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Abstract
Introduction
What are the barriers to gerontological investigation in developing countries?
What are the demographic issues?
Evolution of age pyramids
What are the human resource limitations?
The evolution of training opportunities
What are the material resource limitations?
Development of research
What are the methodological or disciplinary limitations?
Specific pitfalls relevant to developing countries
The evolution of knowledge and understanding of the elderly
What is the present experience?
What is the future of gerontological research?
References
Bibliography 1
Bibliography 2
Noel W. Solomons
Noel Solomons is affiliated with the Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), the research branch for the National Committee for the Blind and Deaf of Guatemala, in Guatemala City, Guatemala.
Life expectancy is increasing in developing countries. Gerontology, the study of the biology of ageing, has had only limited application to third world populations. The published literature on ageing and the elderly in developing countries is generally sparse and primarily descriptive. Nutrition and diet, however, comprise an important fraction of the extant literature. Barriers to gerontological research in the third world include the traditional focus on maternal and child health, limited human and material resources, and methodological pitfalls inherent in the study of ageing. Additional pitfalls related to the ecological and genetic characteristics of pre-industrialized and transitional countries, per se, must also be recognized and avoided. This will allow gerontological research to flourish and create understanding of the problems of ageing in the third world.
C. Gopalan, at the VI Asian Congress of Nutrition in 1991, emphasized the nutritional vulnerability of the elderly people of the third world and called for actions such as sustaining the productivity of the aged into the seventh and eight decades; giving special attention to elderly women, who might be marginalized or widowed; ensuring the micronutrient value of the diet in the context of a reduced total energy demand; encouraging extended family support in preference to collective care by the state; and encouraging the development of geriatrics (and by implication gerontology) as public health specialties [1].
The maximal life-span for the species Homo sapiens is estimated to be 120 years. It is unlikely that diet or nutrition can extend the range any more. It is important to realize that many elderly persons experience variable periods of chronic illness, invalidism, and dependence. This has both a social and an economic cost, in addition to affecting adversely the individual quality of life. This has led to a universal motto for applied gerontology: “Add life to years, rather than years to life.” This concept is known, technically, as “compression of morbidity” [2] or the extension of the “health-span” [3]. It is thought that diet and nutrition can help to maintain function and avoid chronic disability.
Knowledge from research on ageing and the aged has the dual potential of advancing science and assisting in the formation of social and health-care policy. With respect to the former, the more durable, generalizable, and consistent an observation, the more likely that it is truly a generic feature of the ageing process itself [4]. On the other hand, Andrews [5] cites a number of ways in which gerontological research can and should contribute to policy development, such as developing a general profile of the elderly population, including its age composition, sex distribution, levels of education, residence, income, and general socio-economic conditions; describing the problems and needs of the target population, with emphasis on those that influence health status and general well-being; and obtaining feedback on the operation, quality, and impact of particular policies and programmes for the elderly segment of the population.
The convergence and confluence of country-specific and regional initiatives provided the motivation and momentum that has brought us through the pilot exercise of the project on the Nutritional and Food Security Situation of Rural and Urban Elderly from Selected East Asian and Latin American Developing Countries. This has led to a broader interest in the elderly population of the respective countries represented by the CRONOS (Cross-Cultural Research on the Nutrition of Older Subjects) protocol.
TABLE 1. Barriers to gerontological investigation in developing countries.
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Demographic The elderly are perceived as a small and unimportant segment of the populationHuman resources There is a lack of professionals trained in modern gerontologyMaterial resources There are scarce funds and few specialized facilities for biological researchMethodological and disciplinary The biology of ageing has conceptual and methodological pitfalls that must be recognized and addressed in gerontological research |
One would assume that if gerontological investigation were easy (or popular) in developing countries, it would be well established. The following survey of recent literature suggests that this type of research is rare. Hence, one is motivated to look for barriers. Table 1 lists some of the barriers, limitations, and issues that have hindered the development of gerontology in the third world.
A typical age pyramid for a developing country is characterized by a broad base and a rapidly narrowing point. This signifies that “new” members of the population (infants, toddlers, pre-schoolers, and children) constitute the largest single segment. The median age is often in the teens. From a public health point of view, the major constituency, numerically, is the young. Because of adverse sanitary conditions, infectious and parasitic diseases are rampant in tropical countries. They represent a major focus of medical (curative) and public health (preventive) attention, on the one hand, but they contribute to a cumulative early mortality that reduces the number of survivors to adulthood, on the other. Maternal and child health is the traditional watchword of the developing world.
The elderly will always be a small fraction of the population, especially one that is growing rapidly, However, the absolute numbers may be large. Five percent of 10 million is 500,000. To the extent that health-care needs are greatest at both extremes of the life-span, it is necessary to factor into the equation the amount of suffering (pain and disability) and of medical expenses (for consultants and medications) to arrive at the weighted perspective of health problems.
There is a gradual evolution both in the orientation of priorities and in the contour of age pyramids in the third world. In countries such as Chile and Cuba, more than 10% of the population is now over 65 years of age [6]. Most contemporary reviews are full of the demographic projections of the expansion of the older population for the year 2000 or the year l 2020 in a global sense, a globe composed primarily of - poor countries [7]. It is not so much the demographic facts, but the reflex pattern of attending to maternal and child health to the exclusion of other population groups, that needs to be addressed. Again, the convening of this meeting and the financial support from the European Economic Community testify to some recognition of the demographic imperatives.
In developed and developing countries alike, there is a shortage of professionals to attend to the needs of the elderly. These needs include both care (geriatric medicine, dentistry, psychology, social work, etc.) and research (gerontology). Because of the slow-to change patterns and poor incentives, the deficit is greatest where concern for ageing and the elderly is less prominent, i.e., in the third world.
Numerous training programmes based on the special biological characteristics of ageing (see below) have been developed in North America and Europe. Gerontology is inherently cross-disciplinary. Traditionally, the need for personnel has been addressed by inducing professionals to make a mid-career transition. In the area of health research, these professionals are most often physicians and research trained public health specialists, although non medical nutritionists and social scientists have made important contributions. However, in developing countries paediatricians often become the new gerontologists.
Language barriers often stand in the way of a third world student or professional who wishes to participate in a gerontology programme in an industrialized country. Moreover, the development of learning skills and study habits and training in the principles of biology and the scientific method may be deficient in the educational systems of developing countries. Conversely, the focus of training centres in affluent countries on the model of ageing that applies in those countries may limit the applicability of this training to third world needs.
Training programmes are improving for potential third world researchers in gerontology. The creation of networks of communication is one way to facilitate the process. The International Institute on Aging in Malta, affiliated with the United Nations, has taken the leadership in this international networking. It also is coordinating a modest training programme. For Latin America, there now exists a Latin American Committee (COMLAT) of the International Association of Gerontology, with headquarters in Belo Horizonte, Brazil. The COMLAT held a meeting in Spanish and Portuguese just before the XV International Gerontology Congress in Budapest in July 1993.
Indigenous development of gerontology research centres or of gerontology research within centres is a very common motif in the current evolution of the investigation of ageing in developing countries. It is a case of “learning by doing.” Two cases in Central America can be cited. In Guatemala, the Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM) was born with “Aging” as its middle name. As the research branch of the National Committee for the Blind and Deaf of Guatemala, CeSSIAM has been involved with sensory deficits. Ocular and visual problems are most common in later life, and this was a firm justification for-and an incentive to-the development of research in the elderly. In Costa Rica, a country in transition, with improving life expectancy and the emergence of chronic diseases, demographic investigations of the elderly fortified the development, within the University of Costa Rica’s Institute for Health Investigation (INISA), of the Programme for the Study of Aging (PROINVE).
It is important that this “home-grown” ageing research, however, be connected to the larger body of concepts and experience. Participation in international forums in overseas venues and the rigours of peer review of the publications are two ways in which indigenous developments of gerontology can be guided over the correct terrain. Third world countries have certain selective advantages in research. Malnutrition paradigms are widely familiar. Anthropometry is well known, and studies of body composition in the elderly can be conducted easily. The interest in juvenile micronutrient deficiencies can be readily converted to include the elderly. Both Guatemala and Costa Rica have followed these strategies.
Part of the generic definition of a developing country is general poverty and maldistribution of wealth. The small amount of investment in academic facilities rarely takes gerontology into account. In developing countries gerontology has a very low priority compared with laboratories, computer facilities, survey, resources, etc.
Those who would do gerontology research in developing countries can take advantage of a common strategy for efficiency, the sharing of resources. Only a few approaches and techniques for epidemiological or clinical research are specific to a given age group. The same haematological tests serve in both children and adults. The basic biochemical laboratory, although primarily responsible for measuring albumin and retinol, can also be used to measure cholesterol, triglycerides, uric acid, and growth hormone, which are of concern in studies of the elderly.
Specific equipment needs do exist, however The knee-height caliper [8], which makes measurements specific to the loss of height in the elderly, is in expensive and readily accessible. On the other hand, dual-energy X-ray absorptometry (DXA) and computerized axial tomography (CAT scan) are becoming increasingly useful for defining not only the skeletal tissue but also the soft tissue in the body composition of adults. Huge investments of capital are needed to purchase DXA or CAT scan equipment, which may be beyond the reach of developing countries.
Ageing biology is concerned with distinguishing true ageing from non-ageing. There are two theoretical debates raging in gerontology. The first is whether the ageing of cells, tissues, and organs is a genetically programmed event or the cumulative result of disease [9]. If one accepts that senescence is a process distinct from pathology, there are a host of theories as to its origins [10].
In observational and experimental gerontology, the study design must distinguish true ageing from non-ageing confounders. The ideal format is a longitudinal study design, but with human ageing from birth, the amount of time required is more than an investigator’s professional lifetime. More often, inferences about ageing are drawn from cross-sectional comparisons of younger and older people.
TABLE 2. Sources of differences between young and old age groups
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True ageing Intrinsic (genetic): Metabolic cost of tissue repairs and mutation of cells with ageNon-ageing Selective survival: Characteristics that determine whether individuals in a given cohort will die before a certain age |
Table 2 is modified [4] from an illustration in the WHO report Health in the Elderly [11] True ageing can be the result of either intrinsic forces or common extrinsic forces. A common pitfall in drawing inferences from cross-sectional studies is confusing selective survival, secular trends, and differential treatment Selective survival is non-random death due to the lower fitness of those members of a cohort who die in comparison with the fitness of those members who survive. One cannot select comparable populations of 40-year-olds and 80-year-olds, because it is impossible to know which of the 40-year-olds will survive for another four decades. Nevertheless, for asking questions about true ageing, this type of pairing across ages is implicit
In addition, secular trends, that is, changes in exposure to the external environment or in lifestyle, from the formative years of one age group to the formative years of another, may distort the meaning of across-age comparisons. If 100% of a group of 80-year-old men have smoked for 30 years or more, and none of a group of 40-year-olds have smoked, differences between the groups in lung function may be attributed to more than just age effects. Finally, if society treats older people differently from younger ones by giving them a greater or lesser share of wealth, health care, food, etc., across-age differences may be the result of differential treatment or challenge and not just the ageing process.
Another practical issue relates to the distinction between chronological age (the number of years lived) and biological age (the degree of advancement of senescent processes). The former is generally easy to calculate; the latter is difficult both to define conceptually and to measure biologically in humans. There has been much recent discussion of proposed “biomarkers” of ageing [12,13].
The heterogeneity of the population is another problem associated with the study of ageing in free-living individuals [14]. As one studies older populations, the variation between the two ends of the spectrum at a given age for any variable of interest will widen. For example, 25-year-old men have a relatively narrow distribution of pulmonary function, but among surviving 75-year-olds, one will find lung performances ranging from close to that of a 25-year-old man to severely deteriorated values.
The last methodological problem is the comparative interpretation of traditional measurements and indexes across ages. The classical case, and one that influences our present study, is anthropometry. Is the meaning of a skinfold the same with distensible aged skin as it is with taut young skin? Is the body mass index the same with the maximal stature as the denominator term as it is with a standing height compromised by curvature and compression? Is a limb circumference the same when fat is only in subcutaneous locations as it is when fat has infiltrated the bellies of the muscles? These are but a few of the ever-recurring questions about body measurements of the elderly and their interpretive and comparative meaning.
Greater selective pressures may produce a greater degree of selection among survivors, and the harsh nutritional and microbial conditions of early life seven to eight decades ago-and throughout the years-in most developing countries have produced a much greater mortality of the original birth cohorts and a much hardier survivor remnant. This makes selective mortality an even greater confounder of the interpretation of cross-sectional studies in third world than in first world countries. Paradoxically, however, this severe selective pressure may counter one of the other features of ageing populations, the greater heterogeneity alluded to above. It is worth testing data sets from elderly populations of developing countries to determine whether the distributions of variables may be narrower than those from industrialized countries with higher survival rates to any given age.
The extent to which overprotective attitudes from other generations within the family will impede the recruitment of older subjects into studies is unknown. It was our anecdotal experience in recruiting for a metabolic study in healthy elderly people [15] that persons who were living alone or as cogenerational elderly couples were more likely to volunteer for the study than those living in multigenerational homes. In countries like Nepal, in which the elderly are truly venerated and doted upon by their offspring, it is not clear whether investigators would be given easy access to the older subjects, or whether family protests would impede such studies.
The chronological versus biological ageing paradigm truly becomes important in the context of research in developing countries. First, it is widely believed that the error in classification by chronological age is greater where birth records are not available and self-reported age must be relied on. Also, there is the convention of calculating and reporting age. In China life begins at conception, so that Chinese are one year old when they are born. In Central America and Mexico, people report ordinal rather than cardinal years, so that a person in the 44th year of life, having completed 43 years, reports his or her age as 44. The larger issue, however, is that of age “comparability” across regions and ethnicities. If the extrinsic ageing processes differ from one area to another, would it not be reasonable to compare people who are “equally aged” rather than of “equal age”? Logically, this is the case, but “biomarkers” [12, 13] must be agreed upon before such a concept can be operationalized.
One of the rationales of multinational studies is to develop “universal” generalizations about ageing processes. When the focus of the study is a common problem of an industrialized country, such as fall-related hip fractures or Alzheimer’s disease, which are of low prevalence in a given third world country, the advantages for knowledge can be great, i.e., the possibility of identifying the protective factors that may be prevalent in the latter. However, there may be some logistic disadvantages, such as finding enough cases to study in a case-control format.
Widespread illiteracy impedes the self-administered questionnaires that have become so important in studies of chronic diseases [16]. In Haiti and Guatemala more than half of the population is illiterate in the dominant language. For the literate elderly in developing countries, poor vision, uncorrected presbyopia, and poor comprehension limit the feasibility and reliability of self-administered instruments. Even where the older population can read and write, a telephone infrastructure to remind the participants to send in their questionnaires and to clarify problems often is lacking.
It is only through critical reading of the scientific literature and exchange with colleagues from the leading centres of excellence in gerontology that disciplinary insights can be gained. The status of scientific and medical libraries is, if anything, deteriorating with rising subscription costs and shrinking budgets. Electronic accessing of bibliographic citations can partially compensate in countries with e-mail access if the telephone costs can be covered. The Pan American Health Organization is experimenting with the distribution of microfilmed literature on ageing to fortify the bibliographic knowledge in Latin America. Textbooks of gerontology are becoming more widely distributed, ensuring the transfer of the latest knowledge of the biology of ageing to those who can afford them and are multilingual enough to read them. Currently, the third world has made the greatest gerontological progress in epidemiology, followed at a considerable distance by clinical and metabolic research, while research on ageing in animal and in vitro cell models and theoretical gerontology are virtually non-existent.
To assess the present experience, I have focused on three bodies of evidence: recent citations from Index Medicus of research on the elderly of developing countries outside Central America and Mexico; recent citations of abstracts and publications on gerontological and geriatric investigations from Central America and Mexico; and existing multicentre, transnational collaborative studies of the elderly in developing countries.
The first supplemental bibliography of this paper lists 51 publications that show the distribution of emphasis in research or policy publications related to the health of the elderly or the biology of ageing from developing and transitional countries around the world. They are quite diverse in flavour, from generic educational articles on specific diseases to nutritional surveys to socio-gerontology themes. There are many more offerings from transitional countries, such as China, Taiwan, Singapore, Malaysia, Hong Kong, Puerto Rico, Chile, and Brazil, or from disadvantaged populations within developed counties, such as Amerindians in the United States or blacks in South Africa, than from struggling countries, such as Nigeria or India. This could reflect the greater development of scientific publication in the more advanced emerging countries, the greater emphasis on the problems of ageing in these countries, or both.
Another supplemental bibliography lists 21 publications on gerontology or geriatric research from Mesoamerica. Some of these come from the Center for Studies of Sensory Impairment, Aging and Metabolism. One of the few metabolic studies in the elderly from developing countries was performed by our group to determine the true riboflavin requirements for the healthy elderly. As survey research uncovers heretofore poorly appreciated health and nutritional conditions, gerontologists in developing countries must become ever better prepared to pursue detailed clinical and metabolic research.
The presentations that follow represent the culmination of the pilot phase of the project on the Nutritional and Food Security Situation of Rural and Urban Elderly from Selected East Asian and Latin American Developing Countries, which involves the Philippines, China, Thailand, Malaysia, and Indonesia in Asia and Brazil, Guatemala, and Mexico in Latin America. Gary Andrews of Flinders University in Australia [5] was a pioneer in multicentre, transnational studies in gerontology. He compared gerontological health in Fiji, the Republic of Korea, Malaysia, and the Philippines. Mark Wahlqvist of Monash University in Melbourne, Australia, is the chairperson of the collaborative study by the Committee on Nutrition and Aging of the International Union of Nutritional Sciences entitled Food Habits in Later Life (FHLL). Finally, Stefania Maggi is leading the Research Program on Aging of the World Health Organization and the US National Institute on Aging.
The potential for gerontological research in developing countries is bright. Increasing life expectancy ensures that the elderly will be more prominent, both in absolute numbers and as a percentage of the populations in the third world. The implications of this for health care and its cost cannot be ignored.
Gerontological researchers are being developed in third world countries. A few have opportunities to travel abroad for training in recognized centres of excellence in ageing biology. Others are gaining experience by participating in research projects in their own countries. For both the quality of the training and the validity of the research, however, it will be increasingly necessary for developing-country researchers to get some training (doctoral or postdoctoral) outside their countries.
The format of multicentre studies, such as the present one, is both a good training vehicle to get more investigators involved in gerontological field research and a way to fortify the commitment to ageing research in the third world. Such studies require a consensus on both goals and means among the participating entities. Clearly, it is the responsibility of those working in gerontological research to foster high-quality investigation of the issues that they are facing as a result of the growing number of low-income persons who will reach the age of 60 and beyond in the coming decades.
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2. Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med 1980;303:130-40.
3. Cinader B. Aging, evolution and individual health span: introduction. Genome 1989;31:361-7.
4. Solomons NW. Nutrition and aging: potentials and problems for research in developing countries. Nutr Rev 1992;50:224-9.
5. Andrews GR. Health and ageing in the developing world. In: Evered D, Whelan J. eds. Research and the ageing population. Ciba Foundation Symposium 134. Chichester, UK: John Wiley & Sons, 1988:17-32.
6. Meyers GC, Clark DO. Geographic distribution of older persons within countries: an international trend study. Durham, NC, USA: Center for Demographic Studies, Duke University (mimeo), 1989.
7. Kinsella KG. Aging in the Third World. CIR Staff Paper No. 35. Washington, DC: Center for International Research, US Bureau of the Census, 1988.
8. Chumlea AC, Guo S. Equations for predicting stature in white and black elderly individuals. J Gerontol 1992;47:M197-M203.
9. Grimley-Evans J. Ageing and disease. In: Evered D, Whelan J. eds. Research and the ageing population. Ciba Foundation Symposium 134. Chichester, UK: John Wiley & Sons, 1988:38-47.
10. Kirkwood TBL. The nature and causes of ageing. In: Evered D, Whelan J. eds. Research and the ageing population. Ciba Foundation Symposium 134. Chichester, UK: John Wiley & Sons, 1988:193-202.
11. World Health Organization. Health in the elderly. Geneva: WHO, 1989.
12. Hart RW, Chang LW, Turturro A, Kadlubar FF. Recent advances in biomarker research. Introduction. Biomed Environ Sci 1991;4:2-7.
13. Turturro A, Hart RW. Biomarkers of aging. An overview. Biomed Environ Sci 1991;4:130-3.
14. Nelson EA, Dannefer D. Aged heterogeneity: fact or fiction? The fate of diversity in gerontological research. Gerontologist 1992;32:17-23.
15. Boisvert WA, Castaneda C, Mendoza I, Mazariegos M, Langeloh G, Solomons NW, Gershoff S, Russell RM. Prevalence of riboflavin deficiency among the Guatemalan elderly and speculations on its etiology. Am J Clin Nutr 1993;58:85-90.
16. Willett W. Nutritional epidemiology. New York: Oxford University Press, 1990.
Additional recent publications on ageing and elderly research and policy from developing and transitional countries, excluding Mesoamerica
1988
Manson SM, Callaway DG. Health and aging among American Indians: issues and challenge for the biobehavioral sciences. American Indian and Alaska Native Mental Health Research 1 1988(monograph 1):160200.
Woo J. Ho SC, Donnon S. Swaninathan R. Nutritional correlates of blood pressure in elderly Chinese. J Hum Hypertension 1988;1:287-91.
1989
Gelfand DE. Immigration, aging and intergenerational relationships. Gerontologist 1989;29:366-72.
Kapil U. Sood AK. Morbidity pattern in aged persons attending rural health Center in Haryana. Indian J Public Health 1989;33:192.
Litvak J. Aging and research in developing countries. Aging (Milan) 1989;1:85-6.
Payne K. HelpAge International from Sri Lanka to Bolivia via Kenya. Hygie 1989;8(2):23-5.
Woo J. Ho S. Mak YT, Shak CC, Swaminathan R. Protein nutritional status in Chinese in Hong Kong. Eur J Clin Nutr 1989;43:175-86.
1990
Braithwaite FS. The elderly in Barbados: problems and policies. Bull Pan Am Health Org 1990;24: 314-29.
Choo PW, Lee KS, Owen RE, Jayaratnam FJ. Singapore- an ageing society. Singapore Med J 1990;30:486-8.
De Vos S. Extended family living among older people in six Latin American countries. J Gerontol 1990;45:S87-S94.
Litvak J. Aging: a challenge beyond the year 2000. Bull Pan Am Health Org 1990;24:330-4.
Veras RP, Coutinho E, Ney G Jr. Elderly population in Rio de Janeiro (Brazil): pilot study of reliability and validation of the mental health section of the BOAS questionnaire. Rev Saude Publ 1990;24:156-63.
Yassin Z. Terry RD. Health characteristics of rural elderly Malay females in selected villages in Nigeri Sambilan. Med J Malaysia 1990;45:310-8.
1991
Coale AJ, Li SM. The effect of age misreporting in China on the calculation of mortality rates at very high ages. Demography 1991;28:293-301.
Diczfalusy E. The third age, the Third World and the 21st Century. Contrib Gynecol Obstet 1991;18:1-14.
Litvak J. Maggi S. Aging. Infect Dis Clin North Am 1991;5:353-63.
Olubuyide IO, Hart PD, Alli-Gombe A, Adesanya JW, Okosieme ODE, Otunla TE, Kehinde MO, Atoba MA. Disease pattern in the elderly. Cent Afr J Med 1991;37:247-9.
1992
Baiyewu O. Jegede RO. Life satisfaction in elderly Nigerians: reliability and factor composition of the life satisfaction index Z. Age Ageing 1992;21:256-61.
Bester FC, Weich DJ, Albertyn EW. Socio-economic circumstances and functional abilities of elderly black persons in the Orange Free State. South Afr Med J 1992;82:110-3.
Braun S. Chamorro G. Wilson C, Casanegra P. Corbalan R. Iirarrazaval MJ, Kobus C, Valle I. [Risk of chronic oral anticoagulant treatment in elderly patients.] Rev Med Chile 1992;120:552-8 (in Spanish).
de los Rios MG. Diabetes-mellitus in the aged. Rev Med Chile 1992;120:593-601.
Li G. Shen YC, Li YT, Chen CH, Zhau YW, Silverman JM. A case-control study of Alzheimer’s disease in China. Neurology 1992;42:1481-8.
Lopez-Varela J. [Social consequences of ageing.] Boletin de la Asociación Médica de Puerto Rico 1992;84:15-20 (in Spanish).
Xihe Z. Anna X, Zhimei W. Jin B. Xiaoshu C. Dietary survey of the elderly in selected areas of China. Age Nutr 1992;3:78-81.
1993
Andrews GR. Healthy aging: the Asia/Oceania experience. Aging 1993;5:148-53.
Bella AF, Baiyewu O. Bamigboye A, Adeyemi JD, Ikuesan BA, Jegede RO. The pattern of medical illness in a community of elderly Nigerians. Cent Afr J Med 1993; 39(6):112-6.
Bravo-Williams S. Gerontologic outlook for Latin America. Aging 1993;5:144-6.
Dubbelman R. Jonxis JH, Muskiet FA, Saleh AK. Age dependent vitamin D status and vertebral condition of white women living in Curacao (The Netherlands Antilles) as compared with their counterparts in The Netherlands. Am J Clin Nutr 1993;58:106-9.
Leung SY, Ng TH, Yuen ST, Lauder IJ, Ho FC. Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extracranial vessels. Stroke 1993;24: 779-86.
Pan WH, Wang CY, Li LA, Kao LS, Yeh SH. No significant effect of calcium and vitamin D supplementation on blood pressure and calcium metabolism in elderly Chinese [published erratum appears in Chin J Physiol 1993;36:192]. Chin J Physiol 1993;36:8594.
Shao Z. Gao W. Yao Y. Zhuo Y. Riggs JE. The dynamics of aging and mortality in the People’s Republic of China, 1957-1990. Mech Ageing Dev 1993;67:239-46.
Solomons NW, Mazariegos M, Mendoza I. Uses of anthropometry in the elderly in the field setting with notes on screening in developing countries. Asia Pacific J Clin Nutr 1993;2:15-23.
Stahl A. Changing attitudes toward the old in Oriental families in Israel. Int J Aging Hum Dev 1993;37:261-9.
Xiao PG, Xing ST, Wang LW. Immunological aspects of Chinese medicinal plants as antiageing drugs. J Ethno-pharmacol 1993;38:167-75.
Zheng ZX, Wang ZS, Zhu HM, Yang JY, Peng HY, Wang LX, Li J, Jiang XW, Yu YF. Survey of 160 centenarians in Shanghai. Age Ageing 1993;22:16-9.
1994
Chiam PC. Depression of old age. Singapore Med J 1994;35:404-6.
Chiu HF, Lee HC, Wing YK, Kwong PK, Leung CM, Chung DW. Reliability, validity and structure of the Chinese Geriatric Depression Scale in a Hong Kong context: a preliminary report. Singapore Med J 1994;35:477-80.
Kao CH, Lai TL, Wang SJ, Chen GH, Yeh SH. Influence of age on gastric emptying in healthy Chinese. Clin Nucl Med 1994;19:4014.
Kua EH, Ko SM. The ageing of elderly people. Singapore Med J 1994;35:386-9.
Livshits G. Otremski I, Kobyliansky E. Biology of aging in an Israeli population. 2. Polymorphic blood markers and fluctuating asymmetry. Anthropol Anz 1994;52:97117.
McLigeyo SO. The elderly patient in sub-Saharan Africa: the past, the present and the future [editorial; comment]. East Afr Med J 1994;71:141.
Pongpaew P. Tungtrongchitr R. Lertchavanakul A, Phonrat B. Tawprasert S. Migasena P. Schelp FP. Socio-demographic characteristics and health status of urban Thai elderly. Southeast Asian J Trop Med Public Health 1994;25:583-9.
Tracy RE, Rios-Dalenz JL. Rarity of hypertensive stigmata in aging renocortical arteries of Bolivians. Virchows Arch 1994;424:30714.
Woo J. Ho SC, Lau J. Leung PC. Musculoskeletal complaints and associated consequences in elderly Chinese aged 70 years and over. J Rheumatol 1994;21:1927-31.
Woo J. Lau E, Swaminathan R. MacDonald D, Chan E, Leung PC. Association between calcium regulatory hormones and other factors and bone mineral density in elderly Chinese men and women. J Gerontol 1994;49: M189-94.
1995
Benedek C, Berclaz PY, Jequier E, Schutz Y. Resting metabolic rate and protein turnover in apparently healthy elderly Gambian men. Am J Physiol 1995;268(6 pt 1): E1083-8.
Ho SC, Chan SS, Woo J. Leung PC, Lau J. Determinants of bone mass in the Chinese old-old population. Osteoporosis Int 1995;5:161-6.
Osuntokun BO, Sahota A, Ogunniyi AO, Gureje O. Baiyewu O. Adeyinka A, Oluwole SO, Komolafe O. Hall KS, Unverzagt FW, Hui SL, Yang M, Hendrie HC. Lack of an association between apolipoprotein E epsilon 4 and Alzheimer’s disease in elderly Nigerians. Ann Neurol 1995;38:463-5.
Solanki T. Hyatt RH, Kemm JR, Hughes EA, Cowan RA. Are elderly Asians in Britain at a high risk of vitamin D deficiency and osteomalacia? Age Ageing 1995;24(2): 103-7.
Woo J. Ho SC, Sham A, Yuen YK, Chan SG. Influence of age, disease and disability on anthropometric indices in elderly Chinese aged 70 years and above. Gerontology 1995;41(3):17380.
Yeo G. Ethical considerations in Asian and Pacific Island elders. Clin Geriatr Med 1995;11:139-52.
Additional recent abstracts, theses, and publications on ageing and elderly research and policy from Mexico and Central America
1988
Pacheco-Taracena ML. [Hepatic vitamin A reserves and nutritional status of the elderly.] Master of Science in Public Health thesis, Centro de Estudios Superiores en Nutrición y Ciencias de Alimentos (CESNA), Guatemala City, 1988 (in Spanish).
1989
Arzac-Palumbo P. Guzman-Chimal E, Pena de Junco C. [Home geriatric care.] Revista Mexicana de Geriatría y Gerontología 1989;1:26-8 (in Spanish).
Espino DV. [Health of the elderly of Mexican descent living in the United States.] Revista Mexicana de Geriatría y Gerontología 1989;1:10-12 (in Spanish).
Martinez-Arronte F. Medrano MG. [Diabetes in the elderly.] Revista Mexicana de Geriatría y Gerontología 1989;1:13-22 (in Spanish).
1990
Breuer K. Vitamin A status and anthropometric measurements in elderly persons living in a pert-urban area of Guatemala City. Diplomarbeit thesis, University of Bonn, Germany, 1990.
Garcia V, ed. [Mortality and socioeconomic characteristics of the third age.] San Jose, Costa Rica: Centro Latinoamericano de Demografía (CELADE), 1990 (in Spanish).
Llanos G. ed. [A study of the third age in Coronado, Costa Rica.] Monografia 90-01/Serie: Salud del Adulto. San Jose, Costa Rica: Pan American Health Organization, 1990 (in Spanish).
1992
Mendoza I, Solomons NW. [The nutritional situation of the Metropolitan Guatemala City area.] Arch Latinoam Nutr 1992;44(suppl):59-69 (in Spanish).
Mendoza I, Van der Heiden K, Valdez C, Vasquez A, de Portocarrero L, Gamero H. Quan J. Solomons N. [The factors potentially conditioning the food habits of older Guatemalans from a suburban area]. Arch Latinoam Nutr 1992;42(3 suppl):87S-91S (in Spanish).
Ramirez I, Mendoza I, Romero ME, Valdez C, Vasquez A, Haskell M, Breuer K, Solomons NW. [Cardiovascular disease risk-factors in aged Guatemalatecos in a marginal, urban community.] Rev Med Int 1992;3:8-12 (in Spanish).
Valdez C. [Chronic disease patterns and medication use by the elderly.] Rev Med Int 1992;3:3-7 (in Spanish).
Valdez C, Cardona R, Maya JC, Solomons NW. [Morbidity in the elderly of a pert-urban community of the capital city of Guatemala.] Rev Med Int 1992;3:8-12 (in Spanish).
van der Heiden K. Food security problems in elderly people in developing countries exemplified by a pert-urban community of Guatemala City. Diplomarbeit thesis, University of Bonn, Germany, 1992.
1993
Boisvert WA, Castaneda C, Mendoza I, Langeloh G, Solomons NW, Gershoff SN, Russell RM. Prevalence of riboflavin deficiency among Guatemalan elderly people and its relationship to milk intake. Am J Clin Nutr 1993; 58:85-90.
Boisvert WA, Mendoza I, Castaneda C, De Portocarrero L, Solomons NW, Gershoff SN, Russell RM. Riboflavin requirement of healthy elderly humans and its relationship to macronutrient composition of the diet. J Nutr 1993; 123:915-25.
1994
King JE. Nutritional assessment of the elderly of San Pedro Ayampuc, Guatemala: evaluation of anthropometry, biochemistry, and helminthic infection. Master of Science in Health Science thesis, University of California, Berkeley, Calif, USA, 1994.
Romero-Abal ME, Mendoza I, de Ramirez I, Haskell M, Valdez C, Breuer K, Weiser H. Schuep W. [Relationship between plasmatic lipids and fat-soluble vitamins in Guatemalan periurban elderly]. Arch Latinoam Nutr 1994;44: 140-4 (in Spanish).
1995
Mazariegos M, Valdez C, Kraaij S. van Setten C, Liurink C, Breuer K, Haskell M, Mendoza I, Solomons NW, Deurenberg P. Comparative body composition estimates for institutionalized and free-living elderly in metropolitan areas of the Republic of Guatemala. Nutr Res 1995; 16:443-58.
Mendoza I, Boisvert W. Solomons NW. Reproducibility of anthropometric measurements in Guatemalan elderly. Age Nutr 1995;6:155-60.
1996
Mazariegos M, Valdez C, Kraaij S. van Setten C, Liurink C, Breuer K, Haskell M, Mendoza I, Solomons NW, Deurenberg P. A comparison of estimates of body fat using anthropometry and bioelectrical impedance analysis (BIA) with distinct prediction equations in elderly persons in the Republic of Guatemala. Nutrition 1996; 12:168-75.
Solomons NW, Lacle A, Mazariegos M, Mendoza I. Spontaneous lessons from gerontological initiatives in Central America. In: Wahlqvist ML, Davies L, Hsu-Hage BH-H, Kouris-Blazos A, Scrimshaw NS, Steen B. van Staveren WA, eds. Food habits in later life: descriptions of elderly communities and lessons learned. Jointly published on CD-ROM by the United Nations University Press, Tokyo, and the Asia Pacific Journal of Clinical Nutrition, 1996.
