RESUMO
OBJECTIVES: To estimate the current gap and the necessary supply of human resources for care (HRC) for older people experiencing severe care dependence in Latin America and the Caribbean (LAC). DESIGN: Simulation study using previous estimations of severe care dependence for LAC countries. SETTING AND PARTICIPANTS: Older people (aged 65+) experiencing severe care dependence in 26 countries of LAC. METHODS: We calculated the current gap and the necessary supply of HRC in 2020, 2035, and 2050 assuming a mix of complementary human resources, in line with regional standards for long-term care (LTC) schemes, and differing levels of care coverage. RESULTS: Considering 100% coverage of LTC services for the population aged 65+ experiencing severe care dependence, the region will need almost 5 million people working full-time in the sector. This figure is expected to increase to more than 14 million by 2050. Nurse assistants and nurses will be the professional profiles in highest demand. In addition, the region requires 2 million rehabilitation professionals in 2020, and this figure will increase to more than 6 million in 2050. CONCLUSIONS AND IMPLICATIONS: The rapid aging process in LAC will bring several challenges and opportunities to the region. Countries should start designing strategies to reduce the current gaps of HRC to meet older people's care needs in the coming years, in terms of both quantity and competencies, to help ensure that their human rights are met.
Assuntos
Recursos Humanos , Humanos , Idoso , América Latina/epidemiologia , Região do Caribe/epidemiologiaRESUMO
We use longitudinal data from the Mexican Health and Aging Study to analyze the effect of having a parent in need of long-term care on labor supply of men and women aged 50-64 in Mexico. After accounting for both individual and time fixed effects, we find that parents' need of long-term care is associated with both a significant drop in the likelihood of working (by 2.42 percentage points), and a reduction in the number of hours worked (by 7.3%) among women who remain employed. In contrast, we find no effect on the labor supply of men. In a context of rapid population aging, the increase in the need of long-term care risks to hinder the efforts to reduce gender imbalances in the labor market.
RESUMO
OBJECTIVES: Identify the factors associated with future functional dependence in the elderly in Mexico and with receiving or not receiving support for basic activities of daily living (ADLs); and project the prevalence of functional dependence in 2026. METHODS: Data from the 2001 National Health and Aging Study (ENASEM) and from the 2012 and 2015 follow-up rounds were used. A multinomial logistic regression model was used to analyze factors associated with future dependence, and a logistic regression model was used for factors associated with receiving or not support. The projected number of older persons with functional dependence in 2026 was based on data from the 2015 ENASEM and on estimated rates from the model of future dependence. RESULTS: Older people, those with a lower educational level, those with hypertension, arthritis, or diabetes, those who had suffered a stroke or fall, and those with some degree of prior functional dependence had a significantly higher risk of mild or severe dependence and death within 11 years, compared to the reference group. Older people and those with severe dependence had higher odds of receiving support compared to reference groups. By 2026, it is estimated that 18.9% of older people in Mexico will have mild dependence and 9.3% will be severely dependent. CONCLUSIONS: Factors associated with future dependence and death were age, educational level, certain chronic diseases, having fallen, and having prior functional dependence; the factors associated with receiving support for basic ADLs were severe dependence and age. It is estimated that the prevalence of dependence will increase 2.1 times over 25 years (2001-2026).
OBJETIVOS: Identificar os fatores associados à dependência funcional futura e a receber apoio para a realização das atividades básicas da vida diária (ABVD) em pessoas idosas e fazer uma projeção da dependência funcional nesta população no México em 2026. MÉTODOS: Analisaram-se dados obtidos no Estudo Nacional de Saúde e Envelhecimento do México (ENASEM) de 2001 e em rodadas subsequentes da pesquisa de 2012 e 2015. Utilizou-se um modelo de regressão logística multinomial para analisar os fatores associados à dependência funcional futura da pessoa idosa e um outro modelo de regressão logística para analisar os fatores associados a receber apoio. As projeções para 2026 de idosos em situação de dependência foram feitas com base nos dados do ENASEM de 2015 e nas estimativas do modelo de dependência futura. RESULTADOS: Idade avançada, nível de escolaridade mais baixo, ter hipertensão, artrite, diabetes, história de embolia cerebral ou quedas e possuir algum grau de dependência funcional anterior foram os fatores que se associaram a um risco significativamente maior de dependência funcional (leve ou grave) e morte nos 11 anos seguintes em comparação aos grupos de referência. Idosos com idade avançada ou dependência grave apresentaram uma maior probabilidade de receber apoio para a realização das ABVD em comparação aos grupos de referência. A projeção para 2026 no México é que 18,9% das pessoas idosas terão dependência leve e 9,3% dependência grave. CONCLUSÕES: Os fatores associados a dependência funcional futura e morte foram idade, nível de escolaridade, certas doenças crônicas, história de quedas e dependência funcional anterior. Ter idade avançada e dependência grave severa foram os fatores associados a receber apoio para a realização das ABVD. Estima-se que a prevalência de dependência funcional em pessoas idosas aumentará 2,1 vezes em 25 anos (2001-2026).
RESUMO
[RESUMEN]. Objetivos. Identificar los factores asociados con la dependencia funcional futura de las personas mayores en México, así como con recibir o no apoyo para la realización de actividades básicas de la vida diaria (ABVD), y proyectar la prevalencia de la dependencia funcional en 2026.Métodos. Se utilizaron los datos del Estudio Nacional de Salud y Envejecimiento (ENASEM) del 2001 y las rondas de seguimiento de 2012 y 2015. Se estimó un modelo de regresión logística multinomial para analizar los factores asociados con la dependencia futura y un modelo de regresión logística para los factores asociados con recibir o no apoyo. Para las proyecciones de personas mayores en situación de dependencia en 2026 se utilizaron los datos del ENASEM del 2015 y los coeficientes estimados del modelo de dependencia futura.Resultados. Las personas de más edad, las que tenían un nivel de educación más bajo, las que padecían de hipertensión, artritis, diabetes, las que habían sufrido una embolia cerebral o alguna caída, y las que tenían algún nivel de dependencia funcional previa presentaron un riesgo significativamente mayor de dependencia (leve o severa) y de fallecer en los 11 años siguientes respecto a sus referencias. Las personas de mayor edad o con dependencia severa tuvieron mayores probabilidades de recibir apoyo respecto a sus referen-cias. Para el año 2026, se estima que el 18,9% de las personas mayores en México tendrá dependencia leve y el 9,3% dependencia severa.Conclusiones. Los factores asociados con la dependencia futura y con fallecer fueron la edad, el nivel educacional, algunas enfermedades crónicas, haberse caído y tener dependencia funcional previa; los factores asociados con recibir apoyo para la realización de ABVD fueron tener dependencia severa y la edad. Se estima que la prevalencia de la dependencia aumentará 2,1 veces en 25 años (2001-2026).
[ABSTRACT]. Objectives. Identify the factors associated with future functional dependence in the elderly in Mexico and with receiving or not receiving support for basic activities of daily living (ADLs); and project the prevalence of functional dependence in 2026.Methods. Data from the 2001 National Health and Aging Study (ENASEM) and from the 2012 and 2015 follow-up rounds were used. A multinomial logistic regression model was used to analyze factors associated with future dependence, and a logistic regression model was used for factors associated with receiving or not support. The projected number of older persons with functional dependence in 2026 was based on data from the 2015 ENASEM and on estimated rates from the model of future dependence.Results. Older people, those with a lower educational level, those with hypertension, arthritis, or diabetes, those who had suffered a stroke or fall, and those with some degree of prior functional dependence had a significantly higher risk of mild or severe dependence and death within 11 years, compared to the reference group. Older people and those with severe dependence had higher odds of receiving support compared to reference groups. By 2026, it is estimated that 18.9% of older people in Mexico will have mild dependence and 9.3% will be severely dependent.Conclusions. Factors associated with future dependence and death were age, educational level, certain chronic diseases, having fallen, and having prior functional dependence; the factors associated with receiving support for basic ADLs were severe dependence and age. It is estimated that the prevalence of dependence will increase 2.1 times over 25 years (2001-2026).
[RESUMO]. Objetivos. Identificar os fatores associados à dependência funcional futura e a receber apoio para a reali-zação das atividades básicas da vida diária (ABVD) em pessoas idosas e fazer uma projeção da dependência funcional nesta população no México em 2026.Métodos. Analisaram-se dados obtidos no Estudo Nacional de Saúde e Envelhecimento do México (ENASEM) de 2001 e em rodadas subsequentes da pesquisa de 2012 e 2015. Utilizou-se um modelo de regressão logís-tica multinomial para analisar os fatores associados à dependência funcional futura da pessoa idosa e um outro modelo de regressão logística para analisar os fatores associados a receber apoio. As projeções para 2026 de idosos em situação de dependência foram feitas com base nos dados do ENASEM de 2015 e nas estimativas do modelo de dependência futura.Resultados. Idade avançada, nível de escolaridade mais baixo, ter hipertensão, artrite, diabetes, história de embolia cerebral ou quedas e possuir algum grau de dependência funcional anterior foram os fatores que se associaram a um risco significativamente maior de dependência funcional (leve ou grave) e morte nos 11 anos seguintes em comparação aos grupos de referência. Idosos com idade avançada ou dependência grave apresentaram uma maior probabilidade de receber apoio para a realização das ABVD em comparação aos grupos de referência. A projeção para 2026 no México é que 18,9% das pessoas idosas terão dependên-cia leve e 9,3% dependência grave.Conclusões. Os fatores associados a dependência funcional futura e morte foram idade, nível de escolari-dade, certas doenças crônicas, história de quedas e dependência funcional anterior. Ter idade avançada e dependência grave severa foram os fatores associados a receber apoio para a realização das ABVD. Esti-ma-se que a prevalência de dependência funcional em pessoas idosas aumentará 2,1 vezes em 25 anos (2001-2026).
Assuntos
Atividades Cotidianas , Assistência de Longa Duração , Envelhecimento Saudável , Envelhecimento , México , Atividades Cotidianas , Assistência de Longa Duração , Envelhecimento , Envelhecimento Saudável , México , Atividades Cotidianas , Assistência de Longa Duração , Envelhecimento , Envelhecimento SaudávelRESUMO
Many studies have explored the links between music and children's outcomes; however, study designs have not been sufficiently rigorous to support causal findings. This study aims to assess the effects of a large-scale music program on children's developmental functioning in the context of high rates of exposure to violence. The paper describes the results of an experimental evaluation of Venezuela's National System of Youth and Children's Orchestras. The curriculum of the program, better known as "El Sistema," emphasizes social interactions through group instruction and group performances. The randomized control trial was conducted in 16 music centers between May 2012 and November 2013. In total, 2914 children ages 6-14 participated in the experiment, with approximately half receiving an offer of admission to the program in September 2012 and half in September 2013. The treatment group children participated for one semester more than the control group children. After 1 year, full-sample ITT estimates indicate improved self-control (by 0.10 standard deviations) and reduced behavioral difficulties (by 0.08 standard deviations), both significant at 10% after controlling for multiple hypothesis testing. There were no full-sample effects on other domains. Sub-sample effects are larger among (1) children with less-educated mothers and (2) boys, especially those exposed to violence at baseline. In the latter subgroup, we find lower levels of aggressive behavior. We find that the program improved self-control and reduced behavioral difficulties, with the effects concentrated among subgroups of vulnerable children. The results suggest the importance of devising mechanisms to target resources to the most vulnerable children. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02369315.
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Desenvolvimento Infantil , Música , Criança , Feminino , Humanos , Masculino , VenezuelaRESUMO
Prior research on Mexican migration has shown that social networks and economic incentives play an important role in determining migration outcomes. We use experimental data from PROGRESA, Mexico's primary poverty-reduction program, to evaluate the effects of conditional cash transfers on migration both domestically and to the United States. Our study complements a growing body of literature aimed at overcoming longstanding hurdles to the establishment of causal validity in empirical studies of migration. Analysis based on the data collected before and after the program's onset shows that conditional transfers reduce U.S. migration but not domestic migration. The data also enable us to explore the role of existing family and community migration networks. The results show that migration networks strongly influence migration, but that the effect of conditional transfers on migration is apparently not mediated by existing migration network structures. Our results suggest that conditional transfers may be helpful in managing rural out-migration, particularly to the United States.
