Cross-national comparison of disability in Latin American and Caribbean persons aged 75 and older
Introduction
Studies in the U.S. show a gradient of risk between older age and disability. Schiller and Bernadel (2004) estimate that about 3–6% of persons aged 65–74 have difficulty with at least one instrumental activity of daily living (IADL) or activity of daily living (ADL), and that this percentage more than triples to 10–20% in those aged 75 and older. Studies also show that disability in older age is associated with increased risk of hospitalization, co-morbidity and death (Guralnik et al., 1994, Andino et al., 1995, Corti et al., 1996, Ferrucci et al., 1997, Marin et al., 1998, Ramos et al., 2001, Lee and Shinkai, 2003).
In contrast to the U.S., information on disability, its prevalence and associations with health outcomes in Latin America and the Caribbean is limited (Palloni et al., 2002). Research does, however, indicate high rates of disability in persons aged 60 and older. Coelho-Filho and Ramos (1999) reported that 47.7% of Brazilian adults aged 60 and older had at least one IADL or ADL impairment. In an ambulatory group of Chilean geriatric patients, Diaz et al. (2003) found 11% had ADL impairment and 41% IADL impairment. In a study of Cuban adults aged 60 and older 44.5% reported ADL or IADL impairment (Tello-Velazquez et al., 2001).
During the next 2–3 decades disability rates are projected to substantially increase in Latin America and the Caribbean (Serow and Cowart, 1998, Palloni et al., 2002, Brea, 2003). Factors that may contribute to higher future disability rates include fertility declines, an aging population and increased length of life. The United Nations estimates from 2000 to 2030 fertility rates will decline by 16% in Latin American countries and by 9% in Caribbean countries (Naciones Unidas, 2003). World Health Organization (1998) estimates that the number of persons aged 60 and older in Latin America will increase by about 300% during the next three decades. The United Nations also estimates that length of life will increase over the next 30 from 71.9 to 76.7 years in Latin American countries and from 73.4 to 76.6 in Caribbean countries (Naciones Unidas, 2003).
Acquiring basic information on disability will be vital in planning disability-related policy and developing long-term health strategies in Latin America and the Caribbean (Pelaez, 2003). To better understand the needs of this region of the world Pan American Health Organization (1997) has called for cross national comparisons of disability among the older adults of Latin America and the Caribbean: “A comparative data collection project about health status and conditions of older persons is invaluable for scientific and policy purposes”. The importance of cross-national studies also has been argued by a special National Research Council (2001) panel, which stated that “Cross-national studies conducted within a framework of comparable measurement can be a substantially more useful tool for the analysis of policy impact than studies of single countries.”
The goal of the current study was two-fold: (1) compare rates of IADL and ADL difficulties in Latin American and Caribbean countries in those aged 75 and older; and (2) examine sociodemographic and health correlates of IADL and ADL difficulties. Information was from the SABE databases.
Section snippets
Data sources
Data are from the first interview of SABE (Pelaez et al., 2003). The SABE consisted of a round of cross-sectional surveys and includes information on 10,970 men and women aged 60 and older from the cities of seven Latino American and Caribbean countries during 1999–2000. The seven cities included: Buenos Aires, Argentina (n = 1043), Bridgetown, Barbados (n = 1812), Sao Paulo, Brazil (n = 2143), Santiago, Chile (n = 1306), Havana, Cuba (n = 1905), Mexico City, Mexico (n = 1311), and Montevideo, Uruguay (n =
Results
Table 1 presents sociodemographic and health characteristics of Latin American and Caribbean older adults (aged ≥75). Most were aged 75–79, women, ever married, and reported six or fewer years of schooling. The highest percentage of obesity (BMI ≥ 30) was in Montevideo (34.5%) and the lowest was in Havana (9.4%); Havana (47.4%) had the greatest number of persons reporting two or more medical conditions, and Mexico City had the fewest number of persons reporting two or more medical conditions
Discussion
The goal of the study was to examine associations between disability and sociodemographic and health characteristics in a sample of Latin American and Caribbean subjects aged 75 and older. The cross-national analysis follows a recommendation made by Pan American Health Organization (1997) and by National Research Council (2001). Our findings can be summarized as follows. First, disability (IADL and ADL) increased with age, was greater for women than men, and was associated with fewer years of
Acknowledgements
This study was supported in part by Grant P50 CA105631 (UTMB Center for Population Health and Health Disparities) funded by the National Institute of Health and National Cancer Institute (C.A. Reyes-Ortiz), by Grant K02-AG019736 Independent Scientist Award (K.J. Ottenbacher), and by Grant from the Pan American Health Organization (G.V. Ostir).
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