Verónica Montes de Oca

Receipt of Assistance and Extended Family Residence among Elderly Men in Mexico

This article focuses on help received by a nationally-representative sample of 2,376 Mexican men age 60+ in 1994. In the month before the interview, about one-half of the men received in-kind or domestic assistance, two-fifths received financial assistance, and about one-fourth received physical assistance. This was so even as almost half the men still worked, and over half (57%) had no discernable functional limitation. Using logistic regression, the study found support for the common assumption that living arrangements are an important predictor of assistance. Other factors are important too however. In fact, many elders received help from non-coresiding relatives. Beside financial remittances, help from non-coresiding relatives included in-kind, domestic, and physical assistance. Research on Mexico suggests that we need to revisit notions of a modified extended family in which non-coresidential ties can be important. Surveys need questions about frequency of contact and geographic distance between elderly people and their kin.

The Linkage of Life Course, Migration, Health, and Aging Health in Adults and Elderly Mexican Migrants

Migration is a phenomenon that impacts individuals throughout the life course. Particularly, Mexican elderly migrants show evidence of lifetime accumulations of the effects of migration on health conditions. Objectives: Examine how the relationship between historical time and individual time explains different factors impacting the health of Mexican adult and elderly migrants in Mexico and the United States. Method: Data from in-depth interviews with Mexican migrants living in selected locations in Mexico and the United States were used to illustrate the links between life course conditions, aging, migration, and health outcomes. Results and Discussion: According to this theoretical perspective and the data, historical time, age at migration, and the conditions under which the migration trajectory developed, show different impacts on the health and quality of life of the elderly, as revealed through analysis of labor experience, disease and accidents, medical service, health treatment, transnational networks, and family formation.

Exploring the economic and social effects of care dependence in later life: protocol for the 10/66 research group INDEP study

BackgroundIn low or middle income countries chronic diseases are rapidly becoming the main cause of disease burden. However, the main focus of health policymakers has been on preventing death from cancer and heart disease, with very little attention to the growing problem of long-term needs for care (dependence). Numbers of dependent older people are set to quadruple by 2050. The economic impact of providing long-term care is likely to be substantial.Methods/designThe study uses mixed methods and draws on and extends the population-based surveys conducted by the 10/66 Dementia Research Group. We focus on two countries in Latin America (Peru and Mexico), China and Nigeria. The surveys comprised baseline surveys of health, socioeconomic circumstances and care arrangements, repeated three to four years later. We are going back to these households to make a detailed assessment of the overall economic status and the use of health services by all family members. We will compare households where: a) an older resident became dependent between baseline and follow-up (incident care), b) one or more older people were dependent at both time points (chronic care), b) c) no older residents had needs for care (control households) for household income, consumption, healthcare expenditure and economic strain. In each of the four countries we are carrying out six detailed household ‘case studies’ to explore in more depth the economic impacts of dependence, and the social relations between household members and others in their network.DiscussionThe INDEP study will provide a detailed examination of the economic and social effects of care dependence in low and middle income settings. As the proportion of older people with needs for care rises rapidly in these countries, this neglected policy area is likely to become increasingly salient for families, communities and policymakers alike. Our detailed multilevel plans for dissemination will ensure that the study helps to put this important issue on the agenda for the international and national media, the public and researchers.

Transnational Aging: Disparities Among Aging Mexican Immigrants

Abstract Migration between Mexico and the United States has undergone major transformations, changing from an open and circulatory process to a mainly clandestine one. The historical changes of migration and its social impact can be retrospectively examined by analyzing an elderly population that experienced migration in the last seven decades. In this paper, we look at two older groups: 1) “swallow” migrants, those who obtained legalization as Braceros (through an agricultural production bilateral program) or through other mechanisms of US immigration legislation; and 2) undocumented migrants. We compare both groups using in-depth interviews with individuals of fifty years and over living in the Mexican states of Guanajuato and Zacatecas and three US cities: Dallas, Texas; Chicago, Illinois; and Los Angeles, California. By comparing them, we highlight the disparities in their migration experiences. Our findings show the benefits experienced because of the rights obtained by swallows, particularly as a result of their legal status, which allows them to live out their later years benefiting from their transnational social capital.

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

Purpose of the study 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. Design & methods 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. Results 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. Implications 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.

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

Background While 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. Methods Households 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). Results Household 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. Conclusions While 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.

Allocating Family Responsibilities for Dependent Older People in Mexico and Peru

Abstract This paper applies different analytical frameworks to explore processes of family bargaining about providing care for dependent older people in Mexico and Peru. These frameworks include cultural norms, life course effects and material exchange. The paper is based on 19 in-depth qualitative family case studies, which are linked to a wider set of quantitative survey data. Care arrangements and bargaining processes are revealed to be highly gendered, and largely conform to prevailing cultural norms. Rather than neutral and objective, the self-identified role as main carer is found to be subjective and potentially ambiguous. The few men who self-identify as main carers are more likely to play an indirect, organisational role than engage directly in daily care. As such, bargaining mainly relates to which woman performs the main care role, and large family networks mean that there is usually more than one candidate carer. Bargaining can occur inter-generationally and conjugally, but bargaining between siblings is of particular importance. Bargaining is framed by the uncertain trajectory of older people’s care needs, and arrangements are sometimes reconfigured in response to changing care needs or family circumstances. Taking the narratives at face value, the influence of life course effects on bargaining and care arrangements is more obvious than material exchange. There are, however, indications that economic considerations, particularly inheritance, still play an important behind the scenes role.