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Orphaned elderly serious casualty of African AIDS epidemic

The rise in AIDS death rates in sub-Saharan Africa has led to a burgeoning new category of neglected individuals — nearly a million orphaned elderly, or older adults living alone without the benefit of any caregivers, Stanford University School of Medicine researchers have found.

The researchers used existing data to develop the first estimates on the number of elderly individuals left alone, without any adult support, as a result of the AIDS epidemic, said Grant Miller, PhD, MPP, assistant professor of medicine, who is affiliated with the Stanford Center for Health Policy.

"We find that AIDS has produced close to a million elderly people in sub-Saharan Africa who are living without the support of their sons, daughters or other younger adults. Many of them also live with young children under 10 years of age, creating households with a missing generation of adults," said Miller, senior author of the study. "I think this probably understates the magnitude of the problem. We were unable to closely examine material living conditions or elderly health."

The study appears in the June 16 online issue of the British Medical Journal. Miller's co-authors at the Stanford Center for Health Policy are Jay Bhattacharya, MD, PhD, associate professor of medicine, and Eran Bendavid, MD, instructor of medicine.

Miller said he and his colleagues were stunned to learn that no one had taken a systematic look at this potentially large group of needy individuals.

"It just blew me away," he said. "We all know we have this problem with orphaned children. I wondered, do we have a similar problem with orphaned elderly? I searched a variety of publications and didn't find a clear answer."

Tim Kautz, the lead author of the study, said the idea for the project struck a chord with him, as he had spent a summer doing AIDS education in rural Tanzania. He lived there with a family that had taken in an unrelated, elderly villager who had no one else to look after him.

"I saw both the devastation caused by AIDS and the importance of the family in caring for the elderly. This project was a way to combine the two observations," said Kautz, a former Stanford undergraduate now pursuing a PhD in economics at the University of Chicago.

The researchers used data from the Demographic and Health Survey, a USAID-funded database that provides standardized information on maternal/child health, HIV and other health indicators in low- and middle-income countries. The survey covered 123,000 individuals over age 60 living in 22 African countries between 1991 and 2006.

The scientists found a very strong correlation between the rise in AIDS death rates in these countries and an increase in elderly individuals living alone. For every one-point increase in AIDS mortality rates, they found a 1.5 percent increase in elderly people left to manage on their own.

In the 22 countries, the estimates translated into 582,200 to 917,000 elderly people left unattended, the researchers found. About a third of them — or as many as 323,000 — were also caring for young children. These individuals were more likely to be women, uneducated, living in rural areas and poorer than their attended counterparts. The results suggest HIV/AIDS has had a disproportionate impact on elderly people of lower socioeconomic status, the researchers reported.

Kautz said he was surprised the figures weren't even higher. He said he believes there are many more older individuals who have been left alone as their children die of AIDS, but that these elders have moved in with relatives or neighbors. These individuals would not be accounted for in the study, he said.

Although HIV has generally reduced life expectancies in Africa, those who escape the epidemic are living much longer as a result of greater access to health technologies, the researchers said. So there is an increased need for elder care services, they noted.

Yet few African countries have public pension programs or formal systems for caring for elders; most rely on traditional family structures, now undercut by the strain of AIDS, to provide this service. The researchers said the study points to the importance of taking these needy elders into consideration in allocating resources and planning programs.

"This is another component of the social consequences of HIV. So people in agencies who make resource allocation decisions need to consider this cost of HIV, and it's a pretty important one," Miller said. "Those working on the ground dealing with late-stage AIDS patients also need to think about the dependents of these patients."

Policies that help reduce AIDS mortality also will be of help to this group, he said.

"Future work is needed to more closely examine the health and overall welfare of this population, but our work suggests that reducing AIDS deaths in Africa may provide substantial benefits to this under-recognized population," the researchers concluded.

The researchers said the study is just a first step in understanding the problem. They speculate that elderly individuals who are alone suffer greater health problems, though they didn't specifically address the issue in the study. Similarly, they did not look at quality-of-life issues, though they suspect that these elders suffer physical and financial burdens as a result of being primary caregivers for young children. More research is needed on the health, well-being and other issues associated with these neglected elders, they said.

The study was funded by the National Institutes of Health.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit

Ruthann Richter | EurekAlert!
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