A journey without maps-Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru

Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effect...

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Published in:	PloS one Vol. 12; no. 8; p. e0182360
Main Authors:	Mayston, Rosie, Lloyd-Sherlock, Peter, Gallardo, Sara, Wang, Hong, Huang, Yueqin, Montes de Oca, Veronica, Ezeah, Peter, Guerra, Mariella, Sosa, Ana Luisa, Liu, Zhaourui, Uwakwe, Richard, Guerchet, Maëlenn M, Prince, Martin
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 07-08-2017 Public Library of Science (PLoS)
Subjects:	Age Aged Aging Caregivers Caregivers - economics Caregivers - statistics & numerical data Case studies China Chronic illnesses Costs and Cost Analysis Cross-Sectional Studies Dementia Dementia disorders Disability recipients Economic aspects Economic impact Economic problems Elderly Families & family life Family support Female Female roles Geriatrics Health aspects Health care industry Health care policy Health insurance Health problems Health services Health Services - economics Households Housing Humans Insurance Insurance, Health - economics Life Sciences Long term health care Male Medicine and Health Sciences Mental health Mexico Neurosciences Neurosurgery Nigeria Older people Pensions Pensions - statistics & numerical data People and places Peru Population Population studies Populations Psychiatry Psychology Qualitative research Residential communities Residential institutions Rural Population - statistics & numerical data Santé publique et épidémiologie Security Social aspects Social change Social interactions Social participation Social Sciences Socioeconomic Factors Sociology Urban Population - statistics & numerical data Vulnerability (Psychology) Mexico Nigeria Peru China
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Summary:	Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability. We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person. Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a 'journey without maps'. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched. Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 PMCID: PMC5546609 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0182360