Martha Peláez

Survey Data for the Study of Aging in Latin America and the Caribbean: Selected Studies

The article summarizes three of the data collection studies that can assist researchers in examining population aging processes in the Latin America and Caribbean region with an emphasis on cross-national comparisons, including the population of Mexican immigrants in the United States. These are the Survey on Health and Wellbeing of Elders conducted in seven urban centers of the region, the national Mexican Health and Aging Study, and the Hispanic Established Populations for Epidemiologic Studies of the Elderly in the United States. The article describes the studies and marks them as informative, comprehensive, and still underanalyzed in particular for the purpose of cross-national analyses of aging among Latin American and Caribbean populations.

The Tide to Come Elderly Health in Latin America and the Caribbean

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status’ connection to early conditions has some merit.

The Prevalence of Diagnosed Diabetes Among the Elderly of Seven Cities in Latin America and the Caribbean: The Health Wellbeing and Aging (SABE) Project

Objective: To examine the relation of diagnosed diabetes mellitus (DM) to the level of education and body mass index (BMI) among the elderly of seven cities using data from SABE. Methods: The SABE survey was based on a probabilistic sample of the elderly population. Results of various logistic regression models were applied to prevalence rates to adjust for age, gender, and BMI by the covariate method given the variability of these parameters. Results: The prevalence of diagnosed diabetes among the elderly was 15.7% (95% CI 14.7-16.8), with the highest prevalence reported in Bridgetown and the lowest in Buenos Aires. Discussion: There was a high prevalence of diagnosed DM among the elderly of the seven cities. The prevalence of diagnosed DM was strongly associated with BMI and low education. The inclusion of these factors in policies and programs aiming to reduce the prevalence of diabetes among the elderly is recommended.

La construcción de las bases de la buena salud en la vejez: situación en las Américas

The demographics of aging in the Americas are well known. The UnitedNations has published projections showing that by the middle of this century,Latin America and the Caribbean will have 112 persons 60 years and older forevery 100 persons 15 or under (1). North America will have 148 older personsfor every 100 persons 15 or younger. While those numbers are impressive, thephenomenon itself represents more than just numbers. Population aging has an impact in every dimension of life: the fami-ly, the economy, health services, and the general fabric of society. Longevityoffers families the gift of multiple exchanges among three and four genera-tions. At the same time, longevity challenges societies to adjust the cycle ofwork and retirement, and it impels institutions to make the necessary invest-ments so that social service agencies and health care providers have theknowledge and skills needed to offer vital assistance across the life course. Knowledge-based public health will need to rely on scientific knowl-edge that looks beyond child development and well-being of the young inorder to provide the foundations for maintaining quality of life and functionin old age. Planning for an aging society requires data on interrelated domainsof life in old age (health, work, income, social relations) in order to guide pub-lic health functions and services in meeting the needs of an older population. This special issue of the

Religiosity and self-rated health among Latin American and Caribbean elders.

Objective: To describe religious affiliation, importance of religion, and the relationship between religion and self-rated health in persons aged 60 or older living in Latin America or the Caribbean. Method: We used data from seven cities (n=10,587). Multivariate models were used to analyze the associations between religious affiliation and importance of religion with socio-demographic or health factors and self-rated health. Results: Overall, 92% of the total study population had a religious affiliation; among those who are religious, 80% considered religion to be important in their lives. Half of the population (51%) reported fair or poor health. In multivariate models, older age increased odds of having a religious affiliation and religion being important. Women were about four times more likely to have a religious affiliation and over twice as likely as men to indicate that religion was important. Although religious affiliation was associated with poor health, this association was no longer significant after controlling for functional status. Older adults who considered religion as very important were less likely to report fair or poor health compared to those who were less religious (somewhat important, not very important). Conclusions: These older adults have a high prevalence of religious affiliation and most of them consider religion to be important. Better self-rated health was associated with higher self-rated religiosity.

Aging in Developing Countries

This paper addresses the issue of human rights of older persons in developing countries, as distinct but not separate from the general discussion of human rights. An important policy and ethical debate is the trade-off between policies that improve the general protections and access to basic human rights of the population, as a whole, and those that target individual population groups.

More need for the "old" in new public health research in the Americas

Research on the health of older adults in Latin America and the Caribbeanhas been neglected in epidemiology and public health. This is of grave con-cern since dramatic changes in fertility and mortality rates in recent decadesensure a rapid aging of the population in the Western Hemisphere. Persons60 and older in Latin America and the Caribbean now make up 8% of the totalpopulation; by the middle of this century that figure will grow to 22%. Inabsolute numbers, the population of older persons will total over 180 millionby 2050. In the coming decades we expect to find poorer health status andgreater disability in the cohorts of persons who survived childhood and adultdiseases. That higher survivial rate is due more to public health interventionsand less to an improvement in their socioeconomic status. Therefore, policy-makers in Latin America and the Caribbean need to understand the correla-tions among different gradients of poverty, access to health care, social net-works, and health in old age. The epidemiology of aging and longevity provides a framework forunderstanding both the risk factors associated with old age and the atypicalmanifestations of infectious diseases in persons with diminished immunity.Elders in Latin America and the Caribbean will often suffer from a complexmix of infectious and noncommunicable diseases, and infectious diseaseswill continue to be an important cause of adult mortality. Thus, we needmore information on the complex interaction of diseases, frailty, socioeco-nomics, and social networks in old age. We still have great gaps in ourknowledge of aging in the Region of the Americas; it is not surprising thatolder persons are underrepresented as a target population in the publichealth literature. The essential functions of public health, including monitoring, eval-uation, and analysis of the health status of older persons, require the devel-opment and use of multidisciplinary research designs (1), new assessmentprotocols, and adequate survey instruments in order to capture the specificcharacteristics of older adults. With the support of the National Institute onAging of the United States of America, the Pan American HealthOrganization is collaborating with researchers in the Americas to developmore efficient data collection instruments and thus promote demographicand epidemiological studies of older persons. Ideally, in the future, infor-mation systems and researchers in different countries will collect compara-ble data on health and aging and therefore produce important insights intothe roles that culture, socioeconomic status, and different institutionalapproaches play in the health of older persons.While aging research in the developed countries has produced a vastscientific literature, much more dialogue among researchers in all the coun-tries of the Americas is needed in order to develop a better understanding ofthe health and well-being of older adults. In this issue of the

Equity and systems of intergenerational transfers in Latin America and the Caribbean

Las transferencias intergeneracionales deben formar parte de la discusion sobre la equidad en el contexto del rapido envejecimiento de la poblacion de America Latina y el Caribe (ALC), especialmente alli donde los recursos sean escasos. Aunque hay datos que muestran la existencia de cierto grado de intercambio entre las viejas y las nuevas generaciones, el numero creciente de adultos en comparacion con las personas mas jovenes puede crear tensiones en esta relacion. El numero de personas de 60 anos o mas aumentara en los paises de ALC de 42 millones en el ano 2000 a 97 millones en el 2025 y a 181 millones en el 2050. Como proporcion de la poblacion total, el crecimiento sera del 8% en el ano 2000, del 14% en el 2025 y del 23% en el 2050. Este crecimiento creara una tension sin precedentes en las familias, asi como en los sistemas de seguridad social, los servicios de salud y otros servicios sociales. A medida que aumente la incapacidad de las familias para hacer frente a las necesidades economicas y sociales del numero creciente de ancianos, habra una demanda cada vez mayor de mecanismos formales de apoyo entre cohortes, tales como los sistemas de seguridad social y los programas de pensiones. Sin embargo, estos mecanismos son inexistentes o insolventes en muchas naciones de ALC. Una posible solucion, la capitalizacion privada de los programas de pensiones, necesitaria mas de dos decadas para ser viable y dejaria fuera a los segmentos mas vulnerables de la poblacion, como los que trabajan en el sector informal. Dadas estas tendencias, los derechos e intereses de los ancianos deben incorporarse cada vez mas a las agendas politicas, sociales y economicas de los paises de ALC.