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

Background: Health and social conditions of spouseless people are less studied than other people.

Objective: We assessed demographic and socioeconomic characteristics of spouseless people aged 50+ years and self-reported morbidity and health service use in rural Bangladesh.

Methods: We identified 1,456 spouseless people from Abhoynagar and 2,016 from Mirsarai sub-districts in 2009 where a health and demographic surveillance system (HDSS) has been operating since 1984 and 1995 respectively. Information on their self-reported morbidity and health care utilization in the past two weeks was extracted from HDSS database. Social prejudices with spouseless people were obtained through focus group discussions.

Results: Majority (90%) of the spouseless people were above 65 years and females in both areas. Majority were staying in extended nuclear families and labour force. Coverage of the social safety net program was <20%. Self-reported non-communicable diseases were widely prevalent and were the main reasons for medical consultations. Widow women faced societal prejudice.

Conclusions: Attention to increase social safety net program and remove social prejudice is needed.

Elderly women suffer from multiple disadvantages resulting from biases to gender and widowhood. This study will pertain to understand the association between living arrangements and health well being among elderly women in India. The present study utilised data from Indian Human Development Survey (IHDS 2005). Both Bivariate and multivariate analysis have been applied in this study. Eighty three percent of elderly women are living in joint families and three percent are living alone in India. The number of women living in a joint family is higher in urban (84%) than rural (82%) areas. Women’s age, marital status and economic status are found as significant determinants of their living arrangements as well as their health well being. High BP has the highest burden on health in India. Women who are living alone are likely to suffer with any short term and long term morbidity, than other categories of living arrangements. The elderly population, particularly women, are more likely to suffer with multiple health and psychological problems. There is an urgent need to pay greater attention to elderly women and to support holistic policies and programs for ensuring their health well being and social security.

The elderly women are more vulnerable in India due to the patriarchal nature of Indian society. The present study aims at understanding the extent of life style disease (LSDs) among elderly women and to explore the factors associated with the selected LSDs in India. Using IHDS, 2004-05 data we have analyzed three major LSDs namely High BP, Heart disease and Diabetes. This study is restricted to elderly women who are 60 years and above. The study has employed bi-variate and multivariate analysis to find out the association between socioeconomic & demographic characteristics and selected LSDs among elderly women. The results shows that a high proportion of elderly women (38%) suffer from high blood pressure followed by diabetes (18%) and less than ten percent of them report heart problems. Furthermore, the multi-nominal results show that the LSDs is equally prevalent in urban area, high caste groups, educated and non-poor section of the society.

The purpose of this paper is to compare the changes of perceived health expectancies of Chinese elderly from 1987 to 2010, and explore the gender differences in the change of health status. Based on nationally representative data, we calculated the perceived health expectancies of the Chinese elderly for both males and females, and made a comparison with the results of the perceived health expectancies of the elderly among 1987, 1992, 2000 and 2010. We found that the morbidity of the elderly was expanded from 1992 to 2000 and compressed from 1987 to 1992 and from 2000 to 2010, and found that the expansion in morbidity for females was more serious than that for males, even though the increase of life expectancy for females was much quicker than that of males. The changes of health status of the elderly, especially for females, were abnormal from 1992 to 2000. The change in social institutions should take some responsibility for the worsening of health for the elderly at that time.

The ageing of population is often associated with strain of health system due to increasing healthcare utilization among elderly. The extent to which demographic mingles with non-demographic factors, however, was rarely addressed. This study aims at investigating the effects of demographic and non-demographic changes to the future healthcare utilization. Using individual and household level data from various national-level surveys, discrete choice models are used to estimate the propensity of use of healthcare for each population group specified by demographic and non-demographic characteristics, which is then projected to the future population. The study shows that the effects of demographic change are quite substantial in term of size and pattern of utilization. However, these effects can be either compounded or undermined by non-demographic factors, such as health insurance subscription and chronic diseases. The share of health care utilization among elderly is not as high as commonly been perceived. This study offers an insight that the effects of demographic change to healthcare utilization is not straightforward if we are to acknowledge that ageing progresses along with the non-demographic factors as the case in many developing countries.

La dynamique démographique des Caraïbes est très particulière, notamment par la rapidité avec laquelle la population vieillit, un rythme des plus élevés par rapport aux autres régions du monde. Les enjeux cruciaux que sont ceux d’assurer la qualité de vie des aînés d’aujourd’hui et de demain ainsi qu’une gestion efficace de ces sociétés vieillissantes se doivent d’être abordés et pris en compte. Cette étude diffuse les résultats d'une analyse ciblée des caractéristiques sociodémographiques des personnes âgées de quatre États des Caraïbes (Antigua-et-Barbuda, Sainte-Lucie, Saint-Vincent-et-les-Grenadines et Trinité-et-Tobago) à partir des données de leur plus récent recensement. Ce portrait met une emphase particulière sur les conditions de vie, la santé et la participation sur le marché du travail des personnes âgées, soit sur les grands thèmes des trois objectifs du Plan d’action international sur le vieillissement de Madrid. Au niveau de la santé, les résultats montrent une forte prévalence des maladies chroniques des personnes âgées, surtout l’hypertension et l’arthrite. Les femmes semblent être plus vulnérables que les hommes. La fréquentation et l’accès aux établissements de santé diffèrent d’un pays à l’autre. Finalement, seulement deux aînés caribéens sur trois jouissent d’une assurance-santé convenable.

Warren C. Sanderson and Sergei Scherbov
Conventional studies of population ageing include changes in age structures but not changes in the relevant age-specific characteristics of people and, as a result, produce misleading results. Changes in the characteristics of people, such as in their remaining life expectancies, survival rates, disability rates, and cognitive abilities, for example, are all pertinent to a full understanding of population ageing. In this paper we formally develop a systematic approach to the study of population ageing that incorporates changes in the age-specific characteristics of people. We do this by generalizing the concept of age and linking these characteristic-based age indicators to new measures of population ageing. One of these indicators divides the life course into two stages, where the ratio of the durations of the two is kept constant. For example, one of these stages could be considered to be “old age”. This indicator is useful in discussions of the demographic indexation of pension ages. When changing age-specific characteristics are taken into account, we obtain a more comprehensive picture of population ageing.

The proportion of adults reaching 60 in Latin America is expected to grow quickly. Cuba and Puerto Rico are good examples. San Juan and Havana have a substantial fraction of people above age 60. The objective of this paper is to study inequalities in health in two cities: San Juan, Puerto Rico and Havana, Cuba. This research is based on data from PREHCO (Puerto Rican Elderly Health Conditions) and SABE (Health, Well-being and Aging in Latin America) . A socioeconomic index was calculated for Puerto Rico based on six dimensions: assets, household equipment, household ownership, per capita income, financial debts and health insurance; the index for Cuba was based on five dimensions per capita income, household infrastructure, household equipment, education and neighborhood environment. Using k-medians clustering the elderly population was grouped in three clusters: low, medium and high. Important differences by sex, age and certain health conditions were found between older adults in San Juan and Havana.

Present paper is aimed to discuss the association between cognitive test performance, based on Hindi Mini-Mental State Examination (HMMSE), and various self rated psychiatric symptoms among the elderly in different rural areas of Uttar Pradesh and Kerala, States of India. Study in these two states Uttar Pradesh (UP) and Kerala may gives a true picture of India's profiles related to elderly population in almost all respects. The results based on these two Indian states can be compared with the results of any developed and developing country of Asian region.
This study is based on a specially designed sample survey entitled “Socio-Economic Status, Behavioral Problems and Health Hazards of The Elderly Across Diverse Setting in India” of about 1000 elderly people selected from the above two states comprising 600 elderly people from UP and 400 from Kerala.
As a result, the median score based on HMMSE was found less among the elderly sample in Kerala as compared to UP. The low scoring in HMMSE was found significantly associated with higher age and low educational level of the elderly. However, the symptoms of sadness, depressive thoughts, social withdrawal and agitation feeling were also found to be significantly related with HMMSE scores.

The epidemiological transition in India has sharp consequences in terms of increasing longevity but subsequently accelerated pace of non-communicable diseases among graying cohorts. Amidst ageing phenomenon it is prerequisite to explore the levels and covariates of medically diagnosed and self reported health problems of elderly. A cross sectional study was carried out on a sample of 400 elderly people aged 60 and above from two different wards of urban Varanasi, India. Preliminary findings highlight age, gender, marital status, education and income as significant covariates as well as differential in self rated health among elderly. Elderly male enjoyed good health (26.9%) than the female elderly (9%). Married elderly respondents more frequently reported good health status (29.9%) than unmarried (6%), whereas elderly respondents with 10 years and above education reported better health status (24.6%) than those in 8 years (12%), 5 years (22.2%) and no education (9.8%).Among several chronic and degenerative diseases, diabetes (29.9%), hypertension (40.5%), arthritis (25.8%), respiratory tract infection (27%), chronic fatigue (69.2%), gastroesophageal reflux (41%) and anxiety (41.5%) frequently affected the health of elderly.