Comparison of frailty determinants in Latin America: a national representative study in Brazil and Chile.

OBJECTIVE: This study aimed to compare the prevalence and socio-economic determinants of frailty in older adults in Brazil and Chile using nationally representative survey data. STUDY DESIGN: Analytical research using data from the Brazilian Longitudinal Study of Aging (ELSI) and the Chilean National Health Survey (ENS) conducted in Brazil and Chile between 2015 and 2017. METHODS: The study included 5484 older adults aged 60 years or older in Brazil and 2031 in Chile. Frailty was measured using the FRAIL index, and logistic regression models were used to identify the determinants of frailty. RESULTS: The prevalence of frailty is 15.6% and 12.6% in Brazil and Chile, respectively. Frailty is associated with several factors, including age, sex, living alone, residing in urban areas, and decreased life satisfaction. However, the analysis revealed notable differences between countries. A greater number of significant variables were associated with frailty in Brazil, whereas Chile displayed fewer categories with significant odds. Health insurance had no significant effect in either of the two countries. CONCLUSIONS: The limitations in data sources and methodologies make it challenging to compare frailty determinants in Latin America. This study overcomes these barriers and shows that, even within the same region, significant differences exist. Levels and characteristics that are important in one country may not be so in another. The results emphasize the need to consider contextual factors in the implementation of emerging social and healthcare policies, such as home-based long-term care.

Impact Evaluation of Cash-For-Care in Latin America's New Long-Term Care Policies: A Randomized Controlled Trial Pilot Study in Costa Rica.

Latin America is aging rapidly. Thus, governments in the region are reformulating their social protection policies. In 2022, Costa Rica passed a national long-term care law. A discussion developed on how to provide such care, whether through public or private in-kind benefits or cash-for-care (CfC) to beneficiaries. CfC has been used in developed countries with various outcomes. However, there are still no evaluations of its effects in middle-income countries. The objective of this study was to evaluate the impact of CfC pilot study on female caregivers in a middle-income country. The expectations of the program were to find positive effects of CfC on caregivers. After conducting a literature review, we developed four domains of analysis: labor market participation, time for personal activities, use of CfC, and caregiver burnout. The results indicate that CfC has no significant impact on caregivers' integration into the labor market, or ability to have leisure time. However, there was a positive effect on the funding of basic needs and mitigation of factors predicting burnout.

Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica.

The aging of the world's population is a reality. People are living longer, not just in high-income countries, but it remains unclear whether their extra years will be lived in better health. In fact, an increasing number of older adults will probably require help to perform activities of daily living. Within the framework of its Global Strategy and Action Plan on Ageing and Health, the World Health Organization has called on all countries to create suitable and equitable long-term care systems that meet the needs of older people. The challenge is particularly acute in Latin America. The region is aging faster than other areas in the world, and its less-prepared social protection systems suffer from limited economic resources. Costa Rica is one the first middle-income countries to create a national long-term care system. This article describes the main characteristics of this system and discusses it from an international perspective. The results show that it has been designed to prioritize severity of dependency and cost containment, and to reinforce the formalization of care. The outcome of its implementation will affect the decisions of neighboring countries and those with similar economic conditions concerning the development of their own long-term care systems.

O desafio de envelhecer na América Latina: cuidados prolongados na Costa Rica / The challenge of ageing in Latin America: long-term care in Costa Rica

Resumo Embora políticas públicas de cuidados prolongados estejam começando a ser implementadas na América Latina, poucos estudos analisam a situação dos países que compõem a região. Este estudo tem por objetivo examinar programas públicos de cuidados prolongados na Costa Rica e estimar a demanda do país por cuidados formais. Os dados foram obtidos por meio de revisão das Contas Nacionais de Saúde, cinco entrevistas com representantes de instituições governamentais, revisão da literatura científica e relatórios oficiais, e análise dos dados extraídos de uma pesquisa nacional de cuidados. Os resultados indicam a existência de programas fragmentados e focados no enfrentamento à pobreza que não foram projetados para atender às necessidades de cuidados prolongados. Estima-se que, atualmente, 13,4% dos idosos da região necessitam de ajuda na execução de atividades básicas da vida diária, e que o trabalho informal de cuidados é intensivo, oferecido principalmente por um membro da família, e não remunerado.

Abstract Latin America is beginning to implement long-term care public policies. But only a few studies look at the situation of the countries in the region. This study aims to examine long-term care public programs in Costa Rica and to estimate the country's demand for formal care. For this purpose, we have revised its National Health Accounts, conducted five interviews with representatives of governmental institutions, reviewed the scientific literature and official reports, and analyzed the data drawn from a national care survey. The results show the existence of fragmented, poverty-focused programs that were not designed for long-term care needs. The estimated percentage of older adults in the region that currently require help to perform activities of daily living is 13.4%. The informal care work is intensive, mostly provided by a family member, and unpaid.

[Long-term care in Costa Rica: Lessons for Latin America based on international evidenceCuidados de longa duração na Costa Rica: aprendizados para a América Latina partindo de evidências internacionais]. / Cuidados de larga duración en Costa Rica: enseñanzas para América Latina desde la evidencia internacional.

The growing prevalence of functional dependency as a result of accelerated aging and epidemiological transformation has created a pressing need to implement new systems to address the problem of long-term care (LTC) in the Region of the Americas. In March 2021, Costa Rica became the only middle-income country in the Region that has taken steps to introduce a national LTC system. The present article compares the design of this new LTC system with existing systems in Australia, Denmark, Japan, Spain, the United States of America, and Uruguay, and identifies useful lessons for the development of LTC systems in other countries of the Region. Four aspects are analyzed: the legal framework, access and coverage, types of services, and costs and financing. A search of the scientific literature and national and international reports was conducted between 1 January 2000 and 1 April 2021. The results showed that the incipient Costa Rican model follows the main trends that are seen internationally. It is progressively universal, prioritizes home care, incorporates technology tools, creates parameters for measuring the quality of services, provides monetary transfers for family members who serve as caregivers, includes respite services, and offers training for caregivers. At the same time, however, the international evidence shows that models with poor levels of funding have low coverage and offer little diversity in terms of the services provided. Insufficient funding, absence of new economic resources, and weak legal foundations are jeopardizing the expansion, development, and sustainability of the new model in the Americas.

A crescente prevalência de dependência funcional derivada do envelhecimento acelerado e da transformação epidemiológica torna inevitável a implementação de novos sistemas de cuidados de longa duração (CLD) na Região das Américas. Em março de 2021, a Costa Rica se transformou no único país de renda média na Região que iniciou a aplicação de um sistema nacional desse tipo. Neste artigo, compara-se o desenho do novo sistema de cuidados de longa duração da Costa Rica com os sistemas da Austrália, Dinamarca, Espanha, Estados Unidos da América, Japão e Uruguai, e se identificam aprendizados úteis para o desenvolvimento de outros sistemas de CLD na Região. São analisados quatro aspectos: o marco legal, o acesso e a cobertura, os tipos de serviço, os custos e o financiamento. Para isso, foi realizada uma revisão da bibliografia científica e de relatórios nacionais e internacionais entre 1º de janeiro de 2000 e 1º de abril de 2021. O modelo inicial segue as principais tendências da experiência internacional. É progressivamente universal, prioriza a atenção domiciliar, inclui ferramentas tecnológicas, cria parâmetros de qualidade para os serviços, incorpora transferências monetárias para familiares que atuam como cuidadores, inicia serviços de cuidados intermitentes e desenvolve formação para cuidadores. No entanto, a evidência internacional mostra que os modelos com menor financiamento têm baixa cobertura e pouca diversidade de serviços. A escassa generosidade fiscal, a ausência de novas fontes de recursos econômicos e a vulnerabilidade jurídica colocam em risco a ampliação, o desenvolvimento e a sustentabilidade do novo modelo nas Américas.

Cuidados de larga duración en Costa Rica: enseñanzas para América Latina desde la evidencia internacional

[RESUMEN]. La creciente prevalencia de dependencia funcional derivada del envejecimiento acelerado y la transformación epidemiológica hace inevitable la implementación de nuevos sistemas de cuidados de larga duración (CLD) en las Américas. En marzo del 2021, Costa Rica se convirtió en el único país de ingresos medios en la Región que ha iniciado la aplicación de un sistema nacional de este tipo. En este artículo se compara el diseño del nuevo sistema de cuidados de larga duración de Costa Rica, con los sistemas de Australia, Dinamarca, España, Estados Unidos de América, Japón y Uruguay, y se identifican enseñanzas útiles para el desarrollo de otros sistemas de CLD en la Región. Se analizan cuatro aspectos: el marco legal, el acceso y la cobertura, los tipos de servicios, y los costos y la financiación. Para ello se realizó una revisión de la bibliografía científica y de informes nacionales e internacionales entre el 1 de enero del año 2000 y el primer día de abril del año 2021. El incipiente modelo sigue las principales tendencias de la experiencia internacional. Es progresivamente universal, prioriza la atención domiciliaria, incluye herramientas tecnológicas, crea parámetros de calidad para los servicios, incorpora transferencias monetarias para familiares que se desempeñan como cuidadores, inicia servicios de respiro y desarrolla formación para personas cuidadoras. No obstante, la evidencia internacional muestra que los modelos con menor financiamiento tienen baja cobertura y poca diversidad en servicios. La escasa generosidad fiscal, la ausencia de nuevas fuentes de recursos económicos y la debilidad jurídica arriesgan la ampliación, desarrollo y sostenibilidad del nuevo modelo en las Américas.

[ABSTRACT]. The growing prevalence of functional dependency as a result of accelerated aging and epidemiological transformation has created a pressing need to implement new systems to address the problem of long-term care (LTC) in the Region of the Americas. In March 2021, Costa Rica became the only middle-income country in the Region that has taken steps to introduce a national LTC system. The present article compares the design of this new LTC system with existing systems in Australia, Denmark, Japan, Spain, the United States of America, and Uruguay, and identifies useful lessons for the development of LTC systems in other countries of the Region. Four aspects are analyzed: the legal framework, access and coverage, types of services, and costs and financing. A search of the scientific literature and national and international reports was conducted between 1 January 2000 and 1 April 2021. The results showed that the incipient Costa Rican model follows the main trends that are seen internationally. It is progressively universal, prioritizes home care, incorporates technology tools, creates parameters for measuring the quality of services, provides monetary transfers for family members who serve as caregivers, includes respite services, and offers training for caregivers. At the same time, however, the international evidence shows that models with poor levels of funding have low coverage and offer little diversity in terms of the services provided. Insufficient funding, absence of new economic resources, and weak legal foundations are jeopardizing the expansion, development, and sustainability of the new model in the Americas.

[RESUMO]. A crescente prevalência de dependência funcional derivada do envelhecimento acelerado e da transformação epidemiológica torna inevitável a implementação de novos sistemas de cuidados de longa duração (CLD) na Região das Américas. Em março de 2021, a Costa Rica se transformou no único país de renda média na Região que iniciou a aplicação de um sistema nacional desse tipo. Neste artigo, compara-se o desenho do novo sistema de cuidados de longa duração da Costa Rica com os sistemas da Austrália, Dinamarca, Espanha, Estados Unidos da América, Japão e Uruguai, e se identificam aprendizados úteis para o desenvolvimento de outros sistemas de CLD na Região. São analisados quatro aspectos: o marco legal, o acesso e a cobertura, os tipos de serviço, os custos e o financiamento. Para isso, foi realizada uma revisão da bibliografia científica e de relatórios nacionais e internacionais entre 1º de janeiro de 2000 e 1º de abril de 2021. O modelo inicial segue as principais tendências da experiência internacional. É progressivamente universal, prioriza a atenção domiciliar, inclui ferramentas tecnológicas, cria parâmetros de qualidade para os serviços, incorpora transferências monetárias para familiares que atuam como cuidadores, inicia serviços de cuidados intermitentes e desenvolve formação para cuidadores. No entanto, a evidência internacional mostra que os modelos com menor financiamento têm baixa cobertura e pouca diversidade de serviços. A escassa generosidade fiscal, a ausência de novas fontes de recursos econômicos e a vulnerabilidade jurídica colocam em risco a ampliação, o desenvolvimento e a sustentabilidade do novo modelo nas Américas.

Population with Long-Term Care Needs in Six Latin American Countries: Estimation of Older Adults Who Need Help Performing ADLs.

The population in Latin America is ageing, and there is an inevitable demand for long-term care services. However, there are no comparative analyses between Latin American countries of the dependency situation of older adults. This study aims to calculate and compare percentages of older adults who need help performing the activities of daily living in six Latin American nations. The study is observational, transversal, and cross-national and uses microdata drawn from national surveys conducted in Argentina (n = 3291), Brazil (n = 3903), Chile (n = 31,667), Colombia (n = 17,134), Mexico (n = 7909), and Uruguay (n = 4042). Comparable indicators of the need for help in performing the basic and instrumental activities of daily living were calculated. The percentages of older adults in need of help for basic activities of daily living ranged from 5.8% in Argentina to 11% in Brazil; for instrumental activities of daily living, from 13.8% in Mexico to 35.7% in Brazil; and combined, from 18.1% in Argentina to 37.1% in Brazil. Brazil thus has the highest indicators, followed by Colombia. The results warn of the frail physical condition of older people and the high potential demand for long-term care services. The information provided could be useful for further research on and planning for long-term care needs in Latin American and middle-income countries.