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Health Care for Older Persons in Colombia: A Country Profile
Abstract
Colombia is a country of approximately 42 million inhabitants, with some 2.5 million being aged 65 and older. Currently, life expectancy in Colombia is 72.3. By 2025, the population life expectancy at birth will be 77.6 for women and 69.8 for men. The quality of care that people receive as they age in Colombia varies according to where they live. Individuals living in the highly urbanized areas of Colombia receive high-quality care, whereas elderly subjects living in rural areas and in the southern and northern regions are exposed to unemployment, low income, inequity of access to health care, drug trafficking, and armed conflict. In spite of these problems, characteristics of aging of older people in terms of functionality and healthcare access are similar to those of people living in developing countries around the world. This article reviews the particular characteristics of the elderly population in Colombia, especially the significant changes that have happened in recent years, when social instability and conflict have determined that health resources be redirected to other budget priorities such as defense and security.
... One possibility to consider is that rural older adults may have less monitoring and control of chronic diseases, among other inequities in access to health services such as rehabilitation and specialized consultations, which could explain the vulnerability in this population. Inequalities between urban and rural municipalities regarding follow-up health care services or rehabilitation services are common in the Andes Mountains [19]. Another reason, as previously emphasized, is that long travel distances might simply be an inconvenience for patients to adequately control their chronic medical conditions (e.g., hypertension, diabetes); thus, extended distances could result in treatment delays that increase patient mortality [8]. ...
... Our sample identified three statistically significant postoperative variables that predicted a greater mortality risk at 12 months following hip fracture surgery. According to previous studies [16,[19][20][21][22][23][24][25][26][27], these variables included anemia Fig. 1 The Kaplan-Meier survival curve shows 1-year mortality after fracture among rural and urban older people (a Hb level ≤ 9.0 g/dL during hospitalization), a postoperative blood transfusion requirement, and acute postoperative decompensation of chronic disease. Whether anemia is indeed associated with hip fracture mortality remains controversial [20]. ...
... Unlike previous studies, our results show that the time from the fall to surgery and the time from admission to surgery were not significantly associated with 1-year mortality in rural older people. Previously, a delay in the time of surgery has been recognized as the most important factor related to mortality [19]. However, the association of surgical delay with increased mortality risk and complications is controversial [33]. ...
To determine urban–rural differences influencing mortality in patients with hip fracture in Colombian Andes Mountains over a 1-year period.
Purpose
To identify the urban–rural differences of sociodemographic variables, fracture-related characteristics, and preoperative and postoperative clinical factors associated with 1-year mortality in patients over 60 years old who underwent hip fracture surgery in the Andes Mountains.
Methods
A total of 126 patients with a fragility hip fracture during 2019–2020 were admitted to a tertiary care hospital. They were evaluated preoperatively and followed up until discharge. Those who survived were contacted by telephone at 1, 3, and 12 months. Univariate, bivariate, and Kaplan–Meier analyses with survival curves were performed. Relative risk was calculated with a 95% confidence interval.
Results
A total of 32.5% of the patients died within 1 year after surgery, with a significant difference between those who resided in rural areas (43.1%) and those who resided in urban areas (23.5%) (RR 1.70; 95% CI, 1.03 to 2.80, p = 0.036). In the multivariate analysis, anemia (hemoglobin level ≤ 9.0 g/dL during hospitalization) (RR 6.61; 95% CI, 1.49–29.37, p = 0.003), a blood transfusion requirement (RR 1.47; 95% CI, 1.07 to 2.01, p = 0.015), the type of fracture (subtrochanteric fracture (RR = 4.9, 95% CI = 1.418–16.943, p = 0.005)), and postoperative acute decompensation of chronic disease (RR 1.60; 95% CI, 1.01 to 2.53, p = 0.043) were found to be independent predictive factors of 1-year mortality after surgery.
Conclusions
There was a difference in 1-year mortality between patients from rural and urban areas. More studies must be conducted to determine whether rurality behaves as an independent risk factor or is related to other variables, such as the burden of comorbidities and in-hospital complications.
... Intergenerational support varies; there are places in Latin America where levels of support are high. In Colombia, 50% of older adults living in rural areas were financially dependent on family members (Gomez et al., 2009). The Colombian coffee-growing areas are known for having strong child-parent relationships; families share the same house, assume responsibility for the older members and provide emotional and financial support. ...
... Family members tend to support older adults, especially in Latin-American countries (Gomez et al., 2009) There have been studies acknowledging the temporality/changes in support for older adults (Smyer and Hofland, 1982;Tilburg, 1999). One of them was a longitudinal quantitative European (Dutch) study looking at the number of networks (family, friends, neighbours) and contact and instrumental support changes (Tilburg, 1999). ...
In Mexico’s fragmented health-care system, the type of health insurance obtained depends predominantly on a person’s employer. Older women, a disadvantaged workforce compared to men, can face disadvantages in accessing health-care. The government, aiming for universalisation of healthcare services, introduced ‘Seguro Popular’ (SPS), an insurer and provider of health-care, in 2002-2003. The effect of SPS on older women’s health-care is not fully understood. This mixed-methods research aimed to understand the dynamics of older Mexican women’s access to and use of health-care services, to examine inequalities between subgroups of women (e.g. single, rural) and to study whether the variety of insurers provide sufficient access to health-care for older women. The first part of the study (secondary quantitative analysis) used the Mexican Health and Ageing Study (MHAS) as a dataset and the Andersen’s behavioural model as a conceptual framework. It found that older women’s entitlement to health-care insurance was largely derived from being a worker/pensioner’s dependent (through spouse or child(ren)). A 32% of women were affiliated to SPS and about 7% of the participants were unaffiliated to a health-care provider despite being eligible for SPS, while 15% had multiple affiliations. Moreover, women who were single (had never married) had significantly higher odds of being uninsured compared to married participants. The second part of the study (primary qualitative data collection) used thematic analysis to analyse 20 in-depth interviews with older women in Mexico. The results showed that spouses and children enabled the access and use of health-care services, while multiple affiliations were a way of maximising benefits. Participants preferred to receive financial and emotional support from their spouse rather than their child(ren). Some were reluctant to burden their children with expectations of support, while others viewed support from children as natural and reciprocal throughout the life course. Both sets of data lead to a conclusion that there are strong patterns of dependency on spouse and children in terms of access to health-care in later life. In order to provide accessible health-care services, better communication between insurers/providers and stronger presence in rural areas is recommended.
... Their health care system is based on a mandatory health insurance model based on managed competition between private insurers. Colombians are covered by one of the two main insurance schemes: the contributory scheme (CS) for formal workers or the subsidized scheme (SS) for those without the ability to pay (7). Recent studies have also shown that inequalities and inequities have grown among Colombian older adults (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). ...
... year, and no social support or networks (3,7,14,18,25). Our results reinforce the role of inequities in Latin America; for example, in Brazil, several studies have had similar findings concerning the demographic, socioeconomic, and health factors associated with disability (32,33). ...
Objective. To identify the main factors associated with disability in older adults in Colombia, adjusted according to structural and intermediary determinants of healthy aging.
Methods. This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built environment, and health care systems. Data analysis employed multivariate logistic regression.
Results. The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activities of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low educational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability.
Conclusions. Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.
... Unfortunately, as described in Vargas et al. (2014), Colombia and other Latin-American countries face an immense challenge as local governments place a greater emphasis on combatting issues like illiteracy rather than the public health burden posed by terminal diseases such as dementia. As such, access to trained geriatricians is limited throughout the country and is almost non-existent in rural or less developed areas of Colombia (Gómez, Curcio, & Duque, 2009). The number of home care agencies in Colombia is also small, and long-term care facilities for the treatment of those with advanced dementia are accessible only for patients and families that have financial resources to cover the elevated costs (Gómez et al., 2009). ...
... As such, access to trained geriatricians is limited throughout the country and is almost non-existent in rural or less developed areas of Colombia (Gómez, Curcio, & Duque, 2009). The number of home care agencies in Colombia is also small, and long-term care facilities for the treatment of those with advanced dementia are accessible only for patients and families that have financial resources to cover the elevated costs (Gómez et al., 2009). ...
Dementia, characterized by a gradual onset and progressive decline of cognitive function that impacts daily life, is the only top ten cause of death with no cure or means of prevention. Research with a Colombian extended family with a genetic mutation causing Alzheimer’s disease (AD) has helped scholars reconceptualize Alzheimer’s as a continuum that begins several years before symptom onset and has helped set the stage for a clinical trial seeking to find out whether the disease may be preventable. While dementia research ventures in Colombia have expanded at an exponential pace in the past decade, access to quality medical and psychosocial care for dementia remains limited. In this chapter, the current state of dementia in Colombia, South America, is explored, where it is estimated that more than 200,000 individuals are diagnosed with AD. The chapter also describes existing behavioral and psychosocial interventions for patients and caregivers in Colombia including educational workshops, support groups, cinema forums, and the use of social media to communicate the latest developments in dementia research. Special attention is paid to Colombian governmental dementia policy, research, socioeconomic factors impacting diagnosis and access to care, and current treatment developments.
... Currently, life expectancy in Colombia is 72.3 years and by 2025 it will be 77.6 years for women and 69.8 years for men. Colombia is experiencing demographic changes including population aging, decreasing fertility, rapid urbanization, and changes in the epidemiological profile with the persistence of communicable diseases and a concomitant increase in noncommunicable chronic diseases [13]. Despite long-term adverse social conditions related to inequities and violence, elderly population has characteristics in their aging process similar to other areas around the world [13]. ...
... Colombia is experiencing demographic changes including population aging, decreasing fertility, rapid urbanization, and changes in the epidemiological profile with the persistence of communicable diseases and a concomitant increase in noncommunicable chronic diseases [13]. Despite long-term adverse social conditions related to inequities and violence, elderly population has characteristics in their aging process similar to other areas around the world [13]. However, many aspects included in SABE Latin America have not been explored in Colombian older people. ...
Objective . To describe the design of the SABE Colombia study. The major health study of the old people in Latin America and the Caribbean (LAC) is the Survey on Health, Well-Being, and Aging in LAC, SABE (from initials in Spanish: SAlud, Bienestar & Envejecimiento). Methods . The SABE Colombia is a population-based cross-sectional study on health, aging, and well-being of elderly individuals aged at least 60 years focusing attention on social determinants of health inequities. Methods and design were similar to original LAC SABE. The total sample size of the study at the urban and rural research sites (244 municipalities) was 23.694 elderly Colombians representative of the total population. The study had three components: (1) a questionnaire covering active aging determinants including anthropometry, blood pressure measurement, physical function, and biochemical and hematological measures; (2) a subsample survey among family caregivers; (3) a qualitative study with gender and cultural perspectives of quality of life to understand different dimensions of people meanings. Conclusions. The SABE Colombia is a comprehensive, multidisciplinary study of the elderly with respect to active aging determinants. The results of this study are intended to inform public policies aimed at tackling health inequalities for the aging society in Colombia.
... When women in this cohort were giving birth, there was strong opposition to contraception by the Catholic church [30]. As in Brazil, maternal and child health indicators have been poor [31]. In Canada, Kingston is a city with 130,000 inhabitants located in Ontario. ...
... Since Albania, Brazil and Canada have universal health care systems, more than 90% of the population aged 64 to 75 is registered at a health center or has a primary care physician. In Colombia, it is estimated that approximately 82% of individuals in this age group are registered in the public health system [31]. ...
Early maternal age at first birth and elevated parity may have long-term consequences for the health of women as they age. Both are known risk factors for obstetrical complications with lifelong associated morbidities. They may also be related to diabetes and cardiovascular disease development.
We examine the relationship between early maternal age at first birth, defined as <=18 years of age, multiparity (>2 births), and poor physical performance (Short Physical Performance Battery <=8) in community samples of women between 65 and 74 years of age from Canada, Albania, Colombia, and Brazil (N = 1040). Data were collected in 2012 to provide a baseline assessment for a longitudinal cohort called the International Mobility in Aging Study. We used logistic regression and general linear models to analyse the data.
Early maternal age at first birth is significantly associated with diabetes, chronic lung disease, high blood pressure, and poor physical performance in women at older ages. Parity was not independently associated with chronic conditions and physical performance in older age. After adjustment for study site, age, education, childhood economic adversity and lifetime births, women who gave birth at a young age had 1.75 (95% CI: 1.17 - 2.64) the odds of poor SPPB compared to women who gave birth > 18 years of age. Adjustment for chronic diseases attenuated the association between early first birth and physical performance. Results were weaker in Colombia and Brazil, than Canada and Albania.
This study provides evidence that adolescent childbirth may increase the risk of developing chronic diseases and physical limitations in older age. Results likely reflect both the biological and social consequences of early childbearing and if the observed relationship is causal, it reinforces the importance of providing contraception and sex education to young women, as the consequences of early pregnancy may be life-long.
... There are few home-care agencies, and daycare, domiciliary, or other long-term care facilities for advanced dementia care are accessible only to patients and families with sufficient financial resources to cover the high costs. 22,32 Compensating for poor formal governmental support and insufficient financial resources in LACs, 29 female caregivers and caregivers with low education typically Health Policy spend 8-11 h per day providing informal care. This responsibility represents a high, indirect dementiarelated cost for families. ...
The prevalence of dementia in Latin America and the Caribbean is growing rapidly, increasing the burden placed on caregivers. Exacerbated by fragile health-care systems, unstable economies, and extensive inequalities, caregiver burden in this region is among the highest in the world. We reviewed the major challenges to caregiving in Latin America and the Caribbean, and we propose regional and coordinated actions to drive future change. Current challenges include the scarcity of formal long-term care, socioeconomic and social determinants of health disparities, gender-biased burdens, growing dementia prevalence, and the effect of the current COVID-19 pandemic on families affected by dementia. Firstly, we propose local and regional short-term strategic recommendations, including systematic identification of specific caregiver needs, testing of evidence-based local interventions, contextual adaptation of strategies to different settings and cultures, countering gender bias, strengthening community support, provision of basic technology, and better use of available information and communications technology. Additionally, we propose brain health diplomacy (ie, global actions aimed to overcome the systemic challenges to brain health by bridging disciplines and sectors) and convergence science as frameworks for long-term coordinated responses, integrating tools, knowledge, and strategies to expand access to digital technology and develop collaborative models of care. Addressing the vast inequalities in dementia caregiving across Latin America and the Caribbean requires innovative, evidence-based solutions coordinated with the strengthening of public policies.
... La población mundial mayor de 65 años se estima que es de 900 millones de personas (1) y se prevé que estas cifras se triplicarán para el 2030 en un fenómeno denominado "tsunami de cabello plateado" (2). En Colombia durante el 2009, se estimó que 2.5 millones de personas eran mayores de 65 años y un millón tenían más de 75 años; adicionalmente, la expectativa de vida para el 2025 será de aproximadamente 77.6 años y 69.8 años para mujeres y hombres, respectivamente (3). ...
Introducción:
la osteoporosis es una enfermedad que se incrementa conforme nuestra población envejece; ésta se asocia a mayor riesgo de fracturas por fragilidad, conllevando a pérdida de la independencia, dolor crónico e incluso la muerte. Con el fin de evitar dichas complicaciones, es importante caracterizar la población con diagnóstico de fractura por fragilidad e identificar si se está realizando un adecuado tamizaje y abordaje del paciente con riesgo o diagnóstico de osteoporosis.
Material y métodos:
estudio prospectivo realizado en pacientes ingresados con fractura por fragilidad en un hospital de alta complejidad, en el periodo entre marzo-septiembre del 2018. Se realizó una caracterización según variables clínico-sociodemográficas y se aplicó criterios de tamización según diferentes guías con el fin de determinar si se está realizando un adecuado tamizaje y abordaje del paciente con fractura por fragilidad.
Resultados:
se identificaron 70 pacientes con fracturas por fragilidad, la edad promedio fue de 80.01 ± 10.73 años. Se encontró que 81.43% de los pacientes había sido evaluado por médico general, pero tan sólo 50% había sido educado sobre prevención de caídas. Además, el 97.14%, 95.71% y 90.0% de los pacientes cumplían criterios de tamización para osteoporosis según las guías NOF, ISCD y OSC respectivamente y sólo 11.43% habían sido tamizados.
Conclusión:
las fracturas por fragilidad son frecuentes en nuestro medio; sin embargo, los tiempos de atención e intervención son lentos y los esfuerzos en prevención tanto primaria como secundaria están siendo insuficientes.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1319).
... The population as a whole was exposed to an environment of conflict and violence. Many personally experienced its consequences in their own communities and some were displaced from their homes (Cano-Gutierrez, 2016;Cano-Gutierrez et al. 2016;Gomez, Curcio, & Duque, 2009). ...
Large population displacement in developing economies due to internal armed conflict and violence is of international concern. There has been relatively little research on the long-term consequences of displacement on older adult health among populations characterized by rapid demographic, epidemiological, and nutritional transitions during the 20 th century. We examine displacement in the middle-income country of Colombia, which experienced these rapid transitions and a large population displacement over the last 50-60 years due to internal armed conflict and violence. Using a nationally representative survey of adults 60 years and older, SABE-Colombia (2014-2015, n = 23,694), we estimate the degree to which displacement relative to those never displaced is associated with older adult health (self-reported health, major illness/stress, at least one chronic condition, heart disease), controlling for age, gender, SES (socioeconomic status), residence, early life conditions (infectious diseases, poor nutrition, health, SES, family violence), and adult behavior (smoking, exercise, nutrition). We found (1) strong associations between poor early life conditions and older adult health with little attenuation of effects after controlling for displacement, adult SES, and lifestyle; (2) strong associations between displacement and self-reported health; along with poor early life conditions, displacement increases the chances of poor health at older ages; (3) significant positive interaction effects between childhood infections and displacement during young adulthood for older adult stress/major illness, suggesting the importance of the timing of displacement; (4) significant interaction effects between childhood infections and being displaced during childhood, indicating lower levels of older adult stress/major illness and suggesting the possibility of resilience due to childhood adversity. We conclude that displacement compounds the effects of poor early life conditions and that timing of displacement can matter. The results raise the possibility of similar patterns in the health of aging populations in low-income countries that also experience displacement and rapid demographic and epidemiological transitions.
... La calidad de la atención que reciben las personas que envejecen en Colombia varía según el lugar donde viven, pues aquellas que residen en las zonas altamente urbanizadas pueden recibir una atención de buena calidad, mientras que los habitantes de las zonas rurales y en las regiones del sur y del norte están expuestos al desempleo, los bajos ingresos, la desigualdad de acceso a la aten-ción médica, el tráfico de drogas y los conflictos armados (Gómez, Curcio y Duque, 2009). ...
El objetivo de este trabajo fue analizar las relaciones entre calidad de vida y factores sociodemográficos y de salud en 150 adultos mayores colombianos. Fue un estudio descriptivo correlacional, con ejercicios de comparación de grupos a los cuales se aplicaron diversos instrumentos que miden las variables de interés. Los resultados mostraron puntuaciones altas en placer y resiliencia, y bajas en ansiedad, depresión y dolor. El 92.7% de los participantes mostró riesgo de dependencia de otros para la ejecución de sus funciones. Las personas viudas y casadas tuvieron mayores puntuaciones en placer. Aquellos que vivían solos tuvieron una calidad de vida desfavorable; quienes tenían una actividad laboral y estudiaban reportaron mayor placer y autorrealización. Las personas pertenecientes al Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales exhibieron menor resiliencia, calidad de vida, autorrealización y control, y una mayor percepción de dolor. Finalmente, hubo relaciones positivas entre calidad de vida y resiliencia. La ansiedad correlacionó negativamente con control y resiliencia, y la depresión con control, autorrealización, calidad de vida y resiliencia. Se concluye que los adultos mayores refieren mejor calidad de vida en condiciones tales como realizar alguna actividad laboral o académica, contar con una afiliación a un sistema de salud y vivir en compañía.
... La calidad de la atención que reciben las personas que envejecen en Colombia varía según el lugar donde viven, pues aquellas que residen en las zonas altamente urbanizadas pueden recibir una atención de buena calidad, mientras que los habitantes de las zonas rurales y en las regiones del sur y del norte están expuestos al desempleo, los bajos ingresos, la desigualdad de acceso a la aten-ción médica, el tráfico de drogas y los conflictos armados (Gómez, Curcio y Duque, 2009). ...
RESUMEN El objetivo de este trabajo fue analizar las relaciones entre calidad de vida y factores sociodemográ-ficos y de salud en 150 adultos mayores colombianos. Fue un estudio descriptivo correlacional, con ejercicios de comparación de grupos a los cuales se aplicaron diversos instrumentos que miden las variables de interés. Los resultados mostraron puntuaciones altas en placer y resiliencia, y bajas en ansiedad, depresión y dolor. El 92.7% de los participantes mostró riesgo de dependencia de otros para la ejecución de sus funciones. Las personas viudas y casadas tuvieron mayores puntuaciones en placer. Aquellos que vivían solos tuvieron una calidad de vida desfavorable; quienes tenían una actividad laboral y estudiaban reportaron mayor placer y autorrealización. Las personas pertene-cientes al Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales exhibieron menor resiliencia, calidad de vida, autorrealización y control, y una mayor percepción de dolor. Finalmente, hubo relaciones positivas entre calidad de vida y resiliencia. La ansiedad correlacionó negativamente con control y resiliencia, y la depresión con control, autorrealización, calidad de vida y resiliencia. Se concluye que los adultos mayores refieren mejor calidad de vida en condicio-nes tales como realizar alguna actividad laboral o académica, contar con una afiliación a un sistema de salud y vivir en compañía. Palabras clave: Calidad de vida; Resiliencia; Ansiedad/depresión; Riesgo de dependen-cia; Actividades de la vida diaria; Dolor. ABSTRACT The aim of this descriptive-correlational study, with a group comparison, was to evaluate the relationships between quality of life, sociodemographic and health factors in 150 Colombian elderly adults residents of Bogotá. Participants completed a series of questionnaires in order to measure the variables of interest. The results showed high scores on pleasure and resilience, and low scores on anxiety, depression, and pain. Almost 93% of participants, however, showed a risk of dependency on others for functioning properly. Older widows and married people had higher scores on pleasure and people living alone had a dimished quality of life. Similarly, participants who worked and studied reported higher pleasure and self-realization. Participants belonging to social welfare (SISBEN) showed lower resilience, quality of life, self-realization, and control, as well as greater perception of pain. Finally, there were positive associations between quality of life and resilience; the anxiety response was negatively correlated with control and resilience, and depression negatively correlated with control, self-actualization, quality of life, and resilience. In conclusion, older adults
... La gran mayoría de las investigaciones en resiliencia, más concretamente en América Latina, se ha desarrollado a nivel infanto-juvenil, y son prácticamente nulas las investigaciones y programas de intervención en resiliencia con muestras de adultos enfermos crónicos. Paradójicamente, los datos epidemiológicos mundiales indican que son los países en vía de desarrollo, son los que tienen una prevalencia más alta de enfermedades crónicas dentro de un contexto caracterizado por rápidos cambios en los estilos de vida, una alta incidencia de la pobreza, una baja cobertura de seguridad social y un alto nivel de descomposición familiar (Gómez, Curcio y Duque, 2009). ...
Recently there is a gradual and rapid increase of studies on resilience in adults with or without organic diseases that are showing the importance of this construct as a protective factor for mental and physical health. It is therefore the purpose of this paper to show how the construct of resilience has transcended to the field of health especially in chronic disease. It describes the characteristics of resilient adults and psychobiological and genetic processes associated, psychometric instruments used to measure in adults, different physical pathology that have been studied and a developed program of intervention in patients with chronic illness.
... As far as we know, the coverage of family medicine at local medical clinics (Canada) and neighbourhood primary health centres (Brazil) is higher than 90% for the population aged 65-74 years residing in the participating cities. 59 Only Manizales (Colombia) does not have universal coverage for healthcare, but a high percentage of Colombian older adults (around 82%) are covered by the Public Health Insurance. 60 Outside of Canada, response rates were very high, close to 100%. Therefore, we have reasons to believe that these samples are representative of the population registered at those local health centres. ...
Objectives:
To examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults.
Design:
Cross-sectional analysis of the International Mobility in Aging Study (IMIAS). Social support from friends, family members, children and partner was measured with a previously validated social network and support scale (IMIAS-SNSS). Low social support was defined as ranking in the lowest site-specific quartile. Prevalence ratios (PR) of good health, depression and good quality of life were estimated with Poisson regression models, adjusting for age, gender, education, income and disability in activities of daily living.
Setting:
Kingston and Saint-Hyacinthe in Canada, Manizales in Colombia and Natal in Brazil.
Participants:
1600 community-dwelling adults aged 65-74 years, n=400 at each site.
Outcome measures:
Likert scale question on self-rated health, Center for Epidemiological Studies Depression Scale and 10-point analogical quality-of-life (QoL) scale.
Results:
Relationships between social support and study outcomes differed between Canadian and Latin American older adults. Among Canadians, those without a partner had a lower prevalence of good health (PR=0.90; 95% CI 0.82 to 0.98), and those with high support from friends had a higher prevalence of good health (PR=1.09; 95% CI 1.01 to 1.18). Among Latin Americans, depression was lower among those with high levels of support from family (PR=0.63; 95% CI 0.48 to 0.83), children (PR=0.60; 95% CI 0.45 to 0.80) and partner (PR=0.57; 95% CI 0.31 to 0.77); good QoL was associated with high levels of support from children (PR=1.54; 95% CI 1.20 to 1.99) and partner (PR=1.31; 95% CI 1.03 to 1.67).
Conclusions:
Among older adults, different sources of support were relevant to health across societies. Support from friends and having a partner were related to good health in Canada, whereas in Latin America, support from family, children and partner were associated with less depression and better QoL.
... The majority of older adult populations in Brazil, Albania, and Canada are registered in national public health systems that provide universal health insurance coverage. In Colombia, approximately 82% of adults over 60 years of age are covered under social security systems and subsidized public health programs [43]. ...
Objectives:
To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context.
Methods:
A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimate prevalence rate ratios (PRR) of mobility disability and poor physical performance according to gender roles.
Results:
In models adjusted for sex, marital status, education, income, and research site, when comparing to the androgynous role, we found higher prevalence of mobility disability and poor physical performance among participants endorsing the feminine role (PRR = 1.20, 95% confidence interval (CI) 1.03-1.39 and PRR = 1.37, CI 1.01-1.88, respectively) or the undifferentiated role (PRR = 1.23, 95% CI 1.07-1.42 and PRR = 1.58, CI 1.18-2.12, respectively). Participants classified as masculine did not differ from androgynous participants in prevalence rates of mobility disability or low physical performance. None of the multiplicative interactions by sex and research site were significant.
Conclusion:
Feminine and undifferentiated gender roles are independent risk factors for mobility disability and low physical performance in older adults. Longitudinal research is needed to assess the mediation pathways through which gender-stereotyped traits influence functional limitations and to investigate the longitudinal nature of these relationships.
... 34.3 per cent of the overall capacity is situated in São Paolo) (Gragnolati et al., 2011). Similarly, in Colombia LTC institutions exist almost exclusively in metropolitan areas and are mainly supported by religious institutions (Gómez et al., 2009). In Mexico, a very limited amount of institutional services is available across the country, while home-based care is concentrated only in some communities: No availability of nationwide services exist in countries that have legally established family responsibilities even if eligibility rules foresee LTC provisions in the absence of family members. ...
This paper: (i) examines long-term care (LTC) protection in 46 developing and developed countries covering 80 per cent of the world’s population; (ii) provides (data on LTC coverage for the population aged 65+; (iii) identifies access deficits for older persons due to the critical shortfall of formal LTC workers; (iv) presents the impacts of insufficient public funding, the reliance on unpaid informal LTC workers and high out-of-pocket payments (OOP); and (v) calls for recognizing LTC as a right, and mainstreaming LTC as a priority in national policy agendas given the benefits in terms of job creation and improved welfare of the population.
... Albania, Canada, and Brazil have universal health care systems, with more than 90% of the population aged 65-74 years registered at health centers and having a primary care physician. In Colombia, approximately 82% of individuals in this age group were registered in the public medical system (Gomez, Curcio, & Duque, 2009). Education distributions in the Natal and Manizales samples were similar to 2010 and 2005 national census data, respectively, for the target age range (Brasil, 2010;Colombia, 2005). ...
... En definitiva, son pocos los referentes teóricos sobre programas de intervención focalizados en la potenciación de estados emocionales positivos en pacientes de artritis reumatoide, especialmente en América Latina. Paradójicamente, los datos epidemiológicos mundiales indican que son los países en vía de desarrollo los que tienen una prevalencia más alta de enfermedades crónicas dentro de un contexto caracterizado por rápidos cambios en los estilos de vida, una alta incidencia de la pobreza, una baja cobertura de seguridad social y un alto nivel de descomposición familiar (Gómez, Curcio & Duque, 2009). ...
Rheumatoid arthritis is a chronic, autoimmune disease that affects the synovial membrane of joints and is a major public health problem because it affects the quality of life of sufferers. Specifically in the last thirty years, health sciences programs have been developing psycho-educational intervention for managing pain, negative emotional states and training in social and physical skills to reduce social and economic impact. Therefore, the present work is intended to show the development of intervention programs in rheumatoid arthritis which have emphasized psychological strategies. It describes the etiopathology of rheumatoid arthritis, the origin and development of early intervention programs that were focused on the cognitive behavioral model to reach the last generation of intervention approaches that have focused on open emotional expression of negative affect. It ends by highlighting the importance of developing intervention programs in patients with rheumatoid arthritis based on the empowerment of positive emotions, resilience and other variables derived from positive psychology.
... There are other obstacles, particularly to early diagnosis of dementia, that are beyond the scope of this article [51]. However, it is important to recognize that economic crises, epidemics, famine, war, displacement, and natural disasters have devastating effects on populations in resource-poor countries, which relegate the health of elderly individuals to low priority [52, 53] . Barriers to improvement of dementia diagnosis and care are similar to those confronting mental health services [54]. ...
The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resource-poor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen.
Objectives Primary care is the first main interface of health services for the elderly to maintain and improve their health. Therefore, it is essential to evaluate the appropriateness of the way to provide services for this population group, which is one of the most vulnerable classes of society. This study was conducted to explain the structural and functional challenges of comprehensive health centers in Babol City, based on the guidelines of the World Health Organization’s elderly-friendly centers to plan aging-friendly. Methods & Materials The current research was a descriptive qualitative study using the content analysis method with a conventional approach. This research was conducted on elderly people who were referred to comprehensive health centers and their families as well as service providers in the form of in-depth semi-structured interviews until reaching the level of data saturation. Each interview was implemented immediately after implementation, and the content analysis of the interviews was conducted by determining conceptual units, accurate coding, and continuous comparison method until the formation of subgroups and main classes. Results In this study, 23 elderly people with an average age of 71.47±7.88, 5 family members, and 14 service providers participated. A total of 72 codes were extracted from all the interviews, which were divided into five main categories of structural factors, behavioral issues, educational characteristics, social support, and functional challenges during the analysis process. A total of twelve subgroups emerged for the five main classes. Conclusion Several underlying factors exist in the path of making comprehensive health centers elderly-friendly, and which will be impossible to achieve this issue without providing the conditions and eliminating the existing challenges. Therefore, the obtained components may help in identifying, and prioritizing needs, and choosing the type of interventions to adapt comprehensive health centers to the needs of the elderly.
This article identifies and assesses gaps and deficits in the provision of long‐term care (LTC) services in nine middle‐income countries (MIC) across Africa (Algeria, Nigeria, South Africa), Latin America (Brazil, Colombia, Mexico) and Asia (China, India, Turkey). Legislation and entitlement to, conditions for access to and availability of publicly financed or co‐financed LTC services for elderly persons are assessed.
Across the nine selected MIC, it is revealed that hardly any legal entitlements to specific LTC services exist for elderly persons. The most common conditions for access to institutional care are a minimum age and little or no income. With respect to availability, it can be concluded that institutional care facilities are usually concentrated in urban or wealthy areas. In many cases they exist in the capital region only, but even their capacities are limited. Home‐based care is hardly available at all.
El objetivo de la siguiente revisión es presentar el desarrollo histórico de la evolución del constructo “calidad de vida relacionada con la salud”, con especial éfasis en las investigaciones con muestras de enfermos cróicos en Colombia. Se describen los antecedentes históicos que llevaron al surgimiento de los estudios de calidad de vida relacionada con la salud en Colombia, los principales grupos de investigació y algunos estudios publicados en el áea. Por útimo, se hace un anáisis de los resultados encontrados en las investigaciones colombianas.
Background and aim
Due to reported shortcomings in elderly care in Sweden, the government has introduced national guidelines to establish core values and guarantees of dignity. With a bottom‐up perspective, core values and local guarantees of dignity were developed using an participatory and appreciative action and reflection (PAAR) approach and implemented in municipal elderly care. The aim of this study was to evaluate the core values and local guarantees of dignity applied by the municipal healthcare staff caring for older persons.
Method and results
A cross‐sectional descriptive design study using a questionnaire was conducted one year after the implementation of core values and local guarantees of dignity in municipal elderly care. In total, 608 caregivers answered the questionnaire. The results show that the caregivers strived to apply the core values and local guarantees of dignity, but experienced obstacles from the organisation. Proposals were given to facilitate further application of the core values.
El propósito de este estudio fue identificar las diferencias de las creencias-prácticas y afrontamiento espiritual-religioso en función de características sociodemográficas como género, escolaridad, estado civil, con quien vive, ocupación, estrato socioeconómico y tiempo de diagnóstico de la enfermedad en 121 pacientes con diagnóstico de enfermedad crónica de la ciudad de Medellín, Colombia. Se utilizó como medición el inventario de sistema de creencias SBI-15R y la escala de estrategias de afrontamiento espirituales SCS. A nivel de resultados se encontraron diferencias estadísticamente significativas entre las creencias-prácticas y afrontamiento espiritual-religioso en función de la edad, la escolaridad, la ocupación y el estrato socioeconómico, mientras que el género y el tiempo de diagnostico de la enfermedad no fueron variables significativas. En conclusión, independientemente del tiempo de diagnóstico de la enfermedad y el género los enfermos crónicos son más espirituales y religiosos cuando son adultos mayores, no tiene una actividad laboral y pertenecen a un nivel educativo y estrato socio-económico bajo.
The present study aimed to predict the risk of developing cardiovascular disease (CVD) over a 5-year period and how it might vary by sex in an ethnically diverse population of older adults. We used a novel CVD risk model built and validated in older adults named the Systematic Coronary Risk Evaluation in Older Persons (SCORE OP). A population-based study analyzed a total of 1307 older adults. Analyses were done by various risk categories and sex. Of the study population, 54% were female with a mean age of 75±7.1 years. According to the SCORE OP model, individuals were classified as having low (9.8%), moderate (48.1%), and high or very high risk (42.1%) of CVD-related mortality. Individuals at higher risk of CVD were more likely to be male compared with females, 53.9% vs 31.8%, respectively (p<0.01). Males were more likely to be younger, living in rural areas, had higher levels of schooling, and with the exception of smoking status and serum triglycerides, had lower values of traditional risk factors than females. In addition, males were less likely to require blood pressure-lowering therapy and statin drugs than females. This gender inequality could be driven by sociocultural determinants and a risk factor paradox in which lower levels of the cardiovascular risk factors are associated with an increase rather than a reduction in mortality. These data can be used to tailor primary prevention strategies such as lifestyle counseling and therapeutic measures in order to improve male elderly health, especially in low-resource settings.
Objective:
We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries.
Method:
In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]).
Results:
Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males.
Discussion:
Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health.
Background: With the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran. Objectives: This study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare. Design: This study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis. Results: The elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services. Discussion: According to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.
The aim of this study is the validation and identification of cut-off scores for a fast neuro-cognitive test, called TYM (Test Your Memory) which goal is dementia screening. It was translated and adapted to meet a sample profiles that dwell in Rosario. Results between patients and normal controls matched for age and gender were compared. To establish cut-off points the TYM test was compared against other standardized well-known test (Test de Lobo or MEC, Addenbrook Cognitive Test in Spanish -Revised or ACE-R and Pfeiffer Test or PFAQ) in two samples of subjects with 50 demented patients and 100 normal controls each one. Patients with dementia completed the TYM with a mean score of 37/50 and controls scored 47/50. Correlation with the other tests was good. A score of <40/50 had a sensibility of 84% (95% CI 82.2-88.7%) and specificity of 95% (95% CI 92.1-96.9%) in dementia. Cut-off scores were settled using ROC curves. TYM detected 97% of dementia patients while MEC and ACE-R detected 78%. Positive and negative predictive value of the TYM with a cut-off score of <40 was 45% y 95% respectively, with a dementia prevalence rate of 5%. This cut-off score was reduced to 39/50 for those subjects with low level education (<6 years of education). The TYM reveals as a simple, low cost test. Patients and controls completed the test fast and easily and it stands as a valid tool for dementia screening. A prevention must be made, however, against using it with no control by sanitary agents or clinics, who must be in charge of scoring and interpretation of the test results.
Resumen
El objetivo del presente trabajo fue validar y determinar los puntos de corte de un test neurocognitivo rapido de cribado de demencia llamado Test Your Memory ([TYM]; Test Your Memory - Evalua Tu Memoria), traducido y modificado para adaptarlo a las caracteristicas de una muestra de sujetos procedente de la ciudad de Rosario. Se compararon los resultados entre pacientes con demencia y controles normales apareados por edad y sexo. Para la validacion y seleccion de puntos de corte del TYM se lo comparo con otros test estandarizados testigos (Test de Lobo o MEC, Addenbrook´s Cognitive Test en Espanol-Revisado o ACE-R y Test de Pfeiffer o PFAQ) en dos muestras de sujetos formadas por 50 pacientes dementes y 100 controles normales. Los pacientes con demencia completaron el TYM con puntaje promedio de 37/50 mientras que los controles puntuaron 47/50. La correlacion con los otros tests fue muy buena. Un puntaje < 40/50 tuvo sensibilidad de 84 % (95 % CI 82.2-88.7 %) y
especificidad de 95 % (95 % CI 92.1-96.9 %) en demencia. Los puntos de corte se establecieron usando curvas ROC. El TYM detecto 97 % de pacientes con demencia mientras que MEC y ACE-R detectaron 78 %. El valor predictivo negativo y positivo del TYM con un punto de corte de < 40 fue de 95 % y 45 %, respectivamente para una prevalencia de demencia de 5. Este punto de corte se redujo a 39/50 para el caso de sujetos con bajo nivel de escolaridad (< 6 anos de estudios). El TYM es simple y economico, se completo rapida y sencillamente por los pacientes y controles y constituyo una herramienta de cribado valida para la deteccion de demencia. Sin embargo se previene de su uso indiscriminado sin control por agentes sanitarios o clinicos, quienes deben estar a cargo de la puntuacion e interpretacion de los resultados.
The aim of the study was to identify differences in the beliefs-practice and spiritual-religious coping in terms of sociodemographic characteristics such as gender, education, marital status, live with, occupation, socioeconomic status and time of diagnosis of the disease in 121 patients diagnosed with chronic illness from the city of medellin, colombia. was used as measure the systems of beliefs inventory SBI-15R y spiritual coping scale SCS. The results showed statistically significant differences between the beliefs-practice and spiritual-religious coping in terms of age, education, occupation and socioeconomic status, while gender and time of diagnosis of the disease were not variable significant. In conclusion, regardless of time of disease diagnosis and gender for the chronically ill are more spiritual and religious when are being elderly, not have a work activity and have low educational and socio-economic level.
The aim of the next review is to present the development of research on health-related quality of life, with special emphasis on research with chronically ill samples in Colombia. It describes the historical background that led to the emergence of studies of quality of life related to health in Colombia, the main research groups and some published studies in the area. Finally an analysis of the results found in studies in Colombia.
The underlying rationale to support interdisciplinary collaboration in geriatrics and gerontology is based on the complexity of elderly care. The most important characteristic about interdisciplinary health care teams for older people in Latin America is their subjective-basis framework. In other regions, teams are organized according to a theoretical knowledge basis with well-justified priorities, functions, and long-term goals, in Latin America teams are arranged according to subjective interests on solving their problems. Three distinct approaches of interdisciplinary collaboration in gerontology are proposed. The first approach is grounded in the scientific rationalism of European origin. Denominated "logical-rational approach," its core is to identify the significance of knowledge. The second approach is grounded in pragmatism and is more associated with a North American tradition. The core of this approach consists in enhancing the skills and competences of each participant; denominated "logical-instrumental approach." The third approach denominated "logical-subjective approach" has a Latin America origin. Its core consists in taking into account the internal and emotional dimensions of the team. These conceptual frameworks based in geographical contexts will permit establishing the differences and shared characteristics of interdisciplinary collaboration in geriatrics and gerontology to look for operational answers to solve the "complex problems" of older adults.
There are few studies in rural community elders in Latin America. The purpose of this survey was to describe characteristics of elderly people in a rural area of a coffee municipality, including demographic structure, self-perceived health, and presence of falls and their consequences. Survey was cross-sectional and descriptive. A precoded questionnaire and observational guide were used in a randomized sample of rural elders. The sample was 106 (43% female and 57% male). Mean age was 70.2 years (SD 7.52). 94.5% had <5 years of education. Half of the women refered as healthy but only one third of men. Self-assessment health was 25% as well and very well and only 15% poor; 37.6% of people have had a fall during the last year, 11.4% resulted in injury, and 8.5% had fractures. Average of falls was 2.88 (SD 3.47); 28.5% had ADL restriction (walking), 31.4% had IADL restriction (housework), and 70% refered fear of falling as consequences of falls. The low educational level is an important risk factor in these rural elders. The percentage of falls is similar; but fear of falling, fractures and ADL-IADL restrictions are higher than other studies.
Introduction. The process of aging presents functional limitations, loss of autonomy, independence, adaptability and motor disfunction. These changes raise challenges and concerns of vital importance both for those individuals who face them and for government organizations, thus motivating inquiry about the life and health conditions of the elderly. Objective. To describe some components of the quality of life of the elderly population (aged 65 years or older) living in Medellin, including socio-demographic, family, social security and health conditions. Materials and methods. A descriptive study was conducted using the following sources of information: a survey of quality of life that was carried out in 1997 and 2001; death certificates from 1990 to 1999; hospital discharge records from 1990 to 1997; and a telephone survey carried out in the year 2002 in 637 randomly selected elderly individuals. Results. A 168% increase occurred in this population group from 1964 to 2001, substantiating the stage of demographic transition throughout the city. The 65% loss of purchasing power observed between 1997 to 2001 and the situation of isolation in which the elderly population lives, characterize its loss of independence and self-esteem. Conclusion. 97% of the quality of life in the elderly population of Medellin was explained by the following components: independence, social and economic security, and networks of social support.
During the next 20 years, many less developed countries (LDC) will have age structures approaching those of the present time
in more developed countries (MDC). This is occurring more rapidly in the LDC of Asia and Latin America. The future of aging
populations in LDC is dependent on the degree of poverty in these countries. Poverty is a major determinant of disability
and mortality in older persons. With the march of globalization, diseases in LDC are changing from infectious to noncommunicable
diseases, such as diabetes. Nevertheless, infections such as tuberculosis still take a major toll on the elderly. The epidemiological
transition in LDC has created a need for health care transitions from systems based on cure to ones that highlight prevention
and long-term care. LDC have the opportunity to develop systems that differ from those in MDC by capitalizing on the lack
of infrastructure to produce more home-based rather than institution-based long-term care systems. Involvement of the elderly
in the planning of their own futures is of paramount importance. Appropriate planning now will decide the future of the elderly
in LDC during the next 20 to 40 years.
The reform of the Colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, although complicated, model. Some ten years after the implementation of "Law 100," a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. Furthermore, key health indicators and disease control programs have deteriorated. These findings confirm the results in other middle- and low-income countries. The authors suggest the explanation lies in the inefficiency of contracting-out, the weak economic, technical, and political capacity of the Colombian government for regulation and control, and the absence of real participation of the poor in decision-making on (health) policies.
In the developing countries of the world, an aging of the population in general is occurring at the same time that the life expectancy of older adults is increasing. The results of this double aging process are especially striking for health care services because of the concurrent epidemiologic transition, which has led to infectious diseases being replaced by noninfectious, habitually chronic diseases that occur predominantly in older age. In these circumstances, older adults begin to predominate among the patients whom physicians in Latin America now serve and in the near future, older adults will constitute the immense majority of those patients. To respond to this situation, the training of professionals responsible for providing care to older adults should be improved, and the preparation of specialists in geriatric medicine should be enhanced both quantitatively and qualitatively. Future doctors should have the knowledge, abilities, and attitudes to enable them to appropriately serve this population segment. With these aims in mind, structures and procedures should be established that make it possible to impart the specific contents of geriatric medicine during medical school not only as a part of the traditional vertical teaching of the core curriculum of geriatric medicine, but also through the horizontal teaching of some of the material in other subjects. This article discusses why, with what objectives, with what contents, with what procedures, and with what staffing and materials the training of professionals in geriatric medicine should be carried out, and why it is time to give priority to this undertaking. Putting into place the measures proposed in this article should facilitate the incorporation of this subject-matter into the curricula of the medical schools of Latin America.
The process of aging presents functional limitations, loss of autonomy, independence, adaptability and motor disfunction. These changes raise challenges and concerns of vital importance both for those individuals who face them and for government organizations, thus motivating inquiry about the life and health conditions of the elderly.
To describe some components of the quality of life of the elderly population (aged 65 years or older) living in Medellin, including socio-demographic, family, social security and health conditions.
A descriptive study was conducted using the following sources of information: a survey of quality of life that was carried out in 1997 and 2001; death certificates from 1990 to 1999; hospital discharge records from 1990 to 1997; and a telephone survey carried out in the year 2002 in 637 randomly selected elderly individuals.
A 168% increase occurred in this population group from 1964 to 2001, substantiating the stage of demographic transition throughout the city. The 65% loss of purchasing power observed between 1997 to 2001 and the situation of isolation in which the elderly population lives, characterize its loss of independence and self-esteem.
97% of the quality of life in the elderly population of Medellin was explained by the following components: independence, social and economic security, and networks of social support.
Every year the proportion of elderly people increases at a greater rate compared with other age groups, changing the population structure of most countries. Latin America has been internationally known for its higher percentage of young compared with elderly persons. The United Nations predicts that the proportion of elderly persons in Latin America and the Caribbean will be more similar to world figures in 2020 and even higher in 2040. The increasing elderly population in Latin America has increased the demand for advanced degree professionals with gerontology training. Nevertheless, in spite of training efforts during the last decade, the number of gerontology professionals is still insufficient. In total, the authors were able to locate only ten gerontology programs in Latin America (four in Brazil, two in Argentina, and one each in Uruguay, Peru, Cuba, and Colombia). The programs currently available in Brazil and Colombia are described in an effort to share information on the common characteristics of Master's and PhD degree programs in gerontology in Latin America. The authors concluded that, in Latin America, programs focused exclusively on gerontology are scarce.
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JAGS
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