Comparing cost and acceptability two instruments to measure instrumental activities of daily living in older people in Chile.

INTRODUCTION: Population aging and increasing in long-term care needs call for designing and implementing better tools for assessing functional ability. In Chile, the Lawton & Brody (L&B) scale is used for identifying limitations with instrumental activities. This study compares the costs and acceptability of the L&B with a new instrument to measure IADL: the Instrument for the Assessment of Functionality Stages (IDEEF). METHODS: Phone surveys were carried out to apply the L&B and the IDEEF to a sample of 200 older people (60+) participating in public programs for older people in the Metropolitan Region, Chile. Besides the items assessed by each scale, the survey captured completion times and included a short questionnaire on acceptability, data that allowed comparisons between instruments. RESULTS: On average, the L&B takes around 4 minutes to be applied; the completion times for the IDEEF are four times longer. However, the IDEEF performs better in terms of acceptability and has neither gender bias nor dependency bias. CONCLUSION: Both instruments have pros and cons but the IDEEF appears as a feasible alternative to the L&B to improve the assessment of IADL in the country.

The Case for Universal Long-Term Care.

Long-term care (LTC) is one of the most pressing public policy challenges today. Implementing policies to meet the population's demands becomes relevant in many countries, particularly in a context of rapid population aging. Both the technical complexities and the financial burden of implementing LTC policies discourage policy makers' actions in this area. In this environment, targeted policies arise as a solution to reduce the cost of implementing LTC policies. This article presents several arguments in favor of implementing universal-vs targeted-LTC initiatives. Arguments are divided into general arguments against targeting public policies, using categories proposed by Amartya Sen, and LTC-specific arguments, based on the concept of LTC as social security. Information shows that despite the financial arguments in favor of targeted policies, in the case of LTC, its costs may overcome the benefits. These results provide important lessons for policy makers, particularly regarding the design of (universal) LTC policies, warning that the allegedly simple solution of targeting benefits needs to be revisited, and replaced for policies that could balance universalism and resource constraints. This message is particularly important today for countries that face the challenge of increasing LTC needs and tighter resource constraints.

How Do Attitudes of Adult Children Toward Long-Term Care Change with Education? International Evidence.

Global demographic trends indicate that the world population is aging and education acquisition is increasing. For the first time in history, people are expected to spend more years as adults with living parents than as a parent of teenage children, and the average years of schooling have increased dramatically over the past several decades for many countries. Additionally, family-provided care is still the most important form of care to meet care demands worldwide. As strong filial norms could affect older adults' long-term care decision-making, understanding the link between filial obligations and education is critical under these trends. Using individual data from the World Values Survey and an instrumental variables strategy to account for endogeneity, this study finds that adult children with higher education levels have lower filial beliefs. Since population aging is expected to increase the demand for long-term care services, and education can reduce the supply of family-provided long-term care services, countries must start addressing this gap.

Institutional care in four Latin American countries: the importance of fostering public information and evaluation strategies / Atención en centros de cuidados a largo plazo en cuatro países de América Latina: importancia de fomentar la información pública y las estrategias de evaluación / Cuidados institucionais em quatro países da América Latina: a importância de promover informações públicas e estratégias de avaliação

[ABSTRACT]. More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for data- driven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.

[RESUMEN]. En América Latina, más de 8 millones de personas mayores dependen de los cuidados a largo plazo (CLP), lo que representa el 12% de las personas de 60 años o más y casi el 27% de las de 80 años o más Resulta crucial elaborar estrategias sostenibles para la prestación de CLP en la región, incluida la atención en centros de CLP. Este artículo especial tiene como finalidad determinar las características de la atención prestada en centros de CLP en cuatro países (Brasil, Chile, Costa Rica y México), utilizando los sistemas de información disponibles, así como determinar cuáles son las estrategias adoptadas en estos países para brindar apoyo a la atención en centros de CLP. En esta revisión descriptiva se utilizaron fuentes de datos públicas, de libre acceso y de ámbito nacional para recopilar estimaciones demográficas e información sobre la cobertura de la atención en centros de CLP, así como sobre la disponibilidad de datos de libre acceso acerca de la pro- porción de personas con necesidades de CLP, el número de centros de CLP y su correspondiente número de residentes. Estos países tienen una proporción de personas mayores superior a la media de América Latina, pero menos centros de CLP de los necesarios para cubrir la demanda. En las encuestas nacionales no hay una definición estandarizada de la discapacidad, los cuidados a largo plazo y la dependencia. La mayor parte de la información sobre la atención en centros de CLP está fragmentada y no incluye datos periódicos sobre los centros de CLP existentes, sus residentes o sus trabajadores. Estos datos son cruciales para funda- mentar decisiones basadas en la evidencia destinadas a propiciar la priorización y brindar apoyo a los avances en la promoción de políticas en materia de centros de CLP en América Latina. Aunque la información sobre la atención en centros de CLP en la región es fragmentaria e insuficiente, en este artículo se presenta el perfil de los cuatro países seleccionados. Se resalta la necesidad de mejorar la estructura de los sistemas de información sobre CLP basados en datos. Esta falta de información pone de relieve la necesidad urgente de centrarse en este tema y fomentar la investigación al respecto.

[RESUMO]. Na América Latina, mais de 8 milhões de pessoas idosas dependem de cuidados de longa duração (CLD), o que representa 12% das pessoas com mais de 60 anos e quase 27% das pessoas com mais de 80 anos. É fundamental criar estratégias sustentáveis para oferecer CLD na região, inclusive cuidados institucionais. O objetivo deste relatório especial é caracterizar CLD institucionais em quatro países (Brasil, Chile, Costa Rica e México), usando os sistemas de informação disponíveis, e identificar as estratégias adotadas para apoiar os cuidados institucionais nesses países. Esta revisão narrativa usou dados públicos de acesso aberto de âmbito nacional para coletar estimativas demográficas e informações sobre a cobertura de CLD institucio- nais e a disponibilidade de dados de acesso aberto sobre a porcentagem de pessoas com necessidades de CLD, o número de instituições de CLD e o número de residentes nessas instituições. Esses países têm uma parcela maior de pessoas idosas do que a média da América Latina, mas menos instituições de CLD do que a demanda exige. Falta padronização na definição de incapacidade, CLD e dependência de cuidados nas pesquisas nacionais. Em sua maior parte, as informações sobre cuidados institucionais são fragmen- tadas e não incluem instituições de CLD, seus residentes e trabalhadores de maneira regular. É essencial usar dados para guiar decisões baseadas em evidências a fim de favorecer a priorização e apoiar avanços que promovam políticas para CLD institucionais na América Latina. Embora as informações sobre cuidados institucionais na região sejam fragmentadas e insuficientes, este documento traça o perfil dos quatro países selecionados, destacando a necessidade de uma estrutura melhor para sistemas de informações de CLD orientados por dados. A falta de informações ressalta a urgência de aumentar o foco no tópico e encorajar pesquisas sobre o assunto.

Institutional care in four Latin American countries: the importance of fostering public information and evaluation strategies.

More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for data-driven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.

En América Latina, más de 8 millones de personas mayores dependen de los cuidados a largo plazo (CLP), lo que representa el 12% de las personas de 60 años o más y casi el 27% de las de 80 años o más Resulta crucial elaborar estrategias sostenibles para la prestación de CLP en la región, incluida la atención en centros de CLP. Este artículo especial tiene como finalidad determinar las características de la atención prestada en centros de CLP en cuatro países (Brasil, Chile, Costa Rica y México), utilizando los sistemas de información disponibles, así como determinar cuáles son las estrategias adoptadas en estos países para brindar apoyo a la atención en centros de CLP. En esta revisión descriptiva se utilizaron fuentes de datos públicas, de libre acceso y de ámbito nacional para recopilar estimaciones demográficas e información sobre la cobertura de la atención en centros de CLP, así como sobre la disponibilidad de datos de libre acceso acerca de la proporción de personas con necesidades de CLP, el número de centros de CLP y su correspondiente número de residentes. Estos países tienen una proporción de personas mayores superior a la media de América Latina, pero menos centros de CLP de los necesarios para cubrir la demanda. En las encuestas nacionales no hay una definición estandarizada de la discapacidad, los cuidados a largo plazo y la dependencia. La mayor parte de la información sobre la atención en centros de CLP está fragmentada y no incluye datos periódicos sobre los centros de CLP existentes, sus residentes o sus trabajadores. Estos datos son cruciales para fundamentar decisiones basadas en la evidencia destinadas a propiciar la priorización y brindar apoyo a los avances en la promoción de políticas en materia de centros de CLP en América Latina. Aunque la información sobre la atención en centros de CLP en la región es fragmentaria e insuficiente, en este artículo se presenta el perfil de los cuatro países seleccionados. Se resalta la necesidad de mejorar la estructura de los sistemas de información sobre CLP basados en datos. Esta falta de información pone de relieve la necesidad urgente de centrarse en este tema y fomentar la investigación al respecto.

Na América Latina, mais de 8 milhões de pessoas idosas dependem de cuidados de longa duração (CLD), o que representa 12% das pessoas com mais de 60 anos e quase 27% das pessoas com mais de 80 anos. É fundamental criar estratégias sustentáveis para oferecer CLD na região, inclusive cuidados institucionais. O objetivo deste relatório especial é caracterizar CLD institucionais em quatro países (Brasil, Chile, Costa Rica e México), usando os sistemas de informação disponíveis, e identificar as estratégias adotadas para apoiar os cuidados institucionais nesses países. Esta revisão narrativa usou dados públicos de acesso aberto de âmbito nacional para coletar estimativas demográficas e informações sobre a cobertura de CLD institucionais e a disponibilidade de dados de acesso aberto sobre a porcentagem de pessoas com necessidades de CLD, o número de instituições de CLD e o número de residentes nessas instituições. Esses países têm uma parcela maior de pessoas idosas do que a média da América Latina, mas menos instituições de CLD do que a demanda exige. Falta padronização na definição de incapacidade, CLD e dependência de cuidados nas pesquisas nacionais. Em sua maior parte, as informações sobre cuidados institucionais são fragmentadas e não incluem instituições de CLD, seus residentes e trabalhadores de maneira regular. É essencial usar dados para guiar decisões baseadas em evidências a fim de favorecer a priorização e apoiar avanços que promovam políticas para CLD institucionais na América Latina. Embora as informações sobre cuidados institucionais na região sejam fragmentadas e insuficientes, este documento traça o perfil dos quatro países selecionados, destacando a necessidade de uma estrutura melhor para sistemas de informações de CLD orientados por dados. A falta de informações ressalta a urgência de aumentar o foco no tópico e encorajar pesquisas sobre o assunto.

Human Resources for Care in Latin America and the Caribbean: Current Needs and Future Demands.

OBJECTIVES: To estimate the current gap and the necessary supply of human resources for care (HRC) for older people experiencing severe care dependence in Latin America and the Caribbean (LAC). DESIGN: Simulation study using previous estimations of severe care dependence for LAC countries. SETTING AND PARTICIPANTS: Older people (aged 65+) experiencing severe care dependence in 26 countries of LAC. METHODS: We calculated the current gap and the necessary supply of HRC in 2020, 2035, and 2050 assuming a mix of complementary human resources, in line with regional standards for long-term care (LTC) schemes, and differing levels of care coverage. RESULTS: Considering 100% coverage of LTC services for the population aged 65+ experiencing severe care dependence, the region will need almost 5 million people working full-time in the sector. This figure is expected to increase to more than 14 million by 2050. Nurse assistants and nurses will be the professional profiles in highest demand. In addition, the region requires 2 million rehabilitation professionals in 2020, and this figure will increase to more than 6 million in 2050. CONCLUSIONS AND IMPLICATIONS: The rapid aging process in LAC will bring several challenges and opportunities to the region. Countries should start designing strategies to reduce the current gaps of HRC to meet older people's care needs in the coming years, in terms of both quantity and competencies, to help ensure that their human rights are met.

Institutional care in four Latin American countries: the importance of fostering public information and evaluation strategies / Atención en centros de cuidados a largo plazo en cuatro países de América Latina: importancia de fomentar la información pública y las estrategias de evaluación / Cuidados institucionais em quatro países da América Latina: a importância de promover informações públicas e estratégias de avaliação

ABSTRACT More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for data-driven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.

RESUMEN En América Latina, más de 8 millones de personas mayores dependen de los cuidados a largo plazo (CLP), lo que representa el 12% de las personas de 60 años o más y casi el 27% de las de 80 años o más Resulta crucial elaborar estrategias sostenibles para la prestación de CLP en la región, incluida la atención en centros de CLP. Este artículo especial tiene como finalidad determinar las características de la atención prestada en centros de CLP en cuatro países (Brasil, Chile, Costa Rica y México), utilizando los sistemas de información disponibles, así como determinar cuáles son las estrategias adoptadas en estos países para brindar apoyo a la atención en centros de CLP. En esta revisión descriptiva se utilizaron fuentes de datos públicas, de libre acceso y de ámbito nacional para recopilar estimaciones demográficas e información sobre la cobertura de la atención en centros de CLP, así como sobre la disponibilidad de datos de libre acceso acerca de la proporción de personas con necesidades de CLP, el número de centros de CLP y su correspondiente número de residentes. Estos países tienen una proporción de personas mayores superior a la media de América Latina, pero menos centros de CLP de los necesarios para cubrir la demanda. En las encuestas nacionales no hay una definición estandarizada de la discapacidad, los cuidados a largo plazo y la dependencia. La mayor parte de la información sobre la atención en centros de CLP está fragmentada y no incluye datos periódicos sobre los centros de CLP existentes, sus residentes o sus trabajadores. Estos datos son cruciales para fundamentar decisiones basadas en la evidencia destinadas a propiciar la priorización y brindar apoyo a los avances en la promoción de políticas en materia de centros de CLP en América Latina. Aunque la información sobre la atención en centros de CLP en la región es fragmentaria e insuficiente, en este artículo se presenta el perfil de los cuatro países seleccionados. Se resalta la necesidad de mejorar la estructura de los sistemas de información sobre CLP basados en datos. Esta falta de información pone de relieve la necesidad urgente de centrarse en este tema y fomentar la investigación al respecto.

RESUMO Na América Latina, mais de 8 milhões de pessoas idosas dependem de cuidados de longa duração (CLD), o que representa 12% das pessoas com mais de 60 anos e quase 27% das pessoas com mais de 80 anos. É fundamental criar estratégias sustentáveis para oferecer CLD na região, inclusive cuidados institucionais. O objetivo deste relatório especial é caracterizar CLD institucionais em quatro países (Brasil, Chile, Costa Rica e México), usando os sistemas de informação disponíveis, e identificar as estratégias adotadas para apoiar os cuidados institucionais nesses países. Esta revisão narrativa usou dados públicos de acesso aberto de âmbito nacional para coletar estimativas demográficas e informações sobre a cobertura de CLD institucionais e a disponibilidade de dados de acesso aberto sobre a porcentagem de pessoas com necessidades de CLD, o número de instituições de CLD e o número de residentes nessas instituições. Esses países têm uma parcela maior de pessoas idosas do que a média da América Latina, mas menos instituições de CLD do que a demanda exige. Falta padronização na definição de incapacidade, CLD e dependência de cuidados nas pesquisas nacionais. Em sua maior parte, as informações sobre cuidados institucionais são fragmentadas e não incluem instituições de CLD, seus residentes e trabalhadores de maneira regular. É essencial usar dados para guiar decisões baseadas em evidências a fim de favorecer a priorização e apoiar avanços que promovam políticas para CLD institucionais na América Latina. Embora as informações sobre cuidados institucionais na região sejam fragmentadas e insuficientes, este documento traça o perfil dos quatro países selecionados, destacando a necessidade de uma estrutura melhor para sistemas de informações de CLD orientados por dados. A falta de informações ressalta a urgência de aumentar o foco no tópico e encorajar pesquisas sobre o assunto.

Financing networks of care: a cross-case analysis from six countries.

OBJECTIVES: Describe experiences of countries with networks of care's (NOCs') financial arrangements, identifying elements, strategies and patterns. DESIGN: Descriptive using a modified cross-case analysis, focusing on each network's financing functions (collecting resources, pooling and purchasing). SETTING: Health systems in six countries: Argentina, Australia, Canada, Singapore, the United Kingdom and the USA. PARTICIPANTS: Large-scale NOCs. RESULTS: Countries differ in their strategies to implement and finance NOCs. Two broad models were identified in the six cases: top-down (funding centrally designed networks) and bottom-up (financing individual projects) networks. Despite their differences, NOCs share the goal of improving health outcomes, mainly through the coordination of providers in the system; these results are achieved by devoting extra resources to the system, including incentives for network formation and sustainability, providing extra services and setting incentive systems for improving the providers' performance. CONCLUSIONS: Results highlight the need to better understand the financial implications and alternatives for designing and implementing NOCs, particularly as a strategy to promote better health in low- and middle-income settings.

The Economic Value of Caregiving in Chile.

Population aging will increase the demand for long-term care services. Many countries, including Chile, have not implemented comprehensive responses to address these demands, relying on informal care. This article aims to estimate the economic value of caregiving in Chile, contributing to filling a gap in the literature and the policy debate. Economic value is estimated using replacement and opportunity cost approaches using two nationally representative databases: one survey on time use (to estimate hours of caregiving) and one on socioeconomic characterization (to identify caregivers and wages). Regressions for the determinants of caregiving effort and wages in the formal labor market are used to calculate the market value of caregiving time. Results show that the yearly value of caregiving ranges between US$266 million (when assuming a wage equal to the minimum wage for all caregivers) and US$4,946 million (when replacing all caregivers with nurses), i.e. between 0.11% and 1.95% of the country's gross domestic product. The analysis provides several estimations of the economic value of caregivers in Chile and, even considering these calculations can be underestimated, the results show the need to highlight and value the contribution of caregivers and implement policies to address the increase in long-term care needs in the country.

Inequity in mortality rates and potential years of life lost caused by COVID-19 in the Greater Santiago, Chile.

Several studies have shown that, in Chile, income inequality is relevant in explaining health inequities. The COVID-19 pandemic has also had a negative impact, with higher mortality rates in those municipalities of Greater Santiago with lower socioeconomic status. We study inequity in mortality based on Potential Years of Life Lost (PYLL) in 34 urban municipalities of the Metropolitan Region (Greater Santiago) and analyze its evolution between 2018 and 2021 and by COVID-19 waves. To compare the results obtained for PYLL, we also computed the mortality rates adjusted by direct standardization. In addition, we used the concentration index (CI) to measure the health inequalities between municipalities. In the first year of the pandemic, the absolute PYLL and the standardized mortality rate for all causes of death showed an increase of 13.6% and 18.9%, respectively. Moreover, 409,086 years of life were prematurely lost in 2020, one-fifth of them due to COVID-19. The concentration indices confirm inequality in both mortality rates and PYLL, where it is more pronounced when calculating the latter measure. Results show that the deaths due to the COVID-19 pandemic affected the most economically disadvantaged municipalities, and particularly young people in those places.

The Impacts of Two Gender-Transformative Interventions on Early Adolescent Gender Norms Perceptions: A Difference-in-Difference Analysis.

PURPOSE: Inequitable gender norms are widespread and can be harmful to the wellbeing of adolescents. This study estimates the effects of two gender-transformative interventions, Semangat Dunia Remaja or Teen Aspirations (SETARA) and Growing Up Great! (GUG!), on gender norms perceptions and attitudes among very young adolescents in poor urban settings in Bandar Lampung, Semarang, Denpasar (Indonesia), and Kinshasa (Democratic Republic of the Congo). METHODS: The study draws from the longitudinal Global Early Adolescent Study, using a quasi-experimental design to evaluate the interventions. Data collection took place between 2017 and 2020. Our analytical samples included 2,159 adolescents in Kinshasa and 3,335 in Indonesia. We conducted a difference-in-difference analysis using generalized estimation equations and generalized linear models, after stratification by site and sex. RESULTS: The interventions shifted a range of gender perceptions, although effects varied by program, city, and sex. SETARA shifted gender-normative perceptions related to traits, roles, and relations, while GUG! effects were more concentrated on attitudes toward chore sharing. SETARA was most effective in Semarang and Denpasar, but not in Bandar Lampung. In addition, both interventions were more consistently effective for girls than boys. DISCUSSION: Gender-transformative interventions can effectively promote gender equality in early adolescence, but effects are program-specific and context-specific. Our findings emphasize the importance of defined theories of change and consistent implementation in gender-transformative intervention.

Long-term functional ability trajectories and mental health among older people before and after the COVID-19 pandemic onset in Chile.

OBJECTIVES: Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people's mental health in Chile, before and after the COVID-19 pandemic onset. METHODS: We use data from the population-representative and longitudinal 'Chilean Social Protection Survey', sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 (N = 891) and late 2020 (N = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46-50, 51-55, 56-60, and 61-65. RESULTS: Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories. CONCLUSIONS: The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.

Estimación de brechas de geriatras en Chile / Estimation of geriatrician gaps in Chile

Antecedentes: el envejecimiento de la población chilena y la transición epidemiológica que atraviesa el país, ha incrementado la necesidad de formar, entre otros especialistas, a médicos geriatras. Objetivo: estimar la brecha de geriatras en Chile de acuerdo con necesidades epidemiológicas de la población de 65 años y más. Método: se realizó una estimación de brecha de horas de geriatra para la red de salud, a partir de una consulta a 57 geriatras de laboralmente activos de un total de 156 geriatras registrados a enero del 2021. En dicha consulta se indagó sobre tiempo de duración de consulta y frecuencia de consultas ideales de acuerdo con la capacidad funcional de las personas mayores a nivel nacional y por región obtenida de la encuesta Casen 2017. Resultados: a febrero del 2022 existe un total de 162 geriatras en Chile, cifra que equivale a un geriatra por cada 15.806 personas de 65 años y más. De acuerdo con la estimación realizada, se requeriría en Chile, un total de 1.244.689 horas de geriatra anual, equivalentes a la existencia de 589 geriatras a nivel nacional. Conclusión: según los resultados del estudio, a nivel nacional se necesitarían de un total de 589 geriatras para cubrir las necesidades de atención de las personas mayores con algún nivel de dependencia. De acuerdo con estas cifras, al primer trimestre del 2022 el país presentaría una brecha de 427 geriatras. Ante lo elevada de esta brecha, se cree necesario avanzar en estrategias de formación general en geriatría y gerontología en los equipos de salud y socio-sanitarios.

Background:The ageing between the Chilean population and the epidemiological transition that the country is going through has increased the need to train, among other specialists, geriatric doctors.Objective: To estimate the gap between geriatricians in Chile according to the epidemiological needs of the population aged 65 years and over. Method:An estimate of the gap in geriatrician hours was made for the health network based on a consultation of 57 active geriatricians out of 156 registered as of January 2021. In this consultation, the duration and frequency of ideal consultations were inquired according to the functional capacity of the elderly at the national level and by region obtained from the Casen 2017 survey.Results: as of February 2022, there are 162 geriatricians in Chile, equivalent to one geriatrician for every 15,806 people aged 65 years and over. According to the estimate, a total of 1,244,689 hours of annual geriatrician would be required in Chile, equivalent to 589 geriatricians nationwide. Conclusion:According to the study's results, at the national level, a total of 589 geriatricians would be needed to cover the care needs of older people with some level of dependen-ce. According to these figures, in the first quarter of 2022, the country would present a gap of 427 geriatricians. Given the highness of this gap, it is believed necessary to advance general training strategies in geriatrics and gerontology in health and socio-health teams

Long-term Care in the Agenda: The Case of Chile.

The Chilean presidential elections of 2021 included an unprecedented topic in the country's political debate: long-term care (LTC). Although some public policies and programs have been in place for at least 20 years, during this 2021 presidential election LTC was mentioned for the first time in a political campaign. Five out of seven candidates highlighted the importance of LTC in their proposals and designed policies to address it. Why did this topic gain momentum as a campaign topic in 2021? What can explain the sudden inclusion of a new topic on the Chilean political agenda? Using Kingdon's multiple streams framework this article aims to understand the factors explaining the inclusion of LTC in the Chilean political agenda during the past presidential elections. A two-step qualitative research design was performed using a case study approach. As a first step, a documentary analysis of the campaign programs was conducted searching for references to LTC proposals. In a second step, semi-structured interviews were carried out with representatives from three of the seven campaign teams, including the teams that reached the ballotage. Data were analyzed using Kingdon's multiple streams framework. Results showed that the availability of national data on LTC needs helped highlight the problem and acted as a facilitator for advocacy; international organizations and other countries' experiences in implementing LTC systems served as policy entrepreneurs; and four events-the feminist movement, the social outbreak with the constitutional process, and the COVID-19 pandemic-pushed LTC forward on the political agenda. The case of Chile illustrates how Kingdon's framework can be used to identify facilitators for LTC inclusion on the political agenda, serving as an example for other countries facing similar issues and fostering the global debate around the increase in LTC needs.

COVID-19 y personas mayores en Chile: lecciones de dos años de pandemia / The impact of COVID-19 on the health status of older people in Chile

The article presents the main impact of COVID-19 pandemic on the health status of older people, systematizing the information about the direct impact of the pandemic in terms of number of cases, hospitalizations, deaths, the policies implemented for the prevention and management of COVID-19 in older people and the indirect impact of the two years of pandemic. Adopting a broad definition of health, the need to monitor and recover health care of older people is highlighted. The recovery of their functionality and mental health must be emphasized. The policies towards institutionalized older people must be revised. These areas should be the focus of health care policies for older people in Chile.

Older Adults' Vigorous Occupational Physical Activity Levels in Six Countries Are Explained by Country and 'Having Multiple Jobs'.

Several studies have compared physical activity (PA) levels between countries, but none of these studies focused on older adults and occupational PA. This study aimed to assess potential inequalities in older adults' occupational PA across six countries and to ascertain whether having multiple jobs is a factor that interacts with country of residence to modify inequalities. This study adopted a cross-sectional design with a statistical technique screening for potential covariates. Older adults (mean age = 64 years; range = 50-114 years) from six countries (Russia, Mexico, China, India, Ghana, and South Africa) participated in the study. We utilised data from the first wave of the Study on Global AGEing and Adult Health (SAGE). These data were collected from 2007 to 2010. A random sample of 34,114 older adults completed the survey. We analysed the data with a two-way multivariate analysis of variance after screening for the ultimate covariates. There were differences in occupational PA levels (i.e., vigorous and moderate PA) among the six countries. Occupational PA levels were not significantly associated with having multiple jobs. However, having multiple jobs interacted with country of residence to influence vigorous occupational PA. Older adults from most countries who had more than one job reported more vigorous occupational PA. Older adults' occupational PA differed among the six countries, and having multiple jobs was associated with more vigorous occupational PA. Older adults who keep multiple jobs at a time may be more active than their counterparts who had one job or were unemployed.

Factors associated with change in adherence to COVID-19 personal protection measures in the Metropolitan Region, Chile.

Personal protective measures such use of face masks, hand washing and physical distancing have proven to be effective in controlling the spread of the Covid-19 pandemic. However, adherence to these measures may have been relaxed over time. The objective of this work is to assess the change in adherence to these measures and to find factors that explain the change For this purpose, we conducted a survey in the Metropolitan Region of Chile in which we asked the adherence to these measures in August-September 2021 and retrospectively for 2020. With the answers obtained we fit a logistic regression model in which the response variable is the relaxation of each of the self-care preventive actions. The explanatory variables used are socio-demographic characteristics such as the age, sex, income, and vaccination status of the respondents. The results obtained show that there has been a significant decrease in adherence to the three personal protection measures in the Metropolitan Region of Chile. In addition, it was observed that younger people are more likely to relax these measures. The results show the importance of generating new incentives for maintaining adherence to personal protection measures.

[Functionality and seniors: where are we and where should we be going?Funcionalidade e pessoas idosas: onde estamos e para onde devemos ir?] / Funcionalidad y personas mayores: ¿dónde estamos y hacia dónde ir?

The process of population aging will lead to an increase in health problems in older people, mainly related to their functionality. Accordingly, the countries of the Region of the Americas must begin to act to meet this challenge. One of the fundamental tasks involves the ability to measure and monitor functionality in the population. The tools used to evaluate functionality focus mainly on the basic activities of daily living, which limits their preventive capacity, since instrumental activities provide a better prognosis. Using the case of Chile, challenges for the Region were identified, mainly related to the advantages of adopting new methodologies that not only evaluate functional capacity, as current strategies do, but also detect its deterioration early and monitor its stages throughout the dependence stage in older people. This will also make it possible to evaluate initiatives for the prevention and management of loss of functionality.

O processo de envelhecimento populacional levará a um aumento de problemas de saúde nas pessoas idosas, principalmente relacionados à sua funcionalidade. Nesse sentido, os países da Região das Américas devem começar a agir para enfrentar esse desafio. Uma das tarefas fundamentais está relacionada à capacidade de medir e monitorar a funcionalidade da população. Os instrumentos utilizados para avaliá-la estão voltados principalmente para as atividades básicas da vida diária, o que limita sua capacidade preventiva, já que são as atividades instrumentais que permitem um melhor prognóstico. Utilizando o caso do Chile, identificamos desafios para a Região, principalmente relacionados às vantagens de incorporar novas metodologias de avaliação da capacidade funcional que não só habilitem as estratégias atuais, mas também detectem precocemente a deterioração da funcionalidade e monitorem suas fases ao longo da dependência das pessoas idosas. Isso permitirá, ao mesmo tempo, avaliar as iniciativas de prevenção e manejo da perda de funcionalidade.

[The impact of COVID-19 on the health status of older people in Chile]. / COVID-19 y personas mayores en Chile: lecciones de dos años de pandemia.

The article presents the main impact of COVID-19 pandemic on the health status of older people, systematizing the information about the direct impact of the pandemic in terms of number of cases, hospitalizations, deaths, the policies implemented for the prevention and management of COVID-19 in older people and the indirect impact of the two years of pandemic. Adopting a broad definition of health, the need to monitor and recover health care of older people is highlighted. The recovery of their functionality and mental health must be emphasized. The policies towards institutionalized older people must be revised. These areas should be the focus of health care policies for older people in Chile.

Functional Dependency in Mexico: Measurement Issues and Policy Challenges.

BACKGROUND: Different definitions have been used to measure functional dependency (FD) in Mexico. This study aims to explore if different definitions of FD lead to low consistency between the estimations of its prevalence. Accurate estimations of FD are useful to estimate the potential demand for long-term care (LTC) services in the country. METHODS: A literature review including documents with estimations on the number or prevalence of dependents in Mexico with national representativeness between 2000 and 2019 was performed as well as estimations of different definitions of FD, using the National Study on Health and Aging in Mexico (ENASEM). RESULTS: There is a lack of consensus on the definition of FD. Among the most frequently used terms to define FD are "disability" and "dependency." The heterogeneity of definitions results in a wide range of estimations of the demand for LTC. Methodological choices can lead to important differences in FD prevalence estimations. Results from ENASEM 2001 show that FD prevalence could range from 13% to 35% in people 60+; sex prevalences also vary when using different ways to measure FD. CONCLUSION: Besides the highlighted issues in calculating FD in the population, Mexico should consider broadening the assessment of FD, including people with dementia and younger populations. Although the literature search is not systematic, it helps exemplifying the current issues when measuring FD in Mexico. A consensual definition of dependency is required to have a more accurate estimated demand for LTC. Having good data sources is not enough when dissimilar estimations of an indicator like dependency result from the same study. Wide heterogeneity in estimations of dependency could be an obstacle to inform public policies during the construction of a care system in Mexico.