The Well-Being of the Elderly in Asia: A Four-Country Comparative Study

9. Physical and Mental Health of the Elderly

Chapter 9 PHYSICAL AND MENTAL HEALTH OF THE ELDERLY Zachary Zimmer, Josefina N Natividad, Mary Beth Ofstedal, andHui-ShengLin Central to the study ofgerontology and influential in its development have been the changes in health that occur at older ages and the implications of these changes for social and medical services, family relationships, and public programs. It has long been recognized that mortality rates increase at older ages, along with functional limitations and chronic diseases. But the level of the underlying rates are far from fixed and there is considerable variation over time and across groups, prompting intensive study of the empiricallevels as well as underlying mechanisms from the standpoint of biology and biodemography (see Wachter and Finch, 1997). One facet of these studies has been to develop a detailed profile ofthe health status ofthe elderly population as the basis for gauging both their physical and mental well-being and the social and economic implications of a growing older population. In Asia, where the proportion of the population at older ages has been low until recently and where older people traditionally resided with their children , fewer detailed studies have been conducted on the state of their health. In addition, the health infrastructure there and in most developing countries has been oriented toward problems of infectious diseases and maternal and child health. An important start toward collecting more systematic data on the health status of the elderly was a WHO-sponsored study carried out in 1984, 361 362 The Well-Being ofthe Elderly in Asia which surveyed older people in the Philippines, Malaysia, South Korea, and Fiji (Andrews et aI., 1986). A second WHO-sponsored study in the region in 1990 included five additional countries (or specified provinces) (Andrews and Hennink, 1992). These studies, while significant in directing attention to the health ofthe elderly in the Asia and Pacific regions, were often deficient in terms ofsample size and representativeness, limiting the inferences that could be drawn at the national level or for cross-cultural comparisons. Several other multi-country surveys of the elderly in Asia have also included some items devoted to health status (for a review of these surveys, see Andrews and Hermalin, 2000). These include the ASEAN-sponsored surveys of 19841986 (Chen and Jones, 1989), which we have drawn on in several chapters for over-time comparisons with the surveys reported here and will use again below for assessing changes in health status. The surveys conducted among the four focal countries of this study in the mid-1990s each contained a wide range of questions about health conditions . Although the specific measures and amount of detail varied somewhat across countries, the data permit close comparisons on many facets of health. This chapter exploits these data to examine several health-related behaviors and compare the countries on physical, emotional, and cognitive dimensions of health, as well as on differences in levels of self-reported health. In addition to overall country differences, the chapter examines how key sociodemographic groups vary in their health and health behaviors within and across countries. Methodological Issues Much of the data collected in gerontological research on the health of older adults, especially studies that are representative of the broader population, comes from responses that older adults give to survey questions. Accordingly , the validity and accuracy of these self-reported data are dependent upon older respondents' understanding and knowledge of their health conditions and their ability and willingness to report this information accurately. Despite careful attempts at questionnaire wording and at building good rapport with respondents, any health-related data collected via questionnaires have some inherent limitations. This section discusses some of the methodological issues involved in collecting and analyzing this type ofdata. As noted previously, health is a multidimensional construct and information on several different facets was collected from the respondents. Physical health was measured by asking respondents whether they currently have Physical and Mental Health ofthe Elderly 363 specific medical conditions and/or limitations in the ability to undertake several basic activities ofdaily living (like walking, dressing, eating, andbathing). Emotional health was examined by asking respondents about the presence of several indicators of depression or by their level of loneliness. Respondents' cognitive level was assessed by asking them to perform certain tasks such as word recall, and/or by their ability to correctly orient themselves in terms of reporting their age, the date, day ofweek, and so on. In addition, each survey obtained...