Fortunately Dr. Sandra Reyes did not stop looking for new alternatives and after one year she received support and encouragement from Dr. José Gómez de León, one of the outstanding demographer with remarkable vision about the challenge meant by the population ageing in the future in Mexico; from Dr. Julio Frenk who always suggested new possibilities to request financing; from Dr. Onofre Muñoz who financed the development and validation of the instruments; and from the Mexican Health Foundation where she always found a researcher to discuss the proposal and financing sources. Finally, in 1996, she was given support by competition by the National Council of Science and Technology. The research proposal is the first long-term project (five years) financed in the health area and several other research proposals have derived from this one. This book is the first report that is presented five years later, having visited and interviewed elderly people who participated in the cohort on four occasions. Presenting publication reports fro individual topics (demography, health needs, disability, utilisation of services, cost of health services, forecasting, etc.) in scientific journals could be desirable from the methodical point of view, however, the comprehensiveness in the presentation and through discussion of the ageing process in Mexico is added value. The content of this book will surely be useful in the generation of health policies for elderly people in IMSS and nationally in order to achieve the objective of the Healthy and Successful Ageing proposed by International Organisations. Likewise it sill serve as basic reference for other research projects in the field to be carried out in Mexico or in other parts of the world.

DR. GUILLERMO SOBERÓN
Executive President
Mexican Foundation for Health

Table of Contents

Preface      

CHAPTER 1. INTRODUCTION

CHAPTER 2. CONSEQUENCES OF THE AGEING PROCESS
2.1. Population Ageing in the World
2.2. Epidemiological Transition
2.3. Increase in Life Expectancy
2.4. Disease Patterns Complexity
2.5. Increasing Health Services Utilisation
2.6. Inappropriate Application of Technology
2.7. Social and Economic Consequences
       Government Programmes
       Elderly people’s savings
       Family or other relatives support
2.8. Consequences for Health Systems
2.9. International Perspectives on Health Care Cost
2.10. Mexican Perspectives on Health Care Cost
2.11. Summary

CHAPTER 3. HEALTH CARE FOR THE ELDERLY – AN ANALYTICAL FRAMEWORK (See Figure 3.1)
3.1. Factors Influencing the Utilisation of Health Services in IMSS
3.2. Enabling Factors
       Socio-demographic characteristics
       a. Age
       b. Sex
       c. Marital Status
       d. Education
       e. Occupation 
       f. Income 
       g. Type of insurance
       h. Family characteristics
3.3. Predisposing Factors
       Risk factors
       Disability
       Health status
           a. Family history of chronic diseases
           b. Self-perceptions of health status
           c. Sensory losses
                i. Hearing loss
                ii. Vision loss 
           d. Incontinence 
           e. Oral health 
           f. Performance status 
           g. Mental Depression 
           h. Acute Diseases 
            i. Injuries
            j. Chronic Diseases
3.4. Summary

CHAPTER 4. POPULATION AGEING IN MEXICO
4.1. In the International Context
4.2. In the Mexican Context
4.3. Population Insured in the IMSS
4.4. Summary

CHAPTER 5. MEXICAN INSTITUTE OF SOCIAL SECURITY
5.1. The National Health System in Mexico
5.2. Health Sector Reforms
5.3. Reform of IMSS
5.4. Types of IMSS Insurance
5.5. Organisation of IMSS
5.6. IMSS Insurance Benefits
5.7. IMSS Medical Care and Health Benefits
5.8. Summary

CHAPTER 6. STUDY RESEARCH METHODOLOGY
6.1. Location for the study
6.2. Objectives
6.3. Study design
6.4. Sampling Design
       Selection criteria
       Proxy respondent selection
       Sample selection
       Sampling frames
       Sample size
6.5. Questionnaires
       Questionnaire to evaluate mental status
       Questionnaire to evaluate health status, utilisation and cost of health services
6.6. Reference study manual
6.7. Interviewers
6.8. Quality control
6.9. Data Handling and Computing
6.10. Data Analysis
6.11. Variables Used in Analysis
         Demographic characteristics
         Family characteristics 
         Health status
         Health services utilisation
         Cost of health services
6.12. Construction of Indicators
         Activities of daily living (ADL)
         Instrumental activities of daily living (IADL)
         Mental Depression
         Self-perceptions of health
6.13. Control of Bias
6.14. Ethical aspects

CHAPTER 7. CHARACTERISTICS OF THE POPULATION
7.1. Study Population and Response Rates
7.2. Demographic Characteristics
       Age and sex
       Education
       Marital status
       Paid occupation
       Place of Birth
7.3. Income
7.4. Family Status
7.5. Type of Insurance
7.6. Summary

CHAPTER 8. HEALTH STATUS
8.1. Family History of Chronic Diseases
8.2. Self-perceptions of Health
8.3. Behavioural Risk Factors
       Physical activity and exercise
       Cigarette Smoking
       Alcohol consumption
8.4. Reported Activities
       Activities of daily living 
       Instrumental activities of daily living
       Changes in activities generated by health problems
8.5. Hearing and Vision Loss
8.6. Incontinence
8.7. Oral Health
8.8. Mental Depression
8.9. Acute Diseases
8.10. Injuries
8.11. Chronic Diseases
         General Description
         Burden of chronic diseases
8.12. Summary     140

CHAPTER 9. UTILISATION OF HEALTH SERVICES
9.1. Use of the Mexican Institute of Social Security
       Users of health services
       Rates of utilisation
9.2. Utilisation of Health Services in Other Settings
       Private services
       Public services in other institutions
9.3. Summary

CHAPTER 10. COST OF HEALTH SERVICES
10.1. Cost of Health Services Utilisation in the IMSS
10.2. Cost of Health Services Utilisation for Different Health
         Conditions
10.3. Cost of Health Services for Chronic Diseases
10.4. Summary

CHAPTER 11. PREDICTIONS FOR YEARS 2000, 2010, AND 2020
11.1. Health Status
         Acute diseases and injuries
         Chronic Diseases
11.2. IMSS Health Services Utilisation
11.3. Health Services Utilisation in Other Settings
         Private services
         Other Public Services
11.4. IMSS Health Services Costs
11.5. Summary

CHAPTER 12. DISCUSSION
12.1. Study methodology
         The main advantages of this research study were
         Disadvantages of this research study were
12.2. Study results
         Gender differences in social, economic and health conditions
         Improving education: advantages and disadvantages
         Use of other type of health insurance
         Family Characteristics
         Behavioural Risk Factors
         Independence in old age
         General health problems
         Acute diseases
         Chronic diseases
         Utilisation of services in IMSS
         Cost of health services
         Forecasting

CHAPTER 13. CONCLUSIONS AND RECOMMENDATIONS
13.1. Conclusions
         I. Research methodology
         II. Results
13.2. Recommendations
         I. Research methodology
         II. Results     

CHAPTER 14. PROPOSAL FOR COMPREHENSIVE CARE FOR ELDERLY PEOPLE IN THE MEXICAN INSTITUTE OF SOCIAL SECURITY
14.1. Financing health services for elderly people in IMSS
14.2. Delivery of services
14.3. Perspectives in health care for the elderly
         Life cycle perspective
         Health promotion
         Geriatric integral care
         Tanathology
14.4. Orientation
         Gender
         Long term care
         Palliative care
14.5. Levels of care
         Self-care
         Family
         Social benefits care
         First level of care
         Second and third level of care
14.6. Levels of prevention

BIBLIOGRAPHY

ANNEXES

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