10/66 Dementia Research Group Alzheimer's Disease International

INDEP - The Economic and Social Effects of Care Dependence in Later Life

The aim of the INDEP study is to examine the social and economic impacts of care-dependence on older people, carers and households in Peru, Mexico, China and Nigeria.  Our aim is to assess the extent to which onset of dependence serves as an economic shock to households, leading to economic vulnerability and impoverishment, exploring the effects on social relations in the household and beyond, paying particular attention to gender dynamics and decision-making.  INDEP is a mixed methods study: the quantitative cross-sectional survey will be complemented by in-depth qualitative interviews carried out among a purposive sample of case study households.

This study will draw on and extend an established set of international population-based surveys conducted by the 10/66 DRG. The original surveys comprised baseline surveys of health, socioeconomic circumstances and care arrangements, repeated three to four years later. We were thus able to identify three different types of household: those with one or more dependent older people at both time points (chronic dependent), those where an older resident became dependent between baseline and follow-up (incident dependent) and those with no dependent older residents (control households). In the INDEP study, we will go back to these households and make a much more detailed assessment of their overall economic status (measured as food consumption and household income) and the use of health services by all family members. We will use this data to make detailed comparison of the economics, health service use and social dynamics of incident dependent, chronic dependent and control households.



In addition to this quantitative data, in each of the four countries we will carry out six detailed 'case studies' using qualitative research methods (detailed open-ended interviews) to explore in more depth some of the associations observed from the survey data. These interviews will ask household members to describe the experience of living with and caring for a dependent older person; we will also interview the older person about their experiences. We are particularly interested to see: how decisions about care are made, whether dependence is associated with economic vulnerability or impoverishment and what impact changing patterns of dependence and care have upon the social relations between family members. Our mixed methods approach will thus enable us to assess the extent to which onset of dependence serves as an economic shock to households as a whole, leading to economic vulnerability and impoverishment. We will also be able to explore the impact of dependence upon on social relations between household members and others in their network. Given that there is evidence to suggest that the burden of care often falls to women and may be linked to cutting back or giving up paid employment, we are particularly keen to investigate the gender dynamics and decision-making around care.

We are working closely with older people, health and social care professionals and Health Ministries in each of the INDEP countries, as well as with our NGO partners (ADI and HelpAge International) to ensure that findings from the study are communicated to key stakeholders and used to inform policy and practice. We hope that study findings will contribute to the emerging evidence-base about the wider social and economic effects of dependence in later life and will ultimately assist policy-makers to develop healthcare and welfare reforms that meet the needs and preferences of older people and their families.

A movie on the effects of care dependence in later life in Peru (Sobrellevando) was produced and is available on our Youtube channel.

The INDEP study is funded by UK Department for International Development and Economic and Social Research Council (DFID/ ESRC) poverty alleviation program

Project members:
UK - Martin Prince, Peter Lloyd-Sherlock and Rosie Mayston
China - Yueqin Huang and Zhaorui Liu
Mexico - Ana Luisa Sosa and Veronica Montes de Oca
Nigeria - Richard Uwakwe and Peter Ezeah
Peru - Mariella Guerra and Sara Gallardo

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