Explore the vast range of titles available.

This book overviews the issue of population ageing in five countries in South Asia and projects the emerging scenarios. With a new field survey, it also documents existing policies and programs on pensions and social security, and examines their fiscal implications for the economy and society. Ageing of population is an inevitable consequence of the process of demographic transition. Being ahead, the developed regions of the world have long experienced its consequences; but the developing world is only now facing the travails of population ageing. Though the population under the age of 15 years in 2000 was estimated to be 3.3 times the size of the population of 60 years and above, the elderly are expected to surpass the number of children under 15 years by the year 2050. Among the elderly, it is the oldest old-those aged 80 years or more, whose numbers would increase most rapidly. Much of this growth would take place in the poor countries of the world. Five South Asian countries (India, Pakistan, Bangladesh, Sri Lanka and Nepal) account for 100 million elderly persons in the beginning of 21st century and it is expected to reach 400 million in 2050. What are the fiscal implications of this tremendous growth for sustaining pensions and social security schemes in South Asia? Are these countries in need of pension reforms? Would these countries be able to provide good health care for the growing population of elderly persons afflicted by multiple diseases and disability? Experts from leading economic research institutions address the issue with a new survey conducted in each country. The book, in effect: Assesses the ageing scenario in five countries in South Asia: past, present, and future; Reviews existing policies and programs on pensions and social security for the elderly; Reports the findings of a sample survey in each of these countries conducted f

South-East Asia (SEA) is the home of the largest number of the world’s older population. In this scoping review, we aimed to map the existing enablers and barriers of accessing healthcare services among older adults in SEA countries. Articles that were published from January 2001 until November 2021 were searched in four data sources (PubMed, Web of Science, EBSCO Host and The Cochrane Library). Studies pertaining to the factors which assist or obstruct older Southeast Asian adults from assessing healthcare services were chosen for this scoping review. First, two reviewers screened the titles and abstracts of articles in the data sources. After identifying appropriate articles, the reviewers read them. Data extracted by one reviewer were verified by the other reviewer. The findings were then classified according to Penchansky and Thomas’s five domains of access. A total of 19 studies were included in the final scoping review. Accessibility and acceptability were the two factors most often identified as enablers or barriers to older adults from accessing healthcare. Other often mentioned factors were finances, transportation and social/family support. Older adults living in rural areas were especially impacted by these factors. To promote healthy ageing, optimum healthcare and wellbeing among older adults in Southeast Asia, it is extremely important to consider accessibility and acceptability when planning healthcare services.

Introduction Many refugees face challenges accessing water, sanitation, and hygiene (WASH) services. However, there is limited literature on WASH access for refugee populations, including for menstrual health services. Unmet WASH access needs may therefore be hidden, amplifying morbidity and mortality risks for already vulnerable refugee populations. The aim of this study was therefore to quantitatively analyze WASH access among refugee camps, with a focus on households with women of reproductive age. Methods This was a cross-sectional study that utilized the Standardized WASH Knowledge, Attitude and Practice (KAP) Survey. A total of 5632 household questionnaires were completed by the United Nations Refugee Agency in 2019 in 21 refugee camps and settlements in Bangladesh, Kenya, South Sudan, Uganda, and Zimbabwe. WASH access (14 items) and social and geographic stratifiers were analyzed at the household-level including the refugee camp, country of the settlement, having women of reproductive age, members with disability/elderly status, and household size. We calculated frequencies, odds ratios, and performed bivariate and multivariate analyses to measure inequalities. We developed a Female WASH Access Index to characterize WASH access for households with women of reproductive age. Results Most refugee households had high levels of access to improved water (95%), low levels of access to waste disposal facility (64%) and sanitation privacy (63%), and very low access to basic sanitation (30%) and hand hygiene facility (24%). 76% of households with women of reproductive age had access to menstrual health materials. WASH access indicators and the Female WASH Access Index showed large inequalities across social and geographic stratifiers. Households with disabled or elderly members, and fewer members had poorer WASH access. Households with women of reproductive age had lower access to basic sanitation. Conclusions Large inequalities in WASH access indicators were identified between refugee sites and across countries, in all metrics. We found high levels of access to improved water across most of the refugee camps and settlements studied. Access to basic hygiene and sanitation, sanitation privacy, waste disposal, and menstrual health materials, could be improved across refugee sites. Households with women of reproductive age, with 4+ members, and without members with disability/elderly status were associated with higher WASH access. The female WASH access index piloted here could be a useful tool to quickly summarize WASH access in households with women of reproductive age. Highlights Most camps have improved sanitation, albeit often shared and with poor privacy. Most households had access to soap, but few had dedicated hand hygiene facilities. Households with women of reproductive age had lower access to basic sanitation. The Female WASH Access Index summarizes and compares female access across camps. Households with disabled or elderly members, and fewer members had poorer WASH access.

Dementia has become a public health priority along with population ageing worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) has become the desired outcome for people with dementia. The aim of this study was to compare the Quality of Life (QOL) of patients with dementia in Sri Lanka when assessed based on the patient’s and caregiver’s perspectives. A cross-sectional study was conducted among 272 pairs of patients with dementia and their primary caregivers recruited systematically from the psychiatry outpatient clinics of tertiary care state hospitals in the district of Colombo, Sri Lanka. The QOL was assessed using the 28-item DEMQOL among patients and the 31-item DEMQOL-proxy among primary caregivers. The total QOL ratings and subscale scores obtained by patients and caregivers were compared and assessed for the significance of the mean scores using the independent t-test and of the mean difference in ratings using the Wilcoxon test. Agreement between patients and their caregivers on the ratings for QOL was also assessed using the Bland Altman plot. The mean overall QOL score according to patient ratings (mean = 79.7; SD = 12.0) was significantly higher than the caregiver ratings (mean = 70.6; SD = 12.3) (p< 0.001). Mean scores for the four subscales (positive emotion, negative emotion, memory, and daily life) were also significantly higher according to the patient’s ratings (p<0.001). Total scores obtained by patients and their caregivers showed a positive and significant correlation (r = 0.385; p<0.001). Bland Altman plot demonstrated acceptable agreement between their ratings. The study confirms the ability of dementia patients with mild to moderate severity to successfully rate their own QOL. Furthermore, the caregiver’s ratings cannot be substituted for the patient’s ratings and vice versa.

The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science. Data on population demographics, human resources, health funding and social protection for older people were extracted. Local informants were consulted to supplement and verify the data. In the study countries, the number of health professionals with expertise in elderly care was largely unknown, with minimal postgraduate training programmes available in elderly medicine or psychiatry. Older adults are therefore cared for by general physicians, nurses and community health workers, all of whom are present in insufficient numbers per capita. Total average healthcare expenditure was 2.5-5.5% of GDP, with 48.1-72.0% of healthcare costs covered by out-of-pocket payments. Pakistan did not have a social pension; only India and Nepal offered financial assistance to people with dementia; and all countries had disproportionately low numbers of care elderly homes. Inadequate healthcare funding, a shortage of healthcare professionals and insufficient government pension and social security schemes are significant barriers to achieving universal health coverage in LMICs. Governing bodies must expand training programmes for healthcare providers for older adults, alongside increasing social protection to improve access to those in need and to prevent catastrophic health expenditure.

Purpose The objective of this study was to estimate the cross-sectional association of frailty status with overall and domain-specific quality of life (QoL) in rural community-dwelling older adults in Kegalle district of Sri Lanka. Methods A population-based cross-sectional study was conducted with 746 community-dwelling older adults aged ≥ 60 years living in the rural areas of Kegalle district of Sri Lanka in 2016. A three-stage probability sampling design was used to recruit participants. Frailty and QoL were assessed using the Fried phenotype and Older People’s Quality of Life Questionnaire, respectively. Multivariable linear regression was used to estimate the association of frailty with QoL after accounting for the complex sampling design. Results The median (IQR) age of the sample was 68 (64:75) years and comprised of 56.7% women. 15.2% (95% CI 12.4%, 18.7%) were frail and 48.5% (95% CI 43.9%, 53.2%) were pre-frail. The unadjusted means (SE) of the total QoL score for the robust, pre-frail and frail groups were 139.2 (0.64), 131.8 (1.04) and 119.2 (1.35), respectively. After adjusting for covariates in the final multivariable model, the estimated differences in mean QoL were lower for both frail and pre-frail groups versus robust. The estimated reduction in the total QoL score was 7.3% for those frail and 2.1% for those pre-frail. All QoL domains apart from ‘social relationships and participation’, ‘home and neighbourhood’ and ‘financial circumstances’ were associated with frailty. Conclusions Frailty was associated with a small but significant lower quality of life in this rural Sri Lankan population, which appears largely explained by ‘health’ and ‘independence, control over life and freedom’ QoL domains. Interventions aiming to improve quality of life in frail older adults should consider targeting these aspects.

To estimate frailty prevalence and its relationship with the socio-economic and regional factors and health care outcomes. In this study, participants from the harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) were included. The frailty index (FI) was calculated using a 32-variable deficit model, with a value of ≥ 25% considered as frail. Data on demographic (including caste and religion) and socioeconomic profiles and health care utilization were obtained. The state-wise health index maintained by the government based on various health-related parameters was used to group the participants' residential states into high-, intermediate-, and low-performing states. Multivariable and zero-inflated negative binomial regression was used to assess the relationship of frailty index with sociodemographic characteristics, health index, and health care expenditure or hospitalization. Among the 3953 eligible participants, the prevalence of frailty was 42.34% (men = 34.99% and women = 49.35%). Compared to high-performing states, intermediate- and low-performing states had a higher proportion of frail individuals (49.7% . 46.8% . 34.5%,  < 0.001). In the adjusted analysis, frailty was positively associated with age, female sex, rural locality, lower education level, and caste (scheduled caste and other backward classes). After adjusting for the socio-economic profile, FI was inversely associated with the composite health index of a state (  < 0.001). FI was also significantly correlated with total 1-year health care expenditure and hospitalization (  < 0.001 and 0.020, respectively). There is a high prevalence of frailty among older Indian adults that is associated with sociodemographic factors and regional health care performance. Furthermore, frailty is associated with increased health care utilization and expenditure.

ObjectiveOver 850 000 people live with dementia in the UK. A proportion of these people are South Asians, who make up over 5% of the total UK population. Little is known about the prevalence, experience and treatment of dementia in the UK South Asian population. The aim of this scoping review is to identify dementia studies conducted in the UK South Asian population to highlight gaps in the literature which need to be addressed in future research.MethodDatabases were systematically searched using a comprehensive search strategy to identify studies. A methodological framework for conducting scoping reviews was followed. An extraction form was developed to chart data and collate study characteristics and findings. Studies were then grouped into six categories: prevalence and characteristics; diagnosis validation and screening; knowledge, understanding and attitudes; help-seeking; experience of dementia; service organisation and delivery.ResultsA total of 6483 studies were identified, 27 studies were eligible for inclusion in the scoping review. We found that studies of prevalence, diagnosis and service organisation and delivery in UK South Asians are limited. We did not find any clinical trials of culturally appropriate interventions for South Asians with dementia in the UK. The existing evidence comes from small-scale service evaluations and case studies.ConclusionsThis is the first scoping review of the literature to identify priority areas for research to improve care for UK South Asians with dementia. Future research should first focus on developing and validating culturally appropriate diagnostic tools for the UK South Asians and then conducting high-quality epidemiological studies in order to accurately identify the prevalence of dementia in this group. The cultural adaptation of interventions for dementia and testing in randomised controlled trials is also vital to ensure that there are appropriate treatments available for the UK South Asians to access.

ObjectivesThe aims of the present study were to establish the prevalence of stroke, and to explore the association between stroke prevalence and sociodemographic and health factors, disability, cognitive functioning and care needs among older adult residents in Singapore.SettingData were drawn from the Well-being of the Singapore Elderly study—a cross-sectional epidemiological survey conducted from 2012 to 2013 on older adults living in Singapore.ParticipantsParticipants were Singapore residents (citizens and permanent residents) 60 years and above who were living in Singapore during the survey period . Older adult residents who were institutionalised were also included in this study. Those who were not living in Singapore or who were not contactable were excluded from the study. The response rate was 65.6 % (2565/3913). A total population sample of 2562 participants completed the survey. Participants comprised 43.6% males and 56.4% females. The sample comprised 39.4% Chinese, 29.1% Malay, 30.1% Indian and 1.4% other ethnicities .Primary and secondary outcome measuresHistory of stroke, along with other health and mental health conditions, disability and cognitive functioning, were determined by self-report.ResultsWeighted stroke prevalence was 7.6% among older adults aged 60 and above. At a multivariate level, Malay ethnicity (OR 0.41, p=0.012, 95% CI 0.20 to 0.82), hypertension (OR 4.58, p=0.001, 95% CI 1.84 to 11.40), heart trouble (OR 2.45, p=0.006, 95% CI 1.30 to 4.63), diabetes (OR 2.60, p=0.001, 95% CI 1.49 to 4.53) and dementia (OR 3.57, p=0.002, 95% CI 1.57 to 8.12) were associated with stroke prevalence.ConclusionsSeveral findings of this study were consistent with previous reports. Given that Singapore’s population is ageing rapidly, our findings may indicate the need to review existing support services for stroke survivors and their caregivers. Future research could investigate the association between various sociodemographic and health conditions and stroke prevalence to confirm some of the findings of this study.

Health system responsiveness (HSR) has been identified as one of the intrinsic goals of health systems for improvement in health and well-being of population. The HSR deals with the non-medical, legitimate expectations of a population in its interaction with the health system. It becomes essential in case of vulnerable groups like older adults with disability, who are more sensitive and risk-prone to the adversities of healthcare challenges. This paper uses data from the Study on Global Ageing and Adult Health conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007-10 and examines the disability-based disparity in outpatient HSR among the older adults in the above-mentioned countries. Disability and HSR scores have been constructed using Item Response Theory Partial Credit Model. Also, the paper uses bivariate and multivariate analysis and finds that the HSR is significantly and substantially lower among the disabled and severely disabled older adults in all the study countries (except Ghana) as compared with those older adults who are not (or mildly) suffering from any form of disability. The policy efforts in the studied countries should focus on monitoring and reducing these disparities for improving HSR in order to make it inclusive.