Conceptual and measurement issues in assessing disability cross-nationally: Analysis of a WHO-sponsored survey of the disablement process in Indonesia

A cross-national study of quality of life factors associated with patterns of elderly disablement

This study examines individual-level data of non-institutionalized elderly from Bahrain, Burma, DPR Korea, Egypt, Indonesia, Jordan, Sri Lanka, Thailand and Tunisia. The Grade of Membership multivariate procedure is used to determine profiles of disablement, based upon functional disability and depression items, and to examine socio-demographic and quality of life covariates associated with such profiles. The analysis yielded six profiles or types of disablement: functionally and emotionally healthy, functionally healthy with some depressive symptoms, some strength problems, severely depressed, mobility problems and functionally frail. The healthy profile had higher probabilities associated with males, whereas the very depressed, and those with physical strength limitations, and mobility problems were more likely to be female. There is a strong positive association between age and functional disabilities. The more depressed profiles, however, tended to be among the younger age categories, and the depressed had higher probabilities associated with being not married. The examination of quality of life covariates indicates that the functional and emotional limitations generally are correlated with a lower quality of life. The more functionally disabled and the depressed profiles had more negative self-assessments of health and lower morale scores. The very depressed had less instrumental social support in terms of available kin. Also, the functionally and emotionally disabled profiles expressed less satisfaction of visits with family and friends. Country-specific patterns of elderly disablement indicate a possible disability transition such that as countries become more developed there may be an increase in the prevalence of disabled elderly. However, there are exceptions to this trend, and these may be due to both cultural factors and data limitations.

Elderly mental health in the developing world

Growing numbers of elderly in countries of the developing world presage an increase in those affected by organic, age-related mental diseases such as dementia. A simultaneous rise in the burden of non-organic mental disorders in elderly populations is likely because stressors in many countries are affecting the mental health of the elderly directly and/or indirectly by altering the ability of families to provide care for them. This paper reviews studies on the disease burden of mental health problems of the aged in the developing world. It examines evidence on how demographic change, economic change, education, urbanization, war and displacement, and widowhood influence elderly mental health. A look at policies and programs improving the condition of elderly mentally ill throughout the developing world emphasizes positive options for policymakers. Recommendations for future research both identify areas in which investigation would be particularly useful and highlight current methodological problems.