Variations in disability and quality of life with age and sex between eight lower income and middle-income countries: data from the INDEPTH WHO-SAGE collaboration

Abstract

BackgroundDisability and quality of life are key outcomes for older people. Little is known about how these measures vary with age and gender across lower income and middle-income countries; such information is necessary to tailor health and social care policy to promote healthy ageing and minimise disability.MethodsWe analysed data from participants aged 50 years and over from health and demographic surveillance system sites of the International Network for the Demographic Evaluation of Populations and their Health Network in Ghana, Kenya, Tanzania, South Africa, Vietnam, India, Indonesia and Bangladesh, using an abbreviated version of the WHO Study on global AGEing survey instrument. We used the eight-item WHO Quality of Life (WHOQoL) tool to measure quality of life and theWHO Disability Assessment Schedule, version 2 (WHODAS-II) tool to measure disability. We collected selected health status measures via the survey instrument and collected demographic and socioeconomic data from linked surveillance site information. We performed regression analyses to quantify differences between countries in the relationship between age, gender and both quality of life and disability, and we used anchoring vignettes to account for differences in interpretation of disability severity.ResultsWe included 43 935 individuals in the analysis. Mean age was 63.7 years (SD 9.7) and 24 434 (55.6%) were women. In unadjusted analyses across all countries, WHOQoL scores worsened by 0.13 points (95% CI 0.12 to 0.14) per year increase in age and WHODAS scores worsened by 0.60 points (95% CI 0.57 to 0.64). WHODAS-II and WHOQoL scores varied markedly between countries, as did the gradient of scores with increasing age. In regression analyses, differences were not fully explained by age, socioeconomic status, marital status, education or health factors. Differences in disability scores between countries were not explained by differences in anchoring vignette responses.ConclusionsThe relationship between age, sex and both disability and quality of life varies between countries. The findings may guide tailoring of interventions to individual country needs, although these associations require further study.

Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

“…Disability was measured using the 12-item WHO Disability Assessment Schedule, version 2 (WHODAS V.2.0) disability score 11 48. This score measures impairments in function, activity and participation (mobility, self-care, cognition, interaction with others, life activities and social participation).…”

“…Measures were summed to form a score, then normalised to a 0–100 scale, where 0 equals no disability and 100 represents the worst disability. Quality of life was measured using the validated EuroHIS 8-item version of the WHO Quality of Life (WHOQOL) 11 49. Each item was scored on a five-point scale and summed: for the analysis, the score was normalised to a 0–100 scale, with 100 denoting the best quality of life.…”

“…A change in development focus has paralleled this epidemiological shift with the sustainable development goals moving away from single diseases, to a broader array of conditions and access to the health systems required to treat these 9. These changes have come with a realisation that individuals often suffer from multiple concurrent conditions, and that the circumstances in which individuals live impacts both risk of conditions and their physical consequences 10 11…”

Quality of life, level of functioning, and its relationship with mental and physical disorders in the elderly: results from the MentDis_ICF65+ study

“…As underlined by some authors, [36] it is always difficult, in multicenter studies, to interpret possible differences among countries, since different response styles, differences in the meaning of response levels within the various language versions of the questionnaires or, cultural variables, play a possible role in molding the impact on the people's perception of their own QoL and LoF. In agreement with this, data from the European ESEMeD study have shown that among 1659 respondents aged ≥75 years recruited from Belgium, France, Germany, Italy, Netherlands, and Spain, there were significant differences between countries with the lowest QoL scores in Italy and the highest in the Netherlands, although it was not possible to completely understand the reasons for these differences, due to the many variables involved including the different health organizational systems in the countries [17].. On the other hand, significant differences in QoL and LoF, as ascertained by using the WHO-QoL-BREF and the WHODAS II, were also found between Asian and African countries, [37] as well as in low-income countries, with differences not fully explained by age, socioeconomic status, marital status, education or other health factors [38]. However, the data call for attention at the European Union about the need for governmental policies in order to provide more homogeneous health care to the population that is aging amongst the different countries members.…”

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

“…In these studies, two analytical strategies have prevailed. First, the disability is modeled in a continuum range (capture by the WHODAS score), in which higher scores represent a higher level of disability (26,27). Second, a cutoff is applied to the WHODAS score (using the 90th percentile) to generate a dichotomous variable indicating disability (18,28).…”