Category Archives: South America

South America ranks fourth in area and fifth in population among continents. The most populous countries are Brazil, Colombia, Argentina, Venezuela, and Peru. Most of the continent lies in the tropics, and the overwhelming majority of South Americans speak Portuguese or Spanish.

Effects of Dance on Health-Related Quality of Life
With the weather getting warmer in Sao Paulo, Brazil, many Brazilians are getting ready to get out and dance in celebration! One dance group in particular, Arte Par Dancar, has been garnering a lot of media attention for their dance moves… and for their age.

Apart from being fun, dance and movement is a form of exercise that has proven health benefits for older adults. Movement can not only improve quality of life, but certain exercises like Tai Chi, can reduce the risk of falls.

A team of scientists in Brazil set out to understand how specifically dance can benefit older adults. They found that eight weeks of ballroom dancing significantly strengthened the leg muscles of the women who participated in their study. Weak leg muscles are correlated with falls; therefore, strengthening leg muscles is a positive impact of dance. Older women seem more likely to take up dance as an activity, although it is unclear why this trend exists.

Another research study compared the health benefits of Tai chi to those of ballroom dancing. It found that senior ballroom dancers had better balance with their eyes closed, and seniors practicing Tai Chi had better dynamic balance including exponentially improved speed.

While different forms of dance and movement have varied benefits, studies show that dancers of all types have lower BMI’s, longer stride lengths, and higher bone mineral density. In addition to the physical benefits of dancing, there are clear psychological benefits, such as greater connectedness, improved mood, and higher levels of energy.

Recreational older dancers have also noted feeling more engaged in their community, and feeling a greater sense of purpose. An Arte Par Dancar member stated, “Now I am happy here, I dance. I have fun with everyone.” Another 86-year-old member of the dance troop said, “We move a lot doing lots of things. We already passed through our old person stage, now we are young.”

Dance and movement-based exercise is a fun way for older adults to become healthier and widen their social networks. This trend has proven so beneficial that Brazil is not the only country where older adults are learning to Samba!

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

A Brief Highlight of Older Athletes at the Summer Olympic Games

Photo Credit: GCSC
Photo Credit: GCSC

The 2016 Olympics in Rio de Janeiro, Brazil are almost here. Starting next week, athletes from around the world will perform amazing feats including older Olympians who are generally not reported in traditional media. Older athletes have always participated in the games. For example, Brazil’s 2016 Olympic qualifying tournaments had many athletes in their 30’s and a few well into their 40’s. This article will focus on older athletes with the hope that it inspires readers and challenges aging stereotypes.

There are many examples of older athletes to celebrate. In the 2012 Olympics, a 101-year-old marathon runner Fauja Signh carried the Olympic torch. Also in 2012, Hiroshi Hoketsu of Japan was a member of the Equestrian team at age 71. There is also the Senior Olympics – a biennial sports competition for adults aged 50+ – where the average age at the 2015 competition was 68 years old. As Global Health Aging states, “…the process of growing old is unique to each person.” Some people have loss of mobility or cognitive function… and some compete in the Olympics.

Athletes who have staying power lurk within many country teams. For instance, Robert Schedit, a 43-year-old member of Brazil’s sailing team, will compete in his sixth Olympic games! His first Olympics was the 1996 Olympic games in Atlanta, USA. Close behind him is Murilo Antonio Fischer who will compete in his fifth Olympic games at age 37. Fischer, a member of Brazil’s road cycling team, first participated in the 2000 Olympics in Sydney, Australia.

Competing in athletic events or getting up to exercise are in part based on psychology and willpower. My investigation into the Olympics has shown a new narrative, that individuals of all ages succeed in competitive athletics. These sports in addition to regular daily exercise are attainable. Hence society has to redefine expectations as it is possible to be a great athlete well into old age. And for those who do not wish to run a 5 minute mile, any kind of exercise is important!

Grace Mandel covers South America for Global Health Aging. She is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

The Impact of the Chavez Government on Pensions and Health Systems

This is Part 2 of a two-part series on Venezuela’s economic crisis. In Part 1, the main focus was food shortages. In Part 2, pension programs and health systems are emphasized.

On the surface, the status of older adults in Venezuelan society should have been secure. The Chavez government had expanded pensions to cover all older adults regardless of work history in 2011. The program was particularly beneficial to women who often participate in the informal economy or are self employed. The government also subsidized home repairs and gave older adults preferential access to food, allowing them to skip the lines at grocery stores. These new programs were termed the most generous social programs in Latin America.

Photo Credit: Globovisión
Photo Credit: Globovisión

By 2014, at the very beginning of the economic downturn, older adults were already at heightened vulnerability. The Global AgeWatch Index noted that the health system was showing signs of dysfunction. Older adults had problems accessing doctors or medications, infectious diseases were spiking, and there were signs of difficultly in accessing basic care. By 2015, the Index ranked Venezuela 76th out of 96 nations in security for older adults. Despite the “generous” pension program, the nation ranked 66th out of 96 countries for income security. Safety was most concerning since Venezuela scored only 17 percent in this category. As the economic condition deteriorates through the year, the country is likely to perform even worse in 2016.

The health system has also collapsed, leaving older adults without necessary medications and treatment for chronic or acute diseases. Moreover, the Venezuelan government nationalized the pharmaceutical industry, but is still unable to keep up with demand. While news has focused on the Zika virus, other infectious diseases such as malaria and dengue are also reappearing. These diseases can be more deadly for older adults who may have other chronic illnesses. Human Rights Watch recently found a “shortage of medications to treat pain, asthma, hypertension…”, all conditions that impact older adults.

The shortage of doctors and nurses is a long time in the making, and not solely because of low wages. According to the Wall Street Journal, over 13,000 doctors left Venezuela between 2000-2003, and current treatments are often outdated. Women do not have access to radiation, and breast cancer is often treated with radical mastectomy compared to more modern treatments. Finally, as of April 2015, only about 35 percent of hospital beds were operational in Venezuelan hospitals.

Older adults are more likely to be poor, and the poor are less likely to be able to access medical care or pay for food on the black market. The combination of food and medical shortages, and safety threats leaves older adults vulnerable to the resurgence of diseases, creating an unfortunate cycle of dependency. Life expectancy fell after the collapse of the Soviet Union, and it is likely that a similar impact may be felt in Venezuela.

Many of the bloggers and commentators on the Venezuelan imminent collapse are pro-democracy advocates who place blame on the socialist nature of the government. While the socialist nature may be the underlying cause of Venezuela’s current crisis, stable democracies can collapse when faced with economic threats. For example, the University of Michigan Retirement Research Center noted that older adults in the U.S. faced housing insecurity, and were required to work longer in order to recover from the 2007-2009 recession. In an economic collapse, work is scarce and older adults who are already near or below the poverty line become destitute.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.





Venezuela’s Economic Crisis Puts Older Populations-At-Risk

This article is the first part of a two-part series on Venezuela’s ongoing economic crisis. Click here to read Part 2.

Photo Credit: Wilfredo Rodríguez
Photo Credit: Wilfredo Rodríguez

Venezuela is in the midst of an economic collapse. Oil prices have plummeted and the bolivar (Venezuelan currency) has dropped in value compared to the U.S. dollar. The situation is rapidly becoming a humanitarian emergency due to inflation and devaluation of the currency, food shortages, and collapse of the healthcare system. Safety threats and violence have also escalated an already unstable event. While news coverage of these incidents focus on the impact on children or young adults, this crisis has serious implications for older adults who are often vulnerable in the face of disaster.

Food Shortage

One of the hallmarks of media coverage are the pictures of long lines at grocery stores and food banks. In response to the food shortage, the Venezuelan government has instituted a rationing system, in which individuals must appear in person to buy food on the day indicated by the last digit on their ID card. For older adults who lose mobility or cannot make it to the grocery store on their designated day, there are few alternative options. Even for individuals who make it to the grocery store, there is often no food available. In a video posted on YouTube, an older woman states that she is hungry and willing to buy anything. She says, “It is sad that at this age [old age] it has come to this”. (English translation)

A writer for Havana Times shared an experience in a Venezuelan grocery store, “I also saw many elderly people waiting for hours to be able to buy something…”. Older adults often support their family by reserving a spot in the long lines which have thousands of people waiting for hours to reach the front. Exposure to the weather alone makes the ordeal of grocery shopping in Venezuela a threat to the health of older adults. In January of 2016, the government decreed that individuals should engage in their own food production, a daunting task for older adults.

Safety has been a pressing concern, especially surrounding grocery stores and food. In August of 2015, Reuters reported the death of an 80-year-old Venezuelan woman in a supermarket, “possibly from trampling”. In addition to riots and stampedes, there are reports of shots fired and frequent assaults in lines at grocery stores. The army and national police have responded by guarding the lines, but it is unclear whether the people are being protected or controlled by security forces.


With recovery a long way off, there have been calls for other nations to come to the aid of Venezuela. Older adults and children can benefit from food and health assistance but President Nicolás Maduro states that the situation is not nearly as bad as portrayed in the media. For instance, Cuban doctors are helping to mitigate the healthcare crisis in Venezuela. The fact is that foreign aid may not even be enough, hence societies should have strong governments with smart fiscal policies to insure safety nets for older individuals.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

The Dangers of Type 2 Diabetes among Older Hispanics

Photo Credit: Pixabay
Photo Credit: Pixabay

Diabetes is a 5th leading cause of death among Hispanics and Latinos in the USA. Hispanics are 66 percent more likely to be diagnosed with diabetes compared to non-Hispanic whites and they have a 1.4 times greater risk of developing chronic kidney disease due to diabetes, according to the National Kidney Foundation. Moreover, there is currently an epidemic of diabetes among Hispanics and Latinos not only in the United States but also in Central America.

The Dangers of Type 2 Diabetes

Type 2 diabetes carries a number of dangers. While it may be easy to ignore, the disease affects the blood vessels, nerves, heart, kidneys and eyes. Complications of diabetes can eventually become life-threatening or disabling regardless of race. In fact, several studies have found that Hispanics and Latinos are at a greater risk of two of the most serious risks of diabetes: end-stage renal disease and foot amputation. Most cases of end-stage renal disease (ESRD) are caused by diabetes and these cases are on the rise throughout Central and South America, according to a study published in the Clinical Kidney Journal. The study reported that the highest incidence of diabetes-caused ESRD was found in Mexico and Colombia.

Research has found that Hispanics and Latinos are also at a higher risk of foot damage due to diabetes than non-Hispanic whites. Diabetes can lead to nerve damage in the feet and poor blood flow which raises the risk of a host of foot complications. In severe cases, toe, foot, or even leg amputation may be necessary. Diabetes is the leading cause of foot and leg amputations in the United States and Mexico. Between 2001 and 2004, the hospitalization rate for diabetes-related amputation among Hispanics and Latinos increased to 80 per 100,000 compared to roughly 28-31 per 100,000 for non-Hispanic whites.

Diabetics in developing countries are twice as likely to develop foot ulcers and require amputation than those in developed countries. In South and Central America, about 1.25 million diabetics undergo foot amputation. This number is expected to rise to 2.5 million by 2030, according to the International Diabetes Federation.

A great deal of the disparity is attributed to lack of health care and screening. Just 38 percent of adult Hispanics over the age of 40 with diabetes received the recommended annual foot, eye and blood sugar screenings compared to 47 percent for whites and blacks in the U.S. Hispanics were also 3.6 times more likely than non-Hispanic whites to be hospitalized for uncontrolled diabetes and 2.9 times more likely to be hospitalized for foot or leg amputation due to diabetes.

Controlling Type 2 Diabetes

Diabetes can develop at any age but it is most often diagnosed in middle-aged and older people. Screening for type 2 diabetes is especially important after the age of 40. Therefore, it is important to note that while diabetes complications can be very serious, they are avoidable. The best way to avoid serious foot problems, including gangrene and amputation, is by receiving regular diabetic foot care and maintaining a healthy blood sugar level. Seeking the care of a knowledgeable foot and ankle doctor should also be top priority for all diabetic patients to avoid potentially life-threatening complications that may seem benign at first.

Parul Patel, DPM is the lead physician of Infinity Foot and Ankle, a podiatry practice with three locations in Texas. She has more than 11 years of experience in podiatric medicine and specializes in podiatric care such as diabetic podiatry, preventative care and surgical podiatry.

Battling Beauty Stereotypes in Brazil’s Older Women

If you have ever watched a Brazilian telenovela, you might notice that older women look unrealistically younger than the characters they portray, with the help of botox or other “medical miracles”. Older women in Brazil face pressure to look young, not gain weight, and maintain top physical appearance. As women age, their metabolism slows down and wrinkles tend to appear on their faces. This can lead to body image dissatisfaction, which is a distorted perception of appearance that leads an individual to unhealthy lifestyle, weight issues, and/or depression. Such distortion is common among older women in Brazil and having a negative impact on the mental and physical health of this population.

Photo Credit: CarolinaAURO
Photo Credit: CarolinaAURO

Body image dissatisfaction is often discussed in the context of teenage girls. It may cause eating disorders where girls may choose to eat less or vomit after eating, in an effort to maintain a certain physique. Thus, the choices made in adolescence can have a lifelong impact on the health of an individual. Anorexia nervosa and bulimia nervosa are eating disorders that have been linked to low bone mineral density and osteoporosis in teenage years. Both disorders also impact older women. In fact, anorexia nervosa is more likely to cause death in women over 65 than girls or women under 65.

Body image dissatisfaction is a direct result of ageism in society, and the fear of getting older. Older adults may feel less relevant or unwanted if they do not maintain youthful appearances. In a population-based study in southern Brazil, researchers found that women over the age of 50 were most likely to be concerned that they weighed too much. Older men were also more likely to be dissatisfied with their weight than younger men, but the magnitude of the dissatisfaction was smaller than women.

The need to look young in aging women has its roots in an ageist society, where older women are not valued as much as their younger counterparts. Changes in skin and weight are a natural part of aging but in Brazil, many women fear any weight gain. While the solution to this problem is unclear, the media can play a great role by portraying older women who have aged naturally. This population should be able to feel comfortable with their appearance as this may challenge beauty stereotypes and reduce the stigma of growing older. Media, however, is only a small part of the problem and it is clear that older women need to be valued for their contributions to society.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.


Employment Prospects Among Older Adults in South America

Photo Credit: Alex Proimos
Photo Credit: Alex Proimos

Many adults eagerly look forward to their “Golden Years” and one of the key features of this period is retirement. It is easy to imagine golf courses, beaches and time to catch up on reading lists. In reality, many older adults continue to work after age 65. The entirety of South America is undergoing a demographic shift due to an aging population. Thus, many countries are re-examining their existing government pension systems. While it is important to provide economic security in old age, it is also crucial to allow continued avenues of employment and meaningful engagement with society for older adults.

The quality of life in retirement is dependent on the financial resources of the individual. Adults aged 65 and over generally have income from four sources including government funded pensions, private pensions from employers, savings and employment. In the United States, adults with higher education and income potential will often remain in the workforce past age 65. In contrast, adults with lower income levels in low- and middle-income countries remain employed past age 65 to stay out of poverty.

There is a huge variability in percent of the aging population that is working in Latin America. Some Latin American countries, such as Brazil, Argentina and Columbia, have relatively low participation of older adults in the workforce. Such countries are similar to the United States, with only 10-15% of adults past age 65 engaged in paid work. In other countries, such as Peru, Paraguay and Ecuador, 40-50% of adults age 65 and older are still participating in paid work. These countries also have relatively low coverage levels by government and private pension plans, but the correlation between working and government funded pensions is not perfect.

Many countries in South America are re-examining government pension programs to accommodate the aging population. Recent reforms in Paraguay have instituted new rules that prevent individuals collecting government pensions from participating in paid work. Better pension systems may provide more security for older adults, but preventing work has problematic implications for the future role of older adults in society. Social engagement is correlated with improved health and employment can be a meaningful avenue of engagement.

Building strong government and private pensions that will allow a retirement free from financial hardships or poverty is important. However, building systems that prevent older adults from working is equally problematic. Older adults in countries with strong pension systems, such as the United States and Britain, are fighting to re-enter the workforce and be productively engaged in society. It is important that South American countries do not build a pension system that prevents older adults from contributing paid work to the economy.

Grace Mandel is a Masters of Public Health student in Health Policy and Systems at Johns Hopkins University Bloomberg School of Public Health.

The Impact of Sleep Disorders Among the Elderly

Getting adequate sleep is a very common recommendation for achieving and maintaining good health. Insufficient sleep has been linked to a variety of chronic diseases (such as diabetes and heart disease) as well as unintentional injuries (such as motor vehicle accidents and workplace injuries). Poor sleep quality can also contribute to other issues that affect quality of life such as irritability, depressive symptoms, and inability to focus and stay on task.

Photo Credit: Pedro Ribeiro Simões
Photo Credit: Pedro Ribeiro Simões

The global adult population in general experiences a high prevalence of insufficient sleep, with some variation in terms of age, gender, and socioeconomic status. Among the elderly, however, the prevalence and subsequent effects can be especially pronounced. While it is not clear if this increase in prevalence of disrupted sleep and sleep disorders is due to aging itself or co-morbid conditions associated with aging (i.e, chronic pain, dementia), it is important to consider the impact such conditions have on the elderly.

It has been noted that common sleep disruptions among the elderly include trouble falling asleep, snoring, sleep apnea, insufficient time spent in deep sleep, rising early, and achieving fewer hours of sleep each night. The implications for sleep disruptions within this demographic can include a 2 to 3 times increased risk of stroke and mortality.

In considering the impact of sleep disorders among the elderly in the Americas, a study conducted in the Dominican Republic, Peru, Venezuela and Mexico found that 23-31% of older adults aged 65 to 80+ years experienced sleep disruptions. The prevalence appeared higher among women than men. In comparison to previous studies, it was found that among individuals aged 40 and older in Uruguay, Chile, and Venezuela, 34.7% reported trouble falling asleep. Previous findings have also included reports that 25% of individuals aged 18-77 years old in Buenos Aires, Sao Paulo, and Mexico City reported being moderately or severely impacted by sleep problems, with severity increasing with age.

To address sleep disruption among the elderly, it is important that health care providers, community support systems, and social support systems work with the aged to ensure they are experiencing the best quality of life possible. This includes working with the elderly to achieve optimal sleep.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

Aging with Autism in South America

As the world celebrated World Autism Awareness Day on April 2, the conversation around elderly with autism remained sidelined. Blog posts and comment boards were focused on children with autism, a standard practice that is common in other areas. For instance, a quick scan of entries in PUBMED, the National Library of Medicine database, shows that there is almost no literature on elderly with autism. It is pertinent that the experiences of older adults with autism are investigated and documented for available data. Older adults were once children and while some autism symptoms seem to decrease with increasing age, elderly with autism will not reach normal levels of social functioning.

There is now evidence of increased prevalence of and knowledge about Autism Spectrum Disorder (ASD) internationally. In Venezuela, the rate of autism is estimated at 1.1 per 1000 people, while the rate of autism spectrum disorder is estimated at 1.7 per 1000 people. Additionally, 1.5 million people have ASD in Brazil. Despite reports about underestimation of statistics, training in autism diagnosis and early detection should be promoted. Also, it is important to note that children will age even though most statistics focus on children.

Since autism goes undetected, health professionals should work to ensure that resources and services are available for elderly with autism. These include screening and diagnostic tools that are appropriate for older adults. Moreover, the Brazilian Public Health System suggests that autism research is necessary for treatment and intervention strategies to become more widespread. Autism is a life-long condition and while there are still unknowns about aging with autism, nations like Brazil and Venezuela can prepare for the future.

Sophie Okolo is the Founder and Editor in Chief of Global Health Aging.