The face of this tragedy is often the millions of AIDS orphans left behind when their parents succumb to the disease. But depleting an entire generation of people has ripple effects in both directions, a recent study by University of Chicago and Stanford University researchers finds. Since the disease, unlike most, kills largely young and middle-age people, the other demographic left behind are the elderly. As Tim Kautz, an economics graduate student at the University of Chicago, and his colleagues found, the older generation is left with greater responsibility and less support.
The study, published last week in the British Medical Journal, used huge demographic surveys of 22 countries in sub-Saharan Africa to analyze the effects of the AIDS epidemic on the elderly. Despite the huge dip in the middle age groups, the elderly population of Africa is growing – expected to rise 55 percent between now and 2025, according to a United Nations report. In countries where it remains traditional for adult offspring to take care of their ancestors, it’s a real problem when those offspring are disappearing. Kautz observed that family structure firsthand while leading AIDS education courses in Tanzania one summer during his undergraduate years.
“What I observed while I was there living with a host family, made me realize family how the living arrangments are so different from the United States,” Kautz said. “I saw how elderly people lived with adult children…and how important informal networks and family were in caregiving. ”
As an undergraduate at Stanford, Kautz worked with the Center for Health Policy to study the effect of the AIDS epidemic on the elderly population of Africa. Analyzing the surveys, the researchers determined that the number of unattended elderly people (defined here as 60 or older) has already begun to spike, moving from 23.5 percent in 1993 to 26.1 percent in 2004. Extrapolating to the future, that rise is expected to continue; according to their calculation, every one percent increase in AIDS mortality rate leads to a 1.53 percent increase in older people living by themselves. Some more math, and an estimated 582,000 to 917,000 newly unattended elderly people were created in 2006 alone.
In addition to losing their caregivers, the elderly of Africa are also increasingly pressed into service as caregivers themselves, the authors found. The number of “missing generation households,” where the elderly must take over parenting duties for orphaned children, rose by as many as 323,100 in sub-Saharan Africa in 2006 – and even that may be an underestimate, since the authors only counted children below the age of 10 and the elderly may also be caring for adults suffering from AIDS.
The burden of this role reversal from care recipient to caregiver is hard to estimate, the authors admit. But presumably, it would have drastic economic and health consequences. One wonders what was the effect of previous cases where a significant chunk of a middle generation was removed, in World Wars or Crusades, for example. But even in those historical chapters, only one gender was removed from the adult population. The African AIDS epidemic is potentially an unprecedented demographic dent, and this study reminds us that it’s more than just the children that are affected by such a tragedy.
“The epidemic has this negative spillover on a previously under-recognized population that also tends to be very vulnerable, much like the child orphans,” Kautz said. “Because so many of these elderly people now living alone also have the responsibility of taking care of child AIDS orphans, policies that target the elderly people will also have added benefit of helping the child aids orphans.”
(More on this study from Stanford’s research blog, Scope)
Kautz T, Bendavid E, Bhattacharya J, & Miller G (2010). AIDS and declining support for dependent elderly people in Africa: retrospective analysis using demographic and health surveys. BMJ (Clinical research ed.), 340 PMID: 20554660