Autoinforme de salud general en adultos mayores de America Latina y el Caribe: su utilidad como indicador / Self-reported general health in older adults in Latin America and the Caribbean: usefulness of the indicator

OBJECTIVES. To evaluate self-reported general health (SRGH) as a health indicator and to analyze its covariates in people 60 years old or older living in private homes in seven cities of Latin American and the Caribbean.METHODS. This cross-sectional descriptive study was based on data from the Health, Well-Being, and Aging survey (Salud, Bienestar y Envejecimiento, or "SABE survey"), which was carried out in 1999 and 2000 in Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; and Sao Paulo, Brazil. The survey looked at the demographic and socioeconomic characteristics of the participants, several health indicators (self-reported chronic diseases, depression, and cognitivefeatures), the social and family suport network, the use of health services, reported and observed functionality, the respondent's income, and the durable consumer goods in the household. In probit regression models, self-reported fair or poor health was used as the dependent variable. The marginal effect of each categorical explanatory variable was used to indicate the difference between the probability of reporting poor health by persons who did or did not have a given characteristic. RESULTS. In all the cities studied the self-reporting of "excellent" health was very low (6 percent or less). The results of the multivariate analysis of the relationships between SRGH and covariates showed: (1) the relative importance of several health indicators as covariates of SRGH, (2) the association between sociodemographic characteristics and SRGH, and (3) the differences or similarities found among the seven cities with respect to the relationships studied. The level of self-rated good health was highest in Buenos Aires and Montevideo (60 percent), followed by Bridgetown and Sao Paulo (around 50 percent) and Havana, Santiago, and Mexico City (between 30 percent and 40 percent). The respondents evaluation of their memory was the factor that was most strongly related to SRGH, followed by satisfaction with nutritional status and satisfaction with life.CONCLUSIONS. The SRGH captured multiple facets of the health of the older adults, such as suffering from chronic diseases, the degree of satisfaction with the level of nutrition and with life, perception of memory, and any functional problems .... (AU)

Enfermedades cronicas y limitacion funcional en adultos mayores: estudio comparitivo en siete ciudades de America Latina y el Caribe / Chronic diseases and functional limitation in older adults: a comparative study in seven cities of Latin America and the Caribbean

OBJECTIVE. To identify the relationship between selected chronic diseases and the presence of disability in inhabitants 60 years old or older in seven cities of Latin America and the Caribbean. METHODS. In 2000 and 2001 a descriptive cross-sectional study was conducted with a sample of 10 891 persons 60 or older in seven cities: Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; and Sao Paulo, Brazil. This research was part of the Salud, Bienstar y Envejecimiento (Health , Well-Being, and Aging) project (known as the "SABE project"). The dependent variables in the study were difficulty in performing basic activities of daily living, and difficulty in performing instrumental activities of daily living. Compiled from self-reports, the independent variables were : age, sex, educational level, living alone or with other person (s), self-assesed health, and the presence or not of hypertension, diabetes mellitus, cancer, chronic obstructive pilmonary disease, ischemic heart disease, cerebrovascular diseases, and osteoarthritis. The presence of depression and cognitive impairment in the participants was evaluated, and body mass index was also calculated. To compare the degree of influence of the different variables on disability, a standardized coefficient for each association was calculated. RESULTS. In the seven cities studied, the variables that showed a direct association with difficulty in carrying out basic activities of daily living and instrumental activities of daily living were: suffering from a higher number of noncommunicable diseases, from cerebrovascular diseases, from osteoarthritis, or from depression; being older; being female; rating one's own health as bad, and the presence of cerebrovascular diseases, osteoarthritis, or cognitive impairment. CONCLUSIONS. Our research provides the first systematized description of the associations between disability and chronic noncommunicable diseases in older adults in Latin America and the Caribbean. Difficulties that older adults have in carrying out instrumental activities of daily living are the first ones to appear. Therefore, follow-up mechanisms should be established that make possible the early detection of this disability (AU)

Measuring and analyzing activities of daily living and quality of life in community elderly residents [abstract]

The rapid growth of the elderly population as well as the ongoing change in family structure is of public health concern in Japan. Before one can attempt to solve the problem of providing support to the elderly community residents, some assessment of their health status must be undertaken. We measured the activities of daily living (ADL), quality of life (QOL) and SF-36 score of about 716 elderly residents aged 65 years and over by interviewing them at home. The items of our survey included ADL, QOL (PGC), SF-36 scores, the elderly health-awareness, attitude, daily activities and other related subjects. Comparisons were then conducted in regard to the scores on the individual subscales of the SF-36 of residents with each of the diseases and the national-norm scores for Japan. ADL of the people who responded, "go out very often", was 99.9, followed by 98.6 for "occasionally", 87.4 for "seldom". ADL of the people who responded, "able to do shopping for daily necessities", was 99.7 while for "unable" it was 81.1. QOL of the people who resonded that their health status was "excellent" was 98.6, followed by 12.7 for "very good", 11.4 for "good", 8.3 for "not very good" and 7.1 for "not good". About the differences in SF-36 scores standardized with the national-normscores for Japan, only "role limitations due to physical problems" was -0.17 in males; "role limitations due to physical problems" was-0.19, "pain" was -0.10, and "mental health" was -0.01 in females. The survey revealed the prevalence of poor health among those ADL (QOL) showing 8090 (78). From this it may be concluded that ADL, QOL and SF-36 scores are very useful indices for us to rate the elderly patients' health status level, thus enabling us to consider what support is required by them. (AU)

Dietary patterns, nutritional status and activity levels of forth form secondary school children in Trinidad

Proper nutrition during adolescence in important for growth, long-term health promotion, and eating habits and physical inactivity are powerful determinants of some non-communicable chronic disease. The objective was to determine the dietary habits, nutritional status and physical activity patterns of adolescents in 4th form in Trinidad. A cross-sectional design study was used and a random sample of 1512 subjects identified. A qualitative food frequency questionnaire and a physical activity questionnaire were used to determine dietary and physical activity patterns. Weights, heights and triceps skin folds were measured. Adolescents were classified as being thin, normal overweight or obese. 619 girls and 601 boys, ages 14-17 participated. 34 percent was of East Indian descent, 32 percent African, 32 percent of mixed ethnicity and 2 percent other. The results indicated that 14 percent were thin, 74 percent had normal weight, 7 percent overweight and 5 percent obese. More adolescents of East Indian ethnicity were found to be thin. (p>0.001). Although fruits were consumed more regularly than vegetables, few adolescents consumed them daily. Rice and white bread/roti were the most commonly consumed staples. High fibre foods were not frequently eaten. Chicken was the most commonly consumed food from animals. 14 percent ate chicken daily. Fast foods were eaten on a weekly basis. The most important were chicken and chips, hotdogs, doubles, cakes and chocolates. 51 percent consumed alcoholic beverages; 1 percent drank them daily. 12 percent did not participate in any physical activity, while 32 percent exercised less than three hours per week. Walking, weight training, running/jogging and cricket were the most frequently reported activities. 78 percent did not participate in physical education at school. There was no association between body size and exercise, not were there any consistent associations between body size and diet. This study indicated a problem of both thinness and obesity in this population. Eating-related concerns are numerous, and must be addressed. Inclusion of regular physical activity as a tool for enhancing overall health and social values are of paramont importance (AU)

Health status of the elderly in the Marigot Health District, Dominica

The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires: collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20 percent were dependent on care. 74 percent were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40 percent of the study population were known to be hypertensive, and another 13 percent had an elevated blood pressure on examination. Diabetes mellitus was present in 15 percent. 20 percent had a visual acuity of 0.1 or below, and 10 percent had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50 percent of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We suggest the development of a programme oriented approach of primary health care for the elderly to support this.(AU)

Institution care for the elderly in Curacao

This study investigated the need for care among the elderly living in a institution (nursing home or a home for the elderly) in Curacao. Answers were sought for the following questions: (1) what type of care do the elderly living in an institution need (2) is there a difference in needs for care between those living in a nursing home and those living in a home of the elderly? (3) is there an overlap between populations of the two? Interviews were conducted with the head nurses of both types of institutions on the need for care. The instruments used were an 8-item scale on Activities of Daily Living (ADL), a 5-item scale on Household Activities (HHA) and a 4-item scale on Memory and Orientation Disorders (MOD). Additional questions were asked about demographic characteristics, being beridden or incontinent and other physical problems. There were severe limitation for HHA (85 percent), and ADL (57 percent); 43 percent had severe MOD, 55 percent had severe problems with incontinence and 23 percent had one or more additional physical problems. With the exception of MOD, the nursing home population had more severe problems. However, almost half of the elderly in homes had a similarly extensive need for care. Despite differences in the manner in which each institute was financed and the amount of money they received as well as differences in admission criteria and educational level of the personnel, there was a great overlap between the nursing home population and those living in homes for the elderly. It is therefore necessary to (better) integrate these two forms of intramural elderly care.(AU)

Home care for the elderly: needed and received: an analysis of the care needed and care received by the non-institutionalized elderly population in Curacao

Curacao, as well as other Caribbean islands, has a growing number of the elderly. In this study we analyzed the home care needed and received by the elderly. Such data are needed for planning health services. Data from the Curacao Health Study were used for this purpose: a face-to-face interview among a random sample of the population. Of the elderly (aged 65 years and over) 23 percent needed help with one or more activities of daily living (ADL), 6 percent needed help with three or more ADL. Those aged over 75 years especially needed help with these activities. 22 percent of the elderly received informal care, consisting mainly of household tasks, accompaniment or monitoring and emotional support. Daughters were the most important care givers, followed by sons. Elderly with multiple ADL - impairments more often received informal care and also more intensive care (more physical care, e.g. bathing). 24 percent of the study sample indicated that they had no one to take care of them in case of long-term illness. This occurred more often when elderly people live alone (50 percent). The ageing of the population will result in a higher need for informal care. However, social changes such as fewer children per couple, a growing number of elderly living alone and increased participation of women in the labour force, will result in fewer potential caregivers. Ways to stimulate informal care and organize cost-effective formal care should therefore be sought.(AU)

Health status of shut-ins in the Marigot Health District, Commonwealth of Dominica

In the Commonwealth of Dominica, the health and disability status of 108 people who, fo various reasons, are confined to their homes -- the so-called "shut-ins" -- were studied. Eighty per cent of them were over 65 years of age and 10 percent were children. Most shut-ins were independent in self-care but dependent in general activities. Their overall health was poor. Twenty-one suffered from diseases of the musculo-skeletal system c.q. osteoarthritis. 13 from blindness of various origins, 13 from neurological diseases, 13 from CVA, psychosis or dementia and 13 from different other diseases. One-third suffered from more than one disease. A special programme would be required to optimize the home-care for the shut-ins and to encourage them to become more active (AU)

Family support and functional outcome of stroke patients

Stroke is one of the major disorders seen among hospitalised patients in Jamaica and other Caribbean countries. There seems to be, a great need for a better understanding of the dynamics between the functional outcomes of the stroke patients and family support, as so many patients are discharged home after hospitalisation. This study was designed to examine the functional outcomes of stroke patients treated and discharged from the University Hospital of the West Indies during 1993, in relation to family support. A questionnaire, 'Strokequest' was used to collect data from the 35 patients who were included in the study. The results of the study showed that there was a positive correlation between family support and functional outcome. Other socio biological variables such as age, self esteem and severity also had an association. The study identified education and counselling of family members, introduction of community based rehabilitation, greater interface between primary care and secondary care health providers as critical recommendations aimed at improving the functional outcomes of stroke patients and thereby enhancing their potential for social integration (AU)

Gender stress: a preliminary survey with specific reference to female physicians

Practising female physicians in Trinidad and Tobago were studied to identify major casual factors of negative stress. Results indicated that major stressors were as follows: job (36 percent), finance (32 percent), children (20 percent) relationships (20 percent). The minor stressors identified were: children (48 percent), finance (36 percent), relationships (36 percent), job (32 percent), and health (20 percent). The physicians showed the ability to cope with the stress and this was attributed to, inter alia, self-sufficiency, empowerment, self-fulfilment and gender. (AU)

Recent developments in low-cost screening and assessment of childhood disabilities in Jamaica. Part 2: Assessment

This paper summarise the requirements and criteria for assessment of childhood disabilities. It reviews recent research carried out in Jamaica and outlines procedures for medical and psychological assessment used in the International Epidemiological Study of Childhood and Disability as well as local experience in community-based rehabilitation. While the medical assessment procedures were considered to be validated, there is an urgent need for local research and development in psychological assessment. These approaches, while not perfect as yet, bring the possibility of local community capability closer. They will require changes in professional attitudes, training of health and educational personnel, and changes in the service systems, so that screening and assessment can be integrated into existing services. However, although this will obviate the need for new, specialised administrations, improved linkages and lines of referral will be necessary. (AU)

The effect of demographic factors on serum lipids in diabetics of Trinidad and Tobago: possible association with ischaemic heart disease

This study was undertaken in order to investigate the effect of race, sex, weight, activity level and residential area on serum lipoprotein patterns, and to determine how this could possibly relate to the incidence ofischaemic heart disease (IHD). Seven hundred (700) diabetics attending outpatient clinics at Sangre-Grande and Port-of-Spain hospitals were screened. There were 132 males and 249 females of African descent; 99 males and 163 females of East Indian extract, and 19 males and 38 females of other ethnic origins. The average age of the population studied was 50 years (+/-15). The results obtained from this study indicate that diabetes mellitus is apparently more common in women than in men, particularly in those women who have borne children, and the incidence rises markedly after menopause. East Indians have higher triglyceride (TG), very low density lipoprotein cholesterol (VLDL-C) and low density lipoprotein cholesterol (LDL-C), but lower high density lipoprotein cholesterol (HDL-C) concentrations than their counterparts of African origin. TG, LDL-C and total serum cholesterol (TC) concentrations are highest in overweight-obese patients while HDL-C concentrations are highest in the lower weight division. The domestic working class, as well as those who were in retirement, have higher TG, LDL-C and TC than members of other occupational status. The fractions mainly affected by a residential area are TG, HDL-C and LDL-C. Moreover, diabetes mellitus and its consequent impact on lipoprotein homeostasis imposes a greater predilection to IHD, especially among members of the East Indian community.

Social life among females aged seventy five and over in Barbados

A gerontological study in Barbados with specific reference to women, principally concerned with the socio-economic and psychological circumstances of the group. Examined by random sampling, their social relationships, health conditions, retirement, nutrition, employment and attitudes to death. Compares major demographic attributes of the sample to the total elderly proportions. These include: occupational class, marital status, living status, educational attainment, and income source. Findings support that lack of social care and the cost of living are the main concerns of the group. Conclusions highlighted specific areas of disadvantage and dislocation and bear out the view that the circumstances of the group deteriorate rapidly in the latter years of old age. (AU)

Social integration of the physically disabled in Barbados

An emergent concern with the rehabilitation and social integration of disabled people in developing nations has created a need to identify cultural beliefs and behaviours which may affect the integration of the disabled into normative social roles. The focus of this study is the social integration of physically disabled adults among the nonelite, coloured population of Barbados, West Indies. This paper analysed the role participation of 30 physically disabled adults within the context of Barbadian beliefs and behaviours related to the disabled and to the 'normal' adult. Although village Barbadians do not expect the physically disabled to fulfill normative roles, some disabled individuals in this study do perform adult activities, such as maintaining employment and engaging in sexual relationships. However, very few of them participate in the reciprocal relationships among peers and neighbours through which village Barbadians achieve status and 'respect' as adults. (AU)