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Demography of Aging 10 Research on the Demography of Aging in Developing Countries Linda G. Martin and Kevin Kinsella INTRODUCTION The study of the demography of aging in developing countries is a relatively new endeavor, which expanded enormously in the 1980s. Anthropologists have been examining social and economic aspects of aging in developing countries for at least 50 years; most notable is the classic work by Simmons (1945), which presented evidence that high status of the elderly was not necessarily guaranteed in primitive societies. In the 1970s, Cowgill published his modernization theory, which posited that the status of the elderly declines in the process of socioeconomic development (Cowgill and Holmes, 1972; Cowgill, 1974). This theory has since generated considerable response—both positive and negative—in sociology and gerontology. It was only in the 1980s that demographers began to focus on aging in developing countries (see, for example, Treas and Logue, 1986; Kinsella, 1988; Martin, 1988), and economists have been even slower to take up the issue. Demographers were motivated by population projections indicating that declining fertility and mortality, particularly in Asia and Latin America, were resulting in population aging. Their interest was also motivated by the The authors are grateful to John Knodel, George Myers, Beth Soldo, and Richard Suzman for advice.
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Demography of Aging concerns of policy makers in these countries, which arose from those projections and from the focus on aging at the 1982 United Nations World Assembly on Aging. Interest in comparative research involving developing countries has been based on the belief that it can provide insight into the influences of culture and ethnicity, the particular effects of aging in low-income environments, the changing roles of families, and the consequences of new policies and programs. In this chapter, we review research on the demography of aging in developing countries in several substantive areas, namely, basic demography, mortality and health, family demography, population distribution and migration, and economic activity and well-being. We conclude with a summary of data collection and research challenges and provide an appendix that highlights the current availability of different types of data—survey, census, vital statistic, and ethnographic—for research on these topics. BASIC DEMOGRAPHY Much of the early work of demographers on aging in developing countries focused on raising awareness of aging as a policy and research issue. A decade ago, most conference papers and journal articles emphasized projections of population aging and were basically alarmist in their discussions of the implications. No doubt, such consciousness raising was needed. More sophisticated projection work was also done, for example, Yu and Horiuchi's (1987) analysis of the relative contribution of fertility and mortality change, as well as initial age structure, to population aging in more and less developed countries, and Zeng's (1986, 1988) projections of family structure in China. The essence of the projections is that populations are indeed aging in most of the developing world except parts of Africa; United Nations (1991) estimates for 1990 indicate that 56 percent of the world's 65 and over population already lives in less developed countries. Moreover, some of the populations of East and Southeast Asia are aging at substantially more rapid rates than was the case historically in the West (Chen and Jones, 1989). Figure 10-1 presents the changes over time in median ages for countries that in 1989 had per capita incomes of less than $5,000. The data are taken from the United Nation's (1991) estimates for 1970-1975 and medium-variant projections for 1990-1995 and 2010-2015. The countries are divided into 12 subregions of Latin America, Asia, and Africa. The line in the middle of each box indicates the median of the median ages for the countries in that subregion and period. The height of the box shows the interquartile range (25 to 75 percent) within which the median ages of the middle half of the countries in each subregion fall. Latin America and Asia show substantial increases in median age over
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Demography of Aging
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Demography of Aging Figure 10-1 Median and interquartile ranges of median age, 1970-1975, 1990-1995, 2010-2015, for each subregion for countries with per capita income under $5,000 in 1989. SOURCES: Median ages are from the United Nations' (1991) estimates for 1970-1975 and medium-variant projections for 1990-1995 and 2010-2015. Per capita income in 1989 is from the Population Reference Bureau's 1991 data sheet.
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Demography of Aging time, but in East, Middle, and West Africa, there is very little change, with the median of the median ages decreasing between 1970 and 1990, and only barely increasing from 1990 to 2010. Of course, the changes over the latter period are based on the assumptions that the total fertility rates in these three subregions will be on average 4.32, 4.99, and 4.53, respectively. Higher or lower fertility would change the results shown here, but the overall impression of little change in median ages in African populations in comparison to the rest of the developing world would remain. Nevertheless, it is important to remember that such national median ages may mask considerable diversity within countries, with urban and female populations typically being older than rural and male populations. Moreover, static or slow-rising median ages convey nothing about the absolute numerical growth of various age groups. Besides projections of proportions elderly and of median ages, demographers have also used projections of dependency ratios (e.g., the ratio of the under-15 plus 65-and-over population to the population in the middle) to summarize the changes in population age distributions likely to take place.1 The good news is that increases in elderly ''dependents" will likely be more than offset by decreases in young "dependents," at least in the short run, for developing countries, but the bad news in parts of Asia is that when the large birth cohorts of the 1960s and 1970s reach old age, overall dependency ratios are likely to increase. Of course, not all persons under 15, over 65, or even over 80 are dependent in an economic or care-requiring sense. The total costs and contributions, both public and private, of the young and the old have not been adequately determined in the United States (Siegel and Taeuber, 1986), let alone in the developing world. Hence, dependency ratios are useful more as illustrative devices than as analytic tools, and could certainly be refined through incorporation of factors such as age-specific labor force participation and availability of economic resources. Demographers have played an important role in compiling and summarizing the basic characteristics of elderly populations (e.g., marital status, urban/rural residence, labor force participation). An initial effort to produce individual country reports on elderly populations began in 1984 under the auspices of the Committee for International Cooperation in National Research in Demography (CICRED) and resulted in monographs from several developing as well as developed countries. Many of the data generated 1 Crude generational support ratios, which relate the size of successive generations to one another (e.g., persons aged 80 and over versus persons (or women) aged 50-64) also have been used, primarily in developed countries, as indicators of potential care burdens for nonelderly adult cohorts.
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Demography of Aging by the CICRED project became the foundation for the International Data Base on Aging of the Center for International Research at the Bureau of the Census. An expansion of this initial data set formed the basis for the publication Aging in the Third World (Kinsella, 1988) and a subsequent wall chart of summary indicators for 100 countries (Bureau of the Census, 1991). The challenge for the future is to obtain comparable data sets over time that make possible the measurement of changes in demographic and socioeconomic characteristics and provide insight into how the elderly of tomorrow may differ from those of today. MORTALITY AND HEALTH In developing countries, the focus of most nationally and internationally sponsored health programs has been on infectious and parasitic diseases and child survival, and in fact, many developing countries have succeeded in reducing the incidence of tropical diseases and of infant and child mortality in particular (Hill and Pebley, 1989). However, as children survive and age, they are increasingly exposed to risks associated with chronic diseases and accidents. And as fertility decline induces population aging, national mortality and health profiles begin to reflect the growing importance of chronic and degenerative ailments associated with greater numbers of older individuals (Frenk et al., 1989). In the last few years, there has been considerable attention paid to the emerging health issues in developing countries (Caldwell et al., 1990; Jamison and Mosley, 1991; Feachem et al., 1992). In this section, we first review research on mortality in the adult years in developing countries, then discuss research on morbidity and disability, and studies of health care utilization and costs. Mortality Demographers have long been interested in measuring adult mortality in developing countries, but limited or defective data have constrained analysis. Timæus (1991b) points out that also complicating the study of adult mortality are the facts that adult deaths are relatively rare events, that there is not necessarily an appropriate informant about an adult death, and that age misreporting is common. He goes on to review the array of direct and indirect methods that demographers have used to try to estimate adult mortality. Analyzing patterns of causes of deaths and their changes over time is even more difficult. As discussed in the appendix to this chapter, reliable information through vital statistics on cause of death is available for only, at most, half of the deaths in developing countries (Bulatao, 1993), and age exaggeration is a problem, especially in Latin America (Dechter and Preston, 1991).
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Demography of Aging Nevertheless, there is growing evidence that an epidemiological transition is under way in many developing as well as developed countries (see for example, Murray et al., 1992b). Adult survival has improved, death rates for infectious and parasitic diseases have declined, and chronic and degenerative diseases are becoming relatively more important. On a regional basis, the epidemiological transition appears most advanced in Latin America and the Caribbean (Bulatao, 1993). Analysis from the Pan American Health Organization (1990) indicates that cardiovascular diseases are the principal cause of death in the populations of 27 of the 37 countries of the Americas for which recent mortality data are available. In 6 of the remaining 10 countries, cancer or cerebrovascular disease is the leading killer. Bulatao (1993) has estimated that in Latin America and the Caribbean, the ratio of deaths from circulatory system diseases to deaths from infectious and parasitic diseases increased from 0.68 to 1.09 between 1970 and 1985. Frenk et al. (1989) have demonstrated that in some Latin American countries, the stages of epidemiological transition overlap, such that populations suffer simultaneously from high incidences of infectious and parasitic as well as chronic and degenerative diseases. In some cases, pretransition diseases that were once essentially controlled (e.g., malaria, dengue fever, cholera) have reemerged as major contributors to morbidity burdens (Brandling-Bennett, 1991; Oakes et al., 1991). The diversity of experience in Asia defies regional generalization (Ruzicka and Kane, 1991). Clearly, mortality decline has been greater in East and Southeast Asia than in South and West Asia. In Singapore, life expectancy at birth rose 30 years in barely one generation, from 40 years in 1948 to 70 years in 1979 (Bureau of the Census, various years). During the same period, deaths due to infectious diseases declined from 40 to 12 percent of all deaths, while the share of cardiovascular deaths rose from 5 to 32 percent. Data from selected areas of China in 1986 indicate that circulatory diseases are the primary killers, accounting for 47 percent of all deaths, and cancer accounts for 17 percent of deaths (World Bank, 1992). Similar patterns have been reported for Turkey and Sri Lanka, but to date, comparable indicators for the majority of South and West Asia are not available. Improvements in adult survival in African nations, especially in the sub-Saharan region, lag behind those of all other major regions of the world (Feachem and Jamison, 1991). Nationwide health and mortality data typically are unavailable, but subnational and community-level data indicate that infectious and parasitic diseases remain the most important causes of mortality among adults in Africa (Timæus, 1991a). There is evidence, however, that cardiovascular disease, respiratory tuberculosis, and accidents and violence affect adults disproportionately. Several research efforts have moved beyond description of mortality
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Demography of Aging patterns and their changes at the national level. These have included the following: Efforts to compare mortality in urban and rural areas. Bumgarner and colleagues (World Bank, 1992) found considerable differences in mortality from infectious disease in urban and rural China, with rates for rural men being almost twice those for urban men, and the difference being fourfold for rural and urban women. Differences in mortality rates from chronic diseases are much smaller, but rural dwellers experience slightly higher rates than do urban dwellers. Altogether in 1986, circulatory diseases and cancer accounted for 67 percent of reported deaths in urban areas and 64 percent in rural areas. Decomposition of mortality differences in life expectancy between countries and years by gender and causes of death (Pollard, 1982; Arriaga, 1984, 1989). For example, Adlakha and Arriaga (1992) compared patterns of mortality in Guatemala and Costa Rica to identify areas of dissimilarity and highlight realistic targets for scarce health resources. They found that of 25 causes examined, just four—intestinal infection, pneumonia, conditions originating in the perinatal period, and nutritional deficiency—were generally responsible for the large mortality differential for both sexes between the two countries (14-year longer life expectancy at birth in Costa Rica in the mid-1980s). In addition, violence (including suicide and homicide) is an important contributor to lower male life expectancy in Guatemala. These five causes, if reduced to the levels in Costa Rica, would add 10 to 11 years to overall Guatemalan life expectancy, in contrast to only 3 to 4 years added by the other 20 causes. Projections of mortality by cause and broad age groups. Bulatao and Stephens (in press) based their worldwide projections on a model of the relationship between mortality level and cause of death structure in populations with good data. Dowd and Manton (1990) projected death rates from chronic diseases in Cuba, Ghana, Mauritius, Sri Lanka, Tanzania, and Thailand based on information on risk factors in those countries and the estimated relation between risk factors and mortality in more developed countries. Complicating such projections is the extent to which the consequences of changes in behavior (e.g., smoking) affect mortality over time. For example, smoking is thought to have increased rapidly in recent years in China; by 1984, 61 percent of adult Chinese men smoked (British Medical Journal, 1991). Disability and Morbidity Successes in lengthening life expectancy have raised new questions about whether added years of life mean a healthier life or an increased
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Demography of Aging burden of chronic illness. Liang and Whitelaw (1987) have suggested that physical health can be measured in three ways: (1) medically, through detection of disease or impairment; (2) functionally, through tests of the ability to perform activities of daily living; and (3) subjectively, through self-assessment of health or functional ability. 2 To date, data on the health status of adults and, in particular, the elderly in developing countries are largely of the last two types and have been collected through surveys. Census data on particular types of disability (e.g., blindness) are also available for some countries. Surveys generally do not involve physical examinations because of the costs involved, although there are some notable exceptions: for example, the 1976-1977 Indonesian Health Survey conducted by local physician interviewers; physical examination surveys in Colombia, Egypt, and Uruguay (see Murray et al., 1992a, for some of the results); the World Health Organization (WHO) Noncommunicable Disease prevention program, which sponsored cross-sectional surveys focused on cardiovascular disease risk factors such as cholesterol and blood pressure in six developing countries (see Dowd and Manton, 1990); and risk factor surveys in Brazilian cities (see Briscoe, 1990). Perhaps surprisingly, the last indicate that risk factors for chronic diseases are higher among people of lower socioeconomic status than among those of higher status. Most importantly for understanding and modeling health processes, longitudinal data on risk factors and functional status transition rates are virtually nonexistent. The World Health Organization is currently designing three cross-national survey programs that will begin to fill this gap. These surveys (see appendix table) will incorporate clinical as well as self-perceived measures, on a longitudinal basis, and will contrast urban and rural locales in both developed and developing countries. Two of these survey programs are focused on specific causes of disability, osteoporosis and age-associated dementias; the third is a broader investigation of the determinants of healthy aging. The systematic study of disability in developing countries is still in its infancy. Due largely to efforts spearheaded by the United Nations Statistical Office (UNDIESA, 1990), there is greater awareness of the need to collect and tabulate data on impairments, disabilities, and handicaps. The creation of a Disability Statistics Data Base (DISTAT) has been an important first step in highlighting international differences in the definition and description of disability, as well as enabling provisional international comparisons. At present there is enormous variation in international definitions 2 Due to space limitations (and admitted unfamiliarity with the literature), we do not review measurement of mental health.
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Demography of Aging and rates of disablement. Among countries included in DISTAT, crude disability rates for the total population range from less than 0.5 percent in several developing countries (Peru, Egypt, Pakistan, Sri Lanka) to nearly 21 percent in Austria. In recognition of the wide conceptual disparities, an international network has been established to assist countries in defining and developing information on disablement, with the goal of harmonizing concepts of impairment, disability, and handicap (Chamie, 1990). Incidence of disability also differs by age, sex, and other social characteristics. Despite definitional and measurement differences between countries, several patterns emerge. Regardless of the levels of crude disability, rates tend to rise with age and increases are especially notable in later adulthood. Males usually have higher rates than females at most ages. And the profile of disability changes with age as well, because certain disabilities are directly related to age. Muteness, for example, reaches a peak in the later teen years, then is relatively constant at older ages. Deafness, on the other hand, shows a distinct rise with age among adults, especially after age 50. Vision disability is also related to age. The most common survey measures of disability of the elderly in developed countries are activities of daily living (ADLs)—the basic tasks of everyday life such as eating, dressing, toileting, bathing, and ambulation (Katz et al., 1983)—and instrumental activities of daily living (IADLs) such as shopping and using transportation. The ability to perform such activities (especially ADLs) has been found to be a significant predictor of outcomes such as mortality, use of hospital and physician services, insurance coverage, admission to nursing homes, and living arrangements (Wiener et al., 1990). Several surveys of the elderly in developing countries (e.g., those listed in the appendix table that have been conducted by the Association of Southeast Asian Nations (ASEAN), WHO Regional Offices, the United Nations University, and the University of Michigan and the Taiwan Provincial Institute of Family Planning) have asked respondents to assess their abilities to perform ADL and/or IADL. Andrews et al. (1986) have found responses to these questions to be quite reliable in retests and consistent with interviewers' assessments. Unfortunately, as in more developed countries, these questions do not necessarily discriminate well in community-based populations. For example, Andrews et al. (1986) found that the proportions of the 60-and-over population able to perform all of the ADLs were 71 percent in Korea, 90 percent in Malaysia, and 91 percent in the Philippines. Moreover, there is some question about the appropriateness in a developing country setting of some of the instruments developed in industrialized countries. For example, Ikels (1991) in her study of 200 people ages 70 and over in Canton, China, chose not to use any standard instrument and relied instead on her own assessment of the functionality of the individuals through in-depth, informal interviews. Applying such a proce-
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Demography of Aging dure on a larger scale, however, would not likely be feasible. Studies of how the elderly and other age groups spend their time in specific developing country settings could help inform the development of more appropriate instruments for measuring activities of daily living. Numbers of disabled persons are almost certain to increase as a correlate of sheer population growth and population aging (see, for example, Dowd and Manton, 1992, on Indonesia). But an important question for both developed and developing countries is whether or not rates of disability are likely to increase as economies modernize and populations age (Mosley and Cowley, 1991). Census data for Turkey show declining rates of disability between 1975 and 1985 for children, but increases for men and women in almost all adult age groups. This trend also has been observed in Bangladesh and Egypt. Data on disability have been used to estimate years of healthy life expectancy in developing countries.3 For example, although female life expectancy at birth and at age 65 is usually greater than that of males, analysis based on data from the WHO Regional Office surveys of the elderly in Asia indicate that the percentage of lifetime expected to be spent in a healthy state is lower for women than for men (Lamb and Andrews, 1991; Myers, 1993). A multivariate procedure called graded order of membership has also been applied to disability data from developing countries to identify distinctive patterns of disability and the subgroups of the population that manifest them (Manton et al., 1986, 1987). Self-assessments of health are common components of population-based surveys, including various surveys of the elderly in developing countries. Of course, such assessments reflect perceptions of illness, as well as underlying disease patterns, both of which may change in the course of socioeconomic development. Riley (1990) noted for Britain, Japan, and the United States that the prevalence of sickness has increased for all age groups, even as mortality has declined; he reviewed possible explanations for this anomaly, including changing perceptions of illness. There is, of course, tremendous variability in how questions about health are asked (e.g., differences in reference periods—week, month, or ever; whether general questions are followed with probes about specific disease; and whether information on duration and intensity of illness is obtained). Ability to respond about specific diseases or symptoms may be confounded with cognitive ability and with receipt of medical care (Liang and Whitelaw, 3 One effort to facilitate and promote analyses of health expectancy was initiated in 1989. The international network REVES (the French acronym for the International Network on Health Expectancy and the Disability Process) brings together researchers from both developed and developing countries concerned with measuring changes in health status.
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Demography of Aging Liang, J., and N. Whitelaw 1987 Assessing the Physical and Mental Health of the Elderly. Paper presented at the East-West Center Seminar on Research on Aging in Asia and the Pacific, Singapore. Long, W.R. 1993 Pensions in Chile pay off handsomely. Los Angeles Times, September 28. Lopez, M.E. 1991 The Filipino family as home for the aged. Comparative Study of the Elderly in Asia Research Reports 91-7. Population Studies Center, University of Michigan. Machado, C.C., and J.F. Abreu 1991 The Elderly Mobility Transition in Brazil. Paper presented at the University of Colorado Institute of Behavioral Science Conference on the Elderly Mobility Transition, Aspen Lodge, Estes Park, Colo. Manton, K.G., J.E. Dowd, and M.A. Woodbury 1986 Conceptual and measurement issues in assessing disability cross-nationally: Analysis of a WHO-sponsored survey of the disablement process in Indonesia. Journal of Cross-Cultural Gerontology 1(4):339-362. Manton, K.G., G.C. Myers, and G.R. Andrews 1987 Morbidity and disability patterns in four developing nations: Their implications for social and economic integration of the elderly. Journal of Cross-Cultural Gerontology 2(2): 115-129. Martin, L.G. 1987 Census data for studying elderly populations. Asia-Pacific Population Journal (Bangkok:ESCAP) 2(2):69-82. 1988 The aging of Asia. Journal of Gerontology 43:S99-S113. 1989a Emerging issues in cross-national survey research on ageing in Asia. Pp. 69-80 in International Population Conference, New Delhi 1989, Vol. 3. Liege: International Union for the Scientific Study of Population. 1989b Living arrangements of the elderly in Fiji, Korea, Malaysia, and the Philippines. Demography 26(4):627-643. 1990 The status of South Asia's growing elderly population. Journal of Cross-Cultural Gerontology 5(2):93-117. 1991 Population aging policies in East Asia and the United States. Science 251:527-531. Massey, J.M., and E. Shapiro 1982 Self-rated health: A predictor of mortality among the elderly. American Journal of Public Health 72:800-808. McCallum, J. 1992 Asia Pacific retirement: Models for Australia, Fiji, Malaysia, Philippines and Republic of Korea. Journal of Cross-Cultural Gerontology 7(1 ):25-43. McGreevey, W. 1990 Social security in Latin America. World Bank Discussion Paper 110. Mosley, W.H., and P. Cowley 1991 The challenge of world health. PRB Population Bulletin 46(4). Murray, C.J.L., R.G. Feachem, M. A. Phillips, and C. Willis 1992a Adult morbidity: Limited data and methodological uncertainty. Pp. 113-160 in R.G. Feachem, T. Kjellstrom, C.J.L. Murray, M. Over, and M.A. Phillips, eds., The Health of Adults in the Developing World. Washington, D.C.: World Bank. Murray, C.J.L., G. Yang, and X. Qiao 1992b Adult mortality: Levels, patterns and causes. Pp. 23-111 in R.G. Feachem, T. Kjellstrom, C.J.L. Murray, M. Over, and M.A. Phillips, eds., The Health of Adults in the Developing World. Washington, D.C.: World Bank.
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Demography of Aging Myers, G.C. 1992 Demographic aging and family support for older persons. Pp. 31-69 in H.L. Kendig, A. Hashimoto, and L.C. Coppard, eds., Family Support for the Elderly. New York: Oxford University Press. 1993 International research on healthy life expectancy. Proceedings of the 1991 International Symposium on Data on Aging. Hyattsville, Md.: National Center for Health Statistics. Myers, G.C., and D.O. Clark 1991 Population Redistribution and Migration of Older Persons in Developing Countries. Paper presented at the University of Colorado Institute of Behavioral Science Conference on the Elderly Mobility Transition, Aspen Lodge, Estes Park, Colo. Nydegger, C.N. 1983 Family ties of the aged in cross-cultural perspective. The Gerontologist 23(1):26-32. Oakes, S.C., V.S. Mitchell, G.W. Pearson, and C.J. Carpenter, eds. 1991 Malaria: Obstacles and Opportunities. A report of the Committee for the Study of Malaria Prevention and Control, Division of International Health, Institute of Medicine. Washington, D.C.: National Academy Press. Ofstedal, M.B., and L. Chi 1992 Coresidence Choices of Elderly Parents and Adult Children in Taiwan. Paper presented at the annual meeting of the Gerontological Society of America, Washington, D.C. Pan American Health Organization 1989a A Profile of the Elderly in Argentina. Technical Paper No. 26. Washington, D.C. 1989b A Profile of the Elderly in Guyana. Technical Paper No. 24. Washington, D.C. 1990 Health Conditions in the Americas, 1990 Edition, Vol. 1. Scientific Publication No. 524. Washington, D.C. Pan American Health Organization and American Association of Retired Persons (PAHO/AARP) 1989 Midlife and Older Women in Latin America and the Caribbean. Washington, D.C. Pollard, J.H. 1982 The expectation of life and its relationship to mortality. Journal of the Institute of Actuaries 109:225-240. Rahman, O., A. Foster, and J. Menken 1992 Older widow mortality in rural Bangladesh. Social Science and Medicine 34(1):89-96. Ramos, L.R. 1992 Family support for elderly people in Sao Paulo, Brazil. Pp. 224-232 in H.L. Kendig, A. Hashimoto, and L.C. Coppard, eds., Family Support for the Elderly. New York: Oxford University Press. Rees, P. 1991 A tale of two cities: The prospects for future ageing of the populations of London and Harare. Pp. 117-166 in Aging and Urbanization. Proceedings of the United Nations International Conference on Ageing Populations in the Context of Urbanization, Sendai, Japan. New York: United Nations. Riley, J.C. 1990 Morbidity trends in four countries. Population and Development Review 16(3):403-432. 1992 From a high mortality regime to a high morbidity regime: Is culture everything in sickness? Health Transition Review 2(1):71-78. Ruzicka, L., and P. Kane 1991 Mortality Transition and Cause of Death Structure in Asia. Paper presented at the
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Demography of Aging Weinstein, M., T. Sun, M. Chang, and R. Freedman 1989 Household Composition, Extended Kinship, and Reproduction in Taiwan: 1965-85. Paper presented at the annual meeting of the Population Association of America, Baltimore, Md. Wiener, J.M., R.J. Hanley, R. Clark, and J.F. Van Nostrand 1990 Measuring the activities of daily living: Comparisons across national surveys. Journal of Gerontology 45(6):S229-S237. Williamson, J.B. 1992 Public Pension Policy: The Brazilian Model vs. the Chilean Model. Paper presented at the annual meeting of the Gerontological Society of America, Washington, D.C. World Bank 1992 China: Long-Term Issues and Options in the Health Transition. Washington, D.C.: World Bank. Yu, Y.C., and S. Horiuchi 1987 Population Aging and Juvenation in Major Regions of the World. Paper presented at the annual meeting of the Population Association of America, Chicago. Zeng, Y. 1986 Changes in family structure in China: A simulation study. Population and Development Review 12(4):675-703. 1988 Changing demographic characteristics and the family status of Chinese women. Population Studies 42(2):183-203. 1989 Ageing of the Chinese population and policy issues: Lessons from a rural-urban dynamic projection model. Pp. 81-99 in International Population Conference, New Delhi 1989, Vol. 3. Liège: International Union for the Scientific Study of Population.
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Demography of Aging APPENDIX TABLE Surveys of the Elderly in Developing Countries Country Survey Name Sponsoring or Primary Organization Survey Year Coveragea Number of Respondentsa Age Group, Comments (especially if sample nonrandom) Cross-national Indonesia Socioeconomic Consequences of the Ageing of the Population Association of Southeast Asian Nations 1986 Java 4,500 households Households stratified by type of economic activity Household had respondent aged 55 or older Philippines 1984 Three provinces 1,321 60+; provinces selected on basis of major language and Manila 1,254 55+; based on census frame; random Malaysia 1986 Three states 3,246 60+; also 2,111 persons 15-44 re attitudes toward elderly Thailand 1986 National 1,013 60+; Two companion surveys: (1) elderly in institutions; Singapore 1986 National (2) elderly sick in community Philippines Health and Social Aspects of Aging WHO Regional Office for the Western Pacific 1984 Tagalog 830 60+; Tagalog region = 10 provinces and metropolitan Manila Malaysia 1984 Peninsular 1,001 60+; purposive sample Korea (South) 1984 National 977 60+ Fiji 1984 National 769 60+; purposive sample Bahrain WHO Regional 1989 60+ Egypt Office for 1989 60+ Jordan the Eastern 1989 60+ Tunisia Mediterranean 1989 60+ Indonesia WHO Regional 1990 Central Java 1,202 60+ Korea (North) Office for 1990 Three regions 1,150 60+ Myanmar South East Asia 1990 Ethnic Bamar 1,221 60+ Sri Lanka 1990 Western Province 1,200 60+ Thailand 1990 Bangkok + four 1,199 60+ regions 875 60+ Trinidad and Tobago Profiles of the Elderly Pan American Health c. 1985 National 542 60+; Georgetown and its suburbs Organization 3,058 60+; urban areas of 500,000+ Guyana 1984 Capital 1,154 60+ Argentina 1985-1986 Urban 1,562 60+; urban areas of 100,000+ Costa Rica 1984 National Chile 1984-1985 Urban Barbados Brazil Colombia Cuba El Salvador Honduras Jamaica Venezuela
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Demography of Aging Country Survey Name Sponsoring or Primary Organization Survey Year Coveragea Number of Respondentsa Age Group, Comments (especially if sample nonrandom) China Emerging Issues of the Aging of Population in Selected ESCAPb Countries U.N. Economic and Social Commission for Asia and Pacific 1987 Four localities 541 60+; purposive; two localities in Jilin Province, one in Shanghai City, one in Shanghai County Korea (South) ??? Four areas 798 60+; three urban and one rural area; 91 intensive interviews Malaysia 1987 Melaka 372 60+; random sample in West Peninsular state of Melaka Sri Lanka 1987 National 317 60+; purposive Chile Aging and Dementia WHO 1992 Mixed 5,000 55+; longitudinal; four developed countries also in survey; Nigeria 1992 5,000 studies now in the field Costa Rica Determinants of Healthy Agingc WHO c. 1993 55+; longitudinal; sample sizes and strategies Indonesia c. 1993 still to be determined; country list includes Italy Israel c. 1993 Jamaica c. 1993 Thailand c. 1993 Zimbabwe c. 1993 Brazil Osteoporosisc WHO c. 1993 5,000 50+; to include case-control, cross-sectional, and China c. 1993 5,000 longitudinal studies Hong Kong c. 1993 5,000 Jamaica c. 1993 5,000 Nigeria c. 1993 5,000 National Barbados Social and Economic Circumstances of the Elderly University of the West Indies 1982 National 414 65+ China Survey of Aged Population Five University Population Institutes 1986 Five locales NA One per 1,000 sample survey on aged population (presumably 60+ in localities where universities are located: Shanghai, Hubei, Jilin, Liaoning, Beijing). China Survey of the Aged CASS Population Instituted 1987 National 36,755 60+; Tibet excluded China Cognitive Impairment University of Illinois c. 1988 Shanghai 5,055 55+; noninstitutional population China Support Systems for the Elderly China Research Center on Aging 1991 12 areas 20,000 Data not yet released Hong Kong Health Survey of the Elderly University of Hong Kong 1989 National 1,172 55+; self-reported status; includes life-style and social support measures
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Demography of Aging Country Survey Name Sponsoring or Primary Organization Survey Year Coveragea Number of Respondentsa Age Group, Comments (especially if sample nonrandom) India Survey of the Elderly Registrar General c. 1990 National NA 60+; results not yet released Korea (South) Korean Elderly Survey Korean Institute for 1984 Population and Health National 3,704 60+; focus on living arrangements and caretaker attitudes Morocco Aged Persons in Morocco Ministère de L'Artisanat et Affaires Sociales c. 1984 Seven zones 899 58+; sample based on occupation; women underrepresented South Africa Multidimensional Survey of Elderly South Africans Human Sciences Research Council, University of Pretoria 1990-1991 National 4,365 60+ Taiwan Youth and the Old Survey Directorate-General of Budget Accounting and Statistics 1988 NA NA All ages Taiwan Taiwan Provincial Institute of Family Planning and University of Michigan 1989 National 4,049 60+ NOTE: Other recent surveys in developing countries that cover other age groups in addition to the elderly, but that are well suited to the study of the elderly include the Malaysia Family Life Survey II and the Indonesia Family Life Survey, both conducted by RAND. a NA = Not available. b ESCAP = United Nations Economic and Social Commission for Asia and the Pacific. c In planning stages. d CASS = Chinese Academy of Social Sciences.
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Representative terms from entire chapter: