitals during the last decade in Spain. Results show that during these years average hospital spending by age grew constantly for almost all age groups, but especially among the elderly. Health care for people 80 years of age or above increased 141% from 2000 to 2009, even though they represent only 13% of the total hospital expenditure.

This paper compares the relationship between socioeconomic status (wealth and education) and multiple dimensions of elderly well-being--disability, mobility, self-reported health status, memory, depression, and life satisfaction--in a middle-income country (China) and a high-income country (England) based on regression analysis that uses harmonized measurements from the China Health and Retirement Longitudinal Study (CHARLS) and the England Longitudinal Study of Ageing (ELSA). Cross-country comparisons can help identify which relationships are universal and which depend on local contextualizing factors. We find that for physical health measures (self-reported health, ADLs/IADLs, mobility), wealth has stronger relationship in England than in China, with the poorest especially disadvantaged, but that the opposite is true for psychological health measures (life satisfaction, depression). It could be that in China current wealth is less correlated with lifetime wealth, which determines physical health, but that psychological health adapts more quickly to changes in socioeconomic status. We also find that education gradients are greater in China than in England for some measures (ADLs/IADLs, life satisfaction, memory), perhaps indicating that education is a stronger determinant of lifetime opportunities in China.

India, the world’s second most populous country, is developing alongside a rapidly graying population. Since ageing is an emerging issue in India, providing for a rapidly increasing number of disabled elderly persons is bound to be a major challenge for the government and people. In this paper we examine how much difference exists in life expectancy (LE) and disability-free life expectancy (DFLE), to examine the trend of prevalence of disabilities and the disparities in the demographic, socio and economic variables in the prevalence of disability. Data for the study was taken from the Kerala Ageing Survey conducted by Centre for Development Studies in 2004, 2007 and 2010 and Sample Registration System of India. Sullivan’s method is used to calculate Disability Free Life Expectancy (DFLE). The proportion of life expectancy free of disability decreases with age and the proportion of life expectancy to be spent in disabled state increases with age. As more and more people age and tend to develop disability, it will be a huge financial burden to individual, family and government. The paper also outlines the need for early detection and comprehensive policy interventions and social services to be extended to the elderly particularly the disabled.

Session 08.04-Population ageing and Intergenerational Relation
Title: Empty nesting, living alone or childlessness: Issues of care in old age among the tribals of Maharashtra (India)
While the problem of ageing is now accepted as a major issue in the modern India’s urban society, it is assumed that the aged among the tribals are untouched by the forces of modernisation, resulting in their neglect in the national policy framing.
Present study was planned to explore the situation of the elderly persons in tribal society focusing on their living arrangements; and impact on their care in old age.

A field study was carried out among the elderly population of three tribal groups namely Mahadev Koli, Thakar, and Pardhis of Maharashtra and compared with the Lahaulis of Kullu, visited.

Analysis revealed that one- third of couples lived by themselves (22%). Living alone, mostly women (7%), and with distant or non-relatives (13%) were other kinds of living arrangement now on an increase. A few did not have children (3.4%). Thirty -one percent whose children had passed away and 25 percent of tribals reportedly children migrated, hence were empty nesters.

Plight of the childless, deserted and separated tribal women in old age was quite appalling. Some case studies portraying the same will be discussed.