RM Sousa et al. The contribution of chronic diseases to the prevalence of dependence among older people in Latin America, China and India: a 10/66 Dementia Research Group population-based survey. BMC Geriatrics, 2010;10:53.

The number of older people is dramatically increasing worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases that largely contributed to a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. Sousa and associates investigated the prevalence and correlates of dependence among older people from middle-income countries. A one-phase cross-sectional survey was carried out at 11 sites in seven countries (urban sites in Cuba, Venezuela, and Dominican Republic, urban and rural sites in Peru, Mexico, China and India). All those aged 65 years and over living in geographically defined catchment areas were eligible. In all, 15,022 interviews were completed with an informant interview for each participant. The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, dementia, physical impairments, and self-reported diagnoses. Dependence was interviewer-rated based on a key informant's responses to a set of open-ended questions on the participant's needs for care. The investigators estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analyzed, and population-attributable prevalence fractions (PAPF) calculated. The prevalence of dependence increased with age at all sites, with a tendency for the prevalence to be lower in men than in women. Age-standardized prevalence was lower in all sites than in the USA. Other than in rural China, dementia made the largest independent contribution to dependence, with a median PAPF of 34% (range 23%-59%). Other substantial contributors were limb impairment (9%, 1%-46%), stroke (8%, 2%-17%), and depression (8%, 1%-27%).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that demographic and health transitions will lead to large and rapid increases in the numbers of dependent older people particularly in middle income countries (MIC). The prevention and control of chronic neurological and neuropsychiatric diseases, and the development of long-term care policies and plans should be urgent priorities.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The aging of the world is going to require a massive attempt to teach older people to care for themselves. This goal must become a priority for those of use interested in teaching self-management skills to large populations.