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Additional file 3: Sub-group analysis.

Additional file 1: Search terms for Pubmed and other databases.

Additional file 1. Oral Health Questionnaire for Adults. Questionnaire utilised for the dental/surgical survey within in the ASSET project in Ethiopia.

Background: There are several existing systematic reviews of prevalence of dementia for mainland China, Hong Kong and Taiwan, but several studies have been newly reported. The aim of this study is to update prevalence data in this region and test for variation across geographical areas and time periods using the new dataset.Methods: Twenty prevalence studies identified from World Alzheimer Report 2015 (January 2011-March 2015) and an updated search (March 2015-February 2017) were added to the original dataset (N = 76). Meta-regression was used to investigate geographical variation and time trends, taking methodological factors and characteristics of study population into account, and to estimate prevalence and number of people with dementia by geographical area.Results: Compared with northern China, the prevalence of dementia was lower in the central China [-1.0; 95% confidence interval (CI):-2.2, 0.3], south China (-1.7; 95% CI: -3.1, -0.3), Hong Kong and Taiwan (-3.0; 95% CI: -5.0, -1.0) but appeared to be higher in western China (2.8; 95% CI: 0.1, 5.5) after adjusting for methodological variation. The increasing trend from pre-1990 to post-2010 periods was considerably attenuated when taking into account methodological factors and geographical areas. The updated estimated number of people with dementia in all these areas is 9.5 million (5.3%; 95% CI: 4.3, 6.3) in the population aged 60 or above.Conclusions: Geographical variation in dementia prevalence is confirmed in this update, whereas evidence on increasing trends is still insufficient. Differing societal development across areas provides an opportunity to investigate risk factors at the population level operating across diverse life course experiences. Such research could advance global primary prevention of dementia.

BACKGROUND: While links between disability and poverty are well established, there have been few longitudinal studies to clarify direction of causality, particularly among older adults in low and middle income countries. We aimed to study the effect of care dependence among older adult residents on the economic functioning of their households, in catchment area survey sites in Peru, Mexico and China.METHODS: Households were classified from the evolution of the needs for care of older residents, over two previous community surveys, as 'incident care', 'chronic care' or 'no care', and followed up three years later to ascertain economic outcomes (household income, consumption, economic strain, satisfaction with economic circumstances, healthcare expenditure and residents giving up work or education to care).RESULTS: Household income did not differ between household groups. However, income from paid work (Pooled Count Ratio pCR 0.88, 95% CI 0.78-1.00) and government transfers (pCR 0.80, 95% CI 0.69-0.93) were lower in care households. Consumption was 12% lower in chronic care households (pCR 0.88, 95% CI 0.77-0.99). Household healthcare expenditure was higher (pCR 1.55, 95% CI 1.26-1.90), and catastrophic healthcare spending more common (pRR 1.64, 95% CI 1.64-2.22) in care households.CONCLUSIONS: While endogeneity cannot be confidently excluded as an explanation for the findings, this study indicates that older people's needs for care have a discernable impact on household economics, controlling for baseline indicators of long-term economic status. Although living, typically, in multigenerational family units, older people have not featured prominently in global health and development agendas. Population ageing will rapidly increase the number of households where older people live, and their societal significance. Building sustainable long-term care systems for the future will require some combination of improved income security in old age; incentivisation of informal care through compensation for direct and opportunity costs; and development of community care services to support, and, where necessary, supplement or substitute the central role of informal caregivers.

BackgroundExposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversely associated with dementia incidence.MethodsPopulation-based cohort studies of women aged 65 years and over in urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and rural and urban sites in Peru, Mexico and China. Sociodemographic and risk factor questionnaires were administered to all participants, including ages at menarche, birth of first child, and menopause, and parity, with ascertainment of incident 10/66 dementia, and mortality, three to five years later.Results9,428 women participated at baseline, with 72–98% responding by site. The ‘at risk’ cohort comprised 8,466 dementia-free women. Mean age varied from 72.0 to 75.4 years, lower in rural than urban sites and in China than in Latin America. Mean parity was 4.1 (2.4–7.2 by site), generally higher in rural than urban sites. 6,854 women with baseline reproductive period data were followed up for 26,463 person years. There were 692 cases of incident dementia, and 895 dementia free deaths. Pooled meta-analysed fixed effects, per year, for reproductive period (Adjusted Sub-Hazard Ratio [ASHR] 1.001, 95% CI 0.988–1.015) did not support any association with dementia incidence, with no evidence for effect modification by APOE genotype. No association was observed between incident dementia and; ages at menarche, birth of first child, and menopause: nulliparity; or index of cumulative endogenous estrogen exposure. Greater parity was positively associated with incident dementia (ASHR 1.030, 95% CI 1.002–1.059, I2 = 0.0%).ConclusionsWe found no evidence to support the theory that natural variation in cumulative exposure to endogenous oestrogens across the reproductive period influences dementia incidence in late life.

Background: While autonomy is highlighted as central to older people’s wellbeing, there has been little empirical research to inform a measurement approach, support construct validity, or establish its determinants. We aimed to study the health and economic correlates of self-perceived autonomy among community-dwelling older people in Peru, Mexico and China, using a hypothesis-driven approach. Methods: Cross-sectional household surveys in urban and rural catchment areas in each country, comprising household, informant, and older person interviews, to elicit household income and older residents’ autonomy, unmet needs, and quality of life. Households, all with older residents, were selected from previous waves of the 10/66 Dementia Research Group’s comprehensive surveys of ageing and health. Results: Among 937 older respondents in 754 households, diminished autonomy was associated with older age, marital status, lower education, and lower household income. Physical, cognitive and mental morbidities, functional impairment and dependence were strongly and independently associated with diminished autonomy, explaining the effect of age. Controlling for these variables, an older person’s current total income was inversely associated with diminished autonomy (Count Ratio per fifth of total income 0.86, 95% CI 0.81-0.91). Autonomy was positively correlated with wellbeing and life satisfaction, supporting construct validity. Counter to hypotheses, less autonomy was associated with fewer unmet needs in rural sites. Conclusions: The effects of income insecurity, disability and dependence upon autonomy should be tested prospectively to confirm causal direction. Social pensions, and measures to support the rights of frail and dependent older people may be effective policy instruments for promoting autonomy. While the negative impact of diminished autonomy upon older people’s welfare is supported, the association in rural sites between more autonomy and more unmet needs should be further investigated; efforts to promote autonomy may need careful cultural nuancing, to support rather than subvert traditional family care systems.