A cohort study of the effects of older adult care dependence upon household economic functioning, in Peru, Mexico and China.

BACKGROUND: While 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. METHODS: Households 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). RESULTS: Household 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. CONCLUSIONS: 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. 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.

A journey without maps-Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru.

PURPOSE OF THE STUDY: Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability. DESIGN & METHODS: We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person. RESULTS: Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a 'journey without maps'. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched. IMPLICATIONS: Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation.

Turning points and advanced family cycles: aging effect in Mexican homes.

Aging in Mexico is a process with several effects in the families and homes. However, the presence of older members in Mexican families has been scarcely analyzed. In this paper we reflect on the experiences of homes with advanced life cycles when turning points happen, such as widowhood, retirement, empty nest stage and when chronic diseases appear, as well as caring processes and family and social networks weakening, and social and institutional support diminution. We analyze some data from the National Survey on Health and Aging in Mexico (Enasem, 2001) considering the gender differences and, specially, health condition of elder people.

[Mexico and the State of Guanajuato: Intergenerational transfers to the elderly]. / MÉXICO Y ESTADO DE GUANAJUATO: TRANSFERENCIAS INTERGENERACIONALES HACIA LOS ADULTOS MAYORES.

In Mexico, there is a range of formal and informal transfers to help older adults. This paper analyses national trends and the results of a study focused on the federal entity of Guanajuato. The distribution of the support provided confirms that the transfers made by the social security system have an urban bias and that formal transfers from the federal government are oriented to the least urban areas, and especially rural areas. Despite the existence of formal transfers (which are irregular and insufficient), the economic and health needs of older adults remain unmet and, as a result, their relatives make informal transfers. In Mexico, and more specifically in Guanajuato, those who live with older adults provide a very significant amount of support, whereas those who have migrated do not. On the basis of this material, we analyse of the role played by descendants, according to their cohort and migration status. In any case, it is clear that there the dynamics of intergenerational transfers are different in each national entity.

Receipt of assistance and extended family residence among elderly men in Mexico.

This article focuses on help received by a nationally-representative sample of 2,376 Mexican men age 60+ in 1994. In the month before the interview, about one-half of the men received in-kind or domestic assistance, two-fifths received financial assistance, and about one-fourth received physical assistance. This was so even as almost half the men still worked, and over half (57%) had no discernable functional limitation. Using logistic regression, the study found support for the common assumption that living arrangements are an important predictor of assistance. Other factors are important too however. In fact, many elders received help from non-coresiding relatives. Beside financial remittances, help from non-coresiding relatives included in-kind, domestic, and physical assistance. Research on Mexico suggests that we need to revisit notions of a modified extended family in which non-coresidential ties can be important. Surveys need questions about frequency of contact and geographic distance between elderly people and their kin.