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

Abstract

BackgroundWhile 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.MethodsHouseholds 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).ResultsHousehold 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.ConclusionsWhile 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.

Marital Status, Sex and Utilisation of Healthcare Service Among the Older Adults in India

“…Since the life expectancy of women is higher than men in India, it may pose the women a higher risk of ailments and resultant hospitalisation. The studies have reported that household size is associated with the access to inpatient health care services [35][36][37]. Our ndings also indicate that elderly in small family utilise more inpatient health services than the household with big family size.…”

A review of the 10/66 dementia research group

“…The INDEP study was designed to investigate earlier 10/66 findings in more depth across four sites: using mixed methods to explore the social and economic effects of caring for dependent older relatives, comparing outcomes among households with older residents needing care with those with independent older residents [ 48 ]. Results demonstrated that managing older people’s needs for care had adverse effects upon household economies, including lower paid income, lower consumption and increased healthcare expenditure (including more frequent catastrophic healthcare spending) among care households [ 52 ]. Qualitative results revealed the enduring intergenerational financial connectedness of households against a backdrop of changing demands upon family income and resulting strain: e.g.…”

“…Without effective government support, families pieced together the care of older relatives, a task made all the more challenging by the inherent uncertainty of future demands [ 53 ]. As reflected in quantitative findings, this often had serious adverse consequences for the household as a whole, including restriction of healthcare use and food consumption [ 52 , 53 ].…”

Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico

“…At an individual level, dependence can generate feelings of depression, low self-esteem, and hopelessness ( 6 ). At the level of family, it can generate a cycle of impoverishment and reallocation of care roles ( 7 ), while at the societal level, dependence can increase demand for health and care services ( 8 ). This increase demand for health and care services can also increase the costs associated with healthcare of dependent older people.…”