A study conducted by Grace T. Cruz and Josefina N. Natividad of the Population Institute, University of the Philippines Diliman and Yasuhiko Saito of the Advanced Research Institute for the Science and Humanities, Nihon University, Tokyo, Japan examines the future lifetime and functional health transition patterns, or the changes in the health-related quality of life among older people in the Philippines.
Using the data on people ages 50 and above from the areas of Metro Manila (NCR) (urban area) and Leyte (rural area), the researchers were able to determine and analyze the factors that significantly affect the future health and mortality of older people. The data are based on the results of the 1996 Philippine Elderly Survey (PES) and its follow-up study, the 2000 Philippine Follow-up Survey on the Elderly.
The active life expectancy (ALE) determines the functional ability and expected future lifetime of a person given a health state. The analysis of the survey results and computation of the ALE show that age, gender, place of residence, and health status/behavior indicators (i.e., self-assessed health, drinking behavior, exercise) significantly affect future health and mortality, while education has no effect. There are also significant transitions in health status from the 1996 PES to the 2000 Follow-up Survey.
A high rate of recovery from inactive status has been noted in the country, particularly in females. This result suggests that aging does not imply progressive deterioration and that recovery from disability is a significant factor in estimating functional health transition. Findings also show that males have a higher probability of mortality than females. However, a great portion of the remaining life of older females is more likely spent in an inactive state.
The initial health status, which is the health state reported in the 1996 survey, significantly influences the future health status of a person, whether active, inactive or dead. Among the older people who were initially active, 57 percent remained active, 16 percent shifted to inactive state, and 13 percent died.
On the other hand, among those who were initially inactive, 31 percent remained inactive, 25 percent became active, and 40 percent died. These figures clearly show that the initially inactive are more likely to experience mortality and health change over time than the initially active. For some though the initial health status remains the same.
Other results show that urban residents are more likely to experience mortality and health decline than rural residents. This analysis suggests that urbanization may have adverse effects on older people. A possible reason cited by the study for the increased proportion of disability in the urban area is the concentration of health care services in the city, a situation which causes the migration of older people with disability from the rural area to the urban.
Based on the data analysis on drinkers and self-assessed health, self-assessed health has been confirmed to be a significant predictor for mortality. Drinkers in 1996 were found to be less likely to die compared to non-drinkers; this is quite unexpected if we consider the harmful effects of excessive alcohol in the body.
However, researchers explain that this result is due to the inclusion in the non-drinkers category of a large proportion of older people who have stopped drinking because of health reasons. With the negative effects of drinking already existent, the likelihood of mortality is higher among the non-drinkers.
In terms of self-assessed health, those with positive self-assessment of health are as expected less likely to experience mortality. According to the research, physical exercise also helps in avoiding health decline. Those who are initially active and were reported to have exercised regularly are five percent less likely to become inactive in the follow-up survey.
The researchers were able to arrive at the conclusion that the population of older people are expected to increase in the future. However, along with the increase in population is the corresponding increase in the expected number of disabilities mostly among females. This finding reveals that prolonging the life of older people may mean prolonging an unhealthy life.
The research cites this quotation: “The expected declines in functional health (specifically, in the ability to perform normal, everyday activities of daily living) can result in significant restrictions on lifestyles, modifications in recreational and leisure activities, social isolation, poor nutrition and overall decrease in the quality of life (Kiyak and Borson, 1992; Verbrugge and Jette, 1994).”
The study thus suggests that future policies should be able to respond to the expected increase in the number of older people in the coming years in terms of provision of health services, health insurance and social security. The insignificant effect of education to health transitions is quite unexpected. The researchers therefore recommend that further study and verification of results be done on other samples.
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