Abstract
BackgroundWhile 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.MethodsHouseholds 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).ResultsHousehold 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.ConclusionsWhile 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.
Highlights
The inverse correlation between disability and economic status is well established
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
Cross-sectional surveys from Latin America [3,4,5] and Asia [6,7] demonstrate that older people with disabilities are more commonly to be found living under adverse socioeconomic conditions, usually quantified in terms of current household assets
Summary
The inverse correlation between disability and economic status is well established. In the 49 country World Health Survey (over 200,000 adults aged 18 years and older) disability was more prevalent in the poorest than in the richest wealth quintiles in all countries, with a statistically significant gradient in all but six countries [1]. There has been relatively little research on the links between health, disability and poverty in low and middle income countries (LMIC), the impact of care dependence among older adults. Cross-sectional surveys from Latin America [3,4,5] and Asia [6,7] demonstrate that older people with disabilities are more commonly to be found living under adverse socioeconomic conditions, usually quantified in terms of current household assets. These associations were not confirmed in two studies from Nigeria [8,9]. 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
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