title: Exploring the economic and social effects of care dependence in later life: protocol for the 10/66 research group INDEP study.
abstract: BACKGROUND
  In low or middle income countries chronic diseases are rapidly becoming the main cause of disease burden. However, the main focus of health policymakers has been on preventing death from cancer and heart disease, with very little attention to the growing problem of long-term needs for care (dependence). Numbers of dependent older people are set to quadruple by 2050. The economic impact of providing long-term care is likely to be substantial.
  
  
  METHODS
  The study uses mixed methods and draws on and extends the population-based surveys conducted by the 10/66 Dementia Research Group. We focus on two countries in Latin America (Peru and Mexico), China and Nigeria. The surveys comprised baseline surveys of health, socioeconomic circumstances and care arrangements, repeated three to four years later. We are going back to these households to make a detailed assessment of the overall economic status and the use of health services by all family members. We will compare households where: a) an older resident became dependent between baseline and follow-up (incident care), b) one or more older people were dependent at both time points (chronic care), b) c) no older residents had needs for care (control households) for household income, consumption, healthcare expenditure and economic strain. In each of the four countries we are carrying out six detailed household 'case studies' to explore in more depth the economic impacts of dependence, and the social relations between household members and others in their network.
  
  
  CONCLUSIONS
  The INDEP study will provide a detailed examination of the economic and social effects of care dependence in low and middle income settings. As the proportion of older people with needs for care rises rapidly in these countries, this neglected policy area is likely to become increasingly salient for families, communities and policymakers alike. Our detailed multilevel plans for dissemination will ensure that the study helps to put this important issue on the agenda for the international and national media, the public and researchers.
authors.affiliation: Health Service and Population Research Department, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.
authors.forename: Rosie
authors.initials: R
authors.lastname: Mayston
authors.affiliation: Instituto de la Memoria y Desordenes Relacionados, Lima, Peru.
authors.forename: Mariella
authors.initials: M
authors.lastname: Guerra
authors.affiliation: Institute of Mental Health, Peking University, Beijing, China.
authors.forename: Yueqin
authors.initials: Y
authors.lastname: Huang
authors.affiliation: National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico.
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Sosa
authors.affiliation: Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State Nigeria.
authors.forename: Richard
authors.initials: R
authors.lastname: Uwakwe
authors.affiliation: National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico.
authors.forename: Isaac
authors.initials: I
authors.lastname: Acosta
authors.affiliation: Department of Sociology/Anthropology, Nnamdi Azikiwe University, Awka, Nigeria.
authors.forename: Peter
authors.initials: P
authors.lastname: Ezeah
authors.affiliation: Instituto de la Memoria y Desordenes Relacionados, Lima, Peru.
authors.forename: Sara
authors.initials: S
authors.lastname: Gallardo
authors.affiliation: National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico.
authors.forename: Veronica Montes
authors.initials: VM
authors.lastname: de Oca
authors.affiliation: Institute of Mental Health, Peking University, Beijing, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Health Service and Population Research Department, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.
authors.forename: Maëlenn
authors.initials: M
authors.lastname: Guerchet
authors.affiliation: Institute of Mental Health, Peking University, Beijing, China.
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Instituto de la Memoria y Desordenes Relacionados, Lima, Peru.
authors.forename: Maria
authors.initials: M
authors.lastname: Sanchez
authors.affiliation: School of International Development, University of East Anglia, Norwich, NR4 7TJ UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Lloyd-Sherlock
authors.affiliation: Health Service and Population Research Department, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Prince
keywords: Ageing; Developing countries; Long-term care
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