We appreciate Dr. Lloyd-Sherlock's research work on the nature of long-term care in low and middle income countries1. His review of recent evidence indicates an extreme mismatch between the demand for long-term care and the quality of published research. Because aging is a universal concern, it is important to know the information about the nature of a country's long-term care for policymaking and planning2,3. The developments and determinants of demand for long-term care occur differently in different countries and country groups. In high income countries, long-term care needs are primarily related to the growing proportion of elderly in the population; in lowincome countries, long-term care needs are primarily the result of the high prevalence of chronic communicable diseases [such as AIDS and tuberculosis] and the result of physical and mental disability caused by war, violence, and accidents. During the years 2000e2050, the dependency ratios are expected to increase most significantly in high income countries, and meanwhile are expected to growmore slowly or even decrease in low income countries. Economic, social, and political factors may also be dramatically less favorable in low income countries, and the capacity of these governments to achieve social goals may often be compromised. Long-term care is covered very little by public financing schemes in low and middle income countries4. Twothirds of people worldwide who are aged 65 years live in low and middle income countries, but very little research about long-term care has been conducted to support policymaking in these regions. Evidence from population-based research on long-term care from low and middle income countries should help stimulate a wider debate about older people's health and social care demands, and how they should be provided for in these regions. Good quality research that is effectively disseminated can raise awareness,

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