Abstract
Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited. Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%-64%) of their remaining 28 y of life (95% CI, 25.7-33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%-46%) of their remaining 25.4 y (95% CI, 23.3-28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being. Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults.
Highlights
While rapid population growth continues to be a major social and policy issue in sub-Saharan Africa (SSA) [1,2], demographic and epidemiological trends of falling fertility and increasing life expectancy (LE) foreshadow the coming challenge of a growing elderly population in SSA
Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults
With the introduction of the parent sample in the 2008 Malawi Longitudinal Survey of Families and Health (MLSFH), the mean age increased by 5 y, and the sex composition shifted from being majority male to majority female
Summary
While rapid population growth continues to be a major social and policy issue in sub-Saharan Africa (SSA) [1,2], demographic and epidemiological trends of falling fertility and increasing life expectancy (LE) foreshadow the coming challenge of a growing elderly population in SSA. The population of mature adults aged 45+ y will expand more rapidly in the decades than that of any younger 10-y age group in many SSA low-income countries (LICs). Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA’s population, up from 10% in 2010. In 2000, globally, there were about 605 million people aged 60 years or more; by 2050, 2 billion people will be in this age group Much of this increase in the elderly population will be in low-income countries. In low- and middle-income countries, population aging is occurring in parallel with an ‘‘epidemiological transition,’’ a shift from communicable (infectious) diseases to noncommunicable diseases (for example, heart disease) as the primary causes of illness and death
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