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

Populations age globally. This is also the case in low and middle-income countries. In order to meet the challenges of rising chronic care needs for people suffering from non communicable diseases such as heart diseases, stroke, diabetes, visual impairment and dementia, the WHO urges to take action and get the right infrastructure in place. With the increasing ageing in Ghana there is an urgent need to assess determinants of demand for social health insurance for elderly (defined by WHO those 60 years of age and above) in order to assist policy makers and healthcare managers to anticipate timely and address the health protection needs of this growing group. Despite the achievements of Ghana’s National Health Insurance Scheme to enroll near to 70% of the population, recent data show that the actual active enrolment-rate is close to 34% (NHIA Annual Report 2011). With an exemption policy in place for the aged above 70 years of age, Ghana Government foresees protection for a certain group of elderly. This study provides empirical evidence of health seeking behavior and enrolment in social health insurance of 928 elderly above 50. It is expected to offer recommendations on effective policy interventions specifically targeting the aged populations.

The process of population ageing probably represents one of the most daunting challenges in the 21st century. Previous studies have noted differential positive effects of marital status on physical and cognitive health status of elderly. This study attempts to test the hypothesis of poor cognitive status (elevated risk of depression and hypertension) among widowed/separated/single elderly men as compared to elderly women in selected Indian states. The data for the present study comes from the World Health Organization sponsored Global Ageing and Adult Health (SAGE-India) survey carried out by the International Institute for Population Sciences (IIPS), which covered 10,000 households. The sample size has been restricted to 3,294 elderly (men and women) aged 60+ years. The results suggest that widowed/divorced/separated elderly men were at an elevated risk of cognitive dysfunction as compared to elderly women. Large inequalities in access to material, health and social resources between elderly men and women are evident in India. Thus, there is a need for policies to specifically address the dimensions in the physical and mental health of aged.

Background: Self-rated health (SRH) reliability to predict mortality has already been shown. However, differences on SHR among gender have been found, and its importance was highlighted because mortality prediction seems different among male and female. This study aims to compare SRH and associated factors among men and women from a representative sample of Brazilian adults. Method: Data from individuals over 24 years who answered the Health supplement of National Household Sample Survey (PNAD 2008) was analyzed. Logistic models were constructed to predict poor SRH. Independent variables include gender, age, socio-demographics, chronic illness and disability. Results: Overall 29.6 (SE 0.2) of men and 34.6 (SE 0.2) reported a poor health. Independent variables associated with a poor SRH include: low income (OR 3.02 (CI 2.88-3.16)), depression (OR 3.24 (CI 3.07-3.43)), diabetes (OR 2.71 (CI 2.55-2.88)), daily activities (OR 2.21(CI 2.08-2.34)) and instrumental limitations (OR 2.25(CI 2.15-2.37)). Women usually have worst evaluation of health, but men with daily activities/ instrumental limitations have a higher chance of fair/poor SRH (OR 1.43 (CI 1.30-1.57) and OR 1.52(CI 1.41-1.63)). Conclusion: Data show an interaction among gender and disability on SRH which is important for the planning of health care.

This paper aims to explore the association between two chronic health conditions (heart attack and stroke) and disability among older population (50+) in different welfare regimes with the special focus on East European countries. It is of interest to understand the risk of disability due to heart attack and stroke among older population in the countries where the timing of entrance to the phase of cardiovascular revolution has differed remarkable. The analysis includes 16 European countries that carried out the fourth wave of SHARE (Survey on Health, Ageing and Retirement) in 2010-2011. Disability will be measured by using both ADL and IADL instruments combined into three scales (basic, medium, complex) in order to reflect different levels of disability. Odds ratios for two chronic diseases will be calculated in relation to disability levels and logistic regression analysis will be conducted to assess the associations between diseases and disabilities. Model includes demographic (gender, age) and socio-economic variables (the highest level of attained education, partnership status), life-time occurrence of some behavioural aspects such as smoking and alcohol consumption. Cholesterol, blood pressure and diabetes are considered the confounding risk factors to heart attack and stroke.

Health financing in India is a critical issue in the wake of rapid demographic and epidemiological transition, low per capita pubic heath spending and rising health care cost. However, there are few studies that examine the role of changing age structure on health spending in India. The aim of this paper is to examine the effect of population growth and age structural transition on household health spending in India and states. It segregates the increased health expenditure due to changing age structure, increased hospitalization and medical cost (real) using decomposition analysis and projects future cost of medical care. The unit data from 52(25) and 60(25) rounds of National Sample Survey, Census of India 2001 and 2011 and Population Projection of Expert Committee 2001-26 are used in the analyses. Results suggest that the real cost of inpatient care has increased over time for all age groups. During 1995-2004, the changing age structure accounts 22% increase in real cost of hospitalization. The shift in age structure alone would lead to an increase of 47% in hospitalization cost, 43% in outpatient cost by 2021 and an increase of 63% in hospitalization cost and 58% of outpatient cost by 2026 at 2004 prices.

This study assessed the association between employment, chronic disease prevalence and medical care aspects of older population in India .Study have used India Human Development Survey (IHDS, 2005). The assessment of employment by background characteristics reveals that greater proportion of lower socio-economic groups and belonging to rural areas are working at older ages. Moreover importantly, findings suggested a bi-directional relationship between employment and chronic diseases in older population: Older population engaged in regular paid work has lower likelihood of suffering from chronic disease (OR=0.845; p<0.01) compared to people who are not working (OR=1.00); in alternative words, older persons suffering from chronic diseases are unable to work in regular paid jobs. Similarly, greater proportions of not-working older persons, those are suffering with chronic diseases and have monetary support through retirement pension and savings from previous job are seeking more modern treatment and expense on treatment of chronic diseases. Hence, the results fosters that ‘employment determines and is determined by chronic disease prevalence among older population in India’. These results would allow policy makers to greater ascertain the health care and financial needs, alternative social protection programs, and develop appropria

This paper uses a parametric stochastic frontier approach (coming from the economic literature) to explore the impact of the occupational activities and the living conditions in the slums on the health performance among the adult population aged 50 and up. We measure the health performance using the disability scores from the WHO. In our estimation strategy, we first consider the WHODAS II – 12 items score and thereafter simultaneously analyze several dimensions of health state description (cognitive, mobility, pain and discomfort, sleep and affect, etc.). We use individual data from the WHO’s Study on Global AGEing and Adult Health (SAGE) in partnership with the INDEPTH network. The SAGE-INDEPTH survey provides longitudinal data on ageing in various Demographic surveillance sites (DSS) in South Africa, Kenya, Tanzania, and Ghana. This survey collects information on the older persons’ health profiles, economic activities, cares and supports provided and received, and a broad range of self-reported assessments of health and well-being.

Significant changes have occurred in the patterns of aging and epidemiology in developing countries in recent times. Chronic diseases have become major diseases burden in Ghana, as the nation still struggles to deal with communicable diseases. Using the element and progression of chronic disease model as the conceptual framework, the study analysed the prevalence of chronic diseases among aged (60+ years) who reported at Cape Coast Metropolitan (CCM) hospital in 2004 and 2009. The standard multiple regression was the main statistical tool employed in the study.
Hypertensive heart disease (HHD) emerged as the major chronic disease burden reported among the aged (64.6%) especially among the young-old aged (60-75 years). This was followed by diabetes (42%) and cancers (40%). Females dominated in the reported HHD cases while the males reported more diabetes. There was a weak relationship between sex and chronic diseases reported. The young-old reported more chronic diseases than the old-old in both 2004 and 2009. The aged reported more chronic disease cases in 2004 than in 2009.
To sum-up, in-service training for proper records keeping at CCM hospital should be encourage to ensure accuracy of data keeping to update authorities of Cape Coast Metropolitan Health Directorate in policy implementation.

Objectives: To examine age pattern of socioeconomic gradients across various reported and measured health indicators for Indian adults.
Methods: Cross-sectional data on 11,230 Indian adults aged 18-plus from the Study of Global Ageing and Adult Health, India (SAGE, 2007) is used. Bivariate analysis and logit models with interactions of age and socioeconomic status are applied to examine effects of socioeconomic status on health of Indian adults across ages.
Results: Results reveal a more dynamic pattern of age vis-à-vis socioeconomic gradients on the health of Indian older adults. Negative age gradient prevailed on key indicators of adult health across socioeconomic spectrum. However, age gradient was stronger for the poor and less educated adults. Concurrently, key measures of socioeconomic status: years of schooling and wealth quintile indicated an overwhelming positive gradient on health but with considerable heterogeneity across ages and on different domains of health.
Discussion: Overall, results demonstrate a non-static and counteracting pattern of age vis-à-vis socioeconomic gradients on adult health. Results suggest that the trajectories of age and social determinants interactively determine the health of Indian older adult.

Introduction: WHO defines health as a state of mental, physical and social wellbeing. However, there have been limited detailed evidences that systematically assessed the chronological relationships between these three health aspects and long-term care (LTC) needs.
Method: Among the urban dwelling elderly aged 65 years and over, data were collected through self-reported questionnaire in 2001 and 2004 in Tokyo. Ultimately, 8,126 respondents were included in the analysis. Exploratory factor analysis and Structural Equation Model (SEM) method was adopted in the analysis.
Results: By using exploratory factor analysis, 3 factors, named ’mental health’,’ physical health’, ‘social health’ , were defined as latent variables, respectively. The SEM analysis indicated significant direct but negative correlations between ‘physical health 2001’ and ‘LTC needs 2004’. In contrast, ‘mental health 2001’ and ‘social health 2001’ had little direct effects on ‘LTC needs 2004’. Meanwhile, we also observed an indirect effect of ‘mental health 2001’ on ‘LTC needs 2004’ through ‘physical health 2001’.
Conclusions: This study illustrates that the LTC needs is mainly confirmed by physical health, followed by mental and social health. It suggests that maintenance of good physical health may be entirely crucial to decrease the LTC needs.