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Cross Cultural Differences in Lower Middle Income Countries

This study seeks to quantify the independent contribution of physical, mental and cognitive health to overall disability of older people in different cultural and geographical settings.

A secondary analysis will be carried out on data collected from the 10/66 Dementia Research Group’s surveys of older people in eight developing countries: Cuba, the Dominican Republic; Mexico, Argentina, Peru; Venezuela; China and India. All 10/66 studies included the World Health Organisation’s Disability Assessment Schedule II (WHODAS II), to measure overall disability. This project sets out to explain differences in WHODAS II scores between different countries and understand cultural and other factors that might contribute to self-reported disability of older people.

The WHODAS II was developed to measure functioning and disability and has been validated cross-culturally. The initial validation of the WHODAS II, however, included relatively few older people. Other research has indicated cultural effects on self-reporting of health, yet there has been no assessment of cultural effects with respect to self-reporting of disability and functioning. The results of this research will provide important information needed to plan appropriate services in the light of ageing populations in developing countries. By 2025, it is estimated that three-quarters of 1,200 million people aged over 60 will live in developing countries.

A statistical analysis will be carried out on data collected from 16,000 interviews in eight countries with people aged over 65 and a relative or carer.

WHODAS II is a questionnaire completed by an interviewer which records and measures interviewees’ own experience of disability in six areas – cognition (understanding and communication), mobility, self-care, interpersonal interactions, life activities (domestic, leisure and work) and community activities.

The information collected through WHODAS II will be compared with other data collected by the 10/66 Dementia Research Group in the same studies – information about cognitive impairment, other psychiatric diagnoses, information about physical health, socio demographic and socio economic details, behaviour, lifestyle and social support – to look for factors that may have a bearing on disability in later life and may account for differences in WHODAS II scores in different countries.

There will also be a review of existing research into disability among older people to investigate cultural and other factors that may affect older people’s self reporting of functioning and disabiity.

Dr Renata Sousa carried out the analysis for her PhD, supervised by Professor Martin Prince and Dr Cleusa Ferri.

The project is funded by the IoP and the Wellcome Trust.

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