Abstract
BackgroundThe number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We investigated the prevalence and correlates of dependence among older people from middle income countries.MethodsA one-phase cross-sectional survey was carried out at 11 sites in seven countries (urban sites in Cuba, Venezuela, and Dominican Republic, urban and rural sites in Peru, Mexico, China and India). All those aged 65 years and over living in geographically defined catchment areas were eligible. In all, 15,022 interviews were completed with an informant interview for each participant. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, dementia, physical impairments and self-reported diagnoses. Dependence was interviewer-rated based on a key informant's responses to a set of open-ended questions on the participant's needs for care. We estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analysed, and population attributable prevalence fractions (PAPF) calculated.ResultsThe prevalence of dependence increased with age at all sites, with a tendency for the prevalence to be lower in men than in women. Age-standardised prevalence was lower in all sites than in the USA. Other than in rural China, dementia made the largest independent contribution to dependence, with a median PAPF of 34% (range 23%-59%). Other substantial contributors were limb impairment (9%, 1%-46%), stroke (8%, 2%-17%), and depression (8%, 1%-27%).ConclusionThe demographic and health transitions will lead to large and rapid increases in the numbers of dependent older people particularly in middle income countries (MIC). The prevention and control of chronic neurological and neuropsychiatric diseases and the development of long-term care policies and plans should be urgent priorities.
Highlights
The number of older people is set to increase dramatically worldwide
Most will be living in low or middle income countries (LMIC), where chronic diseases are already responsible for the majority of the total disease burden [2]
A recent report from the World Health Organisation (WHO) Global Burden of Disease project on the global prevalence of dependence acknowledged the relative lack of empirical data, from LMIC [5]
Summary
The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. Disability has been widely studied, through the Global Burden of Disease Report; dependence, defined as ‘the need for frequent human help or care beyond that habitually required by a healthy adult’ [5], much less so. A recent report from the World Health Organisation (WHO) Global Burden of Disease project on the global prevalence of dependence acknowledged the relative lack of empirical data, from LMIC [5] Both disability levels and needs for care were inferred from diagnoses; the total population prevalence of dependence was estimated to be similar worldwide, varying from 4.4% to 5.1% by region, and was predicted to increase only marginally by 2050 [5]. Direct estimates from populationbased surveys are limited mainly to older people in high income countries (HIC), with a prevalence ranging between 15% and 17% of those aged 65 and over [6]
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