Severity Levels of Disability Among Older Adults in Low- and Middle-Income Countries: Results From the Study on Global Ageing and Adult Health (SAGE)

Abstract

Background: Recent studies suggest the importance of distinguishing the severity levels of disability in the older adult population. However, there is still no consensus regarding an optimal classification. Few studies have estimated the prevalence of severe disability, and the results have been confined to high-income countries. There is no evidence for low-and middle-income countries (LMICs). Therefore, the aim of this study was to provide estimates of the levels of severity associated with disability in older adult populations in LMICs and to examine their relationship with health and socioeconomic factors. Methods: We used data from the Study on global AGEing and adult health (SAGE), wave 1 (2007-2010). Nationally representative samples of adults over 50 years from China, Ghana, India, Mexico, Russian Federation, and South Africa were analyzed (n = 33,641). We measured disability using the World Health Organization Disability Assessment Instrument version 2.0 (WHODAS 2.0). Disability levels according to severity were identified through the use of latent class analysis. Socioeconomic and health factors associated with severe disability were estimated using ordinal logistic regression models. Results: We identified four groups of older adult: (1) without disability, 43.4%; (2) mild disability, 33.3%; (3) moderate disability, 15.3%; and (4) severe disability, 8.0%. These results were heterogeneous for the six countries analyzed. Education and socioeconomic status were significantly associated with severe disability along with the following chronic conditions: angina, arthritis, asthma, cataracts, chronic obstructive pulmonary disease, depression, diabetes, and stroke. Severe disability was also associated with the frailty status, sarcopenia, and mild cognitive impairment. Conclusions: In this study, we estimated severity levels of disability for the older adult population in LMICs. Our results show that severe disability affects 8% of older adult, and that there are important socioeconomic and health factors associated with this condition. Measuring the severity of disability is a critical element to study the Salinas-Rodríguez et al. Severe Disability in Older Adults causes and consequences of aging. Moreover, the identification of older adult with severe disability is vital to design prevention programs, modify interventions, or develop enabling environments.

Longitudinal association of sarcopenia and mild cognitive impairment among older Mexican adults

“…The presence of sarcopenia was defined, according to previous studies using the Mexico‐SAGE data, 10 as having low SMM, reflected by lower skeletal muscle mass index (SMI), and either or both slow gait speed and weak handgrip strength. Specifically, sarcopenia was determined according to the following criteria: Low SMM.…”

“…However, the inclusion of different conditions such as self‐reported cognition changes, cognitive impairment in one or more domains, functional independence and no dementia is widely accepted 8 . MCI has been observed between 3 and 22% worldwide, 8 whereas in Mexico the prevalence ranges between 6 and 16.5% 9,10 . It is projected that, in low‐ and middle‐income countries, MCI and sarcopenia will only continue to increase, 5,11 making it even more important to understand how these two conditions may be associated.…”

“… 8 MCI has been observed between 3 and 22% worldwide, 8 whereas in Mexico the prevalence ranges between 6 and 16.5%. 9 , 10 It is projected that, in low‐ and middle‐income countries, MCI and sarcopenia will only continue to increase, 5 , 11 making it even more important to understand how these two conditions may be associated.…”

Toward a multidimensional understanding of later life disability: A latent profile analysis

“…Despite the convoluted presentation of disability, a paucity of research has examined disability based on multiple dimensions (Looman et al, 2018;Macleod et al, 2016;Üstün et al, 2010). Of the studies that have, a fraction of that research has concentrated on older adult populations (Freedman, 2018, Gill et al, 2010Montanari et al, 2010;Pongiglione et al, 2017;Salinas-Rodríguez et al, 2020). Another detail worth acknowledging is that almost all or all of those studies have utilized the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) measurement based on the ICF framework (Ferrer et al, 2019;Huang et al, 2015;Subramaniam et al, 2019).…”

“…A person-centered approach is favorable because disablement is not uniform across all older adults. To my knowledge, only four studies, three on older adults and one on adults 18 and older, have attempted to group individuals into different classes based on multiple domains (Macleod et al, 2016;Montanari et al, 2010;Pongiglione et al, 2017;Salinas-Rodríguez et al, 2020). All of these researchers used latent class analysis (LCA) and identified four-class solutions.…”