Many adults 45 years and older in Africa have limited functional ability
The number of adults living into older age in sub-Saharan Africa is rapidly growing yet many older men and women will have an illness or disability that limits their ability to function, according to a study by researchers from the US and Malawi published in this week's PLOS Medicine.
The researchers, led by Collin Payne from the University of Pennsylvania, also show that remaining life spent with severe limitations at age 45 in a sub Saharan African setting (Malawi) is comparable to that of 80-year-olds in the US.
These findings are important as older people with functional limitations have difficulty performing the physical work required in rural agricultural settings and so investing in their health could also potentially boost economic growth.
The researchers (also the authors of this paper) analysed different levels of disability and health expectancies among adults aged over 45 years in Malawi, using information from surveys conducted between 2006-10.
They found that the likelihood of having a physical disability rapidly increased with age, with 45-year-old women in rural Malawi expected to spend 58% of their estimated remaining 28 years with functional limitations, and 45-year-old men expected to live 41% of their remaining 25.4 years with functional limitations.
The authors also calculated that, on average, a 45-year-old woman in Malawi will spend 2.7 years of her life with a moderate functional limitation and 0.6 years with a severe functional limitation before she reaches 55. For a 45 year old man in Malawi, the corresponding values were 1.6 and 0.4 years.
The authors say: "Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation."
They continue: "Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in sub Saharan Africa inadequately target the physical health of mature and older adults."
In an accompanying Perspective, Andreas Stuck from the University of Bern in Switzerland and colleagues (uninvolved in the study), say: "This study emphasizes that health policy should urgently address disability in older persons, an issue largely ignored at present."
They continue: "Investments in improving health in older people will not only improve quality of life across generations, but bring economic return for generations to come."
Funding: CFP is supported by the United States National Science Foundation Graduate Research Fellowship (Grant No. DGE-0822). The authors also gratefully acknowledge the generous support provided by the National Institute of Child Health and Development (grant numbers R03 HD05 8976, R21 HD050652, R01 HD044228, R01 HD053781), the National Institute on Aging (grant number P30 AG12836), the Boettner Center for Pensions and Retirement Security at the University of Pennsylvania, and the National Institute of Child Health and Development Population Research Infrastructure Program (grant number R24 HD- 044964), all at the University of Pennsylvania. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Payne CF, Mkandawire J, Kohler H-P (2013) Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model. PLoS Med 10(5): e1001435. doi:10.1371/journal.pmed.1001435
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