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 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

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

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

Pensions, consumption and health: Evidence from rural South Africa

Background: Increasing numbers of older people in sub-Saharan Africa are gaining access to pension benefits and it is often claimed that these benefits promote healthy forms of consumption, which contribute to significant improvements in their health status. However, evidence to support these claims is limited. Methods: The paper uses data for 2701 people aged 60 or over who participated in a population-based study in rural north-eastern South Africa. It analyses effects of receiving a pension on reported food scarcity, body mass index and patterns of consumption. Results: The paper finds that living in a pension household is associated with a reduced risk of reported food scarcity and with higher levels of consumption of food and drink. The paper does not find that living in a pension household is associated with a higher prevalence of current smoking nor current alcohol consumption. However, the paper still finds that tobacco and alcohol make up over 40% of reported food and drink consumption, and that the correlation between reported food scarcity and body mass index status is imperfect. Conclusions: The paper does not show significant associations between pension receipt and the selected risk factors. However, the context of prevalent obesity and high shares of household spending allocated to tobacco and alcohol call into question widely-made claims that pensions enhance healthy consumption among older people in low and middle-income countries

Institutional ageism in global health policy

The sustainable development goals agreed in March 2016 by the United Nations General Assembly set the global development agenda for the next 15 years. They include an ambitious target to reduce premature mortality from non-communicable diseases by a third by 2030. Premature mortality, defined by the World Health Organization as deaths occurring between the ages of 15 and 70, has gained broad acceptance in health research and policy over the past decade. We argue that it is explicitly ageist, reflecting institutional ageism in global health policy. Its inclusion in the sustainable development goals sends a strong signal in favour of discriminating against older people in the allocation of health resources and the collection of data. We consider the emergence of ageist approaches in global health policy and the potential effects of ageism in the sustainable development goals. We propose a less discriminatory approach

Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control

Background This study uses data from the World Health Organization's Study on Global Ageing and Adult Health (SAGE) to examine patterns of hypertension prevalence, awareness, treatment and control for people aged 50 years and over in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods The SAGE sample comprises of 35 125 people aged 50 years and older, selected randomly. Hypertension was defined as ≥140 mmHg (systolic blood pressure) or ≥90 mmHg (diastolic blood pressure) or by currently taking antihypertensives. Control of hypertension was defined as blood pressure below 140/90 mmHg on treatment. A person was defined as aware if he/she was hypertensive and self-reported the condition. Results Prevalence rates in all countries are broadly comparable to those of developed countries (52.9%; range 32.3% in India to 77.9% in South Africa). Hypertension was associated with overweight/obesity and was more common in women, those in the lowest wealth quintile and in heavy alcohol consumers. Awareness was found to be low for all countries, albeit with substantial national variations (48.3%; range 23.3% in Ghana to 72.1% in the Russian Federation). This was also the case for control (10.2%; range 4.1% in Ghana to 14.1% India) and treatment efficacy (26.3%; range 17.4% in the Russian Federation to 55.2% in India). Awareness was associated with increasing age, being female and being overweight or obese. Effective control of hypertension was more likely in older people, women and in the richest quintile. Obesity was associated with poorer control. Conclusions The high rates of hypertension in low- and middle-income countries are striking. Levels of treatment and control are inadequate despite half those sampled being aware of their condition. Since cardiovascular disease is by far the largest cause of years of life lost in these settings, these findings emphasize the need for new approaches towards control of this major risk facto

Ageism in Indonesia’s national covid-19 vaccination programme

Concern about vaccine nationalism is well founded,1 but it has overshadowed another form of injustice: vaccine ageism. In  many low and middle income countries (LMICs) Sinovac is currently the  main covid-19 vaccine. Initial Sinovac trials in China were only  conducted on adults aged under 60.2  Because of a lack of published evidence, the government of Indonesia  has decided to exclude people aged 60 and over from its initial vaccine  rollout.3 Further trials of Sinovac for older people have since begun in countries such as Brazil,4  yet ongoing Sinovac trials in Indonesia continue to exclude older  people. In 2020 clinical trial leader, Kusnandi Rusmil, said, “Why do we  target people of a productive age? Because these people can work hard,  so the country will not have a deficit.”5  This justification follows an established tradition of using inaccurate  generalisations about older people’s “public value” to justify ageist  discrimination.6 Not  all candidate covid-19 vaccine trials have excluded older people.  Nevertheless, there is a long and problematic history of excluding older  people from trials of vaccines or treatments for conditions that affect  them greatly.7 Media reports suggest that Sinovac may be effective for older people, but at a lower level than for other ages.8 Related findings are, however, yet to be published. In  Indonesia, the official position remains that older people will only be  included either when age specific Sinovac data are published or new  vaccines become available.9  In the meantime, exclusion of older people from vaccination will  exacerbate pressure on hospitals and increase avoidable deaths.  Indonesia is not a unique case: Peru has given its military, private  security guards and election workers higher priority than older adults.10 For  now, nationalist self-interest means LMICs are at the back of the  global vaccine queue; and vaccine ageism means older people are at the  back of the queue in some LMICs.</p

Age discrimination, the right to life and COVID-19 vaccination in countries with limited resources

This paper seeks to develop and apply a simple yardstick based on remaining life expectancy to assess whether specific health policies unfairly discriminate against people on the basis of their age. This reveals that the COVID-19 vaccine prioritisation policies of several countries have discriminated against older people. Conversely, the exclusion of older people from COVID-19 vaccine testing is shown to be non-discriminatory, as is some degree of age prioritisation for limited acute COVID-19 care. Age discrimination in vaccine prioritisation is shown to be embedded in wider ageist attitudes in health policy, which give the lives of older people a lower social value than the lives of people at younger ages