Measurement of Gender Differences in Disability and Care

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Demographic projections indicate that populating aging is imminent in the Middle East, and sex differences in longevity mean that these growing older populations increasingly consist of women. It is well documented that females at other ages have poorer survival prospects and less access to health care compared to males in the region. Because little is known about older adults in general, the extent to which such disparities persist in later life remains unexplored. A related concern is that instruments previously used in this and other developing regions to assess health status and use of services among older adults have not been adequately tested in these cultures. The validity and reliability of survey instruments are relevant to substantive are relevant to substantive questions about gender differences, given that the validity and reliability of self-reported health status and access to care are known to differ by gender elsewhere.. Therefore, prior to exploring the relationship of gender to health status and service use among older adults in the Middle East, relevant instruments need to be validate for use in this setting. The purpose of this pilot project is to test on a representative sample of non-institutionalized older adults in Egypt the validity and reliability of questionnaires that have routinely been used to measure health status and service use among similar populations in industrialized settings. The specific goals of this study are to: 1. determine the feasibility of conducting home-based tests of physical performance in a disadvantaged population of older adults in Egypt, 2. (a) assess the validity of self-reported data on functional limitation in this population, (b) compare the validity of self reported functional limitation by gender, 3. (a) assess the reliability of self-reports of other health conditions and use of health services in this population, and (b) compare the reliability of self-reports of other health conditions and of use of services by gender. The project site will be Minia, Egypt, and a public use dataset will be made available in due course so that fellow researchers can examine other questions about health and aging in this study population. This study will address important methodological questions about the utility of health interview surveys to gather information on older adults (defined here as age greater than or equal too 50 years) in less developed settings. Being among the first to validate in a developing region instruments that were designed to measure health status and service use among older populations in industrialized countries, this study will answer long-standing questions about the cross-cultural applicability of these instruments. In doing so, findings will provide an indication of the accuracy and reliability of existing self-reported data on health status and service use among older populations in other developing countries where similar instruments have been administered without prior validation. Findings may also inform future revisions to estimates of the global burden of disease, for which little reliable information has been available from developing countries. Finally, answers to the methodological questions that motivate this project will enable the study team to develop well-designed instruments and procedures for data collection to be used in subsequent studies of the level and determinants of differences by gender in health status and use of modern health care at older ages in Egypt and other Middle Eastern settings.