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Shrestha A, Ghimire S, Kinney J, Mehta R, Mistry SK, Saito S, Rayamajhee B, Sharma D, Mehta S, Yadav UN. The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study. BMC Geriatr 2024; 24:20. [PMID: 38178009 PMCID: PMC10768249 DOI: 10.1186/s12877-023-04619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.
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Affiliation(s)
- Aman Shrestha
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Saruna Ghimire
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Jennifer Kinney
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Ranju Mehta
- Little Buddha College of Health Sciences, Kathmandu, Bagmati, Nepal
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Shoko Saito
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Deepak Sharma
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Suresh Mehta
- Koshi Province Ministry of Health, Biratnagar, Koshi, Nepal
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia.
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Zhou D, Zhan Q, Li L. The impact of self-employment on mental health of the younger elderly in China. BMC Geriatr 2023; 23:280. [PMID: 37158843 PMCID: PMC10166046 DOI: 10.1186/s12877-023-03948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/31/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND With the prolongation of the life expectancy of the Chinese population and the intensification of the aging process of the population, the mental health problems of the elderly have become increasingly prominent. This study aims to explore whether self-employment can promote and how to promote the mental health of the elderly. METHOD Based on the 2018 China Longitudinal Aging Social Survey (CLASS) data, this paper uses OLS model and KHB method to verify the impact of self-employment on the mental health of the younger elderly and its mechanism. RESULTS The results indicate that self-employment can significantly reduce the depression tendency of the younger elderly and promote their mental health. Heterogeneity analysis shows that self-employment has a more significant positive impact on the mental health of the younger elderly who are self-rated healthy, free of chronic diseases and low-level medical service utilization. The mechanism shows that self-employment can indirectly improve the mental health of the younger elderly through income growth effect and self-worth realization effect, in which the self-worth realization effect is greater than the economic effect. It illustrates that with the development of China's economy, the elderly are pursuing more intrinsic values brought by self-employment than economic benefits. CONCLUSION In view of the above research results, it is suggested to encourage the elderly to actively participate in social activities, provide policy support for the younger elderly to engage in self-employment, increase government support as well as health guarantee level, and improve the subjective initiative of the elderly to participate in self-employment, so that the society can truly realize the healthy aging of "being useful and productive for the elderly".
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Affiliation(s)
- Deshui Zhou
- School of Finance and Public Management, Anhui University of Finance & Economics, Bengbu, Anhui Province, China
| | - Qianqian Zhan
- School of Finance and Public Management, Anhui University of Finance & Economics, Bengbu, Anhui Province, China
| | - Lele Li
- School of Labor and Human Resources, Renmin University of China, Beijing, China.
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Reporting heterogeneity in the measurement of hypertension and diabetes in India. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-019-01017-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cullati S, Mukhopadhyay S, Sieber S, Chakraborty A, Burton-Jeangros C. Is the single self-rated health item reliable in India? A construct validity study. BMJ Glob Health 2018; 3:e000856. [PMID: 30483411 PMCID: PMC6231101 DOI: 10.1136/bmjgh-2018-000856] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/17/2018] [Accepted: 10/06/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction In high-income countries, the self-rated health (SRH) item is used in health surveys to capture the population’s general health because of its simplicity and satisfactory validity and reliability. Despite scepticism about its use in low-income and middle-income countries, India implemented the SRH item in many of its demographic and population health surveys, but evidence of its validity is lacking. The objective was to assess the construct validity of the SRH item in India. Methods Data for 4492 men and 4736 women from the Indian sample of the World Health Survey (2003) were used. Overall, 43 health status indicators were grouped into health dimensions (physical, mental and functional health, chronic diseases, health behaviours) and the SRH item was regressed on these indicators by using sex-stratified multivariable linear regressions, adjusted with demographic and socioeconomic variables. Results Respondents (participation rate 95.6%; mean age 38.9 years) rated their health as very good (21.8%), good (36.4%), moderate (26.6%), bad (13.2%) or very bad (2.0%). Among men, the adjusted explained SRH variance by health dimensions ranged between 18% and 41% (physical 33%, mental 32%, functional health 41%, chronic diseases 23%, health behaviours 18%). In multivariable models, the overall explained variance increased to 45%. The 43 health status indicators were associated with SRH and their effect sizes were in the expected direction. Among women, results were similar (overall explained variance 48%). Conclusion The SRH item has satisfactory construct validity and may be used to monitor health status in demographic and population health surveys of India.
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Affiliation(s)
- Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland.,Swiss NCCR 'LIVES-Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland
| | | | - Stefan Sieber
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland.,Swiss NCCR 'LIVES-Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland
| | | | - Claudine Burton-Jeangros
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland.,Swiss NCCR 'LIVES-Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland
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Abstract
We examine several methodological considerations when eliciting probabilistic expectations in a developing country context using the Longitudinal Ageing Study in India (LASI). We conclude that although, on average, individuals are able to understand the concept of probability, responses are sensitive to framing effects and to own versus hypothetical-person effects. We find that overall, people are pessimistic about their survival probabilities compared with state-specific life tables and that socioeconomic status does influence beliefs about own survival expectations as found in previous literature in other countries. Higher levels of education and income have a positive association with survival expectations, and these associations persist even when conditioning on self-reported health. The results remain robust to several alternative specifications. We then compare the survival measures with objective measures of health. We find that activities of daily life, height, and low hemoglobin levels covary with subjective expectations in expected directions.
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Affiliation(s)
- Adeline Delavande
- Institute for Social and Economic Research (ISER), University of Essex, Colchester, UK
- Nova School of Business and Economics, Lisbon, Portugal
| | - Jinkook Lee
- University of Southern California, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Seetha Menon
- Max Weber Fellow, Department of Economics, European University Institute, Fiesole, Italy.
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Bora JK, Saikia N. Gender Differentials in Self-Rated Health and Self-Reported Disability among Adults in India. PLoS One 2015; 10:e0141953. [PMID: 26536133 PMCID: PMC4633186 DOI: 10.1371/journal.pone.0141953] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 10/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background The extant literature on gender differentials in health in developed countries suggests that women outlive men at all ages, but women report poorer health than men. It is well established that Indian women live longer than men, but few studies have been conducted to understand the gender dimension in self-rated health and self-reported disability. The present study investigates gender differentials in self-rated health (SRH) and self-reported disability (SRD) among adults in India, using a nationally representative data. Methods Using data on 10,736 respondents aged 18 and older in the 2007 WHO Study on Global Ageing and Adult Health in India, prevalence estimates of SRH are calculated separately for men and women by socio-economic and demographic characteristics. The association of SRH with gender is tested using a multinomial logistic regression method. SRD is assessed using 20 activities of daily living (ADL). Further, gender differences in total life expectancy (TLE), disability life expectancy (DLE) and the proportion of life spent with a disability at various adult ages are measured. Results The relative risk of reporting poor health by women was significantly higher than men (relative risk ratio: 1.660; 95% confidence Interval (CI): 1.430–1.927) after adjusting for socio-economic and demographic characteristics. Women reported higher prevalence of severe and extreme disability than men in 14 measures out of a total20 ADL measures. Women aged less than 60 years reported two times more than men in SRD ≥ 5 ADLs. Finally, both DLE and proportion of life spent with a disability were substantially higher for women irrespective of their ages. Conclusion Indian women live longer but report poorer health than men. A substantial gender differential is found in self-reported disability. This makes for an urgent call to health researchers and policy makers for gender-sensitive programs.
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Affiliation(s)
| | - Nandita Saikia
- Centre for Study of Regional Development, Jawaharlal Nehru University, New Delhi, India
- * E-mail:
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Joe W, Rudra S, Subramanian SV. Horizontal Inequity in Elderly Health Care Utilization: Evidence from India. J Korean Med Sci 2015; 30 Suppl 2:S155-66. [PMID: 26617450 PMCID: PMC4659869 DOI: 10.3346/jkms.2015.30.s2.s155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022] Open
Abstract
Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.
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Affiliation(s)
- William Joe
- Institute of Economic Growth, University of Delhi Enclave, Delhi, India
| | - Shalini Rudra
- Jawaharlal Nehru University, New Mehrauli Road, New Delhi, India
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H.Chan School of Public Health, Boston, Massachusetts, USA
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Goli S, Singh L, Jain K, Pou LMA. Socioeconomic determinants of health inequalities among the older population in India: a decomposition analysis. J Cross Cult Gerontol 2015; 29:353-69. [PMID: 25349021 DOI: 10.1007/s10823-014-9251-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study quantified and decomposed health inequalities among the older population in India and analyzes how health status varies for populations between 60 to 69 years and 70 years and above. Data from the 60th round of the National Sample Survey (NSS) was used for the analyses. Socioeconomic inequalities in health status were measured by using Concentration Index (CI) and further decomposed to find critical determinants and their relative contributions to total health inequality. Overall, CI estimates were negative for the older population as a whole (CI = -0.1156), as well as for two disaggregated groups, 60 to 69 years (CI = -0.0943) and 70 years and above (CI = -0.08198). This suggests that poor health status is more concentrated among the socioeconomically disadvantaged older population. Decomposition analyses revealed that poor economic status (54 %) is the dominant contributor to total health inequalities in the older population, followed by illiteracy (24 %) and rural place of residence (20 %). Other indicators, such as religion, gender and marital status were positive, while Caste was negatively associated with health inequality in the older populations. Finally, a comparative assessment of decomposition results suggest that critical contributors for health inequality vary for the older population of 60 to 69 years and 70 years and above. These findings provide important insights on health inequalities among the older population in India. Implications are advanced.
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Affiliation(s)
- Srinivas Goli
- Department of Development Studies, Giri Institute of Development Studies, Sector '0'Aliganj Housing Scheme, Lucknow, 226024, Uttar Pradesh, India,
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Romero M, Vivas-Consuelo D, Alvis-Guzman N. Is Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation? SPRINGERPLUS 2013; 2:664. [PMID: 24353981 PMCID: PMC3866375 DOI: 10.1186/2193-1801-2-664] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/28/2013] [Indexed: 12/24/2022]
Abstract
The purpose of this review is to do a discussion about the use of the HRQoL as a health measure of the populations that enable to analyze its potential use as a measure of development and efficiency of health systems. The principal use of the HRQoL is in health technologies economics evaluation; however this measure can be use in public health when need to know the health state of population. The WHO recognizes its potential use but its necessary to do a discussion about your difficulties for its application and restrictions for its use as a performance indicator for the health systems. The review show the different aspects about the use of HRQoL how a measure of efficiency ot the health system, each aspect identified in the literature is analyzed and discussed, developing the pros and cons of their possible use, especially when it comes as a cardinal measure. The analysis allows recognize that measuring HRQoL in countries could serve as a useful indicator, especially when it seeks to measure the level of health and disease, as do most of the indicators of current use. However, the methodological constraints that do not allow comparability between countries especially when you have large socioeconomic differences have yet to be resolved to allow comparison between different regions.
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Affiliation(s)
- Martin Romero
- Fundación Salutia, Centro de investigación en Salud, Bogotá, Colombia ; Doctarado en Salud Publica - Universidad Nacional de Colombia, Bogotá, Colombia
| | - David Vivas-Consuelo
- Research Center for Health Economics and Management, Universitat Politècnica de València, Valencia, Spain
| | - Nelson Alvis-Guzman
- Research Group on Health Economics, Universidad de Cartagena, Cartagena, Colombia ; Research and Teaching Center, Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia
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Health status and associated factors among the community-dwelling elderly in China. Arch Gerontol Geriatr 2013; 56:199-204. [DOI: 10.1016/j.archger.2012.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 11/24/2022]
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