Functional Dependency in Mexico: Measurement Issues and Policy Challenges

Document Type : Original Article

Authors

1 Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile

2 National Institute of Geriatrics, Mexico City, Mexico

Abstract

Background
Different definitions have been used to measure functional dependency (FD) in Mexico. This study aims to explore if different definitions of FD lead to low consistency between the estimations of its prevalence. Accurate estimations of FD are useful to estimate the potential demand for long-term care (LTC) services in the country.
 
Methods
A literature review including documents with estimations on the number or prevalence of dependents in Mexico with national representativeness between 2000 and 2019 was performed as well as estimations of different definitions of FD, using the National Study on Health and Aging in Mexico (ENASEM).
 
Results
There is a lack of consensus on the definition of FD. Among the most frequently used terms to define FD are “disability” and “dependency.” The heterogeneity of definitions results in a wide range of estimations of the demand for LTC. Methodological choices can lead to important differences in FD prevalence estimations. Results from ENASEM 2001 show that FD prevalence could range from 13% to 35% in people 60+; sex prevalences also vary when using different ways to measure FD.
 
Conclusion
Besides the highlighted issues in calculating FD in the population, Mexico should consider broadening the assessment of FD, including people with dementia and younger populations. Although the literature search is not systematic, it helps exemplifying the current issues when measuring FD in Mexico. A consensual definition of dependency is required to have a more accurate estimated demand for LTC. Having good data sources is not enough when dissimilar estimations of an indicator like dependency result from the same study. Wide heterogeneity in estimations of dependency could be an obstacle to inform public policies during the construction of a care system in Mexico.

Keywords

References

  1. Naciones Unidas. División de Población. World Population Prospects - Population Division - United Nations. https://esa.un.org/unpd/wpp/.  Accessed May 4, 2018. Published 2019.
  2. Manton KG, Stallard E. Medical demography: interaction of disability dynamics and mortality. In: Martin LG, Preston SH, eds. Demography of Aging. Washington, DC: National Academies Press; 1994.
  3. Freedman VA, Martin LG, Cornman J, Agree EM, Schoeni RF. Trends in assistance with daily activities: racial/ethnic and socioeconomic disparities persist in the US older population. In: Cutler DM, Wise DA, eds. Health at Older Ages: The Causes and Consequences of Declining Disability Among the Elderly. University of Chicago Press; 2008:411-438. https://www.nber.org/chapters/c11121.  Accessed August 19, 2020.
  4. Colombo F, Llena-Nozal A, Mercier J, Tjadens F. Help Wanted?: Providing and Paying for Long-Term Care. Paris: OECD; 2011. doi:10.1787/9789264097759-en
  5. Carrera F, Pavolini E, Ranci C, Sabbatini A. Long-term care systems in comparative perspective: care needs, informal and formal coverage, and social impacts in European countries. In: Ranci C, Pavolini E, eds. Reforms in Long-Term Care Policies in Europe: Investigating Institutional Change and Social Impacts. New York, NY: Springer; 2013:23-52. doi:10.1007/978-1-4614-4502-9_2
  6. Huang C, Soldo BJ, Elo IT. Do early-life conditions predict functional health status in adulthood? the case of Mexico. Soc Sci Med. 2011;72(1):100-107. doi:10.1016/j.socscimed.2010.09.040
  7. World Health Organization (WHO). World Report on Ageing and Health. Geneva: WHO; 2015.
  8. Aranco N, Stampini M, Ibarrarán P, Medellín N. Panorama de Envejecimiento y Dependencia En América Latina y El Caribe. Washington, DC: Inter-American Development Bank; 2018. doi:10.18235/0000984
  9. Scheil-Adlung X. Long-Term Care Protection for Older Persons: A Review of Coverage Deficits in 46 Countries. Geneva: ILO, 2015.
  10. Gutierrez-Robledo LM. Relación entre el deterioro funcional, el grado de dependencia y necesidades asistenciales de la población envejecida en México. In: Centro Regional de Investigaciones MultidisciplinariasRelación entre el deterioro funcional  el grado de dependencia y necesidades asistenciales de la población envejecida en M, ed. La Población de México Al Final Del Siglo XX, Vol.  I; 1998. https://www.crim.unam.mx/web/node/1437.  Accessed August 19, 2020.
  11. Hornillos Calvo M, Esteban Dombrid MJ, Urbina Torija J, et al. Influencia de la patología crónica sobre la incapacidad funcional en una población anciana del medio rural. Rev Esp Geriatr Gerontol. 1998;33(5):263-271.
  12. Menéndez J, Guevara A, Arcia N, León Díaz EM, Marín C, Alfonso JC. [Chronic diseases and functional limitation in older adults: a comparative study in seven cities of Latin America and the Caribbean]. Rev Panam Salud Publica. 2005;17(5-6):353-361. doi:10.1590/s1020-49892005000500007
  13. Soria Romero Z, Montoya Arce BJ. [Aging and factors associated with quality of life for elderly people in State of Mexico]. Papeles Poblac. 2017;23(93):59-93. doi:10.22185/24487147.2017.93.022
  14. Sánchez-García S, Sánchez-Arenas R, García-Peña C, et al. Frailty among community-dwelling elderly Mexican people: prevalence and association with sociodemographic characteristics, health state and the use of health services. Geriatr Gerontol Int. 2014;14(2):395-402. doi:10.1111/ggi.12114
  15. Peek MK, Ottenbacher KJ, Markides KS, Ostir GV. Examining the disablement process among older Mexican American adults. Soc Sci Med. 2003;57(3):413-425. doi:10.1016/s0277-9536(02)00367-2
  16. Al Snih S, Graham JE, Ray LA, Samper-Ternent R, Markides KS, Ottenbacher KJ. Frailty and incidence of activities of daily living disability among older Mexican Americans. J Rehabil Med. 2009;41(11):892-897. doi:10.2340/16501977-0424
  17. Villalobos Dintrans P, Bossert TJ, Sherry J, Kruk ME. A synthesis of implementation science frameworks and application to global health gaps. Glob Health Res Policy. 2019;4:25. doi:10.1186/s41256-019-0115-1
  18. Aguilar-Navarro SG, Amieva H, Gutiérrez-Robledo LM, Avila-Funes JA. Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican Health and Aging Study. Salud Publica Mex. 2015;57 Suppl 1:S62-69. doi:10.21149/spm.v57s1.7591
  19. Downer B, Chen NW, Wong R, Markides KS. Self-reported health and functional characteristics of Mexican and Mexican American adults aged 80 and over. J Aging Health. 2016;28(7):1239-1255. doi:10.1177/0898264316656508
  20. García Benítez JC. Análisis del Bienestar de Los Adultos Mayores en México. http://conocimientoabierto.flacso.edu.mx/tesis/255.  Accessed August 20, 2020. Published 2008.
  21. García-González JJ, García-Peña C, Franco-Marina F, Gutiérrez-Robledo LM. A frailty index to predict the mortality risk in a population of senior Mexican adults. BMC Geriatr. 2009;9:47. doi:10.1186/1471-2318-9-47
  22. González CA, Ham-Chande R. [Functionality and health: a typology of aging in Mexico]. Salud Publica Mex. 2007;49 Suppl 4:S448-458. doi:10.1590/s0036-36342007001000003
  23. Grimard F, Laszlo S, Lim W. Health, aging and childhood socio-economic conditions in Mexico. J Health Econ. 2010;29(5):630-640. doi:10.1016/j.jhealeco.2010.07.001
  24. Gutiérrez Robledo LM, del Carmen García-Peña M, Jiménez Bolón J. Envejecimiento y Dependencia: Realidades y Previsión Para Los Próximos Años: Documento de Postura. México, DF: Consejo Nacional de Ciencia y Tecnología (CONACYT); 2014.
  25. Instituto Nacional de las Mujeres. Situación de Las Personas Adultas Mayores En México. http://cedoc.inmujeres.gob.mx/documentos_download/101243_1.pdf.  Accessed August 20, 2020. Published 2015.
  26. López-Ortega M. Limitación funcional y discapacidad: conceptos, medición y diagnóstico. Una introducción a la situación en México. In: Gutiérrez Robledo L, Stalnikowitz D, eds. Envejecimiento y Salud: Una Propuesta Para un Plan de Acción. SALUD, Secretaría de Salud INGER, Instituto Nacional de Geriatría; 2016. https://bpo.sep.gob.mx/#/recurso/3458.  Accessed August 20, 2020.
  27. Lozano Keymolen D, Montoya Arce BJ, Gaxiola Robles Linares SC, Román Sánchez YG. [Functional dependence and its relationship to general mortality in older adults. Mexico: 2001-2015]. Poblac Salud Mesoam. 2018;15(2):38-68. doi:10.15517/psm.v15i2.28660
  28. Angel JL, Vega W, López-Ortega M. Aging in Mexico: population trends and emerging issues. Gerontologist. 2017;57(2):153-162. doi:10.1093/geront/gnw136
  29. Manrique-Espinoza B, Salinas-Rodríguez A, Moreno-Tamayo K, Téllez-Rojo MM. [Functional dependency and falls in elderly living in poverty in Mexico]. Salud Publica Mex. 2011;53(1):26-33.
  30. Mejia-Arango S, Gutierrez LM. Prevalence and incidence rates of dementia and cognitive impairment no dementia in the Mexican population: data from the Mexican Health and Aging Study. J Aging Health. 2011;23(7):1050-1074. doi:10.1177/0898264311421199
  31. Mejía-Arango S, Miguel-Jaimes A, Villa A, Ruiz-Arregui L, Gutiérrez-Robledo LM. [Cognitive impairment and associated factors in older adults in Mexico]. Salud Publica Mex. 2007;49 Suppl 4:S475-481. doi:10.1590/s0036-36342007001000006
  32. de Oca VM, Hebrero M. Family dynamics, aging, and functional impairment in Mexico. Rev Kairos. 2008;11(1):143-166.
  33. Payne CF. Aging in the Americas: disability-free life expectancy among adults aged 65 and older in the United States, Costa Rica, Mexico, and Puerto Rico. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):337-348. doi:10.1093/geronb/gbv076
  34. Smith KV, Goldman N. Socioeconomic differences in health among older adults in Mexico. Soc Sci Med. 2007;65(7):1372-1385. doi:10.1016/j.socscimed.2007.05.023
  35. Trujillo AJ, Mroz TA, Piras C, Angeles G, Tran N. Caregiving and elderly health in Mexico. Int J Health Serv. 2012;42(4):667-694. doi:10.2190/HS.42.4.f
  36. Wong R, Espinoza M, Palloni A. [Mexican older adults with a wide socioeconomic perspective: health and aging]. Salud Publica Mex. 2007;49 Suppl 4:S436-447. doi:10.1590/s0036-36342007001000002
  37. Wong R, Michaels-Obregón A, Palloni A, et al. Progression of aging in Mexico: the Mexican Health and Aging Study (MHAS) 2012. Salud Publica Mex. 2015;57 Suppl 1:S79-89. doi:10.21149/spm.v57s1.7593
  38. Wong R, Michaels-Obregon A, Palloni A. Cohort profile: the Mexican Health and Aging Study (MHAS). Int J Epidemiol. 2017;46(2):e2. doi:10.1093/ije/dyu263
  39. Avila-Funes JA, Melano-Carranza E, Payette H, Amieva H. [Depressive symptoms as a risk factor for dependence in elderly people]. Salud Publica Mex. 2007;49(5):367-375. doi:10.1590/s0036-36342007000500007
  40. Yahirun JJ, Sheehan CM, Hayward MD. Adult children's education and parents' functional limitations in Mexico. Res Aging. 2016;38(3):322-345. doi:10.1177/0164027515620240
  41. Barrantes-Monge M, García-Mayo EJ, Gutiérrez-Robledo LM, Miguel-Jaimes A. [Functional dependence and chronic disease in older Mexicans]. Salud Publica Mex. 2007;49 Suppl 4:S459-466. doi:10.1590/s0036-36342007001000004
  42. Beltrán-Sánchez H, Pebley A, Goldman N. Links between primary occupation and functional limitations among older adults in Mexico. SSM Popul Health. 2017;3:382-392. doi:10.1016/j.ssmph.2017.04.001
  43. Díaz de León González E, Gutiérrez Hermosillo H, Martinez Beltran JA, et al. Validation of the FRAIL scale in Mexican elderly: results from the Mexican Health and Aging Study. Aging Clin Exp Res. 2016;28(5):901-908. doi:10.1007/s40520-015-0497-y
  44. Díaz de León González E, Tamez Pérez HE, Gutiérrez Hermosillo H, Cedillo Rodríguez JA, Torres G. [Frailty and its association with mortality, hospitalization and functional dependence in Mexicans aged 60-years or older]. Med Clin (Barc). 2012;138(11):468-474. doi:10.1016/j.medcli.2011.03.024
  45. Díaz-Venegas C, De La Vega S, Wong R. Transitions in activities of daily living in Mexico, 2001-2012. Salud Publica Mex. 2015;57 Suppl 1(0 1):S54-61. doi:10.21149/spm.v57s1.7590
  46. Dorantes-Mendoza G, Avila-Funes JA, Mejía-Arango S, Gutiérrez-Robledo LM. [Factors associated with functional dependence in older adults: a secondary analysis of the National Study on Health and Aging, Mexico, 2001]. Rev Panam Salud Publica. 2007;22(1):1-11. doi:10.1590/s1020-49892007000600001
  47. University of Texas Medical Branch. MHAS Publications. http://www.mhasweb.org/Publications.aspx.  Accessed August 20, 2020. Published 2012.
  48. VanSant AF. The international classification of functioning, disability and health. Pediatr Phys Ther. 2006;18(4):237. doi:10.1097/01.pep.0000245823.21888.71
  49. Instituto Nacional de Estadística y Geografía (INEGI). XII Censo General de Población y Vivienda, 2000. Aguascalientes: INEGI; 2000.
  50. Federal Ministry of Health. Report by the Advisory Board to Review the Definition on Need for Long-Term Care. Germany: Federal Ministry of Health; 2009.
  51. Jeon B, Kwon S. Health and long-term care systems for older people in the republic of Korea: policy challenges and lessons. Health Syst Reform. 2017;3(3):214-223. doi:10.1080/23288604.2017.1345052
  52. Jefatura del Estado (España). Ley 39/2006, de 14 de diciembre, de Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia. Boletín Oficial del Estado. BOE-A-2006-21990. https://www.boe.es/buscar/pdf/2006/BOE-A-2006-21990-consolidado.pdf.  Accessed August 19, 2020.
  53. Servicio Nacional del Adulto Mayor (SENAMA). Estudio Nacional de La Dependencia En Las Personas Mayores. Santiago: SENAMA; 2010. http://www.microdatos.cl/Documentos/docto_publicaciones/Estudio_Dependencia_Personas_Mayores.pdf.  Accessed May 17, 2018.
  54. Villalobos Dintrans P. [Aging and long-term care in Chile: challenges in the OECD context]. Rev Panam Salud Publica. 2017;41:e86. doi:10.26633/rpsp.2017.86
  55. Sistema de Cuidados (Uruguay). Baremo de dependencia formulario para Sistema de Cuidados. https://www.gub.uy/sistema-cuidados/sites/sistema-cuidados/files/documentos/publicaciones/formulario-de-aplicacion-baremo-de-dependencia.pdf.
  56. Orimo H. [Reviewing the definition of elderly]. Nihon Ronen Igakkai Zasshi. 2006;43(1):27-34. doi:10.3143/geriatrics.43.27
  57. Sanderson WC, Scherbov S. Demography. Remeasuring aging. Science. 2010;329(5997):1287-1288. doi:10.1126/science.1193647
  58. Dintrans PV. Is aging a problem?: Dependency, long-term care, and public policies in Chile. Rev Panam Salud Publica. 2018;42:e168. doi:10.26633/rpsp.2018.168
  59. Villalobos Dintrans P. [Dependency in Chile. Advances and challenges]. Rev Med Chil. 2019;147(1):83-90. doi:10.4067/s0034-98872019000100083
  60. 60. Sistema de Cuidados Uruguay. Cuidades rinde cuentas; 2017. https://www.gub.uy/sistema-cuidados/sites/sistema-cuidados/files/2020-03/Cuidados%20rinde%20cuentas_Agosto%202017.pdf.    Accessed August 20, 2020.
  61. Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición 2018. https://ensanut.insp.mx/encuestas/ensanut2018/descargas.php.  Accessed August 19, 2020.
  62. Villalobos Dintrans P. Designing long-term care systems: elements to consider. J Aging Soc Policy. 2020;32(1):83-99. doi:10.1080/08959420.2019.1685356
  63. Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43(3):337-350. doi:10.1016/j.amepre.2012.05.024
  64. Instituto Nacional de Estadística y Geografía (INEGI). Encuesta Nacional de Ingresos y Gastos de los Hogares. Aguascalientes: INEGI; 2016.
  65. Kingdon JW. Agendas, Alternatives, and Public Policies. Boston: Longman; 2011.
  66. Villalobos Dintrans P, Chaumont C. Examining the relationship between human resources and mortality: the effects of methodological choices. Int J Public Health. 2017;62(3):361-370. doi:10.1007/s00038-016-0935-4
International Journal of Health Policy and Management
Volume 11, Issue 7
July 2022
Pages 1017-1023

Files

History

  • Receive Date: 19 May 2020
  • Revise Date: 30 November 2020
  • Accept Date: 01 December 2020
  • First Publish Date: 19 December 2020

Share

How to cite

Statistics