Open Access Research article

"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"

Renata M Sousa1*, Cleusa P Ferri1, Daisy Acosta2, Mariella Guerra3, Yueqin Huang4, KS Jacob5, AT Jotheeswaran6, Milagros A Guerra Hernandez7, Zhaorui Liu4, Guillermina Rodriguez Pichardo8, Juan J Llibre Rodriguez9, Aquiles Salas10, Ana Luisa Sosa11, Joseph Williams6, Tirso Zuniga11 and Martin Prince1

Author Affiliations

1 King's College London, Institute of Psychiatry, Health Services and Population Research Department, Centre for Public Mental Health, De Crespigny Park, Po Box 60, SE5 8AF, London, UK

2 Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic

3 Psychogeriatric Unit, National Institute of Mental Health "Honorio Delgado Hideyo Noguchi", Lima, Peru

4 Peking University, Institute of Mental Health, Beijing, China

5 Christian Medical College, Vellore, India

6 Institute of Community Health, Voluntary Health Services, Chennai, India

7 Policlinico Universitario 27 de Noviembre, Marianao Ciudad Habana, Cuba

8 Colegio Dominicano de Estadisticos y Demografos (CODE), Santo Domingo, Dominican Republic

9 Facultad de Medicina Finlay-Albarran, Medical University of Havana, Havana, Cuba

10 Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela

11 National Institute of Neurology and Neurosurgery of Mexico, National University Autonomous of Mexico, Mexico City, Mexico

For all author emails, please log on.

BMC Geriatrics 2010, 10:53  doi:10.1186/1471-2318-10-53

Published: 6 August 2010



The number of older people is set to increase dramatically worldwide. Demographic changes are likely to result in the rise of age-related chronic diseases which largely contribute to years lived with a disability and future dependence. However dependence is much less studied although intrinsically linked to disability. We 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. We estimated the prevalence of dependence and the independent contribution of underlying health conditions. Site-specific prevalence ratios were meta-analysed, 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-standardised 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%).


The 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.