Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS

This paper sets out a general framework for analysing long-term care (LTC) systems for older people in different countries and then applies this framework to a specific national setting. The paper considers the extent to which South Africa's emerging LTC system conforms to broader patterns observed across low- and middle-income countries and how far it has been shaped by more local effects. It finds that patterns of demand for LTC vary across different racial categories. Despite having lower rates of ageing that the white population, Africans account for the majority of LTC demand. Residential services cater primarily for older whites and there is a widespread perception that LTC for Africans should be a family responsibility. Across the sector there is evidence of gaps in service availability, limited state oversight and uneven service quality. In 2016 this led to a high-profile political scandal which may prompt more effective state responses to this growing societal challenge

The Admission of Older People Into Residential Care Homes in Argentina: Coercion and Human Rights Abuse

Background and Objectives: There is very little information about the appropriateness of procedures for admitting older people into care homes in low and middle-income countries like Argentina. This study provides the first systematic study of practice and assesses the extent to which current practice respects fundamental human rights. Research Design and Methods: We apply different methods, including document review and national survey analysis. The study also includes a case study of a single city, La Plata, which draws on local key informant interviews, focus group discussions in different neighborhoods, and a clandestine surrogate patient survey led by local pensioners. This innovative design provides a highly triangulated and contextualized data set. Results: Many older people admitted to care homes did not have high levels of care dependency. Care homes did not usually require or even seek the informed consent of older people, regardless of their cognitive status. There were indications of coercive admission by family members, sometimes in order to obtain access to older people’s homes and other property and finances. Discussion and Implications: The study indicates the widespread abuse of the fundamental human rights of tens of thousands of older people in Argentina. There is a need for researchers, policy-makers, and civil society to acknowledge the scale of abuse and develop safeguards

Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990–2017: A population-based study

Background: The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30–70 years. This study focuses on premature avertable mortality from NCDs—premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care—to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017. Methods: We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality. Findings: Globally, premature avertable mortality from NCDs for both sexes combined declined −1·3% (95% UI −1·4 to −1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0–24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing. Interpretation: Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control. Funding: None

Income maintenance strategies of elderly shanty town residents in Buenos Aires, Argentina.

The thesis examines and accounts for patterns of income maintenance among elderly shanty town residents in Greater Buenos Aires (GBA), Argentina. It uses a framework which includes both macro-level institutional responses to ageing (such as national pension and assistance programmes) and responses at the micro-level (individual and household strategies). First, the thesis accounts for the high proportion of elderly in Argentina and explains the origin of shanty towns in GBA. This is followed by an analysis of the evolution of official social security programmes at the national and local levels and the extent to which gaps in them have been filled by non-state institutions. Particular attention is paid to the up-grading of limited, pluralistic initiatives in the early twentieth century, the imposition of a public sector welfare monopoly in the 1940s and the gradual reintroduction of the voluntary and private sectors since the 1970s. Despite the development of a complex bureaucratic apparatus, the mismanagement of insurance funds and an inconsistent commitment to assistance financing prevented universal state protection for the elderly. Case studies of three shanty towns draw attention to the significance of community initiatives for elderly welfare. Whilst these perform a number of functions, they serve primarily as conduits for resources from supra-local state and non-state agencies. A questionnaire survey and semi-structured interviews demonstrate the economic dynamics of individual households containing elderly members. It is shown that most elderly combine income from a number of sources, including pensions, continued employment and family support and that the relative importance of these different sources is strongly influenced by their gender and labour histories. The significance of bureaucratic obstacles and disinformation in preventing access to support from state programmes is also highlighted

The relationship between perceived social support and depressive symptoms in informal caregivers of community-dwelling older persons in Chile

AIM: Depression among caregivers of older persons is a serious concern, but it is often overlooked and neglected in developing countries. The aim of this study was to examine the relationship between perceived social support and depression in informal caregivers of community-dwelling older persons in Chile. Methods: We analyzed cross-sectional secondary data on 377 dyads of community-dwelling older persons and their informal caregivers from a nationwide survey in Chile. The Duke-UNC Functional Social Support Questionnaire (FSSQ) was used to measure caregivers’ perceived social support, and the Center for Epidemiologic Studies Depression Scale assessed their depression. Results: In this study, 76.9% of the caregivers perceived a high level of social support, and 46.9% were assessed as having depression. Based on multivariable analysis, factors that decrease the likelihood of being depressed are a high level of social support (odds ratio (OR) = 0.311, 95% confidence interval (CI): 0.167–0.579) and having taken holidays in the past 12 months (OR = 0.513, 95%CI: 0.270–0.975). Factors that increase the likelihood of being depressed are being a female caregiver (OR = 2.296, 95%CI: 1.119–4.707), being uninsured (OR = 4.321, 95%CI: 1.750–10.672), being the partner or spouse of the care recipient (OR = 3.832, 95%CI: 1.546–9.493), and the number of hours of care (OR = 1.053, 95%CI: 1.021–1.085). Conclusion: Higher levels of perceived social support and holidays were associated with lower levels of depression. However, being female, being the care recipient's partner or spouse, being uninsured, and having long care periods had detrimental effects. Interventions to preserve and enhance perceived social support could help improve depressive symptoms in informal caregivers. Additionally, support should be available to caregivers who are women, uninsured, and the care recipient's partner or spouse, as well as those who provide care for long hours, to ensure they have respite from their caregiving role